Thesis (Ph. D.)--Ohio State University, 2006. / Title from first page of PDF file. Includes bibliographical references (p. 71-87).

Thesis (M.S.N.)--University of North Carolina at Greensboro, 2006. / Title from PDF title page screen. Advisor: Donald Kautz; submitted to the School of Nursing. Includes bibliographical references (p. 32-34).

Older adults represent a growing part of the population of the United States. Due to decreased physical activity, dietary changes, and alterations in metabolic rate this population is susceptible to an increased rate of diseases. The generation entering older adulthood is one which welcomed fast food and meal replacement foods allowing them to adapt to a more sedentary lifestyle and to need programs of preventative health. The Nutrition and Life Satisfaction Survey was used to investigate gardening as a preventative health intervention for older adults. This instrument was used to compare older (age 50+) gardeners and nongardeners on their perceptions of personal life satisfaction, nutrition, health, and gardening habits. The instrument was posted online at the Aggie Horticulture website in spring 2005. Respondents differentiated themselves as gardeners or nongardeners by responding positively or negatively to the question “Do you garden?” Then, they completed the questionnaire about their quality of life andhealth status and, for gardeners, their gardening habits. Results indicated that gardeners had more desirable responses: Overall quality of life scores were higher for gardeners compared to nongardeners, and four individual quality of life statements yielded more positive answers by gardeners. Additionally, gardeners reported a higher consumption of total fruits and vegetables, including herbs, and of vegetables only including herbs. Personal reports of physical activity and of perceived health were higher among gardeners. Females were more likely than males to garden and spend a higher percentage of their budget on fruits and vegetables. Higher consumption of fruits and vegetables and higher levels of physical activity result in healthier lifestyles and, in turn, can increase quality of life.

Les cancers des voies aéro-digestives supérieures sont connus pour entraîner, par eux-mêmes et par leur traitement, une altération significative de la qualité de vie. Depuis le milieu des années septante, un grand nombre dauteurs ont étudié cette qualité de vie. De nombreux outils de mesure ont été fabriqués et le sujet occupe de plus en plus de place tant dans la littérature que dans les congrès scientifiques. Pourtant, jusquà présent, aucune étude importante ne sest penchée sur la perception quont les médecins de la qualité de vie de leurs malades souffrant dun cancer de la tête et du cou ainsi que sur les implications de cette « représentation» médicale. Nous proposons donc ici dessayer de pallier à ce manque et de présenter un travail sur une large population médicale. Lensemble de la population ORL belge ainsi que 3000 médecins traitants belges ont été contactés. Chacun dentre eux a reçu un questionnaire par la poste. Ce questionnaire, totalement anonyme, formulé dans la langue maternelle de chaque médecin (français ou néerlandais) avait pour but de recueillir de manière la plus précise possible des indications sur la perception des soignants. Ces questions portaient aussi bien sur la perception générale de la qualité de vie que sur les symptômes importants et sur les différents traitements habituellement utilisés en oncologie cervico-faciale. Une étude statistique sérieuse de ces réponses nous a conduits à appréhender de manière nettement plus scientifique cette problématique. Par ailleurs, nous nous sommes attachés à comparer dans la mesure du possible cette perception médicale avec ce que le patient pense vraiment de sa propre qualité de vie (sur base de la littérature scientifique existante). 245 ORL ont répondu à létude tandis que 506 généralistes faisaient de même. Lanalyse des réponses démontre que le monde médical accorde énormément dimportance à la qualité de vie. Cette attention portée à la qualité de vie paraît plus importante que chez les patients eux-mêmes. Les médecins sont très majoritairement prêts à sacrifier le pronostic en terme de survie pour maintenir une qualité de vie quils jugeraient plus acceptable. Sur base de la littérature, ceci va à lencontre de la volonté première du malade. Une moitié des médecins répondeurs reconnaissent ne pas présenter dempathie pour leur malade cancéreux. Il transparaît que les soignants perçoivent la qualité de vie liée à un cancer des voies aéro-digestives supérieures comme étant moins bonne que pour dautres localisations néoplasiques. Probablement pour cette raison, ils pensent très majoritairement quune prise en charge psychologique est indispensable pour de tels patients. Ils pensent également de manière générale que leur façon daborder le patient peut indirectement influencer sa qualité de vie. Pour les médecins, tous les symptômes nont pas la même importance en terme de qualité de vie. La douleur joue, pour eux, un rôle prépondérant. Elle est suivie dans lordre par la respiration, lalimentation, la voix et finalement lapparence physique. Des différences interculturelles ont été retrouvées notamment pour la voix et lalimentation. Les médecins perçoivent également différemment les traitements habituellement utilisés en oncologie cervico-faciale sur base de la qualité de vie quils peuvent offrir aux patients traités. La radiothérapie est clairement mieux perçue que la chirurgie. La chimiothérapie offre la moins bonne qualité de vie post-thérapeutique aux yeux de nos confrères. Ces différences ne semblent pas sappuyer sur des éléments cliniques solides quand on se place du côté des patients (sur base de la littérature). Il est important de remarquer également que bien que le médecin traitant souhaite participer à la décision thérapeutique, il se sent sous informé quant aux cancers des voies aéro-digestives et à la qualité de vie résiduelle. En conclusion, nous pouvons affirmer que le médecin considère la qualité de vie du malade comme un point essentiel dans sa prise en charge et est prêt à sacrifier partiellement la survie pour préserver la qualité de vie. Ceci doit ouvrir un débat éthique important et doit nous amener à une question fondamentale : « Sachant que notre représentation de soignant diffère autant de celle du patient tant du point de vue de la qualité de vie que du but principal du traitement, sommes-nous autorisés à imposer notre perception de la maladie et de ses effets dans le choix thérapeutique? ». Par ailleurs, sur base de nos résultats, il serait judicieux que les spécialistes cervico-faciaux puissent mieux informer leurs collègues sur le cancer de la tête et du cou ainsi que sur la qualité de vie résiduelle.

