Older women's “ways of doing”: Strategies for successful ageing

This paper discusses older women's “ways of doing” which are occupational strategies that facilitate successful ageing by maintaining participation in meaningful occupations. The paper adopts an occupational perspective of health. This particular view of people as occupational beings who need to participate in personally meaningful occupations for their health and well being is central to occupational science, which provides the paper's theoretical framework. The occupational strategies were identified in a life history study exploring the occupational life course six rural Australian women. The study data were the women's life stories, which were narratively analyzed from occupational and feminist perspectives. Analysis revealed the women developed strategies, at each life stage, in response to the explicit and implicit exclusions they experienced in relation to occupational participation, within familial and social contexts. This paper focuses on strategies they developed in late adulthood, as a means of facilitating successful ageing. Although the study revealed that each woman developed unique strategies to meet her personal needs for participation, there are some common features of their strategies. This paper describes five significant features of the strategies which were highlighted when they were considered collectively. To enhance understanding of older women's “ways of doing,” two case studies from the life history study are presented and illustrated with examples of occupational strategies. The paper concludes with a discussion on the implications of occupational strategies and an occupational perspective of health for policies and programs that promote successful ageing.     

Family solidarity, popular opinion and the elderly: Perspectives from Norway

Currently, traditional values are being confronted with rapid social changes both outside and within families. Over the last decades, families have been changing shape, from “bottom heavy” (many children) to “top heavy” (many elderly). The norms of filial obligations are, however, still vital. This article discusses the many questions that are raised when family members want to do the “right thing” but, due to society’s changes, may not know what the “right thing” is. About the author: Svein Daatland is head of the research on ageing unit within NOVA-Norwegian Social Research. He is editor of the journalAldring and Eldre (Ageing and the Elderly).     

Which model of successful ageing should be used? Baseline findings from a British longitudinal survey of ageing

BACKGROUND: there is increasing interest in how to age 'successfully' and in reaching consensus over its definition. OBJECTIVE: to assess different models of successful ageing, using a British longitudinal survey of ageing in 2000-1. SETTING: community settings in Britain. METHODS: five models of successful ageing were tested on a British cross-sectional population survey of 999 people aged 65+. The models were biomedical, broader biomedical, social, psychological and lay based. RESULTS: the lay model emerged as the strongest. Respondents who were classified as successfully aged with this model, compared with those not successfully aged, had over five times the odds of rating their quality of life (QoL) as good rather than not good [odds ratio (OR) = 5.493, 95% confidence interval (95% CI) = 2.655-11.364]. CONCLUSION: the lay-based, more multidimensional, model of successful ageing predicted perceived QoL more powerfully than unidimensional models and should be used to evaluate the outcomes of health promotion in older populations.     

Reversibility of hepatic encephalopathy after liver transplantation

Until the advent of Liver transplantation, it was widely believed that Hepatic Encephalopathy (HE) was usually reversible. The exceptions were the so called “Acquired Hepatocerebral Degeneration cases” which were considered irreversible. Paradoxically, it seems, with liver transplantation, we have seen cases that contradict these rules. Whether the “residual effects” of HE, degenerative brain injury or independent neurological insults are causing post transplant neurological deficits is not easy to discern. As more emphasis is being put on maintaining brain ‘status’ after liver transplantation, we are finding confirmation of the largely reversible nature of HE. But, enough important exceptions to this rule are occurring to make further research on this topic mandatory.     

