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Social comparison influences well-being, especially during psychological threat. Social comparison outcomes have been theorized to depend on motivation, frequency, contrast versus identification, with a better- versus worse-off other. To reduce this complexity in the theory, 94 senior-housing residents were interviewed and cluster analysis was conducted. Four clusters emerged. Half the interviewees formed a cluster using only adaptive social comparison methods. Adaptives were contrasted with a cluster of indiscriminate comparers, a cluster striving for improvement, and a cluster of participants disagreeing with most questions. Clusters differed especially in patterns of downward identification, upward and downward contrast. Self-evaluation and uncertainty-reduction also differed between clusters; self-enhancement and self-improvement motivations did not. Cluster membership had no direct effect on well-being, but moderation analysis demonstrated threat-buffering of high neuroticism in the adaptive cluster. The benefits were not due to self-esteem or educational level. By separating individuals rather than behaviors, cluster analysis provides a fresh perspective.

Social comparison influences well-being, especially during psychological threat. Social comparison outcomes have been theorized to depend on motivation, frequency, contrast versus identification, with a better- versus worse-off other. To reduce this complexity in the theory, 94 senior-housing residents were interviewed and cluster analysis was conducted. Four clusters emerged. Half the interviewees formed a cluster using only adaptive social comparison methods. Adaptives were contrasted with a cluster of indiscriminate comparers, a cluster striving for improvement, and a cluster of participants disagreeing with most questions. Clusters differed especially in patterns of downward identification, upward and downward contrast. Self-evaluation and uncertainty-reduction also differed between clusters; self-enhancement and self-improvement motivations did not. Cluster membership had no direct effect on well-being, but moderation analysis demonstrated threat-buffering of high neuroticism in the adaptive cluster. The benefits were not due to self-esteem or educational level. By separating individuals rather than behaviors, cluster analysis provides a fresh perspective.

Coronary heart disease (CHD) is a leading cause of morbidity and mortality in the industrialised world, and places a heavy burden on society in terms of personal disability and health care costs. The first signs of CHD often present acutely as a myocardial infarction (AMI), commonly known as a heart attack. Survivors of a heart attack remain vulnerable to poor health-related quality of life (HRQOL), further cardiac events, and increased morbidity due to a progression of CHD. Thus, the implementation of interventions to reduce these risks is an important public health strategy. To date, secondary prevention and rehabilitation efforts post-AMI focus primarily on the patient. However, it is argued that recovery from AMI occurs within a social context, and that risk reduction strategies are likely to be enhanced if interventions take into account the impact of the event on the quality of life of patients and their partners. Evidence from a review of couple relationship literature indicates that a significant proportion of couples experiences poor HRQOL (i.e., physical and emotional wellbeing) when coping with stressful life events, and that interactive aspects of a couple relationship (i.e., dyadic functioning and behaviour) are associated with individual well-being at such a time. Information from studies of couples dealing with recovery from heart attack is sparse, but tends to reflect the findings from the broader literature. Further research is required with post-AMI couples, though, as there are a number of shortcomings associated with the existing evidence. For instance, it is derived from studies conducted with, mostly small, samples of convenience; many different instruments are used to collect the data; and no studies specifically measure HRQOL. Analytically, most evidence is obtained with univariate and bivariate statistics, and data are analysed as groups of patients or partners, as opposed to dyads. Where multivariable analyses are undertaken a number of bivariate relationships are no longer significant after accounting for covariates such as age and gender; and few researchers investigate predictive associations between dyadic functioning/behaviour and HRQOL outcomes. Finally, there is a paucity of information from comparative analyses. Thus, it is not known whether the well-being of post-AMI couples over time is better than, similar to, or worse than, for example, that in the general population. The research program underpinning this thesis, the QUT-AMI Project, comprised two studies designed to address these methodological issues. The first was an observational, cross-sectional, pilot study conducted in 1998 with 26 post-AMI couples. The main investigation was a prospective cohort study of 93 post-AMI couples undertaken in 1999-2000. In both studies the samples comprised a consecutive series of adult males younger than 75 years who had experienced a first AMI, and their female partners. The