Quality of life: A review of theory and practice implications for individuals with long-term mental illness.

Reviews quality of life (QOL) models and findings applied to individuals with long-term mental illness as an illustration of approaches to QOL methodologies and models. Gap-discrepancy theories are discussed, and life satisfaction and adaptive functioning models of QOL and measurement instruments related to these models are described. QOL represents a viable means of investigating the subjective well-being of individuals with chronic mental illness. Despite psychiatric symptomatology, measuring QOL or subjective well-being represents a viable means of measuring client change or program outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The value of studies of quality of life in chronic respiratory tract diseases in the framework of holistic medicine

Quality of Life (QOL) is a new area of research evaluating the psychical, functional and psychological components of human life. According to current understanding of health issues the measurement of morbidity or mortality does not estimate the health status and describe the influence of illness on human life. The theoretical framework of Health Related Quality of Life is largely based on a multidimensional perspective of human as physical, psychological and social functioning and well-being, along the WHO definition of health. QOL assessment could be carried out using different psychological methods. There are several questionnaires developed to assess the quality of life in patients. The measurement instruments are generic (used in wide range of health related issues), domain specific (concerning some important outcome such as social support, coping), and disease specific which are used to assess patients with particular health problems. QOL assessment could be used as the measurements in pharmacoeconomics and clinical trials. Polish QOL Initiative Group produce Polish version of existing questionnaires--for example The Asthma Quality of Life Questionnaire was registered in Polish language version. Quality of Life researches facilitate doctors to understand patient's perceiving of the health state and help them to live a fulfilling life.     

Improvement in quality of life during 5 years after coronary artery bypass grafting

OBJECTIVE: To describe the changes in various aspects of quality of life (QOL) from before coronary artery bypass grafting (CABG) to 5 years after the procedure. PATIENTS AND METHODS: Patients who underwent CABG in the western region of Sweden in 1988-1991 were approached with questionnaires evaluating their QOL prior to and 3 months and 1, 2, and 5 years after the operation. Three different instruments were used: the Nottingham Health Profile, the Psychological General Well-Being Index, and the Physical Activity Score. RESULTS: In all 2121 patients underwent CABG, of whom 310 died during 5 years of follow-up. With all three instruments QOL had improved 5 years after CABG compared with prior to the operation. However, all three instruments revealed a slight but significant deterioration in estimated QOL between 2 and 5 years after CABG. CONCLUSIONS: QOL 5 years after CABG is better than that prior to the operation, but between 2 and 5 years after the operation a slight deterioration in QOL is observed.     

Calls on reproductive and developmental toxicants to a regional poison center

OBJECTIVES/HYPOTHESIS: Rehabilitation following head and neck cancer surgery has steadily moved into the outpatient realm and become dependent on caregivers with no formal medical background (lay caregivers.) Satisfactory rehabilitation and quality of life (QOL) depend on successful relationships between patients and the lay caregivers. This study evaluates the QOL assessments of patients by themselves and their primary lay caregivers before head and neck surgery. STUDY DESIGN: Institutional Review Board-approved study using validated QOL assessment instrument. MATERIALS AND METHODS: The preoperative QOL status in 50 patients undergoing extensive head and neck surgery was evaluated using the self-administered Medical Outcomes Survey Short Form 36 (SF-36). The patient's primary lay caregiver (spouse, child, or friend) completed a similar questionnaire evaluating the patient's status. RESULTS: Thirty-three (66%) questionnaires were returned. Twenty-five (50%) questionnaire sets were successfully completed by both parties and employable for comparison. Sixty percent of the caregivers were within the 90% confidence interval of the patient's assessment for six or more of the eight parameters evaluated by the SF-36. Likewise, caregiver assessments for specific parameters were consistently congruent with patient evaluation, except for the parameters of bodily pain and general health, for which caregivers demonstrated a trend for overrating pain and underestimating general health. Caregivers of the same generation as the patient demonstrated significantly higher congruence (P = .007). Similarly, a trend for higher congruence was noted in patients with recurrent disease. CONCLUSIONS: The importance of the lay caregiver has increased in the era of greater outpatient rehabilitation. This pilot study indicates that QOL assessment by lay caregivers may be examined with existing instruments and highlights QOL parameters critical to both the head and neck surgery patient and his or her primary lay caregiver.     