This thesis focuses on the role of different psychosocial factors in the course of pain over time in a general population sample of women in Sweden. The main aim was to identify and quantify such factors as predictors of pain, pain-related disability and quality of life within a biopsychosocial framework for the understanding of the pain experience over time.  The studies were based on baseline (BL) and follow-up (FU) measures with 12 months apart among 2,300 women living in Sweden, and included physical and psychological health and socio-economic status. Study I investigated associations between socio-economic status (SES) at baseline and pain and pain-related disability at follow-up, and additionally a possible mediating role of depressive symptoms in such associations. The results indicated that educational level, financial strain and occupational level were associated with pain over time. Symptoms of depression were related to all pain-and SES factors, and might be understood as a mediating factor within this context. The results of Study II showed a link between symptoms of burnout at baseline and several pain-locations. Additionally, among women with pain, the characteristics of the pain experience and pain-related disability were associated with level of burnout over time. Study III focused on the sub sample of women reporting pain at follow-up, and examined possible predictors of their perceptions of quality of life (QOL). Several psychosocial factors were associated with QOL, and seemed to be more important predictors than the characteristics of pain in terms of intensity and frequency. These factors were burnout, emotional distress, and social support. Study IV was an attempt to sum up the results of the previous studies by analysing predictors of the course of pain, i.e. by comparing women that developed pain from BL to FU with those that remained pain-free and to compare women with sustained pain with those who recovered from pain during the assessment period. These analyses showed symptoms of posttraumatic stress (PTSD) to be associated with reporting emerging pain, while pain variables, educational level and social support were related to sustained pain. The results of the four studies in this thesis indicate that psychosocial factors and their interplay with the characteristics of pain can be identified and described in a female sample, with a broad definition of pain, and that these factors play a central role in the experience of pain and its impact on the everyday life of these women. There may be several possible paths leading to the development of persistent pain among women and the identification of risk factors is complicated by never-ending interactions between biological, psychological and social processes. At an early stage, prior to pain development, several risk factors may cluster together (e.g. SES, depression), and work as indicators of, e.g. dysfunctional coping in relation to pain. In the first contact with health care and among primary care personnel the identification of such indicators is crucial so as to find women at risk for prolonged pain conditions. General indicators might then be more easily distinguishable than certain individual behaviour characteristics widely accepted as risk factors for pain and disability (e.g. fear-avoidance). To spread the knowledge of general factors in the first line of health care is therefore of great importance in preventive work. Finally, the results demonstrated that many women report pain with characteristics that to a great extent affect their lives and through interactions with psychological and social health might have grave consequences for perceptions of quality of life.

