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PubMed2003

A biopsychosocial approach to premenstrual dysphoric disorder.

Though epidemiological data is difficult to collect, existing evidence indicates that there is a small but significant population of women in whom premenstrual symptoms, and particularly affective symptoms, severely impair functioning. Although PMDD is predominantly regarded as a biologically based illness, there is strong evidence that variables such as life stress, history of sexual abuse, and cultural socialization are important determinants of premenstrual symptoms. In diagnosing and treating PMDD patients, attention to biological and sociocultural variables is recommended.

Adult↗
PubMed2000

Health-related lifestyles and alienation in Moscow and Helsinki.

Health-related lifestyles (smoking, drinking alcohol, exercise and diet) and feelings of alienation (powerlessness and hopelessness) of the citizens of Helsinki and Moscow are examined and discussed in a framework of life chances and life choices. The data were collected by a postal survey of 18-64 yr old citizens of Helsinki (N = 824) and Moscow (N = 545) in 1991. Almost all respondents in both cities used alcohol, but heavy drinking was more frequently reported in Helsinki. Muscovite men were smokers more often and Muscovite women less often than their counterparts in Helsinki. Nearly half of the Muscovites, but less than one-fifth of the Helsinki respondents considered their diet unhealthy or of poor quality. Regular exercise was much more common among the Finns compared to the Muscovites. The sex difference in health-related lifestyles was wider in Moscow than in Helsinki, especially concerning health-damaging behaviour. Feelings of alienation were more pronounced in Moscow. In both cities alienation was more clearly associated with socioeconomic life chance factors than with lifestyle factors. In Helsinki feelings of alienation had stronger associations both with health and health related lifestyles, which possibly points to a conventional stratification effect of a market-based class society. In Moscow, which represents a more traditional community, alienation seemed to be part of a widely felt general discontent. Health was a highly salient value in both cities, especially among women. In Helsinki a high valuation of health was connected with less smoking, more exercise and a healthier diet. Valuing health did not seem to emerge as a distinct healthy lifestyle in Moscow where behavioural choices were limited by many material constraints.

Adolescent↗
PubMedDate not supplied

Gaining a new perspective on life as a consequence of uncertainty in HIV infection.

HIV infection affects the lives of hundreds of thousands of North Americans. The experience of those infected is one of enormous upheaval. An HIV diagnosis can disrupt both daily life and the ability to plan for the future. Central to this experience is the uncertainty of a disease with vague symptomatology, changing medical management, and social stigma. This qualitative study explores the experience and consequences of uncertainty in the lives of 10 people with HIV infection. In-depth focused interviews were conducted to explore uncertainty after HIV diagnosis. Findings reveal that individuals living with HIV infection form a new perspective on life, which is maintained through five core experiences: surviving the HIV diagnosis, taking care, living in the present, seeking support, and appreciating the positive. Each core experience is comprised of a number of actions used by the individual to formulate and maintain the new perspective on life.

Adaptation, Psychological↗
PubMed2002

Living with angina pectoris--a phenomenological study.

Angina pectoris is a common medical condition with a high mortality and morbidity rate and normally requires medical therapy to control symptoms. The impact of angina and treatment strategies are gauged almost solely on clinical measurements. This approach does not provide insight into the effects of the disease from the patients' perspectives. Understanding these effects enables a patient centred approach to care, which may facilitate adherence to treatment strategies. Previous studies examining heart disease from the patients' perspective have tended to focus on myocardial infarction or coronary surgery and not, as this study does, on angina per se. Unstructured interviews of seven patients with clinically stable angina pectoris were carried out and analysed using a phenomenological approach. Seven themes were identified: limitation and adjustment; resignation; indignation; caution; reluctant compliance; surprise; and the unknown. Patients made adjustments to their lifestyles because of the limitations imposed on them by angina. These changes were accepted reluctantly, initially with annoyance, but ultimately with resignation. They were cautious in everyday activities to avoid something 'worse' happening. On the whole, they were surprised that they had developed the disease despite little understanding of risk factors. They had not considered the long-term effects of the disease. Angina patients need to have access to information sources to understand the disease and to make adjustments to their lives. An opportunity to discuss the disease with a specialist health care professional is essential. The study showed that phenomenology has a contribution to make in areas such as cardiology where the research agenda is predominantly positivistic.

Activities of Daily Living↗
PubMed2003

Experiences of the onset of coronary artery disease in a spouse.

The purpose of this study was to describe the experiences of persons whose spouses have newly diagnosed coronary artery disease (CAD). The purpose was to obtain knowledge that would help us to understand better the life of persons with a chronically ill spouse and to develop the education and rehabilitation of both the patients and their spouses. Data were collected from healthy spouses by an open-ended question. There were 146 informants. They were asked to write about their experiences of everyday life after their spouse had been diagnosed for CAD. The data were analyzed by methods of content analysis. The following categories were formulated to describe the healthy spouses' experiences: slow pace of life, limited life and unsure life. Slow pace of life meant that the disease had been adopted as a normal part of life. Life was organized in a new way, and the earlier busy and work-oriented lifestyle had been given up. The informants whose spouses had medication considered their personal freedom to be limited, because they had to assume responsibility for the care of their spouses. The spouses of the patients who had undergone bypass surgery (CABS) or angioplasty (PTCA) had a new role in the family. They had to monitor for symptoms, treat symptoms, take care, understand and support. They had to assume responsibility for everyday life. They felt themselves to be alone in that situation. They did not receive support from health care providers. All informants felt uncertainty due to financial problems, poorly planned care and unexpected changes in the course of the disease. As a conclusion, it can be said that life was limited by the sick spouse's needs. The disease caused changes in emotional balance, a need for continuous control of life, fears about a new myocardial infarction and worries about many issues of everyday life.

