The current research explores how adult attachment patterns present after an acquired brain injury (ABI) and possible associations with psychological distress, social isolation and health-related quality of life (HRQOL). It was hypothesised that attachment anxiety and attachment avoidance would explain additional variance in HRQOL and that this possible association would be mediated through psychological distress and social isolation. For this quantitative research a non-experimental, cross sectional cohort design was implemented. Forty individuals with ABI completed the Experiences in Close Relationships—Relationship Structures questionnaire, the Quality of Life in Brain Injury questionnaire, the EuroQol-5 Dimension Scale, the Hospital Depression and Anxiety Scale and the Friendship Scale. The results suggest that levels of attachment anxiety and attachment avoidance after an ABI are similar to those reported in healthy samples. Moreover, higher rates of attachment anxiety and attachment avoidance were associated with lower HRQOL, as well as increased levels of anxiety and social isolation. No association was found with depression. However, depression was shown to be the largest significant predictor of HRQOL after ABI (β = -.41, p < .005). Social isolation was also shown to predict HRQOL after ABI (β = .32, p < .05). Mediation analysis suggests that both attachment anxiety and attachment avoidance have an indirect relationship with HRQOL through social isolation, or through social isolation and psychological distress. It is concluded that adult attachment is an important theory to consider after ABI, due to its possible indirect relationship with HRQOL. These findings suggest that professionals should consider individuals' attachment patterns for treatment purposes and try to foster secure attachment patterns during rehabilitation.

Bakgrund: Endometrios är en gynekologisk sjukdom som drabbar ett stort antal kvinnori hela världen. Ofta bemöts dessa kvinnor av kunskapsbrist, misstro och normaliserande attityder som förorsakar försening av diagnos, vård och behandling som skapar onödigt lidande för dessa kvinnor. Sjuksköterskor har en viktig funktion i bemötandet av dessa kvinnor genom att stödja kvinnan, skapa en god allians och ge relevant information. Syfte: Syftet med studien var att beskriva kvinnors upplevelser av livskvalitet vid endometrios samt att granska och beskriva de inkluderade artiklarnas datainsamlingsmetoder. Metod: Litteraturstudien har en deskriptiv design. Data insamlades via databaserna Medline/PubMed samt Cinahl och tolv artiklar återfanns, samtliga med kvalitativ ansats och ligger till grund för resultatet i studien. Resultat: Endometrios medför en kraftigt nedsatt livskvalitet som inverkar på deras parrelation samt sociala liv såsom arbete, skola och fritidsintressen. Kunskapsbrist inom vården leder till normalisering och fördröjd diagnos som skapar onödigt lidande för dessa kvinnor. Många av kvinnorna skapade egna strategier för att hantera sina symtom i  vardagen. Samtliga tolv artiklar med deskriptiv design, har samlat in data genom att intervjua kvinnorna om deras erfarenheter av att leva med endometrios. Slutsats: Endometrios påverkar markant kvinnornas vardag och samtliga relationer på ett negativt sätt. De påverkas både fysiskt, psykiskt och socialt vilket leder till att de får sin livskvalitet kraftigt sänkt. Med ökade kunskaper inom området kan stora ekonomiska besparingar göras om diagnos ställs i ett tidigare skede. Kvinnornas lidande skulle minska och deras livskvalitet öka avsevärt. / Background: Endometriosis is a gynaecological disease that affects a large number of women throughout the world. These women are often treated by the lack of knowledge, distrust and normalizing attitudes. That causes delay in diagnosis care and treatment, which creates unnecessary suffering. Nurses have an important function in the treatment of these women by supporting the woman, create a good alliance and provide relevant information. Aim: The aim of the study was to describe women's experiences of quality of life in endometriosis and to examine and describe the articles included data collection methods. Method: Literature study has a descriptive design. Data were collected through Medline / PubMed and CINAHL and twelve articles were found, all with qualitative approach. These articles were the basis for this study. Results: Endometriosis results in a greatly reduced quality of life that affects their partner, relationship and social life, such as work, school and hobbies. A lack of knowledge in health-care leads to normalization and delayed diagnosis that creates unnecessary suffering for these women. Many of the women created their own strategies to deal with their symptoms in daily life. All twelve articles with descriptive design have collected data by interviewing women about their experiences of living with endometriosis. Conclusion: Endometriosis affects significantly the women's daily lives, and all the relationships, in a negative way. Their health is affected physically, psychologically and socially with the result that they get their quality of life greatly reduced. Significant financial savings can be made by increased knowledge in the field and diagnosis at an earlier stage. Suffering from Endometriosis would be reduced, and the quality of life for those women’s will significantly increase.