average couple in both studies was middle-aged, had been married for many years, and both members of the dyad were working at the time of the heart attack. Prospective participants were identified in major clinical centres that admit cardiac patients, and couples were recruited to the project soon after the patient's heart attack. Clinical data were collected in hospital. Further data were collected with self-administered questionnaires during a home visit at 1 month (pilot and main study), and by mailed questionnaire or during a home visit at 6 months(main study) after the heart attack. The pilot study was undertaken to test recruitment and data collection procedures in preparation for the second (main) study, measure couples' HRQOL at 1 month after the event using the SF-36, and qualitatively investigate life issues for couples coping with recovery from AMI. In the main study couples' HRQOL outcomes were measured at 1 and 6 months post-AMI using the SF-36, and examined for changes over that time. The outcomes were also compared with those from matched population norms to estimate the impact of a heart attack on couples' HRQOL during the early and later recovery period. Additionally, the following relationships were investigated to determine the extent to which:* patients' dyadic functioning (e.g. happiness/satisfaction with relationship, measured with the Marital Adjustment Scale) and use of dyadic behaviour (e.g., hiding concerns and negative feelings from the other member of the dyad, measured with the Protective Buffering Scale) at 1 month predicted patients' emotional well-being at 6 months post-AMI;* partners' dyadic functioning and behaviour at 1 month predicted partners' emotional well-being at 6 months post-AMI;* patients' and partners' dyadic functioning at 1 month predicted patients' or partners' emotional well-being at 6 months post-AMI; and* patients' and partners' dyadic behaviour at 1 month predicted patients' or partners' emotional well-being at 6 months post-AMI. Exploratory analyses were also undertaken to determine the effect of dyadic discrepancies in functioning and behaviour, at 1 month after the heart attack, on patients' and partners' emotional well-being at 6 months after the event. Important findings were as follows:* At 1 month after an AMI the HRQOL of couples is impaired. The major impact is on physical well-being for patients, and emotional well-being for their partners.* In general, couples' HRQOL improves between 1 and 6 months after an AMI.* At 6 months after an AMI, the HRQOL of average couples is similar to that of their peers in the normal population.* There are subgroup variations in the quality of life of post-AMI couples, and these are associated with age, clinically poor physical health, and depression.* The combination of patients' and partners' use of dyadic behaviour at 1 month after an AMI explains 7% of the variation in patients' emotional well-being at 6months after the event, after adjustment for patients' concurrent physical wellbeing and prior levels of emotional well-being, as well as duration of couple relationships.* The combination of partners' perceptions of dyadic functioning and use of dyadic behaviour at 1 month after an AMI explains 5% of the variation in partners' emotional well-being at 6 months after the event, after adjustment for partners' concurrent physical well-being and prior levels of emotional well-being, as well as duration of couples' relationships.* Patients have poorer emotional well-being at 6 months after an AMI if partners use dyadic behaviour infrequently at 1 month after the event.* Partners have poorer emotional well-being at 6 months after an AMI if they are not satisfied/unhappy with the functioning of their relationships at 1 month after the event. Adjusted exploratory analyses, undertaken to determine the extent to which dyadic discrepancies in perceptions of functioning or use of protective buffering behaviour, predict emotional well-being, show that patients who are less satisfied/unhappier with functioning than their partners at 1 month after an AMI have poor emotional wellbeing at 6 months after the event; patients who use the behaviour more frequently than their partners at 1 month after an AMI have poor emotional well-being at 6months after the event; and partners who are less satisfied/unhappier with functioning than their patients at 1 month after an AMI have poor emotional well-being at 6months after the event. The evidence from the QUT-AMI Project supports the proposition that the interaction that occurs within a couple relationship, combined with individual characteristics of members of a dyad, influences the extent to which a heart attack impacts on couples' HRQOL. It is argued that it is not enough to merely focus on implementing secondary prevention strategies with post-AMI patients. Given that poor emotional well-being is known to predict adverse cardiac events, and premature mortality due to cardiac disease, it is recommended that a couple-focused intervention designed to meet specific needs should be implemented with at-risk couples as a public health strategy to improve not only the patients' quality of life but also that of his partner. Further research is recommended to determine the extent to which such an intervention improves post-AMI couples' quality of life.

