Dissertationen zum Thema „“Women’s quality of life”“

Urinary incontinence (UI) is a common public health concern among women worldwide, with adverse effects on their quality of life (QoL). This study aims to explore the prevalence of UI among Omani women aged 18-49 years old, and to explore the impact of UI on women's daily prayers, physical activities, social life, mental health, and general QoL. The study is of quantitative comparative design, and the researcher used the World Health Organization’s (WHOs) International Classification of Functioning, Disability and Health (ICF), as a conceptual framework. The researcher randomly chose four-hundred and one participants from ten primary health care centres in Muscat. The researcher assessed their UI status and impact on different domains of their life using UDI-6 and IIQ-7 respectively, which are validated self-reported questionnaires. From the results, the researcher highlighted the high prevalence (85%) of UI among young Omani women. Additionally, UI did have a statistically significant impact on Omani women’s ability to perform their daily prayers, physical activities, social life, mental health, as well as, their general QoL. The use of ICF framework allows policymakers and public health officials to see the big picture of UI as public health concern in Oman. It forms the basis for implementing cost-effective health education programs at the Primary Health Care (PHC) institutions in Oman, for the goal of improving women’s health and community health.

Although many women find relief from menopause through hormone therapy (HT), current guidelines recommend that HT be used only for short-term relief of symptoms. Women who attempt to stop HT often encounter troublesome recurrent symptoms leading to a diminished quality of life (QoL); 25% of women who discontinue eventually resume HT. Unfortunately, there is little information for women and their health care providers as to the best way to discontinue HT or how to prepare and guide women through this process. An in-depth description of women‘s experiences during HT discontinuation and the factors influencing recurrent symptoms, QoL and discontinuation outcome would provide knowledge to develop much needed counseling and support interventions. The purpose of this study was to explore women‘s experiences discontinuing hormone therapy for menopause. This Internet-based mixed-methods study used a dominant Qualitative Descriptive design with embedded quantitative QoL measurements. Participants completed the quantitative questionnaires online while open-ended questions were completed either online or by telephone. Interview data were analyzed through Qualitative Content Analysis; descriptive statistics were used to explore the quantitative measures. Participants were stratified by discontinuation status for comparison of variations in discontinuation experiences, QoL and influencing factors. Thirty-four women (20 stopped, 9 resumed, 4 tapering) were enrolled. One overarching theme--'a solitary journey'--emerged: although all women embarked on this journey, each woman traveled her own path. Two subthemes--'burden and interference' and 'appraising risk'--encompassed the symptom factors (severity, interference and sensitivity) that influenced women's experiences and the manner in which women evaluated their options. Other influencing factors included: readiness viii and reasons for stopping HT, beliefs about menopause and roles. QoL was strongly connected to symptoms for many but not all women. Information from health care providers was inconsistent; women desired more support from providers and other women. The rich description of women's experiences stopping HT highlights the need for providers to assess women's sensitivity to symptoms and readiness to discontinue to determine which women might benefit from more support. Greater health literacy would enhance women's understanding of HT risks. More research is needed on symptom clusters and interference and strategies for minimizing their impact.

