The purpose of this study was to investigate the relationship between nursing staffing and quality of life (QOL) in nursing homes (NHs). The relationships between nursing staff hours per resident day, nursing staffing skill mix, turnover of nursing staff, and the answers given to QOL questions by 231 residents in Iowa NHs were investigated. Unexpectedly, only part of staffing variables were statistically significantly correlated with QOL of residents and nurse staffing variables seemed to have little influence on predicting QOL of residents in this study. The major differences between this study and previous studies are that previous research focused on quality of care (QOC) and this study measured QOL by measuring residents' outcomes. Previous studies found that nurse staffing is an important factor in improving QOC (and by implication, QOL) of NH residents. Based on the statistically significant relationships, RNs' unique contributions were supported by the findings that NHs with more RNs, compared with LPNs/LVNs and CNAs, had residents with higher scores in the functional competence domain and overall QOL summary items. This study found that nurse staffing turnover is positively correlated with QOL, especially in the individuality domain. However, the whole study takes place in one state, Iowa. Iowa has a homogeneous population with limited racial diversity. Only Iowa NHs were selected and it is questionable whether the findings may be generalizable to the rest of the United States. Further research is required to confirm the relationship and provide policy guidelines, including nurse staffing recommendations, to guarantee optimal QOL for NH residents.

Ensamhetskänslor är något som är ytterst mänskligt och som individ kan man uppleva detta flera gånger under livsloppet. Gruppen äldre betraktas dock att vara särskilt utsatta till att uppleva känslor av ensamhet. Det i sin tur anses innebära flera negativa konsekvenser; fysisk smärta och psykiska besvär. I detta arbetet kommer just detta fenomenet till att undersökas. Undersökningen görs genom metoden diskursanalys. Syftet är att undersöka kopplingen mellan äldre, ensamhetskänslor och depression. Det har gjorts genom analys av totalt 3 studier och 1 rapport av Socialstyrelsen. Våra diskursord, som urskiljdes under datainsamlingen, styr analysen. Diskursorden var följande: ensamhet/ ensamhetskänslor, depression och livskvalité. Som verktyg till analysen hade vi även Louis Althussers teori om subjektspositioner och diskurs samt Judith Butlers teori om genus. I resultatet framgår det faktumet att äldre anses vara en utsatt grupp inom vården på grund av åldrandet och dess konsekvenser. Dessutom diskuteras även ansvaret som ligger på myndigheter och personal som berörs. Slutligen förs det diskussioner om kön och huruvida det påverkar äldres upplevelser av depression och ensamhet. / Feelings of loneliness is something that is entirely human and any individual could experience them in a lifetime. The elderly as a group is perceived to be especially vulnerable when it comes to experiencing feelings of loneliness. This in turn is considered to have several negative consequences; physical pain and psychological distress. This essay will be focusing on this phenomenon specifically. This study is done by method discourse analysis. The purpose is to investigate the connection between elderly, feelings of loneliness and depression. This was done through analyzing the total of 3 scientific studies and 1 report produced by the National Board of Health and Welfare. Our discourse-terms, that were found during the process of data collecting, guide the analysis. The discourse-terms are as follows: loneliness/ feelings of loneliness, depression and quality of life. Another guide that was used were Louis Althussers’ theory of subject positions and discourse as well as Judith Butler's theory about gender. The result addresses the fact that the elderly is considered to be a vulnerable group in healthcare due to aging and its consequences. In addition, the responsibility that lies with the authorities and personnel involved is also discussed. Finally, there are also discussions about gender and whether it affects older people's experiences of depression and loneliness.

