Thesis (M. Phil.)--University of Hong Kong, 1998. / Includes bibliographical references (leaves 145-151).

Thesis (M. Sc.)--University of Hong Kong, 2002. / Includes bibliographical references (leaves 111-116).

Thesis (Ph. D.)--West Virginia University, 2006. / Title from document title page. Document formatted into pages; contains xi, 214 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 155-173).

Thesis (M.Soc.Sc.)--University of Hong Kong, 1997. / Includes bibliographical references. Also available in print.

The aim of this master thesis is to analyze the influence of non-health factors on quality of life in member countries of the European Union. For the analysis, economic and developmental variables were used. The master thesis begins with analysis of life expectancy in the world due to quality of life directly affecting life expectancy. The next part is devoted to the analysis of the influence of GDP on quality of life and correlation between single dimensions of the Human Development Index. The Health index, Inequality-adjusted income index, Expenditure on public health and GNI per capita PPP were analyzed in order to illustrate their influence and importance in provision of quality of life. Unemployment of the age group 55+ and out-of-pocket spending were analyzed to demonstrate their influence on quality of life and life expectancy. Pension systems and retirement age were analyzed with connection to ageing of the population and fiscal problems arising from decreased fertility. Gender inequality is analyzed, drawing adverse consequences of a more equitable, but not a long-term oriented society. As a result of this master thesis, the conclusion was drawn in form of a Quality of life dilemma diagram. The diagram consists of all the variables analyzed in the master thesis displaying positive, negative and likely positive relationships between variables and quality of life. In the conclusion, the problem of sustainability of public finances, welfare state and competitiveness caused by longevity and low fertility affecting future quality of life in the European countries is summed up. The finding of this thesis is that quality of life is a very complex issue and in order to achieve a sustainable quality of life, all the variables have to be wisely governed. Short-term unbalanced improvements in quality of life will very likely retaliate in terms of deterioration of other variables in the future, pulling quality of life down.

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Survival following critical illness is associated with a significant burden of physical and psychosocial morbidity and recovery is often protracted and/or incomplete. Recovery has been measured using, almost exclusively, generic health-related quality of life (HRQoL) questionnaires. There is, however, an inexorable lack of consensus on the conceptual definition of HRQoL, and existing measures have tended to reflect overtly biomedical concerns such as morbidity and impairment at population level. Limited empirical or theoretical work has examined the extent to which widely used measures reflect the individual’s concerns, “health”-related and otherwise. The primary aims of this PhD are to examine HRQoL among a rarely studied sub group of the critically ill patient population: survivors of prolonged critical illness, and to explore the extent to which professionally endorsed measures capture their experiences of and perspectives on the recovery process. The implications of “patient-centredness” are both diverse and far-reaching in terms of policy, practice and critical care outcomes research, and are discussed throughout. A review of the literature among a well studied sub group of the patient population (survivors of Adult Respiratory Distress Syndrome) identified the widespread use of generic and ancillary measures which were invariably developed for use among other patient populations. This approach was seen to offer limited insight to the putative relationship between critical illness-related morbidity and HRQoL. Reflecting existing professional recommendations and practice, the Short Form 36 (SF-36) and the EuroQoL were administered by post to 20 survivors of prolonged critical illness at up to 6 months following ICU discharge. Each subsequently participated in a semi-structured interview, the purpose of which was to explore experiences and perceptions of ongoing morbidity within the contexts of the critical illness “journey” and, importantly, everyday life. A small number (n=5) participated in cognitive interview in order to explore both the everyday logistics of questionnaire completion and the often startling inconsistencies between verbal and questionnaire response. Analysis here revealed the unexpectedly diverse and normally hidden processes through which survivors interpreted and responded to standardised questionnaire items, challenging traditional (i.e. psychometric) notions of validity. Data from the semi-structured interviews were “mapped” onto the dimensions of the SF-36, revealing the highly contextualised and complex inter-relatedness of biomedically defined and ostensibly discrete aspects of experience. Morbidity was conceptualised by survivors in terms of the adaptive and interpretive processes adopted in everyday life (as opposed to a source of loss) and was generally under-reported in questionnaire form. An alternative explanatory framework for HRQoL was subsequently developed. Data were also analysed with reference to the “biographical narrative” of critical illness, a strategy which revealed the significance of survivors’ own stock of “life experience” (health-related and otherwise) in these interpretive and adaptive processes. The unexpectedly phlegmatic nature of survivors’ accounts directed attention to the narrative form, lending credibility to survivors’ claims that “things weren’t that bad”; accounts of seemingly intolerable morbidity were perceived, for example, as “a lucky escape”. This data also revealed, however, the influence of shortfalls in the processes and delivery of acute hospital rehabilitation upon the efficacy of these interpretive and adaptive processes. Mixed methods approaches to HRQoL, in summary, offer significant insights into survivors’ conceptualisations of morbidity, recovery, quality of life and the complex inter-relationships therein. Attention to the processes of adaptation also offers significant potential for the development of patient-centred measures of outcome and the expedition of the recovery process in ways which are most meaningful to survivors.

Objectives: Reviews have suggested that stroke patients and family members frequently hold different impressions of the patient’s quality of life. Understanding such differences may be particularly useful for clinicians who wish to help clients adjust to the effects of a stroke. The aim of this study was to investigate how the responses of stroke survivors and their family members differ when indicating the stroke survivors’ quality of life, and whether such differences are associated with greater time elapsed since the stroke onset. Design and Method: A related-subject design and a correlational design were utilised in this study. People who had suffered a stroke within five years were compared with nominated members of their family. All participants indicated the perceived quality of life of the stroke survivor using the WHOQOL-BREF. The time elapsed since their stroke was recorded and the participants’ mood was assessed. Results: No significant differences were found between the stroke survivors and the family members’ views of the stroke survivors’ quality of life. However, agreement between these groups was found to be low in the Social domain of the WHOQOLBREF. Greater time since the stroke onset was found to correlate with greater discrepancy between groups in the Social domain, but not in the other domains. Conclusions: The results suggest that families’ adjustment to stroke does not conclude when improvement in function slows. Instead, a stroke continues to affect families years after the initial stroke. These findings may be interpreted within the context of quality of life response shift, where changes in the stroke survivors’ evaluation of their social lives may not be identified by their families. This may reflect a common trajectory following stroke. The methodological limitations of this study and suggestions for future research are discussed.