Quality of life is an important yet often unmeasured variable in assessing places to live. Maintaining and promoting a high quality of life is critical for communities striving to sustain and expand their current economic bases. This study presents a format for measuring quality of life and an adaptation of the importance-performance analytical technique for evaluating results. Using results from a quality of life survey, the study demonstrates how policy implications may be suggested from the analysis.

Background The trajectory of recovery after sepsis varies. Survivors may have considerable ongoing limitations, requiring a caregiver for a prolonged period. Objectives To learn about experiences, quality of life, coping, resilience, and social support of caregiver caring for survivors of sepsis. Methods We conducted a convergent mixed-methods study, recruiting informal caregivers of patients who had survived sepsis in the past year and were readmitted to the intensive care unit with sepsis. Individual face-to-face, semistructured interviews and validated surveys on quality of life, coping, caregiver burden, resilience, and social support were administered to caregivers. Interview transcripts were analyzed using content analysis. Surveys were scored and summarized using descriptive statistics. Results Caregivers were primarily middle-aged, White, and female. Half were spouses of their care recipient. Caregivers reported some deficits in mobility, pain, and anxiety/depression. Coping styles varied, with engaged coping being more prevalent. Most caregivers reported mild to moderate burden, all reported either normal or high resilience levels, and types of social support were similar. However, interviews and survey findings were not always consistent. Major themes that emerged from the analysis included (1) advocating for and protecting their loved one, (2) coping with caregiving, (3) uncertain future, (4) rewards of caregiving, and (5) need to optimize communication with family. Discussion Caregivers of sepsis survivors are protective of their care recipient and use a variety of strategies to advocate for their loved one and to cope with the uncertainty involved in a new intensive care unit admission. More advocacy and support are needed for this population.

Numerous satisfaction studies have been conducted in both tourism and marketing which have examined various aspects of travelers and/or consumers. Quality of life satisfaction studies look beyond the types of satisfaction experiences that endure for only a short time to those that "spill over" into individuals' life domains thus enhancing their overall life satisfaction. Many research studies in the discipline of marketing have revealed that the overall quality of life of consumers may be affected by the marketing efforts of organizations for all of the marketing mix elements. Although it logically follows that the marketing endeavors of tourism organizations would likely have the same impact on their consumers (i.e., travelers), little research has been done to date to determine the validity of this premise. The purpose of this study is to examine the effects of leisure tourism on the traveler's quality of life. A model and measurement instrument which help to explain the role of satisfaction with leisure tourism services and experiences in satisfaction with leisure life and overall life were designed for use in this study. The model was based on the hierarchy of life satisfaction model and speculated that overall life satisfaction is derived from satisfaction with the major life domains (e.g., leisure life). Lasting satisfaction or dissatisfaction experienced within the leisure life domain spills up vertically to the most superordinate domain (life in general), thus affecting the overall life satisfaction or dissatisfaction of the traveler. Both the model and the measurement instrument were validated, refined, and extended in this study. A survey of 815 consumers of travel/tourism services who reside in Southwest Virginia was conducted. Structural Equation Modeling (i.e., LISREL) analysis was performed to test the goodness of fit of the model. The results indicated a good model fit. That is, no revisions to the hypothesized model were needed, thus confirming the belief leisure travel does contribute to travelers' overall quality of life satisfaction. Additional analyses were conducted to test the moderating effects of personality type, length of stay, and type of trip on select relationships in the model. Differences of effects for some of the relationships in the model were identified for length of stay and type of trip, but not for the traveler's personality type. Among the key findings of this work are the establishment of those factors which contribute to the overall life satisfaction of travelers, the validation of a measurement instrument which could be used periodically by industry experts to gauge the "health" of the industry in its contribution to the overall life satisfaction of tourism consumers, and the revelation that the length of stay moderates several of the relationships in the model, thus suggesting differences in the way the various identified components influence the overall life satisfaction of short-term versus long-term visitors. / Ph. D.