Rheumatoid arthritis: scientific development from a critical point of view

Rheumatoid arthritis (RA) is classified as a chronic, progressive, systemic autoimmune disorder leading to inflammation, stiffness, defective position and destruction of joints. Finally a complete loss of mobility and functioning can be the result. The fraction of disability varies strongly, for example, a systematic review shows a 50% disability in a period from first occurrence to disability from 4.5 to 22 years. Scientific efforts focused strongly on therapeutic and diagnostic methods during recent years. So far, there is no scientometric approach of the topic rheumatoid arthritis available although there is an increased need to evaluate quality and quantity of scientific research. Density-equalizing algorithms, scientometric methods and large scale data analysis were applied to evaluate the quality and quantity of scientific efforts in the field of rheumatoid arthritis. Data were gained from Pubmed and ISI-Web. During the period 1901–2007, 78,128 items were published by 129 countries including the USA, UK and Germany being the most productive suppliers, representing 45.7% of all publications. Another 23 countries published more than 100 items. In terms of international cooperation the USA proved to be the most successful partner. “Arthritis and Rheumatism”, “Annals of the Rheumatic Diseases” and the “Journal of Rheumatology” are the most prolific journals. The current study is the first analysis of “rheumatoid arthritis” research activities and output. Our analysis revealed single areas of interest, the most prolific journals, authors and institutions dealing with the topic. Nevertheless, statements concerning the scientific quality should be considered critical due to a bias according to self-citation and co-authorship.     

Physician Response to “By-the-Way” Syndrome in Primary Care

BACKGROUND/OBJECTIVE  “By-the-way” syndrome, a new problem raised by the patient at an encounter’s closure, is common, but little is known about how physicians respond when it occurs. We analyzed the content of the syndrome, predictors of its appearance, and the physician response. DESIGN/PARTICIPANTS  Cross-sectional study of 92 videotaped encounters in an academic primary care clinic. RESULTS  The syndrome occurred in 39.1% of observed encounters. Its major content was bio-psychosocial (39%), psychosocial (36%), or biomedical (25%), whereas physician responses were mostly biomedical (44%). The physician response was concordant with the patient’s question in 61% of encounters if the content of the question was psychosocial, 21% if bio-psychosocial, and 78% if biomedical; 32% of physicians solicited the patient’s agenda two times or more in the group without, versus 11% in the group with, the syndrome (P = 0.02). In 22% of the encounters, physicians did not give any answer to the patient’s question, particularly (38.5%) if it was of psychosocial content. CONCLUSIONS  “By-the-way” syndrome is mainly bio-psychosocial or psychosocial in content, whereas the physician response is usually biomedical. Asking about the patient’s agenda twice or more during the office visit might decrease the appearance of this syndrome. Previous presentation: Preliminary data were presented at the 2006 meeting of the Society of General Internal Medicine in Los Angeles as an oral presentation.     

Self-rated ill-health strengthens the effect of biomedical risk factors in predicting stroke,especially for men -- an incident case referent study

OBJECTIVES: To examine how self-rated ill-health interacts with biomedical stroke risk factors in predicting stroke and to explore differences between men and women and educational groups. DESIGN: An incident case-referent study where the study subjects had participated in a prior health survey. SETTING: Nested within the V?sterbotten Intervention Program (VIP) and the Northern Sweden MONICA cohorts. SUBJECTS: The 473 stroke cases had two referents per case, matched for age, sex and residence, from the same study cohorts. RESULTS: Self-rated ill-health independently increased the risk of stroke, specifically for men. The interaction effect between self-rated health and biomedical risk factor load was greater for men than for women. The attributable proportion due to interaction between having a risk factor load of 2+ and self-rated ill-health was 42% for men and 15% for women. Better-educated individuals with self-rated ill-health and two or more of the biomedical risk factors had a higher risk of stroke than the less educated. Calculations of the respective contribution to the stroke cases of self-rated health, hypertension and smoking showed that self-rated ill-health had a role in 20% of the cases and could alone explain more than one-third of the cases among those who rated their health as bad, more so for men than for women. CONCLUSIONS: The results underscore the importance of including both a gender and a social perspective in discussing the role of self-rated health as a predictor of disease outcome. Physicians must be more gender sensitive when discussing their patient's own evaluation of health in relation to biomedical risk factors.     