京都大学 / 0048 / 新制・課程博士 / 博士(地域研究) / 甲第22568号 / 地博第271号 / 新制||地||103(附属図書館) / 京都大学大学院アジア・アフリカ地域研究研究科アフリカ地域研究専攻 / (主査)教授 重田 眞義, 教授 高橋 基樹, 准教授 大山 修一, 准教授 金子 守恵 / 学位規則第4条第1項該当 / Doctor of Area Studies / Kyoto University / DGAM

Sudden cardiac death (SCD) is responsible for 300,000 deaths in the United States each year. Of these 300,000 deaths, 3,000-5,000 are younger adults (18-40 years) (American Heart Association (AHA), 2005; Sudden Arrhythmia Death Syndromes Foundation (SADS), 2005). Implanted cardioverter defibrillators have become the treatment of choice for individuals with life threatening arrhythmias (Cannom Prystowsky, 2004; Glikson & Friedman, 2001; Josephson, Hein, & Wellens, 2004). Although this life sustaining technology has been found to be effective in terminating life threatening arrhythmias, adjustment to an ICD may be difficult for some patients (Ganz, 2004). Few studies have investigated how younger adults manage life with an ICD (Sears, Burns, Handberg, Sotile, & Conti, 2001). It has been reported that older adults view the ICD as an extension of life, whereas, younger ICD recipients associate the ICD with significant life changes, body image concerns, and decreased independence (Arteaga & Windle, 1995). The purpose of this study was to describe the day-to-day experiences of younger adults (18-40 years old) [N = 20] living with an implanted cardioverter defibrillator. A qualitative descriptive design was used with naturalistic inquiry guiding data collection, management, and analysis. Using open-ended, in-depth interviews, younger adults were asked to describe their life after ICD implantation, physiological or psychosocial issues related to ICD implantation, and strategies used to manage life with an ICD. Data were managed using NVIVO software and analyzed using content analysis. The results revealed an overarching theme, A cautious transition to a new normal, with five subthemes: Initial diagnosis: anxiety and concern; Caution, awareness, and security: daily life with an ICD; Childbearing: passing my disease to my children; Financial concerns; and Strategies for living with an ICD: be positive and live life to the fullest. This study presented some of the unique developmental and transitional issues that younger adults with ICDs are facing and strategies they used to assist in adaptation to life with an ICD. Their experiences can provide the basis for intervention programs that are developmentally sensitive and age-specific.

Although many women find relief from menopause through hormone therapy (HT), current guidelines recommend that HT be used only for short-term relief of symptoms. Women who attempt to stop HT often encounter troublesome recurrent symptoms leading to a diminished quality of life (QoL); 25% of women who discontinue eventually resume HT. Unfortunately, there is little information for women and their health care providers as to the best way to discontinue HT or how to prepare and guide women through this process. An in-depth description of women‘s experiences during HT discontinuation and the factors influencing recurrent symptoms, QoL and discontinuation outcome would provide knowledge to develop much needed counseling and support interventions. The purpose of this study was to explore women‘s experiences discontinuing hormone therapy for menopause. This Internet-based mixed-methods study used a dominant Qualitative Descriptive design with embedded quantitative QoL measurements. Participants completed the quantitative questionnaires online while open-ended questions were completed either online or by telephone. Interview data were analyzed through Qualitative Content Analysis; descriptive statistics were used to explore the quantitative measures. Participants were stratified by discontinuation status for comparison of variations in discontinuation experiences, QoL and influencing factors. Thirty-four women (20 stopped, 9 resumed, 4 tapering) were enrolled. One overarching theme--'a solitary journey'--emerged: although all women embarked on this journey, each woman traveled her own path. Two subthemes--'burden and interference' and 'appraising risk'--encompassed the symptom factors (severity, interference and sensitivity) that influenced women's experiences and the manner in which women evaluated their options. Other influencing factors included: readiness viii and reasons for stopping HT, beliefs about menopause and roles. QoL was strongly connected to symptoms for many but not all women. Information from health care providers was inconsistent; women desired more support from providers and other women. The rich description of women's experiences stopping HT highlights the need for providers to assess women's sensitivity to symptoms and readiness to discontinue to determine which women might benefit from more support. Greater health literacy would enhance women's understanding of HT risks. More research is needed on symptom clusters and interference and strategies for minimizing their impact.