This study investigates how tourism affects the quality of life of residents in tourism destinations that vary in the stage of development. The proposed model in this study structurally depicts that satisfaction with life in general derives from the satisfaction with particular life domains. Overall life satisfaction is derived from material well-being, which includes the consumer's sense of well being as it is related to material possessions, community well-being, emotional well-being, and health and safety well-being domains. The model also posits that residents' perception of tourism impacts (economic, social, cultural, and environmental) affects their satisfaction of particular life domains. Lastly, this study investigates that tourism development stages moderate the relationship between residents' perception of tourism impacts and their satisfaction with particular life domains. Accordingly, the study proposed four major hypotheses: (1) residents' perception of tourism impacts affects their QOL in the community, (2) residents' satisfaction with particular life domains is affected by the perception of particular tourism impact dimensions, (3) residents' satisfaction with particular life domains affects residents' life satisfaction in general, and (4) the relationship between residents' perception of tourism impacts and their satisfaction with particulate life domains is moderated by tourism development stages. The sample population consisting of residents residing in Virginia was surveyed. The sample was proportionally stratified on the basis of tourism development stages covering counties and cities in the state. Three hundreds and twenty-one respondents completed the survey. Structural Equation Modeling and Hierarchical Multiple Regression were used to test study hypotheses. The results revealed that the residents' perception of tourism impacts did affect their satisfaction with particular life domains significantly, and their satisfaction with particular life domains influenced their overall life satisfaction. The hypothesized moderating effect of tourism development stages on the relationship between the perception of tourism impacts and the satisfaction with particular life domains was not supported. The results indicated that the relationship between the economic impact of tourism and the satisfaction with material well-being, and the relationship between the social impact of tourism and the satisfaction with community well-being were strongest among residents in communities characterized to be in the maturity stage of tourism development. This finding is consistent with social disruption theory which postulates that boomtown communities initially enter into a period of generalized crisis, resulting from the traditional stress of sudden, dramatic increases in demand for public services and improving community infrastructure (England and Albrecht's (1984). Additionally, residents develop adaptive behaviors that reduce their individual exposure to stressful situations. Through this process, the QOL of residents is expected to initially decline, and then improve as the community and its residents adapt to the new situation (Krannich, Berry & Greider, 1989). However, when a community enters into the decline stage of tourism development, the relationship between the economic impact of tourism and the satisfaction with material well-being, and the relationship between the social impact of tourism and the satisfaction with community well-being may be considered to be the capacity of the destination area to absorb tourists before the host population would feel negative impacts. This is consistent with the theoretical foundation of carrying capacity, suggesting that when tourism reaches its maturity or maximum limit, residents' QOL may start deteriorating. Further, the relationship between the cultural impact of tourism and the satisfaction with emotional well-being, and the relationship between the environmental impact of tourism and the satisfaction with health and safety well-being were strongest in the decline stage of tourism development. Neither the theories of social carrying capacity nor social disruption offered much to explain this result. However, this result is consistent with Butler's (1980) argument that in the decline stage, more tourist facilities disappear as the area becomes less attractive to tourists and the viability of existing tourist facilities becomes more available to residents in the destination community. As residents' perception of negative environmental impacts increases, their satisfaction with health and safety well-being decreases in the decline stage of tourism development unless the area as a destination provides rejuvenating or alternative planning options. It has been well established that residents in certain types of tourism communities might perceive a certain type of tourism impact unacceptable, while in other communities, the same impact type may be more acceptable. Thus, the study suggests that the proposed model should be further tested and verified using longitudinal data. / Ph. D.