HIV is a potentially fatal virus that affects over 1,148,200 people in the United States. Due to the minority status that comes with living with HIV, PLH (people living with HIV) often encounter various aspects of stigma due to HIV, which contributes to suppressed overall psychological quality of life (PQOL).While the relationship between stigma and PQOL in PLH is well documented, little research examines mediators of this relationship. We hypothesized that spirituality (as measured by sense of peace, forgiveness of self and perceived fulfillment of life's goal) mediates the relationship between stigma and PQOL (as measured by depression, mental health and stress). We used an explanatory sequential mixed methods design which utilizes two distinct phases of the research process: quantitative (QUANT) analysis followed by qualitative (QUAL) analysis. Results of the QUANT phase suggest spirituality is a partial mediator in the relationship between stigma and PQOL in PLH. In the QUAL phase, we interviewed 15 PLH to elaborate on the relationships between the three constructs. We found PLH endorsed personalized stigma most frequently. Similarly, our results also indicate PLH experience stress, depression and anxiety as a result of their HIV status. Lastly, participant's interviewed most commonly described their spiritual beliefs as relating to religion or God, which is in contrast to how spirituality was conceptualized in the quantitative portion of our study. In all, QUAL results confirmed QUANT findings, with the one main difference between how spirituality was conceptualized between the QUANT and QUAL qualitative portions of our study. Results highlight the importance of clinicians inquiring about PLH's PQOL, experiences of stigma and spiritual beliefs.

Objectives. To compare four diverse approaches to measuring patient perceptions about health outcomes; the SF-36 Health Survey; clinically derived condition specific instruments; daily time trade-off (DTTO); patient generated index (PGI). The relationship between the instruments and their responsiveness to changes in Health Related Quality of Life (HRQL) was assessed. Results. The response rate exceeded 75% (1327 respondents). The SF-36 had Cronbach's Alpha values above the criterion of 0.7. Test-retest estimates were above 0.7 for al but the role-limitations scales which were above the criterion of 0.5. The specific instruments produced Alpha values and test-retest estimates above 0.7. The DTTO and PGI produced estimates of reliability above 0.5. Evidence for the construct validity of the SF-36 was demonstrated by the differences in scale scores between the general population and four condition-specific groups. Evidence for the construct validity of the specific instruments and PGI was demonstrated by the significant moderate levels of correlation with the SF-36. Evidence for the validity of all four approaches was demonstrated by patient scores behaving as predicted in relation to condition-specific and sociodemographic variables. Comparisons of the four approaches show that the relationship between them is condition dependent. Score changes for the SF-36, specific instruments and PGI were significantly related to self reported health transition. The SRMs for the specific instruments were significantly greater than those for the SF-36. Conclusions. These results demonstrate that the SF-36 has similar properties in United Kingdom patient populations as those in the United States and is satisfactory for comparisons of groups. The clinically derived approach is recommended for constructing instruments where no suitable condition-specific instrument exists. These two approaches are recommended for use as part of a package of instruments for assessing health outcomes.

Arthritis is a growing aging and public health concern in Canada and elsewhere. As with many other chronic health conditions, arthritis occurs more often and has a higher impact on functioning for people who have lower incomes or live in an impoverished environment. There is a large body of research that supports a gradient between socioeconomic status and health and between area level poverty and decreased quality of life. Although this relationship is widely acknowledged, less is known about the influence of broader social conditions at the neighbourhood level on health outcomes. By examining quality of life from the theoretical framework of poverty as a fundamental cause of differences in health (Link & Phelan, 1995) and Bourdieu’s (1984) theory of habitus, I provide an analysis of the direct impact of material and social deprivation on health related quality of life (HRQoL), as well as the impact considering the influence of age, body weight, physical functioning, gender, and coexisting health conditions. I also examine interaction effects between neighbourhood deprivation and individual characteristics. An explanatory three-level multilevel model supported a relationship between individual factors as well as deprivation at the neighbourhood level on quality of life. The impact of neighbourhood deprivation was more pronounced for mental health related life quality, with a history of another health condition making the largest contribution to the model. Physical HRQoL was impacted by gender in interaction with material deprivation and body mass index in interaction with social deprivation. I discuss implications for practice, service delivery, and policy and make suggestions for further research. / May 2016

