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Background: Serum estradiol levels decline after menopause and the effect on mental health-related quality of life (MHR-QOL) is unclear. Objective: To determine if there is an association between endogenous serum estradiol levels and MHR-QOL in healthy postmenopausal women. Methods: This cross-sectional study used baseline Canadian data from the Mammary Prevention.3 trial. Serum estradiol was measured with liquid chromatography-tandem mass spectrometry. Outcomes for MHR-QOL were the Medical Outcomes 36-Item Short Form Health Survey (SF-36) Mental Health Inventory-5 (MHI-5), Mental Component Summary (MCS), and the Menopause-Specific Quality of Life Questionnaire (MENQOL)-psychosocial domain. Results: There were no statistically significant associations between estradiol levels and MHR-QOL in univariate analyses (n=455). Multivariable linear regression predicted statistically significant differences in MCS (R2=0.10, P=0.03) and MENQOL-psychosocial domain (R2=0.10, P=0.04), however estradiol was not a significant predictor. Conclusions: This study did not find a statistically significant association between endogenous serum estradiol levels and MHR-QOL in healthy postmenopausal women.

Problem: Many individuals with chronic illnesses such as stroke and ongoing activity limitations report self-perceived health related quality of life (HRQL) that is similar to that of healthy individuals. This phenomenon is termed response shift (RS). RS describes how people change: internal standards in assessing HRQL (recalibration), values (reprioritization), or how they define HRQL (reconceptualization), after an event such as stroke. Changes in HRQL post stroke may be inaccurate if RS is not taken into account. Increased knowledge of RS may affect the way in which HRQL measures are used, both clinically and in research. The overall objective was to assess RS in construct specific HRQL models post stroke: physical function, mental health, and participation. Methods: Data were analysed from the longitudinal study “Understanding Quality of Life Post-Stroke: A Study of Individuals and their Caregivers”. Six-hundred and seventy- eight persons with stroke at 1, 3, 6, and 12 months post stroke participated. Generic and stroke specific HRQL measures were collected. Descriptive analysis was completed with SAS, and identification of RS utilized structural equation modeling with LISREL. Results: Mean age of participants was 67 years (SD 14.8), and 45% were female. RS was identified in mental health using a framework which was developed for identifying RS statistically with multiple time points. RS was also identified in physical function where it had not been expected, possibly due to the self perceived nature of the response options. The effect size of change in physical function was affected by the presence of RS. The timing of RS in mental health and physical function was primarily around the 12 month time period, and predominantly recalibration RS. RS was also identified in participation. Conclusions: The framework that was developed was useful in identifying RS and incorporated important issues such as multiple testing and validation of the model. The presence of RS affects measurement of HRQL constructs post stroke; recalibration RS can be measured clinically with specific methods to account for RS. RS should also be measured in research studies to ensure accurate measurement of change. Future research should evaluate additional models in stroke and other populations.

Introduction: The effects of chronic pain on health-related Quality of Life (HRQoL) among older Canadian adults with disability was not well known. Study Objectives: This study was conducted to examine the relationship between chronic pain and HRQoL among older Canadian adults with disability aged 55+. Methods: This study was a secondary analysis of cross-sectional data from the 2006 Participation and Activity Limitation Survey (PALS). Weighted data was used to examine the relationship between chronic pain and HRQoL using multivariate logistic regression techniques. Results: An estimated 68% of older Canadian adults with disability reported having chronic pain. Multivariate regression analysis confirmed a significant independent effect of chronic pain on self-reported HRQoL. Conclusion: Our results highlight the importance of pain assessment and management for older adults with disabilities in general and in particular among those with limited communication abilities.

This study examined the relationship between residential environment and subjective quality of life (QOL) for individuals with mental illness. Demographic variables impacting QOL were also examined. The Wisconsin Quality of Life Index---Canadian Version (CaW QLI, Diaz & Mercier, 1996) was administered to a total of 46 participants and was used to assess the QOL of individuals living in a supported residential environment as compared to individuals living in other types of environments. / The major findings were: (1) psychiatric consumers/survivors in the supported residential environment reported higher QOL scores in 4 of the 9 domains examined; (2) residents living in a supported housing facility were more likely to be involved in a greater number of daily activities; (3) education was strongly correlated with 4 of the 9 QOL domains; (4) regression analyses however showed that residential environment or demographic variables on their own did not have a significant effect on QOL. Further research is required to delineate the relationships between residential environment, demographic variables and QOL.

