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PubMed1986

Unemployment-related lifestyle changes and health disturbances in adolescents and children in the western countries.

According to official statistics 11 million under 25's, thereof 5-6 million under 20's in the 12 OECD member states are unemployed at any given time. In depth studies show that this figure is at least 40-50% higher. In many countries a systematic under-reporting exists in the registration of unemployed. Surveys used to show more relevant figures. Unemployment hits mainly adolescents, school leavers, young adults (unskilled male and female) immigrants and then, indirectly, those who are in need of familial and social support, i.e. the frail, sick, disabled children and old people. In many cities in Europe 40-50% of 18-25 year olds are unemployed and figures as high as 90% have been reported (inner cities). Unemployment is endangering the socio-economic status of people, in spite of short-time unemployment benefits and is creating inequalities in health and serious social misfits. Loss of job or the mere prospect of becoming jobless have, in follow-up studies on an individual level, been found to cause elevated blood pressure and serum cholesterol, increased concentration of blood catecholamine and elimination of noradrenaline, an increase in the frequency of stress and psychosomatic diseases. After regaining employment, these values have normalized. Unemployment is therefore considered by many as a real source of stress. Chronic stress is now considered as a major contributor to cardiovascular diseases, ulcers, asthma and some other diseases. According to several well designed and controlled studies on the individual level in the developed countries, the majority of young people do not learn to cope with unemployment. It fosters isolation, loss of self-esteem, frustration and hopelessness.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1996

The menopause: women's psychology and health care.

Menopause has often been described as a time of loss and decay in the lay and medical literature. The present research aims at defining women's perception of themselves and their health care needs in this period of life. Through a community-based sample of women, participative assessments were performed and their conclusions contrasted with the opinions of male and female gynecologists. Though both groups coincided concerning the relevance of loneliness, partnership, beauty and the "empty nest" syndrome, several items showed a marked difference between both groups. Gynecologists tended to perceive women as much more striving for an active sex-life, depressed, lacking projects for the future and worried about their health care than they actually were. Women, instead, stressed the relevance of menopause as a life crisis laden with opportunities for self-accomplishment and positive changes in life-style towards greater autonomy.

Attitude of Health Personnel↗
PubMed2006

Relationships among trait, situational, and comparative optimism: clarifying concepts for a theoretically consistent and evidence-based intervention to maximize resilience.

Research evidence identifies trait optimism as the strongest individual predictor of adolescent resilience when framed within Lazarus's theory of stress and coping. As a precursor to the development of an intervention to maximize resilience, this study clarifies the concept of optimism. Relationships among trait, situational, and comparative optimism were explored. The sample (N = 132) consisted of rural adolescents between 14 and 18 years old who were attending public school. The results demonstrate weak correlations, suggesting that adolescents' perceptions of situations may be amenable to an intervention to maximize resilience but that adolescents also do not expect to experience health or environmental problems. Implications for developing an intervention are discussed.

Adaptation, Psychological↗
PubMed2004

Stress and the aging immune system.

Immune functioning decreases with normal aging and with stress. Social and psychological stressors are a part of daily life and the source of life changing events. Across the lifespan, individuals encounter numerous stressors with effects that accrue at sundry rates due to differential stress exposure, differential stress buffering, differential stress reactivity, differential stress duration (recovery), and differential restorative processes. Research on stress in older adults provides evidence that these processes contribute to effects that mimic, exacerbate, and possibly accelerate the effects of aging on immunity.

Aging↗
PubMed2006

Risk factors and protective factors in relation to subjective health among adult female victims of child sexual abuse.

OBJECTIVE: To investigate the relationships between risk and protective factors and health outcome in a sample of adult females who had been victims of child sexual abuse. METHOD: Both person- and variable-oriented analyses were applied to questionnaire data from a non-clinical group of women (n = 152) reporting sexual abuse during childhood. RESULTS: Six groups with different patterns of risk and protective factors were found by cluster analysis. Two groups (Good Coping and Support Compensation) had significantly better health than expected in spite of severe abuse. Self-esteem and social support were strong predictors of health in the regression models. CONCLUSION: The relationships between risk and protective factors and health may be different in different groups of victims of child sexual abuse. Self-esteem was closely related to health outcome displaying the importance of this concept in clinical practice. Availability of resources seems to be more important for health outcomes than the amount of risk factors.