Bröstcancer är den vanligaste cancerformen bland kvinnor över hela världen. Sjukdomen leder till en förändrad livssituation där stress och ångest blir en del av vardagen. Coping bidrar till en ökad psykisk, fysisk och social förmåga att hantera och leva med en sjukdom. Vilken copingstrategi som används är individuellt och utvecklas med tiden beroende på hur sjukdomsbilden ser ut samt vilka erfarenheter individer har sedan tidigare. Syftet med studien var att belysa hur kvinnor med bröstcancer hanterar sin livssituation genom coping för att uppnå bättre livskvalitet. Studien utfördes som en litteraturstudie där 14 vetenskapliga artiklar granskades. Resultatet påvisade att kvinnor med bröstcancer hanterade sin livssituation genom ett flertal betydelsefulla copingstrategier vilka var acceptans, optimism, humor, stöd, bortträngning, successiv bearbetning, aktivitet, kämparanda och andlighet. Det framkom att coping i stor utsträckning bidrog till att högre livskvalitet uppnåddes, livssituationen blev mer hanterbar samt att stress och oro reducerades. Sjuksköterskan ska främja livskvalitet hos patienter och bör därför inneha kunskaper om coping. Mer kvalitativ forskning inom området är önskvärt för att mer djupgående se vad coping har för effekter. / Breast cancer is the most common form of cancer among women worldwide. The disease leads to changes in their life as stress and anxiety becomes a part of everyday life. Coping provides an increased mental, physical and social ability to cope and live with a disease. Which coping strategy being used is individual and evolves over time, depending on past experiences and clinical picture. The purpose of this study was to elucidate how women with breast cancer manage their life trough coping in order to achieve better quality of life. The study was carried out as a literature study, 14 scientific articles were reviewed. The result demonstrate that women with breast cancer manage their life through a number of important coping strategies which were acceptance, optimism, humor, support, distraction, step by step, activity, fighting spirit and spirituality. It was shown that coping highly contributed to higher quality of life, everyday life was easier to handle and stress and anxiety was reduced. The nurse is obligated to work for quality of life in patients and should therefore possess knowledge about coping. More research in the area is desirable to get a more in depth view of the effects of coping.

I Sverige lever cirka 20 000 personer med stomi, vilken är en kirurgiskt anlagd öppning i bukhålan. Emellertid är det många patienter som har svårigheter med att hantera denna nyuppkomna livssituation. I sjuksköterskans dagliga arbete sker inte sällan möten med personer med stomi. Eftersom sjuksköterskans uppgift är att stödja personerna i deras tillfrisknande och återgång till ett normalt liv, är det av vikt att beskriva dessa personers upplevelser av livskvalitet. Således var syftet att beskriva patienters upplevelser av livskvalitet efter en stomioperation. Litteraturstudien genomförs med 13 artiklar som relaterar till syftet. Resultatet från artiklarna sammanställs under två rubriker, vilka belyser upplevelser som leder till minskad eller ökad livskvalitet. Stomin medför en förändring i livet, vilket initialt medför minskad livskvalitet och att det sociala livet kan bli lidande. Dessa upplevelser övergår för många med tiden till en medvetenhet om att stomin räddat deras liv. Många, särskilt de med permanent stomi, lär sig att acceptera sin stomi och att anpassa sig till den, vilket leder till ökad livskvalitet. Forskning om livskvalitet i förhållande till upplevelser relaterat till att leva med en stomi, bör fortgå för att öka sjuksköterskans förståelse i mötet med dessa personer. / In Sweden about 20 000 people live with an ostomy, which is a surgically constructed opening in the abdominal cavity. However, many patients have difficulty in dealing with this newly emerging circumstance in life. Frequently, a nurse’s daily activities will include the caretaking of people with an ostomy. Since the nurse's task is to support people in their recovery and their return to normal patterns in their lives, it is important to describe these people's experiences of quality of life. The purpose of this study was to describe patients’ experiences of quality of life after a surgery with an ostomy. A literature review was carried out with 13 articles related to the purpose. The results from these articles are sorted under two headings, which highlight the experiences that lead to reduced or increased quality of life. The ostomy involves a change in life, which initially leads to a reduction in quality of life and social life may also initially suffer. These experiences will over time transform into an awareness that the ostomy has saved their lives. Many, especially those with a permanent ostomy, learn to accept their ostomy and to adapt to it, resulting in improved quality of life. Research on quality of life in relation to the experiences related to living with an ostomy, should continue to enhance nurses’ understanding when meeting people with an ostomy.