Thesis (M.Sc.(Physiotherapy)), Faculty of Health Sciences, University of the Witwatersrand, 2009 / Background: The impact of non-traumatic lower limb amputation on participant’s quality of life (QOL) is unknown. In an effort to provide better care for people with lower limb amputation, there is a need to first know the impact of this body changing operation on people’s quality of life. Aim of the study: To determine the impact of lower limb amputation on QOL in people in the Johannesburg metropolitan area during their reintegration to their society/community of origin. Objectives: 1. To establish the pre-operative and post-operative:  QOL of participants (including the feelings, experiences and impact of lower limb amputation during the time when they have returned home and to the community).  The functional status of participants.  Household economic and social status of these participants. 2. To establish factors influencing QOL. Methods: A longitudinal pre (amputation) test –post (amputation) test study utilized a combination of interviews to collect quantitative data and in-depth semistructured interviews to gather qualitative data. Consecutive sampling was used to draw participants (n=73) for the interviews at the study sites pre-operatively. The three study sites were Chris Hani Baragwanath Hospital, Charlotte Maxeke Johannesburg General Hospital and Helen Joseph Hospital. Participants were then followed up three months later for post-operative interviews and key informants were selected for in-depth interviews (n=12). Inclusion criteria: Participants were included if they were scheduled for first time unilateral (or bilateral amputation done at the same time) lower limb amputation. The participants were between the ages of 36-71 years. Exclusion criteria: Participants who had an amputation as a result of traumatic or congenital birth defects were excluded from the study. Participants with comorbidities that interfered with function pre-operatively were not included. Procedures: Ethics: Ethical clearance was obtained from the Committee for Research on Human Subjects at the University of the Witwatersrand and permission was obtained from the above hospitals. Participants gave consent before taking part in the study. Instrumentation: A demographic questionnaire, the EQ-5D, the Modified Household Economic and Social Status Index (HESSI), the Barthel Index (BI) and semi-structured in-depth interviews were used. Data collection: Participants were approached before the operation for their preoperative interviews using the above questionnaires and then followed up postoperatively using the same questionnaires and some were selected to participate in semi-structured in-depth interviews three months later. Pilot study: The demographics questionnaire and the modified HESSI were piloted to ensure validity and reliability. iii Data analysis: Data were analyzed using the SPSS Version 17.0 and STATA 10.0. The significance of the study was set at p=0.05. All continuous data are presented as means, medians, standard deviations and confidence intervals (CI 95%). Categorical data are presented as frequencies. Pre and post operative differences were analyzed using Wilcoxon Signed-rank test. A median regression analysis (both the univariate and multivariate regression) was done to establish factors influencing QOL. Pre and post operative differences in the EQ-5D items and the BI items were analyzed using Chi square/Fischer’s exact depending on the data. Data were pooled for presentation as statistical figures in tables. Both an intension to treat analysis and per protocol analysis were used. A grounded theory approach was used to analyze the concepts, categories and themes that emerged in the qualitative data. Results: Twenty-four participants (33%) had died by the time of follow up. At three months, n=9 (12%) had been lost to follow up and 40(55%) was successfully followed up. The preoperative median VAS was 60 (n=40). The postoperative median VAS was 70. The EQ-5D items on mobility and usual activities were reported as having deteriorated significantly postoperatively (p=0.04, p=0.001respectively) while pain/discomfort had improved (p=0.003). There was no improvement in QOL median VAS from the preoperative status to three months postoperatively The preoperative median total BI score was (n=40). The postoperative median total BI score was 19. There was a reduction in function (median BI) from the preoperative status to three months postoperatively (p<0.001). The ability to transfer was improved three months postoperatively (p=0.04). Participants were also found to have a decreased ability to negotiate stairs (p<0.001). Mobility was significantly reduced three months postoperatively (p=0.04). During the postoperative stage (n=40), 38% of the participants were married. Most (53%) of the participants had no form of income. The highest percentage of participants in all instances (35%) had secondary education (grade10-11), while 25% had less than grade 5. Only one participant was homeless, 18% lived in shacks, 55% lived in homes that were not shared with other families. People with LLA in the Johannesburg metropolitan area who had no problem with mobility preoperatively (EQ-5D mobility item), who were independent with mobility (BI mobility item) preoperatively, who were independent with transfer preoperatively (BI transfer item) had a higher postoperative quality of life (postoperative median EQ-5D- VAS) compared to people who were dependent or had problems with these functions preoperatively. Being females was a predictor of higher reported quality of life compared to being male. Emerging themes from the qualitative data were psychological, social and religious themes. Suicidal thoughts, dependence, poor acceptance, public perception about body image, phantom limb related falls and hoping to get a prosthesis were reported. Some reported poor social involvement due to mobility problems, employment concerns, while families and friends were found to be supportive. Participants had faith in God. Conclusion: Participants’ QOL and function were generally scored high both preoperatively and postoperatively but there was a significant improvement in QOL and a significant reduction in function after three months although participants were generally still functionally independent. Good mobility preoperatively is a predictor of good QOL postoperatively compared to people with a poor preoperative mobility status Generally, most participants had come to terms with the amputation and were managing well while some expressed that they were struggling with reintegration to their community of origin three months postoperatively with both functional and psychosocial challenges.