Adult↗
PubMed2004

Perioperative management of the post-gastric-bypass patient presenting for body contour surgery.

Bariatric surgery has evolved as an effective and relatively safe treatment for morbid obesity. With nearly every region of the body as a potential operative site and an unprecedented number of surgical procedures available, we must give attention to thoughtful perioperative management. Bariatric surgery is a life-changing event for the morbidly obese patient, and the body contouring that follows weight loss often has an equally profound effect. Plastic surgeons must strive to maintain the highest level of safety in this pursuit. The authors address issues surrounding preoperative evaluation and measures to minimize the risk of complications.

Comorbidity↗
PubMed2005

Lifestyle changes following acute myocardial infarction: patients perspectives.

BACKGROUND: Cardiovascular disease accounts for 39% of all deaths in Ireland each year. Many of these deaths are due to acute myocardial infarction (AMI). The diagnosis of AMI has major implications for individuals in terms of health and social gain, health related quality of life and living and adapting to a chronic illness. The diagnosis requires lifestyle changes such as changes to diet, smoking habit, physical activity, and stress management. AIMS: The aim of this descriptive qualitative study was to explore patients' perspectives of making lifestyle changes following AMI. METHODS: Using a descriptive qualitative approach, ten participants were interviewed 6 weeks following discharge about their experiences. Data were collected using in depth interviews and analysed using thematic analysis. RESEARCH FINDINGS: Four themes emerged: lifestyle warning signs, taking responsibility for lifestyle changes, professional support and looking forward to the future. The findings offer insight into the everyday realities, which patients experience regarding lifestyle changes particularly in relation to smoking cessation and stress management. The difficulties encountered by participants 6 weeks following discharge reflect the implementation of too many life style changes at once as well as the lack of professional help in the community to support participants in their endeavours to make lifestyle changes. In addition, overprotection by family members was a source of frustration and aggravation for participants. CONCLUSION: The study highlights the need for the development of primary care services and cardiac rehabilitation programmes to support patients as well as providing information to families to reduce anxiety and fear.

Adaptation, Psychological↗
PubMed2004

Parent-reported health status after pediatric thoracic organ transplant.

BACKGROUND: Thoracic organ transplantation is a life-changing event for a child and family from both a physical and a psychosocial perspective. Accurate pre-transplantation counseling and effective post-transplantation follow-up depend on a good understanding of post-transplantation health status, especially as perceived by families. METHODS: The Child Health Questionnaire-Parent Form 50 (CHQ-P50), an instrument that assesses parent-reported health status of pediatric patients, was administered to 47 pediatric thoracic organ transplant recipients (41 heart, 6 lung) 5 to 18 years of age. RESULTS: Transplant recipients scored lower on the Physical Health Summary (PhS) score than the general population, as evidenced by a lower median score (50.6 vs 55.1, p < 0.0001) and a difference in the distribution of quartiles (p = 0.001), skewed toward the lower quartiles of the general population. The distribution of PhS scores in transplant recipients was comparable to scores of 3 groups of pediatric patients with other chronic health conditions (juvenile rheumatoid arthritis, epilepsy and asthma). The distribution of the Psychosocial Health Summary (PsS) scores was similar to that of the general population, but the median score was lower (51.5 vs 53.2, p = 0.02). Transplant patients clearly scored lower than the general population on 4 of 12 sub-scales, including those assessing general health, physical functioning, family activities and parental emotional impact. No difference was found in sub-scales reflecting self-esteem, mental health, behavior, pain, peer interactions, family cohesion or parental time demands. CONCLUSIONS: Thoracic organ transplantation in children ages 5 to 18 years is associated with an ongoing deficit in parent-perceived physical health status.

Adolescent↗
PubMed2004

Changing perceptions of womanhood: living with Parkinson's Disease.

This study adopted a multiple case study design to develop our understanding of the experiences and adjustments made by women with Parkinson Disease in relation to womanhood. Nineteen women participated in this investigation telling their stories through a combination of individual interviews, group interviews, reflective diaries, reflective tapes and creative writing. Data were analysed using the framework of Intrapersonal, Interpersonal, Extrapersonal and Metapersonal health proposed by Boddy and Rice (Perspectives on Health and Illness, Dunsmore Press, Palmerston North, 1992). Women reported that major changes were required in their lives in each of these aspects of health. In particular women reported labile emotions, changing body images, changing lifestyles, changing relationships with partner, family and friends, increasing dependence, decreasing role fulfillment and the need for support versus increasing isolation. The findings are of particular relevance to nurses and other health professionals involved with women with Parkinson's Disease as well as social services and voluntary agencies.