Constipation is the most common gastrointestinal complaint in the United States, resulting in about 2 million annual visits to the doctor. The purposes of this dissertation were to: 1) describe four theories of traditional Korean medicine; 2) review mechanisms of acupuncture and moxibustion and develop a conceptual model; 3) review findings from randomized controlled trials that tested the effects of acupressure used for the management of symptoms such nausea, pain, and dyspnea; 4) examine the reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) in heart failure patients with constipation compared to those with gastrointestinal disease; 5) describe how Korean women experienced constipation and how constipation affected the quality of life and the experience of using complementary and alternative medicine for constipation; 6) test the effect of acupressure on constipation and to examine the quality of life and depressive symptoms in cancer patients with constipation. Meridian theory explains that acupressure stimulates meridians, a network of energy pathways in the body to increase the flow of bio-energy. Authors of 48 studies supported that acupressure reduced nausea and vomiting during pregnancy, pain, fatigue, and dyspnea. The Patient Health Questionnaire-9 (PHQ-9) was used to examine the depressive symptoms in cancer patients with constipation, but has not been tested in patients with constipation. Therefore, in this study, the psychometric properties of PHQ-9 were tested in patients with constipation. Cronbach’s alphas for the Patient Health Questionnaire were .89 and the correlation between the PHQ-9 and the BDI-II (Beck Depression Inventory) was .81 (p<.01) in 382 heart failure patients with constipation. Ten Korean women reported that living with constipation is a stressful and uncomfortable experience which impacts daily activity, lifestyle, social relationships, and diet. In this pilot study, three out of five patients in the acupressure group reported that acupressure was effective in improving constipation. Cancer patients with less than a four-month history of constipation had less depressive symptoms and higher quality of life compared to patient with more than a four-month history of constipation. In conclusion, acupressure can be a safe and cost effective alternative medicine for constipation.

Quality of life is a term that has been used in various ways by researchers in different fields. In regional or community research, researchers have been concerned to a large extent with a persons overall quality of life as affected by factors such as income, housing, marital status, gender, and regional/community human services. The present research concerns the relationship between perception of quality of life and the use of human services in the community. The data were from Lexington-Fayette County, Kentucky. Family systems theory served as the underlying conceptual framework for this study. Family systems theory would predict that residents perception of quality of life is generally affected by the availability/use of resources and services. These resources and services can be classified as internal and external. According to family systems theory, three domains were identified as potentially affecting ones perception of quality of life: (1) individual characteristics; (2) family characteristics, and (3) use of community human services. Results from the individual perspective showed that being currently married, ownership of residence, education, and young age were positive contributions to perceptions of quality of life. There were no gender or race differences in perceived quality of life. From a family perspective, perception of quality of life was influenced by household income and health situation. From the community human services perspective, neighborhood safety was an important contributor to perception of quality of life. As for financial assistance, turning to family or friends, banks, utility companies, Community Action Council or Department of Community-based Services, and Medicare were more common uses of services than churches or clergy, food banks, the Salvation Army, social/survivor income, and other persons or agencies. This study also investigated gender, income, and age differences in the association of perception of quality of life with the presence of urgent needs for basic living by use of community-based human services. The results provided a broad context for interpreting perception of quality of life. In conclusion, this study provided baseline information concerning perceptions of quality of life and use of community human services by households. The findings provided insight into residents perceptions of quality of life based on their individual characteristics, family situation, and community human services as components contributing to perceptions of quality of life.

This study examined environmental preferences for adolescent patients in hospital patient rooms and activity rooms to determine age-appropriate healing design elements. The health-related quality of life (HRQOL) concept was adapted to this study as a theoretical framework. In order to develop an age-appropriate healing design, a comprehensive understanding of adolescents‘ cognitive developmental stages and their expectations in hospital settings needs to be recognized. Thirty-two adolescent outpatients aged 15 to 18 participated in the survey. Data collection consisted of three different instruments: Emotional state survey with demographics, Photo analysis with semantic differentials, and environmental preference value survey. Comfort, sadness and stress affected adolescent patients‘ preference responses. Adolescent patients preferred having a home-like environment for their patient rooms due to their needs for comfort and control of privacy. They also preferred having enjoyable and controllable activity rooms that supported peer connection, self-identity, and stress reduction. Environmental values that are important to adolescents were control of privacy, a quiet place to go, a place for activity, and having a controllable outside view.

The purpose of this study was to determine how international graduate students rate their health and their Sense of Coherence scores using Antonosky's 29- item "Orientation to Life Questionnaire" and to identify associations between international graduate students self-rated health status, Sense of Coherence scores, Sense of Coherence sub-scores, and biometric measures. The study found that international graduate students at Ball State University rate their health as "very good" and report having a high Sense of Coherence score and sub-scores. Additionally, positive associations between international graduate student's self-rated health and Sense of Coherence scores and sub-scores were identified. However, no significant correlations were found between international graduate students' self-rated health and their biometric measures. / Fisher Institute for Wellness and Gerontology