Due to advances in detection and treatment, increasing numbers of women are diagnosed with, and surviving, breast cancer each year, making women with breast cancer one of the largest groups of cancer survivors. Hence, ensuring good healthrelated quality of life (HRQoL) following treatment has become a focal point of cancer research and clinical interest. While our understanding about the impact of breast cancer is improving, little is known about the HRQoL among survivors in non-urban areas. This is important locally, as 45% of breast cancer survivors in Queensland, Australia, live outside major metropolitan areas. Therefore, this study investigated the HRQoL and accompanying correlates among regional and rural breast cancer survivors, and made comparisons with urban breast cancer survivors as well as women from the general population without a history of breast cancer. Three population-based studies comprise this project. Original data were collected by way of self-administered questionnaire from 323 women, diagnosed with a first, primary, invasive, unilateral breast cancer during 2006/2007 and residing in regional or rural areas of Queensland, 12 months following diagnosis. HRQoL was assessed using the Functional Assessment of Cancer Therapy, Breast plus additional concerns (FACT-B+4) questionnaire. Data from two existing data sources were also utilised. Women diagnosed with a first, primary, invasive, unilateral breast cancer in 2002 and residing within 100kms of Brisbane provided information on HRQoL, measured by the FACT-B+4, via self-administered questionnaire at six (n=287), 12 (n=277) and 18 (n=272) months post-diagnosis. Data at 12 months post-diagnosis was utilised for comparison with region and rural women with breast cancer. General population data for HRQoL, collected by self-administered questionnaire in 2004 using the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire, were derived from a subgroup of female residents without a history of breast cancer from urban (n=675), regional (n=184) and rural (n=281) Queensland. The two studies involving women with breast cancer were recruited sequentially through the Queensland Cancer Registry, whereas the study involving the general population used telephone survey methods initially to identify participants. Women who participated in all studies were aged between 30 and 74 years. Raw scores for overall HRQoL (FACT-B+4, FACT-G) and subscales were computed. According to developers of the instrument, raw score differences of eight points between groups on the FACT-B+4 scale and five points on the FACT-G scale reflect a clinically meaningful differences in HRQoL. Age-adjusted, mean HRQoL was similar between regional and rural women with breast cancer 12 months following diagnosis (e.g., FACT-B+4: 122.9 versus 123.7, respectively, p=0.74). However, younger regional and rural survivors reported lower HRQoL scores compared with their older counterparts (e.g., FACT-B+4: 112.0 and 115.8 versus 129.3 and 126.2, respectively, p<0.05 for all). In addition to age, other important correlates of lower overall HRQoL (FACT-B+4) among regional/rural breast cancer survivors included: receiving chemotherapy, reporting complications post-surgery, poorer upper-body function than most, higher amounts of stress, reduced coping, being socially isolated, not having a confidante for social-emotional support, unmet healthcare needs, and low self-efficacy. Multiple linear regression analysis was used to address the hypothesis regarding similarity of HRQoL following breast cancer among women residing in regional and rural locations. After adjusting for the above factors, there was no statistically significant or clinically important difference in overall HRQoL (FACT-B+4) between regional and rural women with breast cancer 12 months following diagnosis (122.1 versus 125.1, respectively, p=0.07). Data from regional and rural women were pooled, based on the above analyses, and compared with urban women. Multiple linear regression analysis was used to test the hypothesis that HRQoL following breast cancer among women residing in regional/rural locations would be lower than that reported by women residing in urban locations. Potential confounders of the association between overall HRQoL (FACT-B+4) and place of residence included: marital status, upper-body function, amount of stress and perceived handling of stress. After adjusting for factors that differed between urban and regional/rural survivors, overall HRQoL (FACT-B+4) was lower among younger regional/rural survivors than their urban peers, and the findings were both statistically significant and clinically important (115.3 versus 123.7, respectively, p=0.001). Older women reported similar mean HRQoL, regardless of regional/rural or urban residence (128.2 versus 131.6, respectively, p=0.03). Further multiple linear regression analyses were undertaken to investigate whether women with breast cancer would report HRQoL equivalent to that reported by similarly-aged women in the general population. After adjusting for potential confounding factors that are known or suspected risk factors for breast cancer (age, marital status, education level, private health insurance, smoking status, physical activity, body mass index, co-morbidities), overall HRQoL (FACT-G) among breast cancer survivors was comparable to the general population 12 months following diagnosis (urban: 88.0 versus 86.9, respectively, p=0.28; regional/rural: 86.2 versus 85.8, respectively, p=0.79). However, 26% of survivors experienced worse overall HRQoL (FACT-G) compared with normative levels. HRQoL subscales contributing most to this deficit were physical well-being, with 29% of breast cancer survivors reporting scores below the norm, and emotional well-being among younger women, with 46% reporting scores below the norm. Logistic regression analysis was used to identify subgroups of breast cancer survivors who reported HRQoL below normative levels; reporting poorer upper-body function than most and not handling stress well increased the odds of reporting overall HRQoL (FACT-G: odds ratios (ORs) = 4.44 and 4.24, respectively, p<0.01 for both), physical well-being (ORs = 5.93 and 2.92, respectively, p<0.01 for both) and emotional well-being (among younger women: ORs = 2.81 and 5.90, respectively, p<0.01 for both) below normative levels. The cross-sectional nature of the study design for regional and rural breast cancer survivors, and the potential selection and response biases in all three studies, represent the main limitations of this work. The cross-sectional design precludes causal inference about observed associations, but even characterising relevant correlates allows for adjustment of potential confounding and provides insight into factors that may be important in contributing to HRQoL among breast cancer survivors. Moreover, the potential impact of the latter limitations is in the conservative direction, whereby differences in HRQoL between groups will be more difficult to identify. Since these biases are expected to be present to a similar degree across all study groups, the absolute difference in HRQoL by residence and cancer status observed are likely to exist. In contrast, the work is supported by a population based, state-wide sample of breast cancer survivors, comparisons with the general population, and use of standardised instruments. Therefore, the conclusions derived from this research are likely to be generalisable to the wider population of women in Queensland with unilateral breast cancer, aged 74 years or younger, and perhaps to similar women in other western countries, depending on variations in healthcare systems and the provision of oncology services. This research supports the initial supposition that while some findings may generalise to all breast cancer survivors, non-urban breast cancer survivors also have distinct experiences that influence their HRQoL. Results from this work highlight the HRQoL domains and characteristics of breast cancer survivors most in need of assistance to facilitate recovery following diagnosis and treatment. Characteristics include some already established and reconfirmed here, namely, emotional wellbeing among younger women, and other novel subgroups, including regional/rural survivors who receive chemotherapy or have a low self-efficacy and all survivors, regardless of residence, with upper-body problems or a low perception of handling stress. These results demonstrate the potential for identifying subgroups of women with breast cancer at risk for low HRQoL who may benefit from additional attention and possible tailored recovery interventions to increase their overall HRQoL. As such, researchers and clinicians need to consider the role of these factors when designing interventions to assist women as they deal with the challenges imposed upon them by their breast cancer. However, it was found here that the FACT-G instrument has ceiling effects. This means that positive changes reflecting improved status, such as those achieved through recovery interventions, will often fail to be measured appropriately if there is no room to indicate improvements. Overall HRQoL results indicated that there is room for improvement past 12 months following treatment, with a significant proportion of breast cancer survivors reporting HRQoL below normative levels. HRQoL concerns 12 months following diagnosis are likely to be distinct from the more acute issues reported earlier on in the literature. Therefore, the development of a cancer survivorship module to accompany the FACT-G would be useful to counteract the ceiling effects observed as well as to capture issues distinct to cancer survivorship. This is the first study to describe in detail the HRQoL of breast cancer survivors across all areas of Queensland and to compare it to the HRQoL reported by the general population of Queensland. Therefore, it represents a unique and substantial contribution to the existing knowledge on survivorship issues following diagnosis and treatment for breast cancer in Australia. Through this research, a number of questions remain that could be addressed by relevant investigations and which are likely to be important in the future to ultimately guide practice. Specifically, implementation of the concept of HRQoL in practice is the next important step forward. Furthermore, the development of a survivorship care plan that incorporates guidelines on HRQoL recovery could provide options for referral and support.

Existing career theories are largely based on a stable working environment and have focused excessively on men and single work roles. In the postindustrial era, however, women’s careers, characterized by the constant negotiation of multiple roles and more frequent job changes, have had implications on the changing nature of careers. The general purpose of this thesis is to increase knowledge about the process of career development of women. The focus is on two aspects: Life Career (characterized by multiple role constellations over the life course) and Occupational Career (characterized by different shapes of occupational movement over the life course). Three sets of questions addressed these two aspects of career: trajectory patterns, interrelationships, and antecedents and consequences. Career biographies covered ages 16 to 43. Antecedents reflecting individual agency (e.g., life role value, aspiration, and early experiences) were investigated. The impact of family context on occupational choice was also examined. Among the consequences examined were midlife work wellness and stress, health, and wellbeing.