Definition of disease duration in ankylosing spondylitis

Two definitions of the “disease duration” of ankylosing spondylitis (AS) have been used in the literature: (1) duration since first symptoms connected with AS and (2) duration since diagnosis of AS. To investigate how useful these definitions are for research, we reinvestigated the data of four surveys completed by patients with AS in the years since 1996. We found that the majority of the patients remembered the age at first symptoms with an accuracy of ≤1 year, and that the difference between both definitions (the delay in diagnosis) was between 9.8 and 10.4 years on average, with extreme values of more than 30 years being not very seldom. Because the error made using the duration since diagnosis as “disease duration” is much larger than the inaccuracy taken into account using the duration since first symptoms, only the duration since first symptoms connected with AS should be used as definition for the term “disease duration” of AS.     

Expectations of Filial Obligation and Their Impact on Preferences for Future Living Arrangements of Middle-Aged and Older Asian Indian Immigrants

Filial obligation, described as culturally-defined rights and duties that prescribe how family members are expected to care for and provide support to each other, is an important variable that influences older immigrants’ preferences for living and care arrangements. This exploratory study examined variables associated with expectations of filial obligation among middle-aged and older, Asian Indian, first generation immigrants and explored the relationship between variations in expectations of filial obligation and expressed preferences for future living arrangements. Data were collected through telephone surveys of 226 English-speaking immigrants in Atlanta, GA. Although no significant relationships were observed between filial obligation expectations and length of residence in the U.S., respondents indicated a variety of preferred future living arrangements. Contrary to current living arrangement patterns found among older immigrants, very few respondents preferred to move in with their children. The most popular preference was to “move closer to children,” followed by “moving to a retirement community” with the majority preferring a retirement community geared to Asian Indians. Other preferences included “not moving” and “returning to India.” Variations in expectations of filial obligation, length of residence in the U.S., and self-rated health were significantly associated with these preferences. Implications are discussed for building capacity within ethnic communities to address living arrangement preferences and their repercussions for caregiving in ethnic families and in communities.     

Difficult Biliary Cannulation

Endoscopic retrograde cholangiopancreatography (ERCP) is the most technically challenging procedure routinely performed by endoscopists. ERCP cannulation requires the insertion of a subcentimeter catheter through a tiny orifice at a distance of almost a meter from the operator. Only after successful cannulation of the bile duct can the real “business” of ERCP be performed (eg, sphincterotomy, stone extraction, stent placement). Selective bile duct cannulation is all the more exacting due to the occasional anatomic challenge (eg, postsurgical anatomy, duodenal stricture) or wayward catheter. Serious morbid complications can and do occur, even in the hands of the most gifted and facile endoscopists. Although there are some “tricks” to facilitate successful cannulation of the bile duct, experience “trumps” all tricks. Of greatest importance when faced with a difficult cannulation is the recognition of one’s personal limitations.     

Hospitalized patients’ satisfaction with caregivers’ conduct and physical surroundings

The study examined the relative contribution of caregivers’ conduct and physical conditions of the hospital setting to patients’ global satisfaction with health care, while controlling for self-assessed health status. The study was performed in the Soroka Medical Center, which is the only inpatient facility for a population of 360,000 in southern Israel. Patients were interviewed using a structured questionnaire. Inclusion criteria were patients over 17 years of age, fluency in Hebrew, and hospitalization in the internal medicine wards for 24 hours or more. The dependent variable was “global satisfaction.” The independent variables were “satisfaction with caregivers’ conduct,” “satisfaction with physical surroundings and conditions,” and “self-assessment of health.” The three independent variables accounted for 36.8% of the variation in patients’ satisfaction with care, of which 87% related to “satisfaction with caregivers’ conduct.” In conclusion, hospital patients value the caregivers’ conduct more than the physical environment. From the Department of Epidemiology and Evaluation of Health Services, Faculty of Health Sciences, Ben-Gurion University of the Negev and Soroka Medical Center, Beer-Sheva, Israel The author is a Senior Lecturer of Epidemiology and Biostatistics.     