Coronary artery bypass grafting (CABG) is a procedure used to help improve and save the lives of thousands of coronary artery diseased patients every year. Measuring health-related quality of life (HRQL) significantly contributes to understanding patient perceptions of outcomes attributable to this surgery. Previous research on patient outcomes for CABG has included the evaluation of changes in HRQL at intervals of 3-6 mo postsurgery. There is a lack of research, however, that evaluates how physical fitness levels of CABG patients prior to surgery, may affect these HRQL outcomes. The purpose of this study was to develop a prediction equation, using fitness in addition to other combined variables, that predicts HRQL 3 mo after CABG. This study evaluated the influences of prior physical fitness, when these attributes are considered in combination with other clinical variables. Moreover, whether these variables would be possible predictors of health-related quality of life outcomes 3 mo after CABG were evaluated. These variables consisted of heart disease risk factors, physical fitness measures, and whether or not the patients had histories of various comorbid conditions, including that of prior history of myocardial infarction. The HRQL was assessed using the Medical Outcomes Study Short Form 36 (MOS SF-36), and concurrently, questionnaire data were collected with several other patient perceived measures expected to have potential confounding influences on HRQL; the MOS Social Support Scale; Beck Depression Inventory; Health Complaints Scale; the Life Orientation Test for optimism/pessimism. In all, 45 men and 10 women, were evaluated just prior to and 3 mo following CABG. Two of the eight subscales of the MOS SF-36 were predicted at an adjusted R 2 of greater than 50%. The sum of three skinfolds was the only physical fitness measure combined with current smoker, Beck Depression Inventory, presurgical General Health Perception and the Medical Outcomes Study Social Support Scale, that contributed most to predicting General Health Perception (R 2 =.68). Elbow flexion was the only physical fitness variable, combined with four presurgical MOS SF-36 subscales (Mental Health, Role Physical, Social Functioning and General Health Perception) that contributed to predicting the subscale of mental health (R 2 =.61). Physical fitness did contribute to predicting the global scope of health perception and mental health. Physical and social domains of HRQL, however, were not significantly predicted. Presurgical HRQL was most significant when predicting postsurgical HRQL. Therefore, in order to predict postsurgical HRQL, presurgical HRQL should be used. Physical fitness variables can be utilized to contribute to predicting certain aspects of HRQL. / Master of Science

Work-life balance, happiness and well-being go hand-in-hand with the quality of life, the quality of working life and the level of satisfaction with both. A recent survey that took place in the Czech Republic in 2018 attempted to measure the quality of life using the WHOQOL questionnaire developed by the World Health Organization. It also used the SQWLi instrument proposed by Vinopal et al. to measure the quality of working life perceived subjectively. The overall aim of this work is to challenge the theory of Danna and Griffin, summarized back in 1999, which says that the quality of life and the quality of working life are interrelated domains. It is interesting to see whether the same results can be achieved even nowadays- almost 20 years after their statement was issued-with respect to the Czech population. The spillover theory supports Dana and Griffin's statements, showing the causal association between the concepts. The main questions of the study are the folllowing. First, is there a relationship between the quality of life and the quality of working life?. Second, how strong is the association between the quality of life and the quality of working life? Third, what are the levels of association between the quality of life and the quality of working life with respect to socio-demographic...

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第21457号 / 人健博第64号 / 新制||人健||5(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 古田 真里枝, 教授 若村 智子, 教授 万代 昌紀 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