Results showed that (1) Career patterns were highly diverse, including nine distinct life career patterns and ten occupational career patterns. (2) Occupational and life careers were significantly related, indicating that the paid work career is embedded in the overall life role structure throughout the life course. (3) Individual agency factors predicted life career. Occupational career was related to life career more than family context. (4) Occupational career did matter in work wellbeing. In terms of stress, health, and wellbeing at midlife, there was little difference among life career patterns, but more significant differences among occupational career patterns. The thesis indicates career theory can benefit from taking multiple roles and career development into account. Implications for career counseling, social policy, and organizations are discussed.

Background: The definition of urinary incontinence is involuntary loss of urine that is objectively detectable and results in a social and hygienic inconvenience for the individual. There are different types and causes of urinary incontinence and the symptoms often occur more frequently with higher age. Women are affected to a greater extent than men. Urinary incontinence may affect everyday life and lead to changes in quality of life. Aim: To illuminate women's experiences of living with urinary incontinence. Method: A literature study was conducted using qualitative analysis through five steps. An analysis of ten qualitative articles was carried out. Results: Four main themes emerged, a suffering in everyday life, perceived body perception, feelings about sexuality and hope and despair. The results showed that living with urinary incontinence affected everyday life activities. The women felt limited and learned to cope through different strategies. Urinary incontinence affected the women's body image and could result in less confidence and the feeling of powerlessness. The complex situation sometimes leads to negative sexual effects. Women lived with the hope to recover but at the same time there were feelings of despair for what the future would hold for them. Conclusion: Women suffering from urinary incontinence experience restrictions in their everyday life, in physical, mental and social aspects. It creates a feeling of loss of control. And many women suffer in silence without seeking help. Urinary incontinence has a negative effect on their quality of life.

Currently, between 21.9 and 23 million veterans have served in the United States armed forces. Of those, 2 million are women, and of those, only 6.5% use the Veterans Health Administration system. These females often suffer from physical and mental health disorders, and overall impaired quality of life (QOL), rendering their healthcare needs complex. Seeking, and providing care in this specialty area may become overwhelming not only for the women seeking the care, but also for healthcare systems that are unfamiliar with the specific needs of this population. A retrospective medical records review was completed of 51 female veterans between the ages of 40 and 60 years, and who attended a women’s health specialty clinic in a women’s health center in the VA healthcare system. This center provides comprehensive women’s health services to female veterans. By attending this center, female veterans are having most if not all of their healthcare needs met in one location. Some of the services provided at the center include: primary care; gynecology; other gender specific health care needs; mental health care; and social assistance among other issues that may be associated with the overall QOL and depression. Despite this study having a small sample size (n = 51), the participants were ethnically diverse: White (52.9%); African American (29.4%); Hispanic/Latino (15.7%); and Asian/Pacific Islander (2%). The overall results of this study reveal that female veterans who attend this clinic, have significantly lower baseline scores for QOL when compared to a North American population reference value. Means and standard deviation for total Menopause Rating Scale (MRS) score were; (n = 51, M = 21.2, SD = 9.2) compared to the North American women population reference values (n = 1,376, M = 9.1, SD = 7.6), z = 9.41, p < .0001, cohens d = 1.31. These results were significantly lower for all MRS subsets. The higher the means and standard deviation, the lower the QOL. A paired sample t-test indicated significant improvement in QOL after treatment in QOL (t = 7.80, p < .0001), and depression levels (t = 3.74, p < .0001) among female veterans attending the women’s health specialty clinic. Forward stepwise multiple linear regression models were fit to explore the association between the following variables and the outcomes of QOL and depression levels: low socioeconomic status (SES); number of deliveries; years of service; and military sexual trauma (MST). The only predictor that appeared to be significantly associated with higher MRS scores at baseline was a history of MST (β = .363; t = 2.44; p = 0.02). Higher MRS scores can be interpreted as lower QOL among female veterans. Despite the complexities and unique needs of female veterans, the findings of this study suggest that timely, comprehensive and gender specific healthcare can significantly improve overall QOL and depression levels. In addition, further studies are need to assess what other variables may have a direct association with QOL, depression levels, and overall health of female veterans.

This article analyzes data collected from Liberian women afflicted by the Ebola virus disease, survivors of the virus and noninfected persons living in Ebola-affected homes. This research is one of the first statistical analyses examining factors diminishing quality of life: negative experiences, stigma, and psychosocial symptoms among females affected by the virus after the outbreak. The research presents a thorough literature review, including research related to other infectious diseases like HIV/AIDS, to inform the gap in studies on Ebola’s effects on quality of life. Women who are Ebola virus disease survivors demonstrate significant differences in stigma and psychosocial stress when compared to their female peers. This article attempts to broaden understanding of the conditions and mental health of women affected by Ebola.

Quality of life (QoL) in cancer survivors is an important area of research. While data are available about QoL and breast cancer, there is a paucity of research regarding older breast cancer survivors. The purpose of this research was to examine QoL in older women with early stage breast cancer, within the first year of post-treatment survivorship. The specific aims of this study were to: 1) Describe the changes in overall QoL and the four QoL domains of Physical, Psychological, Social, and Spiritual well-being; 2) Examine the effects of a psychoeducational support intervention on QoL outcomes in older women; and 3) Describe nurses' perceptions of their interactions with older breast cancer survivors. A descriptive, longitudinal design was used to answer the research questions. Data for this study were drawn from the Breast Cancer Education Intervention (BCEI), a longitudinal psychoeducational support intervention for women with early stage breast cancer. Fifty women from the BCEI who were 65 years of age and older were included in this sample, of whom 24 were assigned to the Experimental (EX) Group and 26 were assigned to the Wait Control (WC) Group. Data were collected at three time points: baseline, three months, and six months after study entry. Measurement tools included the BCEI Demographics Form, the Quality of Life-Breast Cancer Survey (QoL-BC), and field notes of the BCEI Research Nurses. The QoL-BC survey is a 50-item scale that measures QoL in women with breast cancer. Descriptive statistics, Generalized Estimating Equation (GEE) methods and t-tests were used to answer research questions #1 and #2. Content analysis was used to answer research question #3. Subjects reported good overall QoL at baseline, but QoL declined over six months. Physical and Psychological well-being declined from baseline to six months later. Social well-being initially improved from baseline to three months but declined at six months. Spiritual well-being initially declined at three months and improved at six months. There was insufficient power to detect a difference in the effects of the BCEI Intervention between the two groups. However, the decline in overall QoL was less in the EX Group. Field notes focusing on nurses' perception of their interactions with older women revealed four themes. These themes include: continuing breast-related health, personal health issues, family health issues, and potential stressors. Results from this study suggest that: 1) changes in overall QoL and within the four QoL domains occur over time; 2) decline in overall QoL was lessened by the BCEI Intervention; and 3) concerns after treatment are both breast cancer and non-breast cancer related. Study findings can direct future research in the following areas: 1) identification of specific concerns within each QoL domain that could lead to an increase or decrease in well-being in older breast cancer survivors; 2) interventions tailored to the needs of older breast cancer survivors to maintain, improve, or lessen decline in QoL after treatment; and 3) reconceptualizing QoL in older breast cancer survivors to include non-cancer related factors.
Ph.D.
School of Nursing
Other
Nursing PhD