Background: Prostitution has been documented in most societies, although the context in which it occurs may vary greatly. In Queensland, Australia, sex workers can operate from legal brothels or privately but all other sectors of the sex industry are prohibited. It is assumed that regulation of the sex industry through legalization leads to better health and social outcomes for sex workers and their clients. However, this assumption has rarely been subjected to empirical scrutiny. Aims: This research examined the occupational health and safety of female sex workers in Queensland and explored the relationship between legislative change, workplace violence, mental health and job satisfaction. Sex workers interviewed in 2003 (after legalisation) were compared to a prior study of this population conducted in 1991 (before official regulation of the sex industry). Further, in-depth analysis of the 2003 cohort compared sex workers employed in legal and illegal sectors, to assess violence, health status and job satisfaction. Methods: Cross-sectional, convenience sampling was used to collect data from female sex workers in 2003. This data was compared with data collected earlier (in 1991) and explored differences in the two samples using bivariate analysis. Similar recruitment strategies on both occasions were used to recruit women from all known sectors of the Queensland sex industry. The 1991 comparison sample (Boyle et al. 1997) included 200 women (aged between 16 and 46 years), and in 2003, 247 women (aged 18 to 57) participated. The 2003 sample included workers from legal brothels (n=102), private sole-operators (n=103) and illegal street-based sex workers (n=42). Using data collected in 2003, this study assessed the relationship between physical and mental health and job satisfaction and two main independent variables, i.e., current work sector and recent workplace violence. Bivariate analysis of physical health and independent variables showed no significant relationships and therefore further analysis was not undertaken. However, analysis of mental health and job satisfaction showed complex interactions between multiple variables and therefore linear modeling was performed to adjust for confounding. Results: Analysis of the 1991 and 2003 samples showed little apparent change over time in self-reported sexually transmitted infections (STIs). There were substantial changes over time in the types of sexual services being provided to clients, with the 2003 sample more likely to provide 'exotic' services. Violence experienced ever in their lifetime differed; in 1991, 29% reported having ever been raped compared with 42% in 2003 (p= &lt0.01). In 2003, 50% of illegal sex workers reported having ever been raped by a client compared with 12% of private sex workers and 3% of brothel-based sex workers (p=&lt0.01). Overall, the sex workers reported roughly equivalent job satisfaction to Australian women. A desire to leave the sex industry was most strongly correlated with reduced job satisfaction (p=&lt0.01). Satisfaction was also relatively low among those whose family was not aware of their sex work (p=&lt0.01). Similarly, the mental and physical health of this sample was comparable to age-matched women from the general population. Wanting to leave the sex industry was most strongly associated with poor mental health (p=&lt0.01), as was recent sexual or physical assault by a client (p=0.06) and the woman's main work sector (p=0.05). Illegal sex workers reported substantially lower mental health scores than their counterparts in legal sex work. Conclusions: Self-reported STI diagnosis was high in these samples but the prevalence appears not to have changed over time. Comparing 2003 to 1991, there were trends towards safer and more diverse sexual practices. It is likely the sex industry has 'professionalized' and now includes more sex workers providing specialist, 'exotic' services. This sample of female sex workers reported high rates of violence, with those working illegally at greatest risk. Analysis suggests a complex interaction between variables contributing to mental health and job satisfaction. In general, it appears that the majority of sex workers enjoyed at least as much job satisfaction as women working in other occupations. It also appears that this sample had equivalent mental health to women from the general population, although the sub-group of illegal workers generally had poorer health. Job satisfaction and the extent of workplace hazards (especially risk of violence) were also strongly associated with different sectors of the sex industry. It is probable that legalisation has benefited some (perhaps most) but there are health and safety concerns for those outside the legal framework. Legislative reform should focus on violence prevention, promoting reporting of violent events to police, and further exploration of the impact of legislation on the health of workers in the sex industry.

