Religious coping is used to describe how individuals use their religion and religious beliefs to help them cope with difficult situations. Researchers have investigated the role of religious coping in those with cancer; however, little research has been completed with long-term survivors of cancer. Additionally, little research has been completed regarding religious coping and long-term survivorship using advanced statistical analyses. This investigation sought to clarify the role of religious coping in long-term survivors of cancer and their quality of life. Using structural equation modeling, religious coping was tested as both a mediator and a moderator of quality of life. The study used a sample of 213 participants who were long-term survivors of cancer. The participants completed mail surveys assessing demographic variables, quality of life, and religious coping. Despite poor model fit, religious coping was a mediator in the relationship between demographic variables and quality of life. In the mediation model, both age and sex predicted religious coping. In the moderation model, the only significant path was between religious coping and quality of life. Results of the study indicate that religious coping acts as a mediator in the relationship between demographic variables and quality of life. Religious coping influences quality of lifeand may be beneficial to explore when working with long-term survivors of cancer. These findings enhance the clinical perspective of religious coping and have important ramifications on psychotherapeutic interventions for working with survivors of cancer. Psychologists who work with survivors of cancer should consider and respect the role religious coping has on the survivor. Future research must continue to explore the pathways through which religious coping operates. More work must be done with long-term survivors of cancer and with ethnically diverse populations. Researchers must continue to use advanced statistics to study these complex relationships instead of relying on simple count and frequency data that only measure if religious coping is present. As the world of psycho-oncology continues to grow, so must the understanding of the variables involved in healthy and happy survivorship / Department of Counseling Psychology and Guidance Services

Introduktion Bröstcancer är den vanligaste cancersjukdom hos kvinnor i den svenska befolkningen. Vid icke spridd cancer är behandlingen alltid operation där en del eller hela bröstet opereras bort. Det kan vara mycket svårt för många kvinnor att acceptera bröstförlust och mastektomi upplevs ofta av kvinnor som ett trauma och ger en försämrad kroppsuppfattning.   Syfte Syftet var att beskriva kvinnornas livskvalitet och psykosociala tillstånd efter mastektomi.   Metod En systematisk litteraturstudie baserades på granskning av 14 kvantitativa artiklar och en kvalitativ artikel. Artiklarna kvalitetsgranskades, analyserades och diskuterades och sammanställde resultatet med olika tema.   Resultat Analysen resulterade i två huvudkategorier: Livskvalité och psykosociala konsekvenser. De psykosociala konsekvenserna efter genomförd mastektomi bestod av tre subkategorier nämligen: sämre kroppsuppfattning, minskad sexuell lust samt ångest och depression vilket i sin tur ledde till försämrad livskvalitet.   Slutsats     Försämrad livskvalitet, dålig kroppsuppfattning och psykisk ohälsa såsom depression, ångest samt försämrat sexualliv påvisades hos majoriteten av kvinnor som genomgick mastektomi. Det är därför viktigt att vårdpersonal ökar sina kunskaper och förståelse för individens behov för att kunna ge rätt stöd och erbjuda olika anpassade insatser i syftet att minska den psykiska påverkan och öka kvinnornas livskvalité. / Introduction Breast cancer is the most common cancer among women in Sweden. For non- metastasized cancer, the treatment is always surgery where part or the entire breast is surgically removed combined with radiation therapy, hormonal and chemotherapy. It can be very difficult for women to accept breast loss and mastectomy is often experienced by women as a trauma and gives a diminished body image.   Aim Purpose was to describe women's quality of life and psychosocial condition after mastectomy. Ethical considerations have been made.   Method Method vas a systematic literature study based on 14 quantitative articles and one qualitative article. The articles were reviewed for quality, analyzed and discussed and the results summarized in different themes.   Results The analysis resulted in two main categories: Quality of life and psychosocial consequences. The psychosocial consequences after the mastectomy was described in three sub-categories namely: poor body image, decreased sexual desire, as well as anxiety and depression, which in turn led to reduced quality of life.   Conclusion Reduced quality of life, poor body image and psychological problems such as depression, anxiety and impaired sexual life was found in the majority of women who underwent mastectomy. It is therefore important that health professionals look to the individual's needs and increase their knowledge and understanding to provide the right support and offer various proper services with the aim to reduce psychological stress and increase quality of life.