ABSTRACT Introduction The advent of potent anti-retroviral agents for HIV treatment has resulted in marked decrease in deaths. Health workers now have to ensure that their patient’s physical, social, and psychological well-being is optimized. This study used a validated tool to measure Health Related Quality of Life concepts amongst HIV patients in a public treatment program. The main objective of this research was to establish factors that are associated with poor quality of life of these patients with the purpose of using this information as a basis for determining who would require individualized medical care and attention. Materials and methods The study is set at Bontleng Clinic in Gaborone, Botswana. The study questionnaire consisted of two parts: part one for collecting data on sociodemographic, illness and treatment related factors, and part two was the Medical Outcomes Study – Short Form tool used to obtain data on quality of life concepts. Two groups of participants were interviewed: ART-Naïve (n=90) and ARTExperienced (n=110). The study protocol had ethical approval from both the University of the Witwatersrand, Johannesburg and the Ministry of Health in Botswana. iv Results A smaller proportion of ART-experienced participants reported various disease symptoms as compared to those participants who were ART-naïve. Statistically significant differences were noted for: weight loss (25% vs 77%), diarrhoea (3% vs 11%), cough (19% vs 39%), and night sweats (24% vs 43%) for ART experienced and ART Naïve patients respectively. CD4 counts and HB levels were also significantly higher in patients on HAART. The overall QoL summary score was significantly higher (better) in the ART-experienced (mean score 53 out of 100) compared to the ART-naïve group (mean score 47 out of 100). Therefore being on ART favoured a higher QoL score. However, changes in the three laboratory indices of CD4 count, Hb level, and viral load had no statistical significant association with HRQoL scores. Multiple regression identified only five factors as being associated with better QoL scores. These factors were to do with the absence of the following disease symptoms: weight loss, diarrhoea, night sweats, and feet pains; as well as absence of recent hospitalisation. Discussion The study patients do respond well to HAART with significant improvements in all dimensions of QoL. This is in keeping with findings from other populations. In assessing these patients at the initiation of HAART, and at subsequent visits, one must take into account any history of recent hospital admission, history of weight loss, and most importantly presence/absence of various disease symptoms. Conclusions and recommendations Symptoms, regardless of the underlying cause: be it due to HIV disease itself or drug side effects; greatly impact patients’ quality of life. Efforts should be made to include the assessment of symptoms in the continuum of care of HIV patients. The introduction of newer potent anti-retroviral agents with fewer side effects should also favour the beneficial impact of HAART.