Multiple myeloma cells and cells of the human osteoclast lineage share morphological and cell surface markers

The aim of the study was to compare the quality of life (QOL) and needs of people with schizophrenia in comprehensive treatment systems in two countries. One hundred people with schizophrenia and schizoaffective disorder were randomly selected from the caseload of a community mental health center in Boulder, Colorado, and 70 were similarly selected from public psychiatric treatment services in and around Bologna, Italy. Subjects were interviewed with QOL and needs assessment instruments and rated with the Brief Psychiatric Rating Scale. Objective QOL measures favored Bologna subjects over Boulder subjects, particularly with respect to employment, accommodation, and family life. In a factor analysis, objective QOL variables sorted separately from subjective satisfaction ratings, suggesting that they measure different underlying constructs. Patient needs in both Boulder and Bologna samples were primarily psychological and social rather than basic survival issues. Boulder subjects were more likely to report accommodation needs. Many apparent QOL advantages for Bologna subjects could be attributed to the greater frequency with which the Italian patients lived with family of origin. Living with family also appeared to confer practical benefits in meeting needs. Objective QOL measures discriminated between patient populations better than subjective ratings of satisfaction and well-being.     

Quality of life before and after liver transplantation for cholestatic liver disease

Liver transplantation (LT) is an established therapy for patients with end-stage primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC). In this report, we describe the health status and quality of life (QOL) in patients with these cholestatic liver diseases before and after LT. A QOL questionnaire was completed by 157 adult patients with PBC or PSC before and 1 year after liver transplantation at the Mayo Clinic or Baylor University Medical Center. This questionnaire measured four aspects of QOL, including symptoms; physical, social, and emotional functioning; health perceptions; and overall QOL. Changes in these QOL parameters before and after LT were described, and regression analysis was used to assess the relationships between clinical and QOL factors. There were no differences in QOL parameters between patients with PBC and PSC. QOL following transplantation was substantially better than before transplantation. This was observed in all four aspects of QOL. The degree of improvement as measured by effect size (difference in mean scores divided by the pretransplantation standard deviation) was 0.53 for symptoms (P <.01), 1.16 for function (P <.01), 2.37 for health satisfaction (P <.01), and 1.16 for overall QOL (P <.01). Patients' overall QOL before transplantation was significantly related to subjective and objective health status indicators and clinical factors such as ascites and renal dysfunction. QOL at 1-year follow-up, however, could not be adequately predicted by the pretransplantation subjective health status and clinical factors. Patients with end-stage cholestatic disease undergoing LT experience substantial improvement in all aspects of QOL addressed in this study. The patients' QOL 1 year after LT could not be predicted by pretransplantation variables used in this study.     

A simple instrument for assessing stress in clinical practice

Methods to assess the role of stress factors in patients with medical conditions are often rather complex, require specific training, and are difficult to use in clinical practice. We attempted to develop a short index tailored to a busy clinical setting, which would be easy to use while providing adequate individual information. This index (Psychosocial Index) was largely derived from well-established instruments, such as Kellner's Screening List for Psychosocial Problems. In addition, on the basis of the patient's self-report of items, the clinician is asked to rate four dimensions of the patient's life: stress, wellbeing, psychological distress, and illness behaviour. The questionnaires of 34 female patients with functional medical disorders were first rated by an internist and afterwards, blindly, by a psychiatrist. Agreement between the two raters was excellent, as measured by the intraclass correlation coefficient. It is hoped that this Psychosocial Index may provide a new tool for psychosomatic research and practice.     

A prospective study on the relationship between body mass index and mortality from all causes in 15,827 middle aged and elderly citizens

A case of a person struck by lightning is presented in which treatment consisted of 60 min of resuscitation, followed by a 3 day period of artificial ventilation. Persons who are struck by lightning might benefit from prolonged resuscitation efforts, since patients such as this one, as well as similar cases described in the literature, have survived without major sequelae. In our opinion, on-the-spot advanced life support, hypothermia and a moderate rehydration policy contributed to this patient's successful resuscitation.     