The origin of this study is due to research Botma (1999) undertook among Free State farmers in order to determine what the global level of perceived stress was, but also to determine which specific stressors they experienced and what its intensity was. With this study Botma (1999) found that the stressors by which the farmers are confronted, hold negative implications for their quality of life. The purpose of the current study namely to develop a capacity building programme by means of which quality of life can be facilitated, resulted therefore from the abovementioned research. The capacity building programme entailed the following components: stress, psychological well-being, quality of life and subjective well-being. The capacity building programme was also subjected to evaluation in order to determine its effect on the participants. In order to achieve this objective, the following scales were used in the empirical study: Quality of Lie Questionnaire (Evans & Cope, 1989), Sense of Coherence Scale (Antonovsky, 1993), Satisfaction with Life Scale (Diener, Larsen & Griffen, 1985), Affectometer 2 (Kamman & Flett, 1983), COPE (Carver, Scheier & Weintraub, 1989) and the Spiritual Well- Being Scale (Ellison & Smith, 1991). All these scales showed satisfactory reliability indices. A sample of 60 participants from three districts in the Free State was used. As far as the qualitative component of this research was concerned, focus groups were led with 10 participants, and in-depth interviews were conducted with four respondents. The empirical part of this study indicated that there was no difference between the experimental and control group before the intervention had VII taken place. On conclusion of the program, clear differences could be detected within the experimental group as well as between the experimental and control group. The experimental group showed an improvement in spirituality, subjective well-being and quality of life. These results were also reflected by the focus groups and by the in-depth interviews. It is however interesting to note that the above-mentioned changes that had taken place in the participants are mainly concerned with their affect and not with their behaviour as such. The reason being the fact that the focus of the programme is spiritual and mainly emphasises the improvement of the affective quality of life of the participants. The results of the in-depth interviews indicate the fact that the capacity building programme still has a long-term effect on the participants. Recommendations are made with regard to the capacity building programme in terms of changes to for example the inclusion of behavioural change. This research contributed to the understanding of spirituality, psychological well-being, subjective well-being and quality of life as well as to its application in a capacity building programme for farmers. / Thesis (Ph.D. (Psychology))--North-West University, Potchefstroom Campus, 2004.

