Sub-health has been used to describe an intermediate state between health and disease. The impact of SH on HRQOL deserves more attention because HRQOL is an important goal of health care, and a significant determinant of health service utilization. The aim of this study was to establish the epidemiology of Sub-health and explore the relationship between SH and HRQOL. Two studies were conducted in Hong Kong. The first study was to develop and validate a Sub-health questionnaire (SHQ) for classifying people into Health, SH & Disease. The standard 7-step method of development of a psychometric measure was used to develop the SHQ. The initial SHQ, was then field tested on a sample of 13 Chinese adults. Pilot testing of the final version was conducted on 55 Chinese adults to confirm. Psychometric testing by a longitudinal survey on 353 Chinese adults who completed the SHQ, the SF-12v2 Health Survey and a structured questionnaire on sociodemographic data, and health service utilization at baseline, 2 to 4 weeks and 3-month. All HS items had Content Validity Index (CVI) on clarity and relevance of > 75%. The HS items demonstrated good internal consistency (Cronbach’s alpha=0.82). The overall test-retest reliabilities of classification of the health state were moderate with Kappa > 0.57. The SHQ was responsive in detecting a change in health states in 36.4% subjects in 3 months. Item scores of HS scales had significant correlation (r>0.4) with corresponding SF-12v2 scores, and there were significant differences in SF-12v2 summary scores between SHQ groups. The second was a longitudinal study on Sub-health and HRQOL of general population to evaluate the validity and psychometric property of SHQ, to establish determine the epidemiology SH, and to explore the relationship between HRQOL of SH. 1231 Chinese adults were randomly selected from the general population by telephone survey with the SHQ, SF-12 Health Survey and a structured questionnaire on demographics and service utilization. 353 subjects had completed 3 to 12 months follow up surveys. The prevalence of Sub-health is 40.67% in Hong Kong. There were significant differences in SF-12v2 scores in that SH group had higher scores than those of disease group but lower scores than those of health group. SH was associated with higher use of medical resources than health. Conclusively, the SHQ is a useful screening tool for the diagnosis of SH. There is a linear relationship between change in health status and changes in HRQOL or health service utilizations. It preliminary explored the clinical relevance of the SH to a culture and health care system that is different from that of mainland China where the concept originated. The results would be useful in populations worldwide if the SHQ could be cross-culturally adapted to identify the SH epidemiology. The study has also, provided evidence supporting the conceptual base of SH in the Chinese medicine context, which may be modifiable by treatment based on TCM Body Constitution classification. / published_or_final_version / Family Medicine and Primary Care / Doctoral / Doctor of Philosophy

Subjective quality of life (QOL) has been measured as one of the important clinical outcomes of schizophrenia. Many studies on examining the relationship between subjective QOL and symptomatology as well as neurocognitive functions were reported. Consistent data have suggested that the severity of depressive symptoms contributed to poor subjective QOL of schizophrenia. However, reports on the relationship of subjective QOL with negative symptoms, neurocognitive functions, and duration of untreated psychosis were largely inconsistent. The current study on the examination of subjective QOL in schizophrenia, is to emphasize the importance of inner experiences of schizophrenia but do not treat them as Freedman (1974) called “average schizophrenic”, in order to find out a more effective intervention for improving subjective QOL of schizophrenia. The purpose of the present cross-sectional study was to replicate these previous studies on investigating factors related to subjective QOL of schizophrenia including, positive symptoms, negative symptoms, neurocognitive functions, as well as duration of untreated psychosis. Besides, as most previous studies focused on chronic schizophrenia, this study involved first episode remitted psychosis patients, and to test whether it was the same phenomenon between chronic schizophrenia and first episode remitted psychosis on subjective QOL. The study result can contribute to propose suitable treatment for improving QOL of persons with schizophrenia. In this study, 140 subjects with first episode remitted schizophrenia were examined. Significant associations between subjective QOL and psychopathology, neurocognitive functions were found; modest correlation of duration of untreated psychosis was also reported. Also, subjective QOL was associated with self-perception on the illness outlook in the first episode population. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine

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Leg ulceration negatively affects quality of life (QOL). The relationship between important clinical attributes such as ulcer severity, pain and health related quality of life (HRQL) is poorly understood. The Wilson and Cleary model of Health Related Quality of Life (WC model) is a guiding framework that links clinical measures to QOL. Thesis Objectives: I describe the relationship between ulcer severity, comorbidity, etiology and pain and HRQL. Methods: An integrative mixed-methods approach was used: a systematic review of studies that examined the relationship between clinical variables and HRQL or QOL as outlined in the WC model (n=22); a review of studies (n=11) that compared the HRQL of persons with leg ulcers to population normative scores; and, an analysis of the relationship between clinical factors and HRQL in a cohort of 564 persons with venous leg ulcers drawn from two randomized control trials. Results: There is empirical support for the causal linkages between disease severity, symptoms, function, health perception and QOL that comprise the causal pathway as outlined in the WC model. Venous ulcers are associated with a poor quality of life, and numerous aspects of functioning are impaired, in particular physical function. In 564 individuals with venous ulcers, pain was present in 78.8%. Those younger than 65 years were 1.5 times more likely to be in the higher pain group compared to those 65 and older. Physical HRQL was significantly impaired. Predictors of poor physical HRQL included venous-arterial ulcers, a more severe ulcer, arthritis and a higher level of pain. Poor mental HRQL was associated with the younger age group, a comorbid condition and a higher level of pain. Increasing ulcer duration negatively affected mental state, but the findings were of borderline significance. Conclusion: The WC model is a clinically useful framework to select variables to represent HRQL and to base hypotheses about causal associations between clinical variables and QOL. Future research should focus on specifying the measurement models to represent disease severity, symptom status and functional status. Clinically the WC model is a useful bedside heuristic to explore the impact on leg ulceration on daily life and wellbeing. / Thesis (Master, Nursing) -- Queen's University, 2010-01-16 13:11:38.045

This research examines Hemodialysis patients' psycho-social characteristics and predictors of quality of life and compliance at a small rural hospital. Sixty-four patients from the hemodialysis unit at Renfrew Victoria Hospital in Renfrew, Ontario, and a satellite unit at St. Francis Memorial Hospital in Barry's Bay, Ontario, were assessed using the Social Work Patient Profile, Perceived Quality of Life and Compliance Indices. Bivariate correlation and multiple regressions were conducted on psychosocial, physical and mental health variables to determine if they correlated, and could be predictors of, social worker and nurses' perceptions of patients' quality of life and compliance. / Findings support multiple correlations between variables. Younger age, recreation, family support, self driving to dialysis, dementia, diabetes as the cause of chronic kidney failure (CKF), and other as the cause of CKF were significant individual predictors of social work quality of life score. Significant individual predictors for the nurses' quality of life scores were dementia, glomeruloneph, compliance, level of education, and polycystic kidney disease as the cause of CKF. The statistically significant risk factors for nurses' quality of life were lower levels of education and dementia. The four psychosocial variables that predicted compliance to treatment, suggested that there was increased compliance for patients who had recreation and family support, and increased risk factors with age and lower levels of education.

Thesis (MHlthSc(OccTh))--University of South Australia, 1998

Thesis (M. Nurs.)--University of Hong Kong, 2007.

Thesis (M. Nurs.)--University of Hong Kong, 2007.

Thesis (M. Nurs.)--University of Hong Kong, 2007.

Thesis (M. P. H.)--University of Hong Kong, 2007.