The MaiMwana Project is a community-based intervention that organises women's groups (WG) in rural villages in Malawi. During the meetings, women discuss, develop and implement strategies to overcome maternal and neonatal issues. This intervention combines social strategies with empowerment, capacity building and knowledge across different sectors. It emphasises health promotion activities that rely on community engagement and participation aimed at changing behaviour of healthy individuals. The effectiveness of MaiMwana WGs is measured through a cluster randomised controlled trial design on maternal and neonatal mortality rates. However, the impact of the intervention is likely to occur on different aspects of women's wellbeing, not only on health. Conventional economic evaluation techniques might fail to address comprehensively the complexity of community-based interventions such as the MaiMwana Project. Applying Sen's capability framework may provide an appropriate response to address this shortcoming. A crucial argument of Sen's approach is that wellbeing is the freedoms people have to pursue the kind of life they have reason to value. Social policies should aim to expand people's capabilities, and a policy is considered successful if it leads to an expansion of people's capability set. In order to assess and monitor progress in society, there is a need for developing multidimensional measures of wellbeing based on a broader evaluative space. This thesis develops an outcome measure inspired by Sen's capabilities approach to assess women's wellbeing in rural Malawi. To achieve this, the study has five objectives: i. Identify a set of capabilities relevant to the context ii. Propose a methodology to measure robustly these capabilities iii. Aggregate the capabilities into a single metric (index) iv. Validate and test the index. During the exploratory phase, a series of focus groups was held in order to identify and value locally relevant dimensions of quality of life, or capabilities. The capabilities were assessed with a household survey on a sample of 345 women of reproductive age in Mchinji District, Malawi. The capabilities were aggregated into an index using four different methods: data-driven (principal component analysis), normative (equal weights and participatory exercise) and hybrid (survey ranking). The index was validated against the criteria of content validity, construct validity and reliability.

Background and Objectives: Extensive research has shown that chronic pelvic pain (CPP) can have a detrimental impact on a woman’s quality of life (QoL). QoL is a subjective, multidimensional concept that refers to an individuals’ perception of their social, emotional, physical and psychological wellbeing. There is currently very little literature exploring the possible psychological predictors of QoL in this patient group. Therefore the purpose of this report was to provide a systematic review of the literature concerning predictors of QoL in women who experience CPP. Design: Systematic review. Method: Relevant papers were obtained through scanning five electronic databases and searching references and bibliographic lists. Studies were selected if they included women who had a diagnosis of CPP, included a standardised QoL measurement tool and predictors (psychological, social or clinical features), used a quantitative design and were available in English. A total of 12 studies were eligible for the review. All 12 papers were assessed for their quality using the 16 item Quality Assessment Tool for Studies with Diverse Designs (QATSDD; Sirriyeh, Lawton, Gardner & Armitage, 2011). Results: Similarly to other studies investigating QoL, income, number of years of education, the effect of CPP on a woman’s job and having a partner present were found to be statistically significantly associated with improved QoL. The frequency and intensity of pain, sexual dysfunction, comorbid physical health conditions, higher BMI, higher number of physician visits and surgical procedures were statistically related to a lower QoL. Dyspareunia and intermenstrual pelvic pain were both found to be statistically significantly related to a poorer QoL. Having a diagnoses of endometriosis or deep infiltrating endometriosis (DIE) or fibromyalgia were also found statistically to be significant predictors of a poorer QoL. Psychological factors found to be statistically associated with a poorer QoL included increased catastrophizing, depression, anxiety, perception of poorer pain control and a history of sexual and physical abuse and other lifetime trauma. Conclusions: This review has demonstrated that there are a number of possible predictors of poorer QoL in women with CPP. Interventions to target these predictors, may be worthy of further investigation.

Thesis (M.A.)--Boston University
Background: In order to best treat breast cancer related lymphedema it is important to realize that it is a progressive, and for some, a lifelong condition requiring surveillance. Breast cancer patients are educated to be aware of the signs of lymphedema, as are physicians. This is critical to capturing those patients most in need of treatment since there are less options and more comorbidities associated with more severe swelling. Impaired shoulder usage, loss of range of motion and discomfort associated with the swelling of lymphedema can severely impact a patient’s lifestyle reducing their ability to work, be self sufficient and lowering their quality of life. Since 20% or more of patient’s treated for breast cancer will go on to deal with lymphedema in the long term or transiently it is necessary to understand who is most affected and at what level of swelling it is necessary to treat this condition. Methods: As a part of the lymphedema screening protocol at Massachusetts General Hospital we were able to analyze data on 138 women with newly diagnosed breast cancer. They were followed for at least 18 months and measured at least 3 times using the perometer, which records their arm volume and compares it to baseline. At the same time they were asked to fill out the LEFT-BC questionnaire to assess their quality of life and answer relevant questions relating to arm usage. [TRUNCATED]

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Bachelors
Health and Public Affairs
Nursing

African American breast cancer survivors are at a greater risk of experiencing disparities in mortality, treatment, and quality of life. The purpose of this phenomenological study was to explore the impact that breast cancer had on the quality of life of African American breast cancer survivors from a psychosocial, physical, spiritual, and economic perspective. Face-to-face, in-depth interviews were conducted with 9 volunteers who met the eligibility criteria of being breast cancer survivors of African American decent. The sample of survivors ranged in ages 45 to 80 and was between 6 to 30 years postdiagnosis. Giorgi's phenomenological method was used to extract themes or meaning units. Thematic analyses led to 4 established quality of life categories and 2 empowerment emerging themes. The quality of life categories were psychosocial (body image, acceptance), physical (complications of treatment), spiritual (reliance of God), and economic (insured and uninsured). The empowerment categories and emerging themes were formal social networks (whether a sense of empowerment was encouraged), keep moving, and support from other survivors. The final empowerment category was informal social networks-whether a sense of empowerment was encouraged (friends and family was supportive, husband not involved in care). Positive social change implications include providing African American breast cancer survivors information on social networks to achieve a sense of support.