The purpose of this study was to describe how women with fibromyalgia experienced their quality of life. The method used was a literature study with a descriptive design. The search for scientific articles was done by the databases Academic Search Elite, CINAHL, Medline via PubMed and Cohrane Library. The articles were quality-tested and the content studied, resulting in four categories as follows. Research involving the physical aspects of the quality of life showed that sleeplessness, tiredness and pain was commonly occurring symptoms in women’s daily life which affected their life-situation. The symptoms stopped them from planning or actively taking part in social activity. The psychological aspects of quality of life showed that women with fibromyalgia expressed a longing for the life they lived before the disease. The result of the social aspects showed that the women with fibromyalgia wished to spend a lot of time with their families and expressed how important it was. Fybromylagia also had negative effects on their relationships and divorce was not unusual. Work was highly prioritised and estimated as stimulating. The lack of specific symptoms of the disease made the women questioned by people in their environment and by health-personnel. The positive sides of the disease was found in the existential aspects. The women started to reflect about their duties in life and learned how to prioritise in a proper way. / Syftet med denna studie var att beskriva hur kvinnor med fibromyalgi upplevde sin livskvalitet. Metoden som användes var en litteraturstudie med beskrivande design. Sökningen av vetenskapliga artiklar skedde i databaserna Academic Search Elite, CINAHL, Medline via PubMed och Cohrane Library. Artiklarna kvalitetsbedömdes, innehållet studerades och resulterade i fyra kategorier. Forskning rörande den fysiska aspekten av livskvalitet visade att sömnlöshet, trötthet och smärta var vanligt förekommande symtom i kvinnornas vardag som påverkade deras livssituation. Symtomen hindrade dem från att planera eller aktivt delta i sociala aktiviteter. De psykiska aspekterna inom livskvaliteten visade att kvinnor med fibromyalgi gav uttryck för en längtan efter det liv de levt innan sjukdomen. Resultat tillhörande den sociala aspekten visade att kvinnor med fibromyalgi hade en önskan av att få spendera mycket tid tillsammans med familjen och uttryckte hur viktig den var. Sjukdomen fibromyalgi hade också en negativ inverkan på förhållande och skilsmässa var inte ovanligt. Arbete prioriterades högt och arbetslivet uppskattades som stimulerande. Bristen på ett synligt symtom på sjukdomen fibromyalgi gjorde att kvinnorna blev ifrågasatta av personer i omgivningen och sjukvårdspersonal. Under de existentiella aspekterna föll de positiva sidorna med sjukdomen fibromyalgi in. Kvinnorna började reflektera över måsten och plikter i livet samt lärde sig att prioritera på ett bra sätt.