Activities of Daily Living↗
PubMed2005

Building a successful support group for post-amputation patients.

The purpose of this article is to identify five steps to attain a successful amputee support group and share the process for establishing and maintaining a peer visitation program for in-patient amputees. Whatever the cause, losing a limb is a life-changing event that one should not go through alone. Support groups can assist patients and their families through this transition in a positive and healthy way.

Amputation, Surgical↗
PubMed2006

Patient empowerment in theory and practice: polysemy or cacophony?

OBJECTIVE: This paper examines how the term "empowerment" has been used in relation to the care and education of patients with chronic conditions over the past decade. METHODS: Fifty-five articles were analysed, using a qualitative method of thematic analysis. RESULTS: Empowerment is more often defined according to some of its anticipated outcomes rather than to its very nature. However, because they do not respect the principle of self-determination, most anticipated outcomes and most evaluation criteria are not specific to empowerment. Concerning the process of empowerment, our analysis shows that (i) the educational objectives of an empowerment-based approach are not disease-specific, but concern the reinforcement or development of general psychosocial skills instead; (ii) empowering methods of education are necessarily patient-centred and based on experiential learning; and (iii) the provider-patient relationship needs to be continuous and self-involving on both sides. CONCLUSION: Our analysis did not allow for the unfolding of a well-articulated theory on patient empowerment but revealed a number of guiding principles and values. PRACTICE IMPLICATIONS: The goals and outcomes of patient empowerment should neither be predefined by the health-care professionals, nor restricted to some disease and treatment-related outcomes, but should be discussed and negotiated with every patient, according to his/her own particular situation and life priorities.

Attitude to Health↗
PubMed2004

Life-course experiences and mortality by adult social class among young men.

Circumstances over the life-course may contribute to adult social class differences in mortality. However, it is only rarely that the life-course approach has been applied to mortality studies among young adults. The aim of this study is to determine to what extent social class differences in mortality among young Finnish men are explained by living conditions in the parental home and life paths related to transitions in youth. The data for males born in 1956-60 based on the 1990 census records are linked with death records (3184 deaths) by cause of death for 1991-98, and with information on life-course circumstances from the 1970, 1975, 1980, and 1985 censuses. Controlling for living conditions in the parental home-social class, family type, number of siblings, language and region of residence-reduced the high excess mortality of the lower non-manual (RR 1.51, 95% CI: 1.28-1.79), skilled manual (RR 2.94, 2.54-3.40), and unskilled manual class (RR 4.08, 3.51-4.73) by 10% in all-cause mortality. The equivalent reduction for cardiovascular disease was 28% and for alcohol-related causes 16%. The effect of parental home on mortality differences was mainly mediated through its effect on youth paths (pathway model). Educational, marital, and employment paths had a substantial effect-independent of parental home-on social class differences from various causes of death. When all these variables were controlled for adult social class differences in cause specific mortality were reduced by 75-86%. Most of this reduction in mortality differences can be attributed to educational path. However, marital and employment paths had their independent effects, particularly on the excess mortality of unskilled manual workers with disproportionately common exposure to long-term unemployment and living without a partner. In summary, social class differences in total mortality among men in their middle adulthood were only partly determined by parental home but they were mainly attributable to educational, marital, and employment paths in youth.

Adult↗
PubMed2004

The Israeli kibbutz as a venue for reduced disability in old age: lessons from the Cross-sectional and Longitudinal Aging Study (CALAS).