Background: The global burden of osteoporosis includes considerable numbers of fractures, morbidity, mortality and expenses, due mainly to vertebral, hip and forearm fractures. Underdiagnosis and undertreatment are common. Several studies have shown decreased health-related quality of life (HRQOL) after osteoporotic fracture, but there is a lack of data from long-term follow-up studies, particularly regarding vertebral fractures, which are often overlooked despite patients reporting symptoms. Aim: The overall aim of this thesis was to evaluate the usefulness of a recent low-energy fracture as index event in a case-finding strategy for osteoporosis and to describe and analyse long-term HRQOL in postmenopausal women with osteoporotic fracture. The specific aims were to describe bone mineral density and risk factors in women 55-75 years of age with a recent low-energy fracture (I), estimate the impact of osteoporotic fractures on HRQOL in women three months and two years after a forearm, proximal humerus, vertebral or hip fracture (II), investigate the changes and long-term impact of vertebral or hip fracture on HRQOL in women prospectively between two and seven years after the inclusion fracture (III), and describe how HRQOL and daily life had been affected in women with vertebral fracture several years after diagnosis (IV). Design and methods: Data were collected from southern Sweden between 1998 and 2008. A total of 303 women were included in Study I, and this group served as the basis for Studies II (n=303), III (n=67), and IV (n=10). A cross-sectional observational, case-control design (I), and a prospective longitudinal observational design (II-III) were used. In Study IV a qualitative inductive approach with interviews was used and data were analysed using a qualitative conventional content analysis. Results: The type of recent fracture and number of previous fractures are important information for finding the most osteoporotic women in terms of severity (I). Hip and vertebral fractures in particular have a significantly larger impact on HRQOL evaluated using the SF-36 than do humerus and forearm fractures, both during the three months after fracture and two years later, compared between the different fracture groups and the reference population (II). Women who had a vertebral fracture as inclusion fracture had remaining pronounced reduction of HRQOL at seven years. At the mean age of 75.5 years (±4.6 SD), the prevalence of vertebral fracture suggests more negative long-term impact on HRQOL, more severe osteoporosis and a poorer prognosis than a hip fracture does, and this effect may have been underestimated in the past (III). Study IV demonstrates that the women’s HRQOL and daily life have been strongly affected by the long-term impact of the vertebral fracture several years after diagnosis. The women strive to maintain their independence by trying to manage different types of symptoms and consequences in different ways. Conclusions and implications: Type and number of fractures should be taken into account in the case-finding strategy for osteoporosis in postmenopausal women between 55 and 75 years of age. The long-term reduction of HRQOL in postmenopausal women (age span 55-75 yr) with vertebral fracture emerged clearly, compared to women with other types of osteoporotic fractures and references in this thesis. The results ought to be taken into consideration when developing guidelines for more effective fracture prevention and treatment, including non-pharmacological intervention for women with osteoporotic fractures, with highest priority placed on vertebral fractures and multiple fractures, to increase or maintain HRQOL.

Thesis (Honors)--Ohio State University, 2005.
Title from first page of PDF file. Document formattted into pages: contains 23 p.; also includes graphics. Includes bibliographical references (p. 22-23). Available online via Ohio State University's Knowledge Bank.

The purpose of this study was to examine direct and interactive relationships of stimuli and adaptive modes on help-seeking and quality of life. Stimuli were external (social network characteristics, social support need) and internal (age, symptom, symptom severity, satisfaction with social support). Adaptive modes were physiologic function, self-concept (enabling skill, mastery), role function (socioeconomic status, self-care), and interdependence (trust in health care provider, dyadic adjustment). The conceptual framework was based on Roy's Adaptation Model. Data were secondary analyzed using stepwise multiple regression to test the research hypothesis. The sample consisted of 102 married/cohabitating women with breast cancer. Thirteen instruments measured the variables. Factor analysis constructed indices for variables having multiple measures. Social support need had a direct effect on help-seeking. Number in the network interacted with education on help-seeking. Number of symptoms interacted with mastery on help-seeking. Self-care had a direct effect on quality of life. Satisfaction with social support, number of symptoms, and number in the network interacted with self-care on quality of life. Age interacted with self-care and trust in health care provider on quality of life. Severity of symptom interacted with mastery on quality of life. Social support need, the interaction between number in the network and education, and the interaction between number of symptoms and mastery significantly contributed to help-seeking. The interaction between satisfaction with social support and self-care significantly contributed to quality of life. Based on multiple interactive effects of stimuli and adaptive modes relative to help-seeking and quality of life rather than separate direct effects, Roy's Adaptation Model may better specify interactive relationships of stimuli and adaptive modes than simple direct relationships. To promote women's help-seeking, nurses should assess the number in women's social networks and women's level of education, be aware of women's level of social support need, recognize women's symptoms, and enhance women's sense of mastery. To promote women's quality of life, nurses should assist women toward improved perception of social support, which should increase their level of satisfaction with social support, and encourage performance of self-care activities.

