Self-esteem and optimism in rural youth: gender differences.

AIM: To identify and describe gender-related differences in the self-esteem and optimism levels of rural adolescents. BACKGROUND: Self-esteem and optimism have been broadly examined and are associated with health-practices, social interaction, attachment, resiliency, and personal identity. Information describing the relationship of self-esteem and optimism as it relates to gender is limited. METHODS: Using a cross-sectional survey design, students (N = 193) from three high-schools in rural Pennsylvania, USA completed the Rosenberg Self-Esteem Scale and the Optimism Scale-Life Orientation Test-Revised as part of a National Institute of Health, National Institute of Nursing Research funded study. RESULTS: Both instruments' mean scores were in the range of average for this population, with females scoring lower than males in both self-esteem (p < 0.0001) and optimism (p < 0.0001). The results of this study have nursing implications for evidenced based interventions that target self-esteem and optimism. Attention to self-esteem and optimism in female youth is recommended.

Health status versus utilities of patients with end-stage liver disease.

BACKGROUND: Health-related quality of life (HRQL) in patients with end-stage liver disease (ESLD) can be evaluated using either health-status questionnaires or utility assessment techniques. The two approaches have never been compared in terms of the values they assign to health prior to liver transplantation. STUDY DESIGN: We assessed health status of patients with ESLD using validated disease-specific instruments covering multiple domains (measures of disease, psychological status, personal function, social/role function, and general health perception). We also elicited utilities using formal approaches (standard gamble [SG] and time tradeoff [TTO]) and a simpler alternative (visual analog scale [VAS]). PATIENTS: Outpatients and inpatients at a single center prior to liver transplantation (n = 78). PRINCIPAL FINDINGS: Health status was generally poor (median physical symptoms score on a 0-1 [worst to best] scale, 0.33; psychological symptoms, 0; happiness, 0.50; personal function, 0; social/role function, 0.40; and general health perception, 0.40). The median VAS score was 0.50. The median TTO was 0.79, indicating that half of the patients in our sample chose healthier life in return for a 21% shorter life expectancy. The median SG score was 0.50, indicating that half of the patients were willing to take up to a 50% risk of death in exchange for perfect health. CONCLUSIONS: Both health status measures and utility assessments indicate that HRQL is compromised in patients awaiting liver transplantation. Despite the overall consistency between the two approaches, however, health status measures do not serve as reasonable proxies for utilities. For formal economic evaluations such as cost effectiveness analyses, only direct measures of utility can be used to quantify health states.