Empowering assisted living front-line care staffs to better care for alzheimer’s and dementia residents

Creating a feeling of empowerment among front-line care staff members may assist in better coping and achievement of quality care with a growing assisted living resident population who have Alzheimer’s disease or other forms of Dementia. The purpose of this qualitative research study was two fold in nature: (1) identify the training needs of front-line care staff members, and (2) create a training manual which would empower these front-line care staff workers to conduct their care duties in a more confident, effective, and sensitive manner. The first phase of this research was conducted with 24 front-line care staff in three assisted-living facilities in Illinois, New Mexico, and Florida, all women 18-69 years of age (M=36.8, SD=7.3), with 6 months to 10 years work experience in this job (M=2.19 years, SD=2.3 years). All reported that they had not received sufficient training in caring for this growing segment of the resident population. Based on responses to a needs-analysis questionnaire (n=24), a “Dementia-related Care Training” manual was developed. The following four themes emerged from needs analysis responses, and were the bases for the training modules: (1) experiencing the meaning of Alzheimer’s disease or other forms of Dementia, (2) acknowledging residents’ changing care needs over time, (3) realizing the importance of individualized care for residents, and (4) empowering front-line care staff members in the care process. The training manual was administered at the same three locations with some participants from the original sample (n=18), in order to receive feedback about the manual’s effectiveness and usefulness for a front-line care staff. Post-training feedback indicated that using such a training manual in an on-going manner would increase front-line care staffs’ job satisfaction and job commitment, as well as reduce job stress through better on-the-job coping skills learned. overseeing the licensing of all of the Brookdale owned and managed properties (67 total) throughout the United States. She also assists with staff training at the properties according in to state regulations. Ms Gurnik is a member of both ASA and LSN (Life Services Network). Her on-going research focuses on “quality of life” ageing issues related to caregiving, the workplace, retirement adjustment, and later-life education. Her area of specialty is industrial gerontology, the study of the ageing workforce.     

Common Processes in Evidence-Based Adolescent HIV Prevention Programs

Dissemination of evidence-based HIV prevention programs for adolescents will be increased if community interventionists are able to distinguish core, essential program elements from optional, discretionary ones. We selected five successful adolescent HIV prevention programs, used a qualitative coding method to identify common processes described in the procedural manuals, and then compared the programs. Nineteen common processes were categorized as structural features, group management strategies, competence building, and addressing developmental challenges of adolescence. All programs shared the same structural features (goal-setting and session agendas), used an active engagement style of group management, and built cognitive competence. Programs varied in attention to developmental challenges, emphasis on behavioral and emotional competence, and group management methods. This qualitative analysis demonstrated that successful HIV programs contain processes not articulated in their developers’ theoretical models. By moving from the concrete specifics of branded interventions to identification of core, common processes, we are consistent with the progress of “common factors” research in psychotherapy.     

Resection and primary anastomosis in acute complicated diverticulitis,a systematic review of the literature