The purpose of the following study was to evaluate sexual trauma and the effects on women veteran's quality of life ratings and current and past coping strategies. Participants were screened for sexual trauma history and divided into five mutually exclusive categories: 1)childhood sexual trauma, 2)civilian adult sexual trauma, 3)military sexual trauma, 4)multiple sexual trauma, and 5)no sexual trauma. Results of the study were mixed, retaining some hypotheses and rejecting others. Results regarding differences in QOL for the sexual trauma groups were rejected, as none of the QOL analyses were significant. Issues of small effect size for the QOL measure and low power to detect differences are discussed as limitations in the current study. Several significant findings were detected in the coping analyses. As predicted, the no trauma group was found to use significantly more approach coping strategies than the sexual trauma group for the past problem. Additionally, the sexual trauma group used significantly more avoidant coping techniques for past problem than the no trauma group. No between group differences were detected for sexual trauma type, however, several significant differences emerged in the comparisons of the multiple sexual trauma and military sexual trauma group's past coping compared to the no sexual trauma group's coping strategies. For past coping, the no trauma group used more approach strategies than the military or multiple trauma group. Past and current significant CRI subscale differences were also detected. Results regarding the relationship between QOL and CRI were rejected, as the two scales were not found to correlate significantly. Trauma history and avoidant coping were also nonsignificant predictors for General Life Satisfaction on the QOL measure. Additional exploratory analyses are presented as well as implications for research, theory and clinical practice.

Background: This study set out to construct a conceptual framework that can be used in social work with women in the Middle East and other settings where women have limited access to resources, which, as a result, limits their decision-making capacity. The framework has both an empirical and a theoretical base. The empirical base comprises data from two intervention projects among Iranian women: single mothers and newly married women. The theoretical base is drawn from relevant psychological and social work theories and is harmonized with the empirical data. Psychosocial intervention projects, based on learning spaces for coping strategies, were organized to assess if Iranian women could use a problemsolving model (i.e. focused on cognition and emotion simultaneously) to effectively and independently meet challenges in their own lives and improve their quality of life. Methods: Descriptive qualitative and quasi-experimental quantitative methods were used for data collection and analysis. Forty-four single mothers and newly married women from social welfare services were allocated to nonrandomized intervention and comparison groups. The intervention groups were invited to participate in a 7-month psychosocial intervention; the comparison groups were provided with treatment as usual by the social welfare services. The WHOQOL-BREF instrument was used to measure quality of life, comparing each intervention groups’ scores before and after the intervention and with respective comparison groups. In addition, content analysis and constant comparative analysis were performed on the qualitative data collected from the participants before, during and after the intervention. Results: The results of the quasi-experimental study show significant and large effect sizes among the women exposed to the intervention. Small and not statistically significant effect sizes were observed in the women provided with traditional social welfare services. Accordingly, teaching coping strategies can be a means to improve the quality of life of women in societies where gender discrimination is prevalent. The qualitative findings from the Iranian projects illustrate a process of change —socio-cognitive empowerment— with regard to thinking, feeling and acting among women during and after the intervention. The women developed a number of mental capacities essential to coping and life management. All women used the model effectively, and consequently, made more deliberate decisions to improve their life situations. Conclusion: The practical lessons from the Iranian projects highlight the possibilities of empowering women through fostering mindfulness and deliberate decision making as well as achieving consciousness. This study provides provisional evidence that psychosocial intervention projects, based on learning spaces for coping strategies, can help many clients to achieve their goals and improve their quality of life, and that this psychosocial intervention project can be a useful model for social work practice with women in the Middle East. The conceptual framework can help social workers to bridge the gap between theory and practice: that is, to draw from existing social work theories and, through the psychosocial intervention model, better apply this knowledge in their practical work with women in challenging social environments.

Depressive women’ quality of life and its changes during three years of the outpatient treatment is analyzed in this study. This study looks deeper into the factors which are helpful in assessment of recourses enhancing efficiency of mental health services and providing for better treatment and health protection strategies on behalf of the users of those services. The longitudinal panel survey of changes in women’ quality of life during three years of outpatient treatment of depression (in Kaunas city, Sanciu mental health center) is presented in the empirical part of the dissertation. 62 women participated in 3 screenings. The results of research show that more positive evaluation of the quality of life is related to the following factors: the older age of the beginning of the illness, absence of co morbid somatic illness, patient’s older age, having a paid job and interactions of these factors. Positive changes in quality of life occur during the first year of outpatient treatment of depression, while during the second-third year of treatment women’ quality of life remains stable or worsens, but after three years it becomes again better than in the initial screening. It is found that the recovery after one year of treatment is the most significant factor predicting more positive changes in the quality of life, while other important factors are: smaller number or less expressed clinical indicators of depression and social and demographic indicators (younger age, living with... [to full text]
Disertacijoje nagrinėjama depresija sergančių moterų gyvenimo kokybė ir jos kitimas trejų metų ambulatorinio depresijos gydymo laikotarpiu, kaip veiksniai, galintys padėti įvertinti psichikos sveikatos paslaugų vartotojų išteklius, svarbius sveikatai užtikrinti bei kuriant efektyvesnes sveikatos apsaugos ir gydymo strategijas. Empirinėje darbo dalyje pristatomas moterų gyvenimo kokybės kitimo trejų metų ambulatorinio depresijos gydymo laikotarpiu, tyrimas, atliktas Kauno m. Šančių Psichikos sveikatos centre. Trejuose tyrimo etapuose dalyvavo 62 moterys. Šio tyrimo rezultatai atskleidžia, kad depresija sergančių moterų susirgimo pradžios amžius, gretutinių somatinių ligų buvimas, amžius, mokamo darbo turėjimas ir šių rodiklių sąveikos, susiję su gyvenimo kokybės vertinimu. Išanalizavus rezultatus nustatyta, kad per pirmuosius ambulatorinio depresijos gydymo metus moterims vyksta teigiami gyvenimo kokybės pokyčiai, o per antrus- trečius gydymo metus moterų gyvenimo kokybė nesikeičia arba blogėja, tačiau po trejų gydymo metų yra geresnė nei gydymo pradžioje. Nustatyta, kad po vienerių metų gydymo pasiektas pasveikimas yra reikšmingiausias veiksnys, lemiantis didesnius teigiamus gyvenimo kokybės pokyčius, kiti svarbūs veiksniai - mažesnis depresijos klinikinių rodiklių kiekis ir/arba išreikštumas bei socialiniai ir demografiniai veiksniai (jaunesnis amžius, gyvenimas su partneriu, žemesnis išsilavinimas). Tyrimo rezultatai patvirtino, jog teigiami gyvenimo kokybės pokyčiai... [toliau žr. visą tekstą]

Thesis (Ph.D.)--University of California, Davis, 2002.
Degree granted in Epidemiology. Dissertation completed in 2001; degree granted in 2002. Also available via the World Wide Web. (Restricted to UC campuses)