Self-assessed quality of life (QoL) is analysed using a QoL questionnaire (Hörnquist’s QLcs) covering the life spheres: somatic health, mental well-being, cognitive ability, social and family life, activity, financial situation, meaning in life and a global score for ‘entire life’. In all, 487 unemployed and 2917 employed subjects aged 25-64; and 651 unemployed subjects and 2802 in work (including employment, studying and military service) in the 18-24 age group, were investigated in a population-based cross-sectional study on life and health in northern Sweden in 1997. In line with previous findings, results showed that unemployed people exhibited poorer QoL.The greatest difference between unemployed people and those in work was in the financial domain (18-24, 25-64). Unemployed women (aged 25-64) rated the final values of QoL – ‘entire life’ and meaning in life – higher than unemployed men did. In the young group (aged 18-24), unemployed women did not rate any of the domains higher. The young unemployed men rated somatic health and mental well-being higher. Interaction effects were interpreted in the following way: a) unemployed men (aged 25-64) were worst off in the global domain ‘entire life’; b) employed respondents, having a university/college education was beneficial for QoL, while for unemployed respondents (25-64) it was not; c) in the young group (aged 18-24), people in work rated their activity higher than unemployed people, and the effect was strengthened when they were regularly active during leisure. Close friends and cash reserve were important for all participants, no matter whether they were employed or not. The risk of being young and unemployed was greater if the person had a shorter education, worse economy (according to their own ratings) and was in the upper half of the age group (aged 21-24). Finally, the conclusion that QoL is poorer when in unemployment – both for the young and those who are older (aged 25-64) – is in line with earlier findings; however, in contrast to three previous studies, we conclude that psychological well-being is even poorer for young people than for those who are older. Intervention, in terms of steadily improved labour market conditions to counteract the negative effects of exclusion from the labour market, is of great importance from a public health perspective. / Självskattad livskvalitet (QoL) har analyserats med ett QoL instrument (Hörnquist’s QLcs) omfattande livsdomänerna: kroppslig hälsa, psykiskt välbefinnande, kognitiv förmåga, socialt liv, sambo/familjeliv, aktivitet, ekonomi, livsmening och en global skattning för ’hela livet’. Totalt, 487 arbetslösa och 2917 anställda i åldrarna 25-64; och 651 arbetslösa och 2802 i sysselsättning (anställda, studerande och värnpliktiga) i åldersgruppen 18-24 år, undersöktes i en befolkningsenkät (tvärsnittsstudie) om hälsa och livsvillkor i norra Sverige 1997. Som i tidigare studier visade resultaten sämre QoL bland de arbetslösa. Största skillnaden mellan arbetslösa och sysselsatta fanns i den ekonomiska domänen (18-24, 25-64). Arbetslösa kvinnor (25-64) skattade finala värden av QoL – ’hela livet’ och livsmening - högre än arbetslösa män. I den unga gruppen (18-24), skattade inte arbetslösa kvinnor högre i någon av livsdomänerna. De unga arbetslösa männen skattade kroppslig hälsa och psykiskt välbefinnande högre. Interaktionseffekter tolkades på följande sätt: a) arbetslösa män (25-64) låg sämst till i den globala domänen ’hela livet’; b) bland de anställda var universitets/högskolexamen fördelaktigt för QoL men inte bland de arbetslösa (25-64); c) i den unga gruppen (18-24) skattade de sysselsatta aktivitet högre än de arbetslösa, och effekten stärktes ytterligare när de var regelbundet aktiva på sin fritid. Nära vänner och tillgång till kontanter var viktiga för alla deltagare, oavsett om de var i sysselsättning eller inte. Risken att vara ung och arbetslös var större om individen hade kortare utbildning, sämre ekonomi (enligt deras egna skattningar) och befann sig i den övre halvan av åldersgruppen (21-24). Till sist, slutsatsen att QoL är sämre när man är arbetslös – både för unga och de äldre (25-64) – överensstämmer med tidigare forskning; dock, i motsats till tre tidigare studier, är det psykiska välbefinnandet sämre bland de unga jämfört med bland de äldre. Intervention, i form av stadigt förbättrade arbetsvillkor för att motverka negativa effekter och utestängande från arbetsmarknaden, är av stor betydelse i ett folkhälsoperspektiv.

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.

Urininkontinens är ett globalt problem som förekommer hos mer än 50 miljoner av världens befolkning och är tre gånger vanligare bland kvinnor än hos män. Urininkontinens medför en försämrad livskvalitet genom att bland annat påverka kvinnors fysiska, psykiska, sexuella och sociala välbefinnande. Sjuksköterskan kommer i kontakt med kvinnor som har urininkontinens och för att kunna ge god vård och främja hälsa behövs kunskap om hur kvinnor upplever urininkontinens. Syftet med litteraturstudien var att beskriva kvinnors upplevelser av att leva med urininkontinens. Metoden var en litteraturstudie som bestod av 13 vetenskapliga artiklar. Resultatet visade att kvinnors upplevelser av urininkontinens var besvärande men att vissa kvinnor använde sig av strategier för att hantera vardagen. Fyra kategorier var framträdande: upplevelsen av förlorad kontroll, upplevelsen av urininkontinens som tabubelagt ämne, upplevelsen av begränsningar i vardagen och upplevelsen av att hantera vardagen. Trots att urininkontinens är vanligt förekommande finns fortfarande brister i vårdens omhändertagande av urininkontinenta kvinnor. Sjuksköterskor bör bli bättre på att identifiera och informera kvinnor som lever med urininkontinens. Mer kunskap om urininkontinens inom sjuksköterskeutbildning och bland vårdpersonal behövs. / Urinary incontinence is a global problem that affects more than 50 million people and is three times more common among women than in men. Urinary incontinence means reduced quality of life by affecting women physically, psychologically, sexually and socially. Nurses encounter women with urinary incontinence and in order to provide high quality care and promote health, knowledge is needed on how women experience urinary incontinence. The purpose of this study was to describe women's experiences of living with urinary incontinence. The method was a literature review consisting of 13 articles. The result showed that women's experiences of urinary incontinence were bothersome but that some women used strategies to cope with everyday life. Four categories were prominent: the experience of loss of control, the experience of urinary incontinence as a taboo subject, the experience of limitations in everyday life, the experience of dealing with everyday life. Although urinary incontinence is common, there are still deficiencies in the health care of urinary incontinent women. There is a need for nurses to become better at identifying and informing women living with urinary incontinence. More knowledge about urinary incontinence is needed in nursing education and among health professionals.