Background Recently, Taiwan has been faced with the migration of numbers of women from Southeast Asian (SEA) countries. It was estimated that the aggregate number of SEA wives in Taiwan was more than 131,000 in 2007 (Ministry of Foreign Affairs, 2006).These women are often colloquially called, “foreign brides” or “alien brides”; most of them are seen as commodities of the marriage trade, whose marriages are arranged by marriage brokers. Some women can be regarded as being sold for profit by their families. These young Vietnamese immigrant women come to Taiwan alone, often with a single suitcase, and are culturally and geographically distinct from Taiwanese peoples; the changes in culture, interpersonal relationships, personal roles, language, value systems and attitudes exert many negative impacts on their health, so greater levels of acculturation stress can be expected. This particular group of immigrant women are highly susceptible and vulnerable to health problems, due to language barriers, cultural conflicts, social and interpersonal isolation, and lack of support systems. The aims of this study were to examine the relationships between acculturation and immigrantspecific distress and health outcomes among Vietnamese transnational married women in Taiwan. This study focuses on Vietnamese intermarriage immigrants, the largest immigrant group in the period from1994 through to 2007. Methodology The quantitative study was divided into two phases: the first was a pilot study and the second the main study. This study was conducted in a communitybased health centre in the south of Taiwan, targeting Taiwanese households with Vietnamese wives, including the Tanam, Kaohsiung, and Pentong areas. This involved convenience sampling with participants drawn from registration records at the Public Health Centre of Kaohsiung and used the snowball technique to recruit 213 participants. The instruments included the following measures: (1) Socio-demographic information (2) Acculturation Scale (3) Acculturative Distress Scale, and (4) HRQOL. Questions related to immigrant women’s acculturation level and health status were modified. Quantitative data was coded and entered into the SPSS and SAS program for statistical analysis. The data analysis process involved descriptive, bivariate, multivariate multiple regression, and classification and regression trees (CART). Results Six hypotheses of this study were validated. Demographic data was presented and it revealed that there are statically significant differences between levels of acculturation and years of residency in Taiwan, number of children, marital status, education, religion of spouse, employment status of spouse and Chinese ethnic background by Pearson correlation and Kendall’s Tau-b or Spearman test. The correlations of daily activity, language usage, social interaction, ethnic identity, and total of acculturation score with DI tend to be negatively significant. In addition, the result of the one-way ANOVA supported the hypothesis that the different types of acculturation had a differential effect on immigrant distress. The marginalized group showed a greater immigrant distresses in comparison with the integrated group. Furthermore, the comparison t-test revealed that the Vietnamese immigrant women showed a lower score than Taiwanese women in HRQOL. The result showed higher acculturative stress associated with lower score of HRQOL on bodily pain, vitality, social functioning, mental health, and mental component summary. The CART procedure to the conclusion that the predictive variables for the physical component of the SF-36 (PCS) were: alienation, occupation, loss, language, and discrimination (predicted 28.8% of the total variance explained). The predictive variables for the mental component of the SF-36 (MCS) were: alienation, occupation, loss, language, and novelty (predicted 28.4% of the total variance explained). Conclusion As these Vietnamese immigrant women become part of Taiwanese communities and society, the need becomes apparent to understand how they acculturate to Taiwan and to the health status they acquire. The findings have implications for nursing practice, research, and will assist the Taiwanese government to formulate appropriate immigrant health policies for these SEA immigrant women. Finally, the application of this research will positively contribute to the health and well being of thousands of immigrant women and their families.

The dissertation {\clq}qHealth Related Quality of Life (HRQoL) in Eating Disorders`` is divided into theoretical and practical part. In the theoretical part is analyzes the problems with eating disorders. It is especially focused on its two basics forms, anorexia nervosa and bulimia which are illnesses occasioned by hypothrepsia. The next part drala with history, symptoms, cause, medication, process, prognosis and complications resulting from these disorders, including the main diagnostic criteria and prevalence data. Women are affected by both diseases more frequently than man. Mental anorexia occurs mostly between the 14th and 15th year of the life, mental bulimia at the age of 13 to 20 years. The second part is practicaly aimed at evaluation of SF-36 forms, where I verify hypotheses how eating disorders influence quality of life of theirs carriers and how the changes in quality of life are dependant on the grade of education. The analysed results indicate the difference between the sick and the healthy individuals and also the fact the level of education is important too.