Objective: To evaluate the influence of obesity, fertility status, and androgenism scores on health-related quality of life in women with polycystic ovary syndrome (PCOS). Design: Cross-sectional, correlational. Setting: Private reproductive endocrinology practice in two southeast U.S. cities. Participants: Convenience sample of 128 women with PCOS, half of whom were attempting to conceive in addition to being treated for PCOS. Most were White (97%), married (78%), with a mean age of 30.4 years (SD ± 5.5). Main Outcome Measures: The Health-Related Quality of Life Questionnaire (PCOSQ) for women with polycystic ovary syndrome. A laboratory panel and clinical measures, including body mass index, waist-to-hip ratio, and degree of hirsutism. Results: The most common health-related quality of life concern reported by women with PCOS was weight, followed in descending order by menstrual problems, infertility, emotions, and body hair. Conclusions: The psychological implications of PCOS are easily underestimated and have been largely ignored. Nursing has a pivotal role in recognizing these concerns and implementing therapy to improve quality of life in women with PCOS.

Background and Objectives Menopause is a natural transition, an important life event that represents the end of reproductive phase in women at age of 50. Menopausal symptoms or hormone replacement treatment (HRT) may influence women’s quality of life (QOL). Different health-related quality of life (HRQOL) scales are developed to demonstrate the effects of menopausal symptoms or treatment. The aim of this review is to identify the menopause-related measures and evaluate the psychometric properties of these scales. Method Literature search using the keyword: “menopause” or “menopausal” or “perimenopausal” or “climacteric symptoms” or “vasomotor symptoms” AND “menopause-related quality of life measures” or “menopause-related quality of life instruments” or “menopausal health-related quality of life measures” or “menopausal health-related quality of life instruments” or “menopause-related health status measurement” or “menopause-related health functioning” AND “women”. Results Total 5 menopause-related quality of life measures were identified: -the MENCAV Quality of Life Scale (MENCAV) -Menopause-specific QOL Questionnaire (MENQOL) -Menopause-specific QOL Questionnaire-Intervention (MENQOL-Intervention) -Menopausal Quality of Life Scale (MQOL) -Utian Quality of Life Scale (UQOL) All measurement scales have good internal consistency shown. Construct validity was reported in all measures. Known-groups validity was evaluated in MQOL and MENCAV. Content validity was shown in MQOL and UQOL by focus group meeting with menopausal women. Construct validity was reported in all measures. Convergent validity was reported in MQOL, MENCAV, UQOL and MENQOL-Intervention, the relationships between scores were evaluated. Discriminant validity was assessed in MENQOL. All measures reviewed either convergent or discriminant validity and no measure reviewed both. All measures except UQOL have reported responsiveness. Conclusion MENCAV is the best measure and supposed to be the most updated one developed in 2008. This measure is not as popular as UQOL, MENQOL etc. It demonstrated the highest psychometric quality score in this review. Standardization of measurement scales for comparison of the menopausal symptoms and QOL can reduce the anxiety of participants who answer different questionnaires with same domain. Further research on extensive psychometric evaluation across ethnicities may be beneficial to menopausal women.
published_or_final_version
Public Health
Master
Master of Public Health

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.
Objective: Childhood abuse has been found to be associated with adult-onset asthma; however, this association has not been studied in low- and middle-income countries with a high burden of gender-based violence, including childhood abuse. We examined the odds of asthma diagnosed at age 18 or older in relation to history of physical and sexual abuse among Peruvian pregnant women. Methods: This cross-sectional study collected demographic characteristics, history of abuse and asthma diagnoses from 3081 pregnant women. Logistic regression procedures estimated adjusted odds ratios and 95% confidence intervals (aOR, [95% CI]) for asthma diagnoses in relation to abuse. Results: Overall, 71% of the women reported a history of abuse (<18 years), and asthma was diagnosed among 2.6% of the cohort participants. The prevalence of physical only, sexual only and both physical and sexual childhood abuse was 38, 8 and 25%, respectively. The history of physical only (1.16, [0.63–2.17]), sexual only (2.11, [0.92–4.84]) or both physical and sexual childhood abuse (1.75, [0.94–3.29]) was positively associated with increased odds of asthma, although the associations were not statistically significant in the multivariate analysis. However, the odds of asthma increased with increasing numbers of abuse events (ptrend = 0.01). Women who reported ≥3 abuse events had an increased odds of asthma (1.88, [1.06–3.34]). Conclusion: Our results do not provide convincing evidence that childhood abuse is associated with asthma among pregnant Peruvian women; however, we were able to demonstrate that an increased number of abuse events are associated with asthma. Further research is required to better understand the effects of abuse on asthma.
This research was supported by an award from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01-HD-059835). The NIH had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. The authors wish to thank the dedicated staf f members of Asociacion Civil Proyectos en Salud (PROESA), Peru, and Instituto Especializado Materno Perinatal, Peru, for their expert technical assistance with this research.
Revisión por pares