The overall aim of the thesis was to study post-resuscitation care of cardiac arrest (CA) patients with a focus on therapeutic hypothermia treatment, outcomes up to six months post-CA and relatives’ experiences during the hospital stay. In Paper I, the aim was to asses effectiveness of hypothermia treatment with cold, 4°C, intravenous crystalloid infusion combined with ice packs. In conclusion, the described cooling method was found to be useful for inducing and maintaining hypothermia, allowed good temperature control during rewarming and to be feasible in clinical practice. The aim in Paper II was to investigate biomarkers and the association of serum glial fibrillary acidic protein (GFAP) levels with outcome, and to compare GFAP with neuron-specific enolas (NSE) and S100B. The result showed increased GFAP levels in the poor outcome group, but did not show sufficient sensitivity to predict neurological outcome. Both NSE and S100B were shown to be better predictors. A combination of the investigated biomarkers did not increase the ability to predict neurological outcome. In Paper III, the aim was to investigate whether there were any changes in and correlations between anxiety, depression and health-related quality of life (HRQoL) over time, between hospital discharge and one and six months post-CA. There was improvement over time in HRQoL, but changes over time in anxiety and depression were not found. Physical problems seemed to affect HRQoL more than psychological problems. The results also indicate that the less anxiety and depression patients perceive, the better their HRQoL. In the fourth paper, the aim was to describe relatives’ experiences during the next of kin’s hospital stay after surviving a CA. The analysis resulted in three themes: The first period of chaos, Feeling secure in a difficult situation, and Living in a changed existence. In conclusion, the results of the thesis have helped to improve knowledge within the areas studied and reveal aspects that should be taken into account in the overall treatment of this group of patients. The thesis have also shown the importance of developing an overall view and establishing a chain of care from an individual’s CA until follow-up for both the patient and his/her relatives.

The purpose of the study is to describe the impact of oral health-related quality of life (OHRQoL) on the lives of pre-seniors and seniors living in Nova Scotia, Canada. This cross-sectional study involved 1461 participants, grouped by age (pre-seniors [45-64] and seniors [65+]) and residential status (long-term care facility [LTC] or community). OHRQoL was measured using the 14-item Oral Health Impact Profile questionnaire. Approximately one in four pre-seniors and seniors reported at least one OHRQoL impact ‘fairly/very often’. Of those residing in the community, pre-seniors (28.8%) reported significantly more impacts than seniors (22.0%). Logistic regression revealed that for the community dwelling sample, those who were dissatisfied with their teeth or dentures were 5.16 times more likely to report an impact ‘fairly/very often’, which was the strongest indicator. Among the LTC sample, those who have poor perceived mouth health were 9.87 times more likely to report an impact.

The purpose of the study is to describe the impact of oral health-related quality of life (OHRQoL) on the lives of pre-seniors and seniors living in Nova Scotia, Canada. This cross-sectional study involved 1461 participants, grouped by age (pre-seniors [45-64] and seniors [65+]) and residential status (long-term care facility [LTC] or community). OHRQoL was measured using the 14-item Oral Health Impact Profile questionnaire. Approximately one in four pre-seniors and seniors reported at least one OHRQoL impact ‘fairly/very often’. Of those residing in the community, pre-seniors (28.8%) reported significantly more impacts than seniors (22.0%). Logistic regression revealed that for the community dwelling sample, those who were dissatisfied with their teeth or dentures were 5.16 times more likely to report an impact ‘fairly/very often’, which was the strongest indicator. Among the LTC sample, those who have poor perceived mouth health were 9.87 times more likely to report an impact.