Made available in DSpace on 2014-07-29T15:04:46Z (GMT). No. of bitstreams: 1 Dissertacao Jacqueline Andreia Bernardes.pdf: 383558 bytes, checksum: f3ba4aba5fe21fd775c87d3c5266640e (MD5) Previous issue date: 2006-02-24 / Hemodialysis is the most frequently renal substitutive therapy used by patients with chronic renal failure. However, continuation with this kind of treatment had demonstrated to provoke disarranging and changes on daily routine, affecting patient s quality of life. Present study main objective was evaluate the quality of life in chronic renal failure patients receiving hemodialysis treatment, by means of the instrument called Kidney Disease and Quality of Life Short Form (KDQOL-SF). Were interviewed 72 chronic kidney failure patients under hemodialysis treatment in Goiânia / GO, Brazil. For statistical data analysis, a significance level of 5% and a 95% of confidence interval were used. The majority of patients are male, with mean age of 51.1 ± 16,6 years (20 to 80 yr), catholics, and they just know how to read and write as education level. The time of hemodialysis treatment was 12 - 60 months for most of them, as well as the family income is 01 or 02 salaries. The majority doesn t work and live with their family or spouse. The results evidenced that the quality of life of chronic renal failure patients receiving hemodialysis treatment is impaired in some aspects. The Dimensions Physical Role, Work Status, Burden of Kidney Disease and Emotional Role had the lowest scores (20.49, 22.2, 34.55, 36,57 respectively). The highest values were obtained in the Dimensions Dialysis Staff Encouragement (88.37), Quality of Social Interaction (80.83), Patient Satisfaction (80.09), Sexual Function (73.86) and Cognitive Function (80.74). The individual s perception in each Dimension was significantly interfered by advanced age, gender, time of treatment, family support, religious choices, level of instruction and by work. Present study indicates that quality of life in chronic renal failure patients receiving hemodialysis treatment is affected and justifies a professional involvement to care of these people, just the way they deserve to be cared of. / A hemodiálise é a terapia renal substitutiva mais utilizada pelos portadores de insuficiência renal crônica. Entretanto, a permanência neste tipo de tratamento tem provocado desajustes e mudanças na rotina diária, alterando de maneira negativa a qualidade de vida desta população. Este estudo descritivo exploratório teve por objetivo avaliar a qualidade de vida dos portadores de doença renal crônica em tratamento hemodialítico por meio de um instrumento denominado Kidney Disease and Quality of Life Short Form (KDQOL-SFTM 1.3). Foram entrevistados 72 pacientes em uma unidade hemodialítica do município de Goiânia/GO. Os dados foram submetidos à análise estatística, com intervalo de confiança de 95% e p < 0,05. A maioria (52,8%) é do sexo masculino, com idade média de 51,1 anos (variação entre 20 e 80 anos), afirma ser católica, apenas sabe ler e escrever, tem renda mensal entre 1 e 2 salários mínimos, companheiro fixo e faz tratamento hemodialítico entre 12 e 60 meses e a maioria não trabalha. Pode-se concluir que o portador de insuficiência renal crônica em tratamento hemodialítico sofre várias alterações na qualidade de suas vidas evidenciadas pelo valor atribuído às diferentes Dimensões. As Dimensões que obtiveram os maiores escores foram Estímulo por Parte da Equipe de Diálise (88,37), Qualidade da Interação Social (80,83), Satisfação do Paciente (80,09), Função Sexual (73,86) e Função Cognitiva (80,74). Os menores escores foram obtidos nas Dimensões Função Física (20,49), Papel Profissional (22,22), Sobrecarga da Doença Renal (34,55) e Função Emocional (36,57). Observou-se que a percepção dos indivíduos frente aos aspectos analisados em cada Dimensão do KDQOL-SF não é homogênea. Essa percepção foi influenciada pela idade, gênero, tempo de tratamento, presença ou não de um companheiro fixo, religião, grau de escolaridade, se reside sozinho ou não e pelo trabalho. Os