Coronapandemin har skapat stora konsekvenser för världens befolkning och i Sverige har restriktioner och rekommendationer införts som begränsat människors liv. Tidigare forskning gällande livskvalitet under pandemin har bedrivits utanför Sverige med kvantitativa mätinstrument. Syftet med denna studie var att undersöka upplevd livskvalitet i Sverige under pendemin. Tolv individer, varav sex män och sex kvinnor, mellan 20-52 år med olika sysselsättningar medverkade. Semistrukturerade intervjuer användes vid insamlingen av data och tematisk analys användes vid databearbetningen. Resultatet visade att det sociala livet förändrats, mer tid spenderats i hemmet och att livsstilen blivit mer stillasittande. Det fanns även en större förväntan att kunna leda sig själv i form av att skapa rutiner. Nära relationer och betydelsefulla fritidsaktiviteter ökade livskvaliteten under pandemin medan den begränsade rörligheten i samhället minskade livskvaliteten. Studiens slutsats var att individens förmåga till anpassning avgjorde hur livskvaliteten upplevdes under pandemin. Vidare forskning föreslogs studera livskvaliteten över tid under pandemin.

The past literature suggest that transportation can impact quality of life (QOL) both directly and indirectly. The first part of this dissertation attempted to comprehensively evaluate the impact of transportation (specifically public transit, and walkability) along with physical built environment, and sociodemographic indicators on community QOL, and overall life satisfaction (OLS) of an individual living in his community. The study used an advanced technique of structural equation modeling (SEM) to evaluate the impact of these factors on community QOL and individual’s OLS. The study results revealed that physical built environment, public transit need for a community, perceived public transit importance for a community, quality of public transit services, quality of walkability conditions, ease of travel in a community (mobility indicator), and sociodemographic indicators significantly impact community QOL, and also individual’s OLS either directly or indirectly through community QOL mediating variable. The literature review suggests that accessibility to important non-work amenities improve people’s QOL. So, it is important to examine social equity in terms of individual’s ability to access non-work amenities that are important for their daily life interests. The second part of dissertation focused on equity analysis in terms of people’s ability to access non-work amenities through public transit, and walk in the US. The non-work amenities considered in this study are: 1) grocery store or supermarket, 2) personal services, 3) other retail shopping, (4) recreation and entertainment, and (5) health care facility. It is concluded that equity in terms of public transit access to non-work amenities is regressive for the older age people, people without driving license, individuals who are covered under Medicare/Medicaid program (elderly, low income, people with disabilities), and non-metro area residents disadvantaged groups. In terms of walk access to non-work amenities, it is concluded that older age people, people without driving license, physically disable people, unemployed and students, people living in non-metro areas, and females face injustice. These groups are already disadvantaged in society because of their financial, and physical health constraints and should be having sufficient and easy public transit and walk access to their daily needs.

Background: Endometriosis is a gynecological disease caused by endometrium, or cells similar to the endometrium, that grows outside the uterus and creates a chronic inflammation. The most commonly reported symptoms are dysmenorrhoea, dyspareunia, severe or irregular bleedings and pelvic pain. The underlying cause of the disease is not yet established and 5,726,6% of women in fertile age are estimated to be affected. Health care professionals has an important role in nursing care, as it might affect quality of life in women with endometriosis. Purpose: The aim of the study is to describe women's experiences of living with endometriosis. Method: Literature study based on an analysis of 18 scientific articles with qualitative and quantitative content. Results: Four main themes are represented in the result; Experiences of health care, Physical consequences, Mental pain and Endometriosis controls women’s social lives. Conclusion: The literature study shows that endometriosis has a major impact on women's lives, which affects relationships, life opportunities and quality of life. The majority have experienced negative meetings with health care and a lack of knowledge. This leads to a long wait for diagnosis and insufficient treatment options. Further research should focus on results-oriented treatments and symptomatic therapies for endometriosis patients. Studies should also include transgender patients and patients that has undergone gender reassignment surgery, that is seeking health care for endometriosis-related symptoms.