It is important to identify ways to moderate disability in old age. We assessed whether the kibbutz way of life results in reduced disability by examining risk factors for disability in three comparable populations: kibbutz members (lifetime kibbutz exposure); parents of kibbutz members who came to live on the kibbutz in old age due to health and social needs (old age exposure); and comparable Israelis in the general population (no exposure). Kibbutz members were less disabled, defined as needing help with at least one of five activities of daily living, than the other groups. Kibbutz members had 30% lower risk of disability, after controlling for sociodemographics and social networks, health and health behaviors, and life history and background. Introducing length of residence in current home and death of a child to the analysis reduced this finding to non-significance. Overall, risk of disability was significantly higher for older age groups, women, homemakers, people with more comorbid conditions, those with more children, and those with a child that had died, while risk of disability was significantly lower for those with larger social networks, those who had engaged in physical activity at midlife, and those who had lived in their homes longer. Since occupations on the kibbutz (primarily agricultural and blue collar) have equal pay, and kibbutz members have complete economic security, our results suggest that it is not such occupations themselves but their association with low incomes that have contributed to previous associations of blue collar and agricultural occupations with poor health and high disability. Lower disability among kibbutz members may be due to the social, economic, and instrumental support provided on the kibbutz, as well as to an active life style, suggesting features of kibbutz life that can be replicated elsewhere to reduce disability.

Activities of Daily Living↗
PubMed2006

Is chronic widespread pain biographically disruptive?

This article draws on findings from a study of eight people (aged 40-60) with chronic widespread pain and their families, living in the West Midlands area of the UK. Data were generated through a series of in-depth interviews, based on a lifegrid and on participants' diaries. We explore the experience of chronic widespread pain in the context of sufferers' biographies, examining how people attempt to account for and give meaning to their pain onset and development and how they remake identity following disruption to their lives. We use these accounts to consider whether chronic widespread pain is biographically disruptive, or whether any of the alternative notions better describe the experience. We conclude that the consideration of context in biographical disruption should extend to lifestage and perceived life expectancy.

Adaptation, Psychological↗
PubMed2003

Self-concept as a "BMT patient", illness intrusiveness, and engulfment in allogeneic bone marrow transplant recipients.

OBJECTIVE: The experience of cancer and its treatment by bone marrow transplantation (BMT) can enhance the salience of one's status as a patient in the evolution of self-concept. Illness and the patient role can come to dominate the sense of self, resulting in feelings of hopelessness, helplessness, and distress ("engulfment"). Illness-induced lifestyle disruptions ("illness intrusiveness") introduce adaptive demands, challenging preexisting conceptions of self. Illness intrusiveness and engulfment may interact, leading affected individuals to construe themselves as highly similar to a prototypical "BMT patient". METHODS: Ninety allogeneic BMT outpatients completed the Illness Intrusiveness Ratings Scale, Modified Engulfment Scale, and a semantic differential measure of self-concept as a BMT patient in an interview context. RESULTS: Illness intrusiveness correlated significantly with engulfment (r=.58, P<.0001) and with self-concept as a BMT patient (r=.27, P<.016). Engulfment did not correlate significantly with self-concept as a BMT patient (r=.15). Multiple regression analysis, controlling for relevant covariates, indicated a significant Illness Intrusiveness x Engulfment interaction effect on self-concept as a BMT patient [F(1,84)=4.93, P<.029]. CONCLUSIONS: Self-concept as a BMT patient increases as cancer and its treatment introduce increasing lifestyle disruptions (illness intrusiveness). These effects are amplified when self-experience is dominated by disease and treatment and patients feel helpless, hopeless, and distressed (engulfment).

Adaptation, Psychological↗
PubMed1997

Stress and sensitization in children: a controlled prospective psychophysiological study of children exposed to international relocation.

This controlled prospective study investigated the development of sensitization as a result of international relocation in children, using the analyzing system Phadiatop. The effects of climate and predisposition to allergy were also measured. Children were examined prior to and during their first year of living abroad. A control group living at home was also examined during the same period. Participants answered a questionnaire before and after 1 year abroad, and blood samples were collected to determine sensitization. Before going abroad, there were no significant differences in atopic sensitization between groups nor in other key variables. After 1 year abroad, the proportion of children showing sensitization had increased significantly as compared with the control group at home. The exposed group reported an increase in skin symptoms during the year abroad. This study suggests that unidentified factors associated with foreign relocation increase the risk of sensitization in predisposed children. Stress might be one factor.

Acclimatization↗
PubMed1984

Recurrent abdominal pain in school children: the loneliness of the long-distance physician.

The recurring of abdominal pain can be a taxing clinical ordeal for the primary care physician or consultant. It often is a test of stamina, of diagnostic self-confidence, of fiscal constraint, and of vigilance for rare conditions. The clinician is apt to be haunted by the lingering question: "Am I missing something?" That which might or might not be "missed" comprises the content as well as the rationale for this review.

Abdomen↗