Adaptation, Psychological↗
PubMed1992

Some determinants of population variation in cortisol levels in a British urban community.

Urinary cortisol excretion rates were determined from three urine samples given over 2 days, a rest day and a working day, by 51 men and 50 women. Each subject also completed a questionnaire relating to life style factors and to perceived levels of stress, busyness and happiness on each day. In men, an association between raised cortisol and high levels of stress was found. In women, high levels of busyness were associated with low cortisol excretion rates. The subjective experiences measured accounted for around 10-20% of cortisol variation in this naturalistic setting.

Adult↗
PubMed2000

Differences in verbal behaviours of patients with and without emotional distress during primary care consultations.

BACKGROUND: In primary care consultations patients with emotional distress tend to give verbal cues or symptom reports with psychological or psychiatric contents. This study examined the cue behaviour defined not only by psychological, but also by medical, social and life episodes related contents in patients with and without emotional distress, recognized and not by their GP. The GP's verbal behaviour in relation to patients' cue emission was also investigated. METHOD: For the six participating GPs two groups of matched pairs of patients (N = 238) were created. The two groups comprised either patients considered by GPs as being without emotional distress or patients considered as emotionally distressed. Within each pair, one patient was a case (GHQ-12 score > 2) and the other was the matched control (GHQ-12 score < 3). The medical interviews with these patients were transcribed and classified according to the Verona Medical Interview Classification System (VR-MICS). RESULTS: GHQ positive patients of both groups gave more cues in terms of total proportion than their matched controls (GHQ negative patients). The proportion of cues given by patients was related also to GP's verbal behaviour, increasing with closed psychosocial questions and decreasing with the use of active interview techniques. Attribution of emotional distress was more frequent when patients were high attenders and had a past psychiatric history. The content of cues changed in relation to GP's attribution: recognized patients gave more cues and more often with psychological content, patients not recognized as distressed gave mainly cues related to their lifestyle and life episodes. CONCLUSIONS: To improve the recognition of those emotionally distressed patients most likely to be missed GPs should increase their attention to cues related to life style and life episodes.

Adult↗
PubMed2001

Healthy aging among inner-city men.

OBJECTIVE: Until now, prospective studies of aging have begun with 50- to 60-year olds, not adolescents. Premature deaths, childhood variables, and alcohol abuse have been often ignored. So has positive aging. As people live longer, gerontology needs to understand the determinants of health as well as illness in the later years. METHOD: The present study follows a cohort of adolescent boys (332 inner-city youths) for 60 years or until death. Complete physical exams were obtained every 5 years and psychosocial data every 2 years. Predictor variables assessed prior to age 50 include six variables reflecting uncontrollable factors--parental social class, environmental strengths, number of family problems, major depression, ancestral longevity, and premorbid physical health at age 50--and six variables reflecting (at least some) personal control: alcohol abuse, smoking, marital stability, body mass index, coping mechanisms, and education. The four outcome variables chosen to assess healthy aging at 70 reflected both "mind" and "body." They included objectively assessed variables (death and/or disability prior to 70, and objective mental health) and two subjectively assessed variables (perceived instrumental activities of daily living and life enjoyment). RESULTS: Multivariate analysis suggested that positive aging at 70 could be predicted by variables assessed prior to age 50. More hopeful still, if the six variables under some personal control were controlled, depression was the only uncontrollable variable that affected the quality of subjective and objective aging. CONCLUSIONS: First, we may have greater personal control over our biopsychosocial health after retirement than previously recognized. Second, in this cohort, psychiatric rather than sociological predictors appeared more important.

Adolescent↗
PubMed2000

Stability and change in structural social relations as predictor of mortality among elderly women and men.

In a follow-up study of 70-95 years old women and men (n = 911) we studied the association between change and stability in three structural aspects of social relations (contact frequency, contact diversity, cohabitation status) from 1986-1990 and mortality after the next four years in 1994. Women aged 70-74 years who developed low contact frequency or developed small contact diversity showed significantly higher mortality, adjusted ORfreq: 3.78 (1.08-13.20), adjusted ORdiv: 3.79 (1.24-11.58). Women aged 70-74 years with continuously low contact frequency showed an increased mortality compared to women constantly experiencing high contact frequency, adjusted OR: 2.75 (1.04-7.26). A tendency in the same direction for sustained small contact diversity was found, adjusted OR: 1.98 (0.70-5.61). Among women aged 75+ years no impact of frequency and diversity was demonstrated, whereas continuously living alone was a significant predictor of mortality, when compared to women continuously living with somebody, adjusted OR: 2.57 (1.29-5.09). In men, we found a significantly increased mortality among those who developed high contact frequency and developed large contact diversity ORfreq: 3.91 (1.02-14.94) and ORdiv: 6.04 (1.30-28.03). In summary, we found rather larger age differences in the strength of the association between change in structural social relations and mortality. Furthermore, the associations seemed stronger among women than men, which may however mainly be explained by the small number of men in our cohort.

Aged↗
PubMed1981

Life stress, life-styles, depression, and illness in adult women.

The relationships between life stress and depression and physical illness were investigated in a sample of 122 normal adult women. Results indicated that life stress was associated with both illness and depression in this sample but that both type of stress and life-style were important moderators of these relationships. Thus, work stresses were associated with illness (not depression), and the relationship between life stress and illness was strongest among work-centered women. Family stresses were associated with depression (not illness), and the relationship between life stress and depression was strongest among housewives. Implications for sex role definitions are discussed.

Adult↗