<p>Kvalitet života u vezi sa zdravljem kod starih je najznačajniji aspekt kvaliteta života uop&scaron;te, a<br />merenje kvaliteta života ima značajno mesto u praksi zdravstvene za&scaron;tite i naučnoistraživačkom<br />radu. Cilj istraživanja je bio da se primenom modifikovanog McMaster Health Index Questionnaire<br />utvrde fizička, socijalna i emotivna dimenzija kvaliteta života starih, kao i da se defini&scaron;e validni<br />instrument za procenu kvaliteta života u vezi sa zdravljem kod starih u na&scaron;im uslovima. Istraživanje<br />je sprovedeno u periodu 1998-2000 u obliku studije preseka, putem anketnog upitnika na uzorku<br />stanovni&scaron;tva Novog Sada starosti 60 i vi&scaron;e godina (n=373). Inicijalni anketni upitnik je poslužio za<br />analizu pojedinih domena zdravlja a iz njega su korelacionim analizama izdvojeni ajtemi za &scaron;est<br />skala: fizičko funkcionisanje, samozbrinjavanje, osećanje u vezi korisnosti u dru&scaron;tvu, osećanja u<br />vezi života, socijalno funkcionisanje i samoprocena. Za svaku skalu i za ukupni indeks kvaliteta<br />života (QOL-OLD indeks) je izračunat transformisani skor (ranga 0-100) kao i uticaj pojedinih<br />skala na ukupni indeks kvaliteta života u odnosu na zdravlje. Indeks kvaliteta života QOL-OLD<br />(ranga 0-100) predstavlja sumarnu numeričku vrednost dobijenu iz svih &scaron;est domena. Za svaku<br />skalu kao i za sumarni Indeks utvrđena je pouzdanost i validnost pomoću svetski prihvaćenih<br />kriterijuma za Cronbach Alpha vrednost. Analizom je izdvojeno &scaron;est skala koje imaju uticaj na<br />kvalitet života starih i utvrđeno je da je uticaj fizičkog zdravlja, posmatran kroz skalu fizičkog<br />funkcionisanja i skalu samozbrinjavanja, dominantan i čini 39,3% u globalnom kreiranju indeksa<br />kvaliteta života. Svaki domen kao i ukupni QOL-OLD indeks je analiziran u odnosu na neke<br />sociodemografske determinante za koje se pokazalo da imaju uticaj na pojedine domene kao i na<br />ukupni kvalitet života u odnosu na zdravlje kod starih. Izdvajanjem ajtema iz modifikovanog<br />McMaster Health Index Questionnaire dobijen je skraćeni i validan upitnik za procenu kvaliteta<br />života starih u populaciji ali iza procenu kvaliteta života kod pojedinaca iste starosti.</p> / <p>Health related quality of life of the elderly is the most important aspect of quality of<br />life concept in general, and it&#39;s measurement has an important place in health care<br />practice and scientific work. The aim of this study was to determine physical, social<br />and emotional dimension of health related quality of life among elderly, using<br />modified McMaster Health Index questionnaire, as well as to construct valid<br />instrument for health related quality of life assessment among elderly for our<br />theritory. Cross sectional study was performed during 1998-2000. through poll, on the<br />Novi Sad population sample aged 60 and above (n=373). Initial questionnaire was<br />used for the purpose of analysis of certain health domains, and by using correlation<br />analysis to extract items for six scales: physical functioning, selfcare, social<br />usefulness, emotions about life, social functioning and self perception. Transformed<br />score (range 0-100) was calculated for each scale separatly and for total health related<br />quality of life index (QOL-OLD) as well as percentage influence of each scale on<br />QOL-OLD index. Health related quality of life index (QOL-OLD) presents summar<br />numeric value calculated from all six domains. For each scale and for QOL-OLD<br />validity and reliability was determined using Cronbach alpha value. Analysis<br />extracted six scales which influence quality of life among elderly, and results showed<br />that physical health, covered with physical functioning scale and selfcare scale, has<br />dominant influence (39,3%) in creating global QOL-OLD index. Each domain and<br />QOL-OLD index was analyzed considering some socio-demographic determinants<br />which showed impact on single domains and on total QOL-OLD index. Extracting<br />items from initial modified McMaster Health Index Questionnaire enabled<br />construction of shortened and valid questionnaire for assessment health related quality<br />of life among elderly in the population but also for individuals of same age.</p>