Morphometric nerve fiber analysis and aging process of the human abducent nerve

BACKGROUND: Coronary artery disease (CAD) constitutes a considerable financial burden on society in Finland; it is the cause of death of approximately 7,500 men and 6,500 women annually in a population of 5 million. OBJECTIVES: The purpose of this study was to assess the changes in the quality of life (QOL) of patients with CAD treated by medication, percutaneous transluminal coronary angioplasty (PTCA), and coronary artery bypass surgery (CABS) during 1 year. METHOD: The study population consisted of 280 patients with CAD. One hundred patients had been referred to CABS and another 100 to PTCA, whereas 80 patients were on drug therapy. The patients assessed their health status and QOL in terms of functional capacity and aspects of distress using self-completed questionnaires with the Nottingham Health Profile (NHP) instrument before the operation and 6and 12 months afterwards. RESULTS: The QOL of the patients who had undergone CABS and PTCA was significantly better on the dimensions of energy, pain, and mobility 1 year after the intervention. In the medication group, the only improvement took place on the dimension of social isolation, whereas both energy and mobility deteriorated. CONCLUSIONS: The results on QOL obtained in this study support the notion that patients continue to have many problems even after medical treatment with a good outcome. The problems occur in different areas compared with the pretreatment situation as on the dimensions of social isolation and emotional reaction. The rehabilitation of CAD patients is therefore important because the new problems are manifested differently from those seen before the illness or the treatment. The patient's QOL and personal preference for a treatment modality should be important criteria in the choice of treatment.     

In situ hybridization analysis of stanniocalcin mRNA expressing cells in the mouse kidney

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.     

The quality of life of people with mental retardation: in search of an adequate approach

There is a lack of instruments that measure the quality of life of people with mental retardation. These types of instruments could be used in order to give an indication of the quality of care they receive. At the moment we are developing an instrument that measures quality of life. Our first task is to find an adequate definition of 'quality of life'. In this article an attempt is made to define this term as it relates to people with mental retardation. Starting from literature in the field of disabilities, reflections in the social sciences and philosophical analysis, a combined approach is adopted, according to which quality of life consists of specific objective and subjective factors.     

Evaluation of quality of life in oncology

Studies of quality of life are more and more becoming an integral part of cancer care in situations when treatment of cancer patients is burdened with significant toxicity, and results of survival of these patients are unsatisfactory. Modern concept of health-related quality of life measurement means consensus about its two basic features: multidimensionality of concept, and essentially subjective experience in a treated person. As a minimum, domains of physical, psychological and social are assessed, and the patient is considered to be the primary source of information. The most widely used instruments for quality of life assessment are questionnaires, especially developed for cancer patients, with supplemental items for particular diagnosis. These instruments must satisfy the basic psychometric properties-validity and reliability. Quality of life studies are focused mostly on phase III trials, where differences between treatment arms for tumour response and survival are expected to be small. Another approach is developed in parallel which, based upon quality of life measurement, initiates decisions for the treatment of a set of patients up to health policy level. In these "cost-utility" studies, efficacy and cost of the treatment, and improvement of patients' quality of life are independently estimated, and then integrated in medical decision making.     

Effect of the in vivo priming regimen for peripheral blood stem cells (PBSC) mobilization on in vitro generation of cytotoxic effectors by IL-2 activation of PBSC in a murine model

Subjective quality of life (QOL) has often been assessed through questionnaires or structured interviews focusing on the person's satisfaction with various life domains. In particular, most QOL instruments for psychiatric patients are based on this concept. We report on a study casting some doubts on the rationale of this approach. We investigated the QOL of 48 chronic schizophrenic outpatients with a long-term disease history (at least 20 years) using a German version of the Lancashire QOL Profile. The interrelations between general life satisfaction, satisfaction with specific life domains, psychological well-being and psychopathology were studied using correlation analysis and multiple linear regression. Of the life domains assessed, only two, namely social relations and health, contributed significantly to the patients' general life satisfaction, while the others (including work, leisure, family relations and housing) did not. The subscales on psychological well-being (self-esteem, affective state) as well as psychopathology were found to be more closely associated with general life satisfaction than almost all life domains considered. The findings are discussed with regard to the specific situation of the group of patients investigated. They give indications that the life domain approach to measuring QOL has its limitations, in particular when applied to patients having adapted to a very restricted everyday life.     