Objective To determine the safety and feasibility of primary resection and anastomosis with or without a diverting stoma, as compared to Hartmann’s procedure, for patients with acute complicated sigmoid diverticulitis. Search Strategy MEDLINE was searched for studies and trials conducted between 1966 and December 2003. This search revealed trials comparing primary resection and anastomosis to Hartmann’s procedure. The term “diverticulitis, colonic” with the sub-heading “surgery” was used and the search was limited to human studies and clinical trials. Additional studies were found using the MeSH terms: “surgical procedures, operative”, “surgical anastomosis”, and “Hartmann procedure”, combined with the term “diverticulitis, colonic”. The author also searched EMBASE and the Cochrane database for clinical trials using similar terminology. No language restrictions were applied. Results Eighteen studies met the inclusion criteria and reported 884 patients with acute complicated diverticulitis. None of these studies were randomised; it is likely that there was a significant degree of selection bias. No significant differences were found between primary resection with anastomosis and Hartmann’s procedure with respect to mortality, morbidity, sepsis, wound complications and duration of procedure and anti-biotic treatment. Some studies found that primary anastomosis and a protecting stoma, with or without intra-operative colonic lavage, have more favourable results than Hartmann’s procedure. Conclusions This review suggests that surgical resection and primary anastomosis in acute diverticulitis with peritonitis compares favourably with Hartmann’s procedure in terms of peri-operative complications. The need for revision of Hartmann’s procedure could be subsequently avoided. Some articles showed that patients with severe peritonitis, who had a diverting stoma, in the setting of resection and primary anastomosis, had the lowest complication rate. However, the quality of these studies was poor with the presence of selection bias.     

‘In vivo’ optical approaches to angiogenesis imaging

In recent years, molecular imaging gained significant importance in biomedical research. Optical imaging developed into a modality which enables the visualization and quantification of all kinds of cellular processes and cancerous cell growth in small animals. Novel gene reporter mice and cell lines and the development of targeted and cleavable fluorescent “smart” probes form a powerful imaging toolbox. The development of systems collecting tomographic bioluminescence and fluorescence data enabled even more spatial accuracy and more quantitative measurements. Here we describe various bioluminescent and fluorescent gene reporter models and probes that can be used to specifically image and quantify neovascularization or the angiogenic process itself.     

Authentic Community as an Educational Strategy for Advancing Professionalism: A National Evaluation of the Healer’s Art Course

Background Efforts to promote medical professionalism often focus on cognitive and technical competencies, rather than professional identity, commitment, and values. The Healer’s Art elective is designed to create a genuine community of inquiry into these foundational elements of professionalism. Objective Evaluations were obtained to characterize course impact and to understand students’ conceptions of professionalism. Design Qualitative analysis of narrative course evaluation responses. Participants Healer’s Art students from U.S. and Canadian medical schools. Approach Analysis of common themes identified in response to questions about course learning, insights, and utility. Results In 2003–2004, 25 schools offered the course. Evaluations were obtained from 467 of 582 students (80.2%) from 22 schools participating in the study. From a question about what students learned about the practice of medicine from the Healer’s Art, the most common themes were “definition of professionalism in medicine” and “legitimizing humanism in medicine.” The most common themes produced by a question about the most valuable insights gained in the course were “relationship between physicians and patients” and “creating authentic community.” The most common themes in response to a question about course utility were “creating authentic community” and “filling a curricular gap.” Conclusions In legitimizing humanistic elements of professionalism and creating a safe community, the Healer’s Art enabled students to uncover the underlying values and meaning of their work—an opportunity not typically present in required curricula. Attempts to teach professionalism should address issues of emotional safety and authentic community as prerequisites to learning and professional affiliation.     

Consequences of men’s retirement for the continuation of work-related personal relationships

Retirement is an important life-cycle marker and has a major impact on an individual’s functioning. Based upon the social convoy model, it is hypothesized that retirement decreases the likelihood of continuation of coworker relationships. Socio-emotional selectivity theory predicts a decline in the number of peripheral relationships with ageing and thereby a decline in network size and number of co-worker relationships among working and retired people. Data comes from the Longitudinal Aging Study Amsterdam, with five observations between 1992 and 2002. At baseline, 226 men aged 54–81 years were employed; 166 men retired in the course of the study. The results of multilevel regression analyses showed a stable network size for both working and retired men. Among all men, the number of work-related network members declined, but more strongly among retirees. It is concluded that the convoy model fits better with the data than does socio-emotional selectivity theory. His research interests include developments in personal networks and the effects of personal network characteristics and social support on well-being. This study is based on data collected in the context of the “Living Arrangements and Social Networks of Older Adults” and “Longitudinal Aging Study Amsterdam” research programs. These programs are conducted at the Vrije Universiteit in Amsterdam and the Netherlands Interdisciplinary Demographic Institute in The Hague, and are funded by the Netherlands Program for Research on Ageing (NESTOR) and the Ministry of Health, Welfare and Sports.     