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A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements for the degree of Master of Science in Medicine, Johannesburg, 2017 / Objective: Physical activity (PA) is recommended in the management of osteoarthritis (OA) to reduce pain and improve function. Total volumes of PA and sedentary behaviour (SB) have been described in people with knee OA, but detailed information about the patterns of accumulation of PA and SB in knee OA populations is lacking. The purpose of this study was to objectively assess the patterns of accumulation of PA and SB and to explore associations with subjectively measured functional outcomes and quality of life in patients with knee OA. Methods: End-stage knee OA patients (n = 87, 65 ± 8.8 (mean ± SD) years, body mass index 34.4 ± 7.8 kg/m2) with Kellgren-Lawrence-defined grade 3-4 radiographic OA, wore an Actigraph and an activPAL accelerometer for 24 hours a day for 7 consecutive days. Total volumes of SB, light physical activity (LPA), moderate to vigorous physical activity (MVPA), and different bouts of SB, LPA, and MVPA were assessed. Self-report questionnaires were used to assess patient-experienced pain, function, quality of life and activities of daily living were the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index and the Knee Injury Osteoarthritis Outcome Score (KOOS). Results: Of the 87 knee OA patients only 76 and 65 had complete Actigraph and activPAL data respectively. The participants had a mean (SD) age of 65.0 (8.8) years, were mostly women and most were classified as being obese with an average BMI of 34.4 (7.8) kg/m2. The Actigraph mean (95% CI) of awake wear time was 15.6 (15.1-16) hours/day, SB 10.9 (10.5-11.4) hours/day, LPA 4.5 (4.1-5) hours/day and MVPA 8.2 (3.3-13) min/day. Approximately 7% of patients met the current recommended PA guidelines. The activPAL mean (95% CI) of sitting time, standing time, stepping time and number of steps were 9.3 (8.5 – 10.1) hours per day, 5.0 (4.4 – 5.6) hour per day, 76.5 (66.6 – 86.3) minutes per day and 2489 (2130 – 2848) minutes per day respectively. There were variations in the hourly patterns of movement behaviours. Participants were significantly less sedentary between 6 am and 9 am compared to the grand mean of sedentary time per hour over the day (p<0.01) and were significantly more sedentary per hour from 3 pm to 7 pm (p<0.05). Significant correlations were found between WOMAC pain scores and Actigraph measured SB (r=0.277, p=0.031), LPA (r=-0.240, p=0.043), MVPA (r=-0.242. p=0.042), number of steps (r=-0.282, p=0.020), number of breaks in bouts of SB greater than 20 minutes (r=-0.292, x p=0.016), average duration of breaks in SB (r=-0.277, p=0.024), average duration of MVPA bouts (r=-0.326, p=0.012). Significant correlations were also found between WOMAC activity of daily living scores and Actigraph measured LPA (r=-0.206, p=0.048), MVPA (r=-0.246, p=0.029), number of steps (r=-0.286, p=0.010) and average duration of MVPA bouts (r=-0.383, p=0.002). Significant correlations were found between WOMAC pain scores and activPAL sitting time (r=0.029, p=0.02), and stepping time (r=-0.029, p=0.01), between self-reported WOMAC activity of daily living score and stepping time (r=-0.309, p=0.02), between KOOS activity of daily living score and stepping time (r=-0.276, p=0.004), and between KOOS quality of life score and stepping time (r=-0.263, p=0.008). Conclusion: This study describes novel detail of the patterns of activity and sedentary behaviour in patients with knee OA. The use of two accelerometers gives a detailed account of daily activity and the variation throughout the day, highlighting when interventions to improve activity might be most effective. Therefore, interventions should target the long bouts of inactivity in this population. Since even healthy populations of older adults struggle to meet current recommended PA guidelines, it may be important to shift attention from meeting recommendations of MVPA to creating feasible suggestions of doing more light activity and breaking more sedentary time in knee OA patients. / XL2018

Previous studies suggest there are numerous benefits of horticultural therapy programs. The current study explored the benefits of a horticultural therapy program with elderly populations at two facilities in Bowling Green, Kentucky. Fifteen participants attended a 2-hour session on horticulture techniques once a week for four weeks. Using a pretest to posttest study design, changes in participants’ cognition, quality of life, and loneliness were assessed. The pretest was administered verbally by the researcher before the first session and the posttest, including a series of questions about satisfaction with the program, was administered after the last session. Items on each assessment included the Mini-Mental State Exam, the Assessment of Quality of Life, and the Revised UCLA Loneliness Scale. Findings suggest that participants’ cognitive ability significantly improved after participation in the program while quality of life and loneliness perception did not significantly improve. Participants perceived the program as positive and enjoyable.