The long-term effect of day care rehabilitation on individuals with dementia

In the treatment of senile dementia, rehabilitation rather than drugs, could result in more positive long-term effects. A Day Care program designed for individuals with Senile Dementia of the Alzheimer type (SDAT) and Vascular Dementia (VD:MID and BD), activates the brain through memory training, creative arts therapy, physical activity, and social interaction. The objective of this study is to determine if Day Care can modify the patients intellectual decline or even alter the natural course of the dementing illness. 135 SDAT and 213 VD patients were studied over three years. ADL (Activities of Daily Living) measurements were evaluated by the Barthel Index and cognitive measurements by the NM-scale. The Wilcoxon test and the Sign test were carried out using the BI and NM-scale scores. These results indicated a decline or arrest in the progression of SDAT and VD as determined by the multiple logistical models. The 8 variables (risk factors, medication, age at onset, self-rehabilitation, family support, sex, grade of dementia and Day Care) influence on the survival curves was calculated using the Kaplan-Meire Life table method. The Cox proportional hazard analysis was then used to examine the relationship between the 8 variables and dementia. The significantly positive results from these four analyses of the ADL and cognitive measurements indicate that Day Care programs clearly retards the progression of intellectual decline in dementia patients and improves the quality of life (QOL) in all cases. In VD patients the mortality rate was notably decreased through Day Care. These results make one consider the benefits of introducing such programs into society as a strong treatment against the onset of dementia developing into severe, dehabilitating dementia. However a healthy diet, a physically and mentally active life, as well as early diagnosis, are the best preventions against dementia.     

Determinants of the quality of life of patients with diabetes under intensified insulin therapy

OBJECTIVE: The concept of quality of life (QOL) is understood as a multidimensional construct made up of physiological, psychological, and social aspects, but their particular weightings for the global QOL are rarely investigated. We examined 1) the general QOL of patients with diabetes, 2) the significance of the individual QOL aspects for the overall assessment of QOL, and 3) the modulating function of coping mechanism and particular personality traits. RESEARCH DESIGN AND METHODS: A total of 116 diabetes patients under intensified insulin therapy were studied, as were 107 patients with inflammatory bowel disease, 66 patients with chronic hepatitis C, and 229 students who served as control subjects. The examination was based on eight standardized QOL and personality questionnaires (354 items) and assessed by means of linear structural regression models (AMOS 3.6). RESULTS: The QOL of diabetes patients appears to be higher than the QOL of other chronically ill patients. Social, psychological, and physical aspects contribute to the overall QOL, although physical complaints receive a comparatively low weighting. Coping behavior and particular personality traits covary with all QOL aspects, giving these variables greater significance for the QOL than the existence of secondary illnesses. CONCLUSIONS: The hypothesis that the various factors involved in the multidimensional construct QOL receive different weightings was confirmed, making a simple summary score for the general QOL appear unjustifiable. In addition, all aspects that are commonly understood as parameters of QOL are influenced by external factors, such as coping behavior, based on individual personality characteristics.     

Quality of life for individuals with traumatic brain injury: comparison with others living in the community

OBJECTIVES: To provide a conceptual overview of approaches to quality of life (QOL) measurement and an extensive review of research relating to QOL after TBI; to document subjective QOL of individuals with traumatic brain injury (TBI); to explore how subjective QOL differs for people with TBI in comparison to individuals with no disability (ND) and those with spinal cord injury (SCI); and to document the perceptions of unmet important needs and the relationship between such perceptions and subjective QOL. DESIGN: Interview-based data focusing on current perceptions of QOL and unmet important needs, obtained from individuals with TBI, SCI, or ND. Covariance and partial regression analyses were used to explore group differences and to document relationships between variables. SETTING: Individuals drawn from diverse communities across New York State. PARTICIPANTS: TBI group: 430 individuals who identified themselves as having TBI; SCI group: 101 individuals with spinal cord injury; ND group: 187 people who identified themselves as having no disability. Participants were recruited through recruitment ads in general circulation newspapers and newsletters and through contacting a wide variety of community agencies. MAIN OUTCOME MEASURES: Two summary QOL indicators: a Global QOL Measure based on two items tapping the individual's emotion-based view of QOL, and a summary score adapted from Flanagan"s Scale of Needs, reflecting the individual's perceptions of total unmet important needs. RESULTS: Both summary QOL indicators were correlated with demographic characteristics. Unmet important needs were stronger in the TBI group than in the SCI and ND groups. Most areas of unmet important need were moderately correlated with the summary QOL indicators. Analyses of covariance showed that severity of injury was a more powerful modulator of post-TBI QOL judgments than the mere fact of TBI. For example, those with the most severe injury (ie, loss of consciousness [LOC] >1 month) rated their QOL similar to that in the ND group, whereas individuals who had experienced only a brief LOC (<20 minutes) viewed their QOL as significantly lower than that in the ND and SCI groups and lower than other TBI severity subgroups. CONCLUSIONS: This exploration of subjective QOL strengthens the argument that after TBI, the insider"s reaction to injury varies greatly within the population. Thus, severity of injury strongly affects perceptions of QOL. The use of a multimethod approach for exploring the reactions and perceptions of QOL has proven useful in this study.     