Massage therapy for fibromyalgia symptoms

Massage therapy is widely used by patients with fibromyalgia seeking symptom relief. We performed a review of all available studies with an emphasis on randomized controlled trials to determine whether massage therapy can be a viable treatment of fibromyalgia symptoms. Extensive narrative review. PubMed, PsychInfo, CINAHL, PEDro, ISI Web of Science, and Google Scholar databases (inception-December 2009) were searched for the key words “massage”, “massotherapy”, “self-massage”, “soft tissue manipulation”, “soft tissue mobilization”, “complementary medicine”, “fibromyalgia” “fibrositis”, and “myofascial pain”. No language restrictions were imposed. The reference lists of all articles retrieved in full were also searched. The effects of massage on fibromyalgia symptoms have been examined in two single-arm studies and six randomized controlled trials. All reviewed studies showed short-term benefits of massage, and only one single-arm study demonstrated long-term benefits. All reviewed studies had methodological problems. The existing literature provides modest support for use of massage therapy in treating fibromyalgia. Additional rigorous research is needed in order to establish massage therapy as a safe and effective intervention for fibromyalgia. In massage therapy of fibromyalgia, we suggest that massage will be painless, its intensity should be increased gradually from session to session, in accordance with patient’s symptoms; and the sessions should be performed at least 1–2 times a week.     

Cardiovascular Disease Risk Among Light and Nondaily Smokers

Cigarette smoke is a major risk factor for cardiovascular disease and related mortality. Despite overall decreases in smoking prevalence, light and nondaily smoking is increasingly prevalent. However, the health effects of lower-level cigarette consumption have received less empirical attention to date. Previous research suggests a nonlinear dose-response relationship between smoking level and cardiovascular disease and mortality. In this review, we highlight research investigating the relationship between cardiovascular health risk and light and nondaily smoking, including research examining the mechanisms hypothesized to explain the effects of differing levels of cigarette smoking on cardiovascular health. We conclude that the research community should agree on definitions for “light” and “nondaily” smoking in order to facilitate future research regarding the cardiovascular health effects of these types of smoking patterns and that future examination of the cardiovascular effects of nondaily smoking is critical given the dearth of research in this area.     

Clinical implications of body image among rural African-American women

OBJECTIVE: To increase understanding of body image among rural, African-American women through open-ended interviews. DESIGN: Individuals’ perceptions of body image were investigated using open-ended, in-depth interviews that were taperecorded, transcribed, and analyzed to identify common themes and to compare thematic data across three body mass index categories (obese, overweight, and normal). SETTING: University-affiliated rural community health center. PARTICIPANTS: Twenty-four African-American women, aged 21 to 47 years. MAIN RESULTS: Respondents reported the following common themes: dissatisfaction with current weight; fluctuating levels of dissatisfaction (including periods of satisfaction); family and social pressure to be self-accepting; and social and physical barriers to weight loss. The interviews revealed ambivalence and conflicts with regard to body image and weight. Among these women, there was strong cultural pressure to be self-accepting of their physical shape, to “be happy with what God gave you,” and to make the most of their appearance. CONCLUSIONS: The pressure to be self-accepting often conflicted with these obese women’s dissatisfaction with their own appearance and weight. Although the respondents believed they could lose weight “if [they] put [their] mind to it,” those women wanting to lose weight found that they lacked the necessary social support and resources to do so. The conflicts stemming from social pressures and their own ambivalence may result in additional barriers to the prevention of obesity, and an understanding of these issues can help health care providers better address the needs of their patients. This work was supported by grant RO1HL43611 from the National Heart Lung and Blood Institute.