Breast cancer (BC) is the most common and most lethal cancer among women worldwide. More than a million and a half are diagnosed every year with more than 600,000 deaths among women worldwide. It is estimated than 1 in every 7 women will develop breast cancer in their life time. It is a major public health concern with high economic cost as well. BC is a multidimensional construct. Several dimensions of this construct have never been examined before in the United Arab Emirates (UAE). This study investigated major facets of the Quality of life (QOL) among women with BC in the UAE, compared it with a sample of age matched healthy group of women without any neoplastic background, changes in serum biomarkers of women with BC and to detect the impact of the disease on these biomarkers at the beginning of the disease before treatment started and then again 12 months later following treatment for the cancer and the role of ghrelin hormone in BC and depression at a tissue level and at serum level. In order to examine QOL with its all dimensions among women with BC, an epidemiological case-control study was conducted recruiting a sample of 300 women, 155 women with BC and 145 age-matched healthy women without any neoplastic background as a control group. This was carried out by using a series of standardized psychometric tools in addition to conducting a psychiatric diagnostic interview. Moreover, blood biomarker results were reviewed retrospectively for cases and controls at the beginning and then 12 months following treatment for BC. In relation to the histopathological characteristics and treatment modalities for BC, all pathology, medical and oncology data for 155 women with BC was retrieved from the computer system and analyzed retrospectively. Finally, in relation to ghrelin hormone, all mammary morphological types, normal, benign and malignant were examined with immunohistochemistry for the expression of ghrelin and its functioning receptor (GHS-R1a). Serum of the same women, whose mammary tissue sections were examined by IHC, was tested for ghrelin serum level to find out its link to BC and depression. This was carried out by Enzyme-Linked Immunosorbent Assay (ELISA). The results have demonstrated that women with BC had poor QOL in comparison to the control group. They had poor view of their body image and sexuality and moreover physical disability rate was high. They also tended to suppress negative emotions to a great extent. Anxiety symptoms were also high. Major depressive disorders and post traumatic disorders were lower among women with BC compared to healthy controls. Several risk factors turned to be linked to BC. These included age, having night shift work, hypertension, diabetes mellitus, oral contraceptive pills, hormonal replacement therapy and not breast feeding. In terms of significant traumatic life events, the Arabic version of the CESC English scale showed to have high validity and reliability among women with BC in the UAE. The results also showed that the levels of several serum haematological and biochemical markers seemed to be abnormal among women with BC compared to healthy control. These included elevated levels of platelet, basophils, liver enzymes, lactate dehydrogenase and tumour serum markers. On the other hand, they were low levels of serum magnesium, C-reactive protein and creatinine. Analysis of histopathological characteristics indicated that the aggressive biological nature of the disease was at the late stage and presentation to medical services for treatment. Clinically, women with BC seemed to have all treatment modalities for BC with high rate of mastectomy and axillary clearance. Regarding ghrelin hormone and it relation to BC, the results showed that malignant mammary tissues had an exclusive and differential immune-reactivity to ghrelin hormone, whereas its receptor, the GHS-R1a, was immune-reactive all mammary tissue morphological types. In addition, more metastasis to the lymph nodes was significantly correlated with more immune-reactivity to ghrelin receptor. The results for gene expression for pro-ghrelin, ghrelin and its receptors were inconclusive It is concluded that breast cancer is the most common cancer among women in the UAE. It attacks women at an earlier age than their counterparts in the West. More attention should to be allocated to the QOL and the unmet psychosocial needs of women with BC. This in turn would improve compliance to treatment and prognosis as well. It is also recommended that awareness campaigns and early screening should be applied for early detection of the disease to prevent late presentation to the medical services and other complications.

Numerous studies have shown that women with better social support have fewer problems adjusting to breast cancer. However, these studies have a tendency to focus only on emotional support and to assess social support at only one point in time. Additionally, the effect of type of treatment on the use of social support has been overlooked. The present study assessed social support as a multidimensional construct. Changes in social support over time and its relationship to life quality at each point in time were examined, as well as any differences due to treatment type. Tangible assistance, satisfaction with support, and negative interaction decreased over time. Tangible assistance and need for support were found to be greater for women receiving chemotherapy, and their life quality decreased. Tangible assistance, advice, and negative interaction were negatively related to life quality, while satisfaction with support was positively related.

Ovarian cancer is a malignancy characterized by poor prognosis, high levels of distress, and impaired quality of life (QOL). Investigation into the contributors to QOL is of psychological and prognostic significance in cancer. Contemporary stress theories and empirical accounts identify early life adversity and recent life stress as those sources which exert significant impact on physical and psychological health. To date, life stress research in cancer has yielded few designs which operationalize both indices of early life and recent life stress exposures. Moreover, despite the high-resolution stress data provided by the Life Events and Difficulties Schedule (LEDS) system, no studies to date comprehensively operationalize the early life adversity data obtained during each interview. Therefore, the proposed study is the first of its kind to comprehensively obtain ratings and examine effects of early life adversity data collected as part of the LEDS interview. It is also the first to examine independent influences of differentially timed life stress indices on psychological variables important to psychosocial functioning in ovarian cancer. Early life adversity was experienced by 43.1% of the sample. Adversity varied in content, number of occurrences, and severity. Ongoing difficulties, but not recent life events or early life adversity, were significantly associated with pre-surgical depression and QOL. Ongoing difficulties were also associated with lower depression, sleep, and QOL scores at all time-points. Early life adversity was associated with a poorer trajectory of sleep and QOL over the first year post-diagnosis. Findings are discussed with attention to behavioral and biological mechanisms. Applications to generative and cumulative theories of life stress are proposed. These findings lend support to the potential benefit of interventions aimed toward practical support and stress management in patients with ovarian cancer, as well as provide guidelines for use of early life adversity data obtained through the LEDS interview.

Urinary incontinence has already been identified worldwide for years as a health problem affecting essentially women, which can interfere with their overall quality of life. However in Rwanda, this problem has yet not been addressed adequately either because of lack of expertise, or because of cultural traditions associated with taboos among women. Social conditions of women facing this problem hinder them from seeking possibly adequate medical assistance. It is important that this problem be addressed because it may lead to disability, social seclusion, psychological stress and economic burdens. This study was a pioneer one, intended to diagnose the extent of the problem through determining the prevalence of urinary incontinence as well as its impact on the quality of life among women. The study will hopefully be followed by the promotion of physiotherapy to tackle the problem and therefore reduce the number of people suffering from urinary incontinence.

Background: In Sweden around 6500 women suffer each year from breast cancer and during lifetime every tenth women is affected. Mastectomy (removal of part of or the whole breast) is carried out mostly in purpose to remove malign tumours or in prophylactic purpose. The breast can be rebuilt through breast reconstruction. Method: The result analysis was based on nine articles. A Manifest content analysis was used and data from the articles where divided into themes and patterns, on the basis of these categories were created. Aim: The aim of this study was to describe women’s experience of quality of life which has undergone breast reconstruction after mastectomy. Results: The result is presented in categories: psychic, social, physical, body image and sexual. After breast reconstruction women can suffer from psychological, social, physical, body image and sexual dysfunctions. Women’s quality of life after breast reconstruction varies. Women should in right time receive support from medical staff. Body image, body reality and self-image are affected by illness. A good body image can improve self-confidence which can improve quality of life. Conclusion: Participations and awareness can be linked to good quality of life after breast reconstruction. Therefore information is an important foundation stone in the care.