Orientador: Daniele Cristina Cataneo / Coorientador: Antonio José Maria Cataneo / Banca: Luiz Eduardo Villaça Leão / Banca: José Ribas Milanez de Campos / Banca: Luis Carlos Losso / Banca: Tânia Ruiz / Resumo: Hiperidrose é um distúrbio caracterizado pela secreção inapropriada e excessiva de suor. Sua etiologia pode ser primária (HP) ou idiopática e secundária (HS) a outras desordens e sua prevalência não é bem definida. Estabelecer a prevalência da hiperidrose na cidade de Botucatu- Brasil. Orientar os pacientes quanto à patologia e suas prováveis formas de tratamento e avaliar a qualidade de vida relacionada à HP. Foi realizado um inquérito populacional para identificar os casos de hiperidrose em indivíduos maiores de cinco anos, moradores na zona urbana da cidade de Botucatu, localizados por intermédio de amostragem sistemática de conglomerados. Foi calculado um número amostral de 4.033 participantes, utilizando-se os mapas censitários da cidade; a seguir, foram sorteadas quadras de cada setor para obter-se os domicílios. Dez entrevistadores previamente treinados foram responsáveis por aplicar um questionário que avaliou a presença de sudorese excessiva. Após análise dos questionários os indivíduos que referiram hiperidrose foram entrevistados por um médico para confirmação ou não do diagnóstico. Todos os indivíduos foram orientados e, caso houvesse indicação, o tratamento foi oferecido. Foram visitados 1.351 domicílios totalizando 4.113 moradores, sendo 2.150 (52,3%) do gênero feminino. A idade variou de cinco a 97 anos (média ± DP = 38,3 ± 21,2). Oitenta e cinco indivíduos (2,07%) queixavam-se de suor excessivo, sendo 51 (60%) do gênero feminino com idade variando de cinco a 72 anos (média ± DP = 33,9 ± 17,3). O efeito psicossocial mais frequente devido à sudorese foi o constrangimento, e o fator predisponente mais frequente foi o nervosismo. Cinquenta e um indivíduos (60%) concordaram em receber a visita médica para a confirmação do diagnóstico. Vinte e três (45%) apresentavam HP (prevalência de 0,93%)... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The hyperhidrosis is characterized by the excessive sweating and its etiology can be primary or idiopathic (PH) and secondary (SH) to other diseases but its prevalence is not well defined. To establish the PH prevalence in the city of Botucatu- Brazil. To perform orientation related to the pathology and its probable forms of treatment and evaluate the quality of life related to PH. A population survey was performed in order to identify the cases of hyperhidrosis in individuals aged over five years, residents in Botucatu urban area and selected by cluster systematic sampling. A sample number of 4,033 participants was calculated using the Census maps from the city and a selection of blocks in each sector was carried out in order to obtain the households. Ten previously trained interviewers were responsible for applying a questionnaire that evaluated the presence of excessive sweating. After the questionnaires analysis the individuals that referred hyperhidrosis were interviewed by a physician in order to confirm the diagnosis. All subjects were instructed and the treatment was offered in case of indication. 1,351 households were surveyed with a total of 4,113 residents, in which 2,150 (52.3%) were female. The age ranged from five to 97 years (average ± MD = 38.3 ± 21.2). Eighty-five individuals complained about excessive sweating (2.07% prevalence); 51 female (60%), anging from five to 72 years (average ± MD = 33.9 ± 17.3). The most frequent psychosocial effect related to excessive sweating was the embarrassment whereas the most frequent predisposing factor was nervousness. Fifty-one individuals (60%) agreed to receive medical evaluation in order to confirm the diagnosis. Twenty-three (45%) had PH (0.93% prevalence), 15 (29.4%) had SH caused by obesity as well as menopause or thyroid disorder and 13 (25.5%) individuals had normal sweating. If any... (Complete abstract click electronic access below) / Doutor