Ciaran A. O’Boyle

Individual quality of life factors distinguishing low-burden and high-burden caregivers of dementia patients.

Dementia patient (n = 72) and caregiver characteristics and individual quality of life (IQoL) factors distinguishing low- and high-burden caregivers were evaluated. Measures included patient cognitive, functional and behavioural status, and caregiver burden, well-being, social support appraisal and IQoL. The caregivers were divided by median split into low- and high-burden groups. In the high-burden group daughters were over-represented, psychological morbidity was higher, QoL was lower, the patients were more behaviourally disturbed, and there was a trend towards more negative appraisal of informal social support. Of the many QoL factors elicited from caregivers, only ‘time for self’ and ‘finances’ differed significantly between the groups. A need for more time away from the patient is a major QoL concern for highly burdened caregivers, and a perceived lack of adequate informal support and/or financial constraints are contributory factors.

Measuring the Quality of Life of Dementia Patients Using the Schedule for the Evaluation of Individual Quality of Life

The importance of quality of life (QoL) assessment in research and clinical practice is gaining increasing recognition. The Schedule for the Evaluation of Individual Quality of Life (SEIQoL) is based on a phenomonological approach in which the individual’s views are central. As cognitive impairment may affect insight and the ability to make judgements this study explored the feasibility, validity and reliability of using the SEIQoL to measure the quality of life of elderly dementia patients. The SEIQoL was administered to 20 patients meeting DSM-IIIR criteria for mild dementia. Cognitive status was evaluated using the Mini-Mental State Examination (MMSE) and CAM COG (from the CAMDEX). All patients were able to complete some elements of the SEIQoL, but only 6 were willing or able to complete the full procedure. Mean CAM COG scores distinguished these 6 patients from the remaining 14 (p<.01). For these 6 dementia patients the mean internal variance (R2), an estimate of construct validity, was .70, and the i...

General practitioner and public health nurse views of nutritional risk factors in the elderly

A number of risk factors for malnutrition in the elderly have been identified, but their relative importance has yet to be established. General practitioners and public health nurses were interviewed to elicit the relative weights placed on 6 major risk factors when assessing nutritional risk in the elderly (living alone, recent bereavement, denture problems, mobility problems, psychiatric morbidity and multiple medication use). Participants rated risk for 35 hypothetical cases, described by their status on the 6 risk factors. Multiple regression models of these judgments revealed a consistently high weight for psychiatric morbidity compared to the other factors. Little group variation in diagnostic policies was observed between general practitioners and public health nurses or by case gender. These policies may reflect the perception that psychiatric problems pervade many areas of life functioning related to nutritional intake and are therefore more likely to cause malnutrition than other, more specific risk factors.

Quality of Life assessment: A paradigm shift in healthcare?

The assessment of patient qUality of life is assuming increasing importance in medicine and healthcare. In addition to their biological effects, illnesses, diseases and their treatments can have significant impact on mobility, mood, life satisfaction, cognition and the ability to fulfil occupational, social and family roles. The emerging quality of life construct may be viewed as a paradigm shift in outcome measurement since it shifts the focus of attention from symptoms to functioning. This holistic approach more clearly establishes the patient as the centre of attention and subsumes many of the traditional measures of outcome. This paper introduces the concept of quality of life and describes the significant difficulties in definition, measurement and interpretation that must be addressed before such measures can be used as reliable and valid indicators of disease impact and treatment outcomes. It is argued that the unique individual perspective of the patient on his or her own quality of life must be incorporated into outcome assessments aimed at improving the quality of healthcare delivery in chronic diseases and in terminal conditions.The assessment of patient quality of life is assuming increasing importance in medicine and healthcare. In addition to their biological effects, illnesses, diseases and their treatments can have significant impact on mobility, mood, life satisfaction, cognition and the ability to fulfil occupational, social and family roles. The emerging quality of life construct may be viewed as a paradigm shift in outcome measurement since it shifts the focus of attention from symptoms to functioning. This holistic approach more clearly establishes the patient as the centre of attention and subsumes many of the traditional measures of outcome. This paper introduces the concept of quality of life and describes the significant difficulties in definition, measurement and interpretation that must be addressed before such measures can be used as reliable and valid indicators of disease impact and treatment outcomes. It is argued that the unique individual perspective of the patient on his or her own quality of life must be i...

Quality of life and cardiovascular medication

The current status of quality of life research is briefly outlined as a background to work on the quality of life issues addressed in studies of cardiovascular medication. Chronic heart failure and hypertension provide the main focus for this report. The measures used and assessment issues for these studies are described; from functional status to health status or health-related quality of life to individually defined quality of life assessment. Finally, the key issues of concern for quality of life research in this area in the 1990s are outlined.

Quality of Life in an Elderly Urban Female Population At Risk for Nutritional Deficiency

The promotion of adequate nutritional intake is an important health strategy with elderly populations. This study assessed the quality of life of 84 nutritionally at-risk elderly female community residents using measures of physical, social and psych01ogical functioning. These were then compared with normative data for females from the same urban population. The results indicated that the study sample had significantly poorer functioning in terms of physical disability (p<.01), symptoms of ageing (p<.001), self esteem (p<.001), depression (p<.01) and cognition (p<.001). The healthy sample had a significantly more positive perception of both their current health (p<.001) and their health compared to others of the same age (p<.01), and overall rated themselves as happier (p<.001) than did the nutritionally at-risk group. These findings confirm an association between poor nutritional status and a lower quality of life in the elderly. The impact of a nutrition intervention programme on the well-being of the a...

No (safer) sex please, we’re Irish: Sexual functioning and use of safer sexual practices in an Irish HIV positive cohort

This study examined the implications for sexual functioning of having a HIV positive diagnosis. Also examined was whether safer sex was being routinely practiced. Findings are reported from first contact interviews in a prospective study of 52 people with HIV who were ambulatory and living in the community. A majority were infected through injecting drug use. Results indicated a disruption in sexual functioning that was particularly evidenced by a decrease in sexual activities and decreased interest in and satisfaction derived from sex. This disruption was reported in particular by female respondents. Almost half of the overall study group reported never or not always practicing safer sex. Women were found to be the least likely to adopt safer sexual practices. These findings have implications for HIV prevention programmes directed at drug-using populations and, more specifically, those directed at drug-using women.

Training Surgeons as Medical Educators in Africa

Based on the effect of essential surgical procedures, as evidenced in the Lancet Commission on Global Surgery and the World Health Assembly resolution on Strengthening Emergency and Essential Surgical Care and Anaesthesia as a Component of Universal Health Coverage, surgery is now recognized as an essential component of global public health. The third edition of Disease Control Priorities (DCP3) has a specific volume devoted to essential surgery and argues that a large proportion of the burden of disease can be ameliorated through surgery, that the provision of essential surgery is cost effective, can be expanded safely and effectively, and disparities in the delivery of safe surgical care need to be addressed. High-quality surgery is affordable and feasible in low resource settings. Though the global number and distribution of specialist surgical providers remains inaccurately measured, there is agreement that there is an insufficient surgical workforce worldwide, so the task being addressed in many lower and middle income countries (LMICs) is how to develop health professionals with the necessary surgical skills. In many regions, local training programmes, supplemented by international organizations, are making significant inroads into addressing the surgical skills gap. The vast majority of internationally led surgical training initiatives in LMICs have focused on clinical skills teaching. Some focus on particular specialties (such as 2nd Chance [http://2nd-chance.org/?lang=en] and IVUMed [http://www.ivumed.org]), others on particular procedures or specific skills (such as Operation Smile