Cerebrovascular disease is one of the leading causes of death among persons aged 50 and above and when a stroke does not result in death, it can cause residual cognitive, motor and behavioural disabilities. Emotional effects of brain injury range from reduced quality of life to various neuropsychiatric disturbances and are of great interest in the South African context and throughout the world as they pose a major obstacle to the rehabilitation process. This study explored the relationship between emotion processing, neuropsychiatric symptoms and quality of life specifically, how they operate following a cerebrovascular accident. In order to achieve this, an adult population of high functioning stroke survivors completed the emotion processing scale (EPS), Minnesota Multiphasic Personality Inventory (MMPI-2) and comprehensive quality of life inventory (ComQOL-A5) and a factor analysis provided statistical evidence suggestive of intercorrelations among the variables. The results lent support to this theoretical relationship and determined the structure of this relationship as follows: The satisfaction with quality of life after a stroke that relates to traditional masculine or feminine roles, when not fulfilled, related to neuropsychiatric symptoms of general maladjustment i.e. schizophrenia and psychopathic deviate. The second factor encompassed symptoms of general anxiety both internally and externally directed: Internally directed anxiety included symptoms of hypochondriasis and hysterical conversion, while externally directed anxiety included neuropsychiatric symptoms of paranoia. The third factor was associated with mood modulation in that elevated mood connected to neuropsychiatric symptoms of hypomania and depressed mood connected to symptoms of depression and social introversion. Finally, emotion processing and psychasthenia made up the last principal component, namely emotion modulation. This meant that avoidance of emotional iv content, suppression of emotion, unprocessed emotion etc. related to neuropsychiatric symptoms of obsessions or compulsions. High functioning stroke survivors’ behaviours were thus characterised by general maladjustment, anxiety, and symptoms related to mood and emotion modulation. This study underlies the importance of diagnosing, treating and monitoring stroke survivors’ emotional alterations and suggests the usefulness of its application in clinical settings to evaluate the effectiveness of treatments or more general interventions to improve the neuropsychiatric sequelae and quality of life of stroke survivors. Improved understanding of these constructs from the stroke survivor’s perspective has obvious impact for the therapeutic interventions inherent in stroke rehabilitation and as such, contributes towards the fields of neuropsychology, neuropsychotherapy and the social sciences.

No description available.

by Yip Mei Po. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references (leaves 128-150). / Abstract and questionnaire also in Chinese. / Acknowledgements --- p.i / Abstract --- p.iii-iv / Chapter Chapter 1 --- Introduction --- p.1 / Chapter Chapter 2 --- Literature Review / End stage renal failure and dialysis therapy --- p.3 / Stress / The concept of stress --- p.4 / Lazarus' stress and coping model --- p.5 / Different approaches to stress --- p.6 / Stressors in hemodialysis patients: a convergence of chronic strains and daily hassles --- p.8 / The outcome of stressors in hemodialysis patients --- p.10 / Coping / Definition: Coping as a process --- p.12 / Problem focused and emotional focused coping --- p.12 / Functions of coping: its effectiveness --- p.14 / The use of coping methods in hemodialysis patients --- p.17 / Factors affecting coping response to illness in hemodialysis patients --- p.19 / Social Support / Approaches to social support: definitions and measurements --- p.22 / The effect of social support on adjustment to illness --- p.25 / "Social support as a coping resource in hemodialysis patients," --- p.27 / Quality of life / Quality of life as an adjustment outcome to illness --- p.28 / "The quality of life concept: dimensions, components and measurement" --- p.29 / Limitations of studies of quality of life in hemodialysis patients --- p.33 / Approaches to quality of life in hemodialysis patients --- p.34 / "The relation between stress, coping, social support and quality of life" --- p.36 / Chapter Chapter 3 --- Method / Research design --- p.38 / Research hypothesis --- p.40 / Operational definitions --- p.41 / Population --- p.42 / Sample --- p.43 / Ethical issue --- p.47 / Data collection --- p.50 / Instruments --- p.56 / Data analysis --- p.64 / Chapter Chapter 4 --- Results / Descriptives analyses --- p.66 / Correlation analyses --- p.83 / Regression analyses --- p.88 / Supplementary qualitative data --- p.90 / Chapter Chapter 5 --- Discussion and conclusion / Stressors --- p.98 / Coping --- p.104 / Social support --- p.108 / Quality of life --- p.110 / "Stress, coping, social support and quality of life" --- p.114 / Predictors of quality of life --- p.119 / Conclusions --- p.122 / Chapter Chapter 6 --- Limitation of the study --- p.124 / Implications and recommendations --- p.126 / References --- p.128 / Appendices / Chapter A. --- Table showing relationship of the use & effectiveness of eight coping styles with length of time on treatment / Chapter B. --- Descriptions of eight coping styles on the 1987 revised Jalowiec Coping Scale / Chapter C. --- A Sample of interview script / Chapter D. --- Letter of ethical approval / Chapter E. --- Letter of request for permission to conduct researchin clinical setting / Chapter F. --- Letter of request for revealing Hemodialysis Stressor Scale / Chapter G. --- Questionnaire / Chapter H. --- Consent form