Relationship between quality of life, social support and disease-related factors in HIV-infected persons in Venezuela

This study examines the relationships among health-related quality of life (HRQL), social support, sociodemographic factors and disease-related factors in persons infected with the human immunodeficiency virus (HIV) living in Venezuela. A sample of 118 HIV-infected persons living in Caracas, Venezuela, was surveyed using a written questionnaire that included a Spanish translation of the Interpersonal Support Evaluation List (ISEL) developed for this study, the Medical Outcomes Study Short Form-36 (SF-36) and a symptom inventory. All three instruments showed good internal consistency reliability. Multiple regression analyses were used to model SF-36 sub-scale scores as a function of symptoms, social support, HIV-status and use of antiretroviral drugs. The models explained between 16 and 39% of the variance in the different HRQL domains. Controlling for other variables in the model, level of symptomatology was significantly associated with all HRQL domains except social functioning and role-emotional scores. Social support was significantly associated with all HRQL domains except physical functioning and bodily pain. The use of antiretroviral drugs was significantly associated with social functioning. The study indicates the importance of social support to the quality of life of HIV-infected individuals in this culture.

Assessing the burden of sexual and reproductive ill-health: questions regarding the use of disability-adjusted life years

The use of the disability-adjusted life year (DALY) as the unit in which to calculate the burden of disease associated with reproductive ill-health has given rise to considerable debate. Criticisms include the failure to address the problem of missing and inadequate epidemiological data, inability to deal adequately with co-morbidities, and lack of transparency in the process of ascribing disability weights to sexual and reproductive health conditions. Many of these criticisms could be addressed within the current DALY framework and a number of suggestions to do so are made. These suggestions include: (1) developing an international research strategy to determine the incidence and prevalence of reproductive ill-health and diseases, including the risk of long-term complications; (2) undertaking a research strategy using case studies, population-based surveillance data and longitudinal studies to identify, evaluate and utilize more of the existing national data sources on sexual and reproductive health; (3) comprehensively mapping the natural history of sexual and reproductive health conditions--in males and in females--and their sequelae, whether physical or psychological; (4) developing valuation instruments that are adaptable for both chronic and acute health states, that reflect a range of severity for each health state and can be modified to reflect prognosis; (5) undertaking a full review of the DALY methodology to determine what changes may be made to reduce sources of methodological and gender bias. Despite the many criticisms of the DALY as a measurement unit, it represents a major conceptual advance since it permits the combination of life expectancy and levels of dysfunction into a single measure. Measuring reproductive ill-health by counting deaths alone is inadequate for a proper understanding of the dimensions of the problem because of the young age of many of the deaths associated with reproductive ill-health and the large component of years lived with disability from many of the associated conditions.

Socioeconomic status and morbidity in the last years of life

OBJECTIVES

This study evaluated the effect of socioeconomic status, as characterized by level of education, on morbidity and disability in the last years of life.

METHODS

The analysis used data from the National Health Interview Survey (1986-1990), with mortality follow-up through December 1991.

RESULTS

Among 10,932 decedents 50 years or older at baseline interview, educational attainment was inversely associated with long-term limitation of activity, number of chronic conditions, number of bed days, and days of short hospital stay during the year preceding the interview.

CONCLUSIONS

Decedents with higher socioeconomic status experienced lower morbidity and disability and better quality of life even in their last years of life.

Aging of population and elderly care in Sri Lanka

"The main purpose of this paper is...to examine the trends [and] characteristics of the elderly population [in Sri Lanka] and to inquire into the status of elderly support and care.... There is considerable evidence to show that [the] mechanisms of family support and care of the elderly have weakened. There is an increasing demand for institutional support by the elderly. This paper attempts to identify some of the underlying reasons that have prompted the elderly to make the decision to move out of the family kinship network and seek institutional support."

The role of local school quality in rural employment and population growth

"This study investigates the influence of school quality (measured at the high school level) on 1980 to 1990 population and employment change for nonmetropolitan fringe and hinterland census tracts in South Carolina. A Boarnet variation of the Carlino-Mills model is used to examine the interdependence of population and employment change.... Results...indicate that fringe tracts' population growth was positively related to student test scores, and hinterland tracts population and employment growth were negatively related to student-teacher ratios. Empirical results suggest that local school quality provided a positive influence on rural growth, primarily in terms of residential growth. The role of school quality for employment growth was less clear."

Effects of social support and personal coping resources on mortality in older age: the Longitudinal Aging Study Amsterdam

This study focuses on the role of social support and personal coping resources in relation to mortality among older persons in the Netherlands. Data are from a sample of 2,829 noninstitutionalized people aged between 55 and 85 years who took part in the Longitudinal Aging Study Amsterdam in 1992-1995. Social support was operationally defined by structural, functional, and perceived aspects, and personal coping resources included measures of mastery, self-efficacy, and self-esteem. Mortality data were obtained during a follow-up of 29 months, on average. Cox proportional hazards regression models revealed that having fewer feelings of loneliness and greater feelings of mastery are directly associated with a reduced mortality risk when age, sex, chronic diseases, use of alcohol, smoking, self-rated health, and functional limitations are controlled for. In addition, persons who received a moderate level of emotional support (odds ratio (OR) = 0.49, 95% confidence interval (CI) 0.33-0.72) and those who received a high level of support (OR = 0.68, 95% CI 0.47-0.98) had reduced mortality risks when compared with persons who received a low level of emotional support. Receipt of a high level of instrumental support was related to a higher risk of death (OR = 1.74, 95% CI 1.12-2.69). Interaction between disease status and social support or personal coping resources on mortality could not be demonstrated.

Quality of life and economic evaluation

The author examines "the place and role of quality of life in economic evaluation and welfare economics. That exercise certainly involves norms and judgments, but it is also influenced by our reading of factual possibilities, and it influences, in its turn, the nature of prescriptive possibilities we explore and the descriptive statements we choose to make. In this sense, the topic is not confined to welfare economics and involves other branches of economics as well." This essay consists of two lectures, the second of which examines how longevity, life expectancy, and gender- and race-determined mortality differences can contribute to our understanding of quality of life.