católicos e evangélicos tanto têm menos dificuldades no trabalho como enfrentam melhor os sintomas da doença renal comparados aos indivíduos que afirmam não ter religião. As mulheres referiram maior incapacidade para realizar atividades corriqueiras, apresentam mais depressão, ansiedade e menor bem-estar, assim como têm mais dificuldades no trabalho. Aqueles que têm mais de 60 anos enfrentam mais dificuldades para realizar atividades físicas, têm menor qualidade de sono e pior funcionamento sexual. Os que fazem hemodiálise há menos que 12 meses obtiveram escores mais altos nos aspectos ligados à energia e fadiga, bem-estar emocional, funcionamento físico e dor. A presença de um companheiro fixo ou de um familiar influenciou para melhor no que se refere aos aspectos físicos, atividade sexual e efeitos da doença renal. Os entrevistados com 1º grau de escolaridade têm mais queixa de fadiga, da saúde em geral, mais dor e menor bem-estar emocional. A maioria não trabalha em função da doença renal ou da perda da visão. Os que trabalham percebem mais o impacto da doença no papel profissional. Esse estudo buscou identificar quais aspectos requerem maior atenção por parte da equipe multiprofissional, utilizando-se da premissa de que quem sabe onde a vida foi alterada é o próprio indivíduo. Portanto, as Dimensões que obtiveram mais baixo escore indicam por onde começar, sem desvalorizar as demais, pois a QV pode ser alterada cada vez que o indivíduo percebe e valoriza aspectos diferentes de sua vida. A competência e a sensibilidade do profissional permitirão acompanhar essas oscilações, individualizando e qualificando o cuidado ministrado.

Doctor of Philosophy / Department of Horticulture, Forestry, and Recreation Resources / Candice A. Shoemaker / The objectives of this study were to determine exercise intensity of common gardening tasks in older adults and to investigate if older gardeners meet the physical activity (PA) recommendations (intensity and time) through their daily gardening. Kinds of gardening tasks, body postures, and bodily pain while gardening of older gardeners were investigated and the possibility of gardening as a predictor for a physically active lifestyle and life satisfaction in older adults was determined. Older participants were randomly recruited from the community of Manhattan, KS. To determine the exercise intensity of gardening, the heart rates of older adults were measured by radiotelemetry during gardening or garden tasks, and then oxygen uptake and energy expenditure were measured via indirect calorimetry using a submaximal graded exercise test. Overall health conditions by the Short Form 36 Health Survey (SF-36), hand functions by hydraulic hand dynamometer and pinch gauge, and bone mineral density (BMD) by dual-energy x-ray absorptiometry were measured. An observational study and weekly logs were conducted to study kinds of gardening, postures, and bodily pain of older gardeners. The Community Healthy Activities Model Program for Senior (CHAMPS) questionnaire was used to measure leisure-time PAs (frequency per week of all PAs and calories expended per week in all PAs). In conclusion, the nine gardening tasks were found to be low to moderate intensity PA in healthy older adults (1.6 ± 3.6 METs). Gardening observed was moderate intensity (3.8 ± 1.4 METs) PA in older adults and the subjects met the PA recommendation, which is at least 30 minutes of moderate intensity PA on most days of the week through their daily gardening (moderate intensity; average 33 hrs/wk in May and 15 hrs/wk in June and July). The older gardeners showed higher values for hand function and some SF-36 domains (physical function, bodily pain, and physical summary) than older non-gardeners. Gripping, stooping, lifting, stretching, walking, standing, kneeling, sitting, and squatting were observed while older adults gardened and lower back pain was the main bodily pain reported. Furthermore, gardening was found to be a predictor for leading a physically active lifestyle and high life satisfaction in older adults.