Abstract The aim of this literature review was to describe the quality of life in stoma patients after stomasurgery. Different combinations of the keywords “stoma”, “Quality of Life”, “stomasurgery” were used when searching in the databases Medline, Cinahl, Academic Search Elite and PubMed. A total of nineteen articles were used in the result. Fifteen studies had comparing design and four studies had describing design. Eighteen studies used questionnaires and one study used interviews for data collecting. Five studies did not concern the instruments' validity or reliability, fourteen studies referred to previously performed reliability's/validity tests. The sample sizes varied from 7 to 704 patients. Long-term quality of life in stoma patients shows contradictory results. Four studies showed that a brook uniting reservoir/pouch more or less did not change the quality of life. But that the body perception became better. One study showed that men´s Quality of Life was not effected by having a stoma, while women were effected to a greater extent, which led to a changed lifestyle and self-image among the women. Three studies showed that patients that are fecal incontinent has better social quality of life if they undergo stomasurgery. Four studies showed that patients with colon or rectal cancer and stoma had poorer quality of life than non-stoma cancer patients. Four studies showed that more therapy such as colostomy irrigation and relaxation gives better quality of life. Keywords; “Quality of Life”, “stoma” and “stomasurgery” / Sammanfattning Syftet med litteraturstudien var att beskriva människors upplevelse av livskvalitet efter en stomioperation. Olika kombinationer av sökorden ”stoma”, ”quality of life”, ”stomasurgery” användes vid sökning i databaserna Medline, Cinahl, Academic Search Elite och Pub Med. Totalt användes 19 artiklar i resultatet. Resultatet visade att samtliga studier hade som syfte att undersöka livskvaliteten hos stomiopererade patienter. Femton studier hade jämförande design och fyra studier hade beskrivande design. Arton studier använde sig av enkäter och en studie använde sig av intervjuer för datainsamling. Fem studier berörde inte instrumentens validitet eller reliabilitet, fjorton studier refererade till tidigare utförda reliabilitets/validitetstester. Undersökningsgruppernas storlek varierade från 7 till 704 patienter. Resultatet var motstridigt inom långsiktig livskvalitet hos stomiopererade. Fyra studier visade att en bäckenreservoar/pouch i stort sett inte förändrade livskvaliteten, men att kroppsuppfattningen blev bättre. En studie visade att mäns livskvalitet inte påverkades av att ha stomi, medan kvinnor påverkades i större utsträckning, vilket ledde till en förändrad livsstil och självbild hos kvinnorna. Tre studier visade att patienter som är avföringsinkontinenta får bättre social livskvalitet om de genomgår en stomioperation. Fyra studier visade att patienter med tjock eller ändtarmscancer och stomi hade sämre livskvalitet än de med endast cancer. Fyra studier visade att mer terapi i form av tarmsköljning eller avslappning ger bättre livskvalitet. Nyckelord; ”livskvalitet”, ”stomi” och ”stomioperation”

Is the biggest tideland reclamation project in the world (the STRP) sustainable? Since 1991, the STRP which aims at converting mudflats into 401 km2 farmland and industrial complex has been carried out in the southwestern coast of South Korea. I designed a comparative study between two neighboring rural townships with nearly identical social and ecological features except that one is within the project area and no longer has mudflats, and the other is outside of the project area and has retained its mudflats (an important source of clams). This dissertation answers the question above by comparing, sustainable development indicators and quality of life indicators in the two townships. I expected to find that people living in the township within the project area would be more sustainable because they have gone through with the environment versus development controversy in their own villages and many of them participated in person in protests with the national/local environmental movement organizations. This study uses one of the best known consumption-based sustainable development indicators (SDIs) - Personal Ecological Footprint (PEF), combined with the ethnographic data from the two townships (Gyehwa-township and Simwon-township) – to demonstrate that the PEF values of the two townships appear to be the same and the status of quality of life is quite similar. As an explanation of the unexpected result, this study contends that the level of sustainable development of the people in the in-project area (Gyehwa-township) has been more affected by nation-wide economic development trajectory than by a major regional development project (the STRP). The first stage of the STRP - the construction of the dykes - has brought about a significant effect of displacement, which cannot be said to be sustainable. However, the total influence on sustainable development in South Korea by the STRP will be determined by the progress of the second stage - internal development.