The short tandem repeat loci hTPO, THO1 and FGA

PURPOSE: The purpose of this study was to describe perceptions of quality of life (QOL) of Hispanic patients with cancer pain. DESCRIPTION OF STUDY: This qualitative pilot study is guided by the conceptual framework of pain and QOL. From interviews with 17 Hispanic patients with cancer pain, data on perceptions of QOL were analyzed and are reported here. RESULTS: The study demonstrated the influence of culture on perceptions of QOL and the impact of pain on QOL. Several themes were identified for each domain of QOL, including physical, psychological, social, and spiritual well-being. The role of the family and faith in God were important components of QOL for all patients. CLINICAL IMPLICATIONS: It is important for clinicians to devote greater attention to cultural assessment and to include cultural beliefs in cancer care to improve QOL for Hispanic patients. The role of the family and religious beliefs should be included in the planning and evaluation of each patient's care.     

Quality of life in chronic venous insufficiency (CVI). Results of a study with the newly developed Tübingen Questionnaire for measuring quality of life of patients with chronic venous insufficiency

Across the boundaries of the medical specialties we have realized how important the concepts of quality of life and disease-related coping behavior are to understand the patients' subjective perception of the medical condition and its treatment. Although standardized instruments are already available for different medical indications and even in the related fields of peripheral vascular and cardiac diseases, phlebology still lacks standardized concepts for evaluating quality of life and/or disease-related coping behavior in patients with chronic venous insufficiency (CVI). We report on a newly developed instrument specifically designed for recording quality of life in patients with CVI. It not only meets the requirements of psychometric standards, but has also proven its applicability in clinical use. The "Tübingen Questionnaire for measuring Quality of Life in patients with CVI (TLQ-CVI)" and the results of a study on quality of life in 142 patients with various stages of chronic venous insufficiency are presented. It was possible to distinguish between Stage I/II and Stage III CVI patients with respect to parameters such as "leg complaints" and "day-to-day fears and worries". These convey clinically relevant insights into the patient's subjective perception of the disease and how they cope. The information gathered provides a set of reasonable target scores for clinical studies presently being carried out at various study centers in Germany incorporating the TLQ-CVI.     

Chromatographic analysis of water and wine samples for phenolic compounds released from food-contact epoxy resins

PURPOSE: To evaluate how well a rapid, self-report of the costs of illness correlates with health-related quality of life. METHODS: A total of 211 patients, participating in a clinical trial of an arthritis medication, completed a Quality of Well-being scale interview and an 18-item self-assessment of healthcare utilization. Subjects completed both these instruments at each of three time points during the trial. RESULTS: Correlations between the measures and across time suggest that patient-reported costs are associated with quality of life and function. CONCLUSIONS: A self-reported cost of illness measure may provide valuable information. With the increase move to assess cost as well as health outcomes, such rapid self-report techniques may prove useful to health services researchers, healthcare system managers, and clinicians.     

Illness intrusiveness and quality of life in end-stage renal disease: Comparison and stability across treatment modalities.

Examined the impact of illness intrusiveness (ILI) on quality of life (QOL) in 99 patients with end-stage renal disease. Ss were interviewed twice, 6 wks apart, to determine differences in perceived ILI across treatment modalities, life domains, and time. Life domains were affected differentially across treatments. Perceived ILI correlated significantly with treatment time requirements, uremic symptoms, intercurrent nonrenal illnesses, fatigue, and difficulties in daily activities. Significant QOL differences emerged across treatment modalities for satisfaction/happiness and pessimism/illness related concerns but not for depression/distress. Perceived ILI correlated significantly with each of these QOL measures. Findings substantiate the construct of ILI as a mediator of the psychosocial impact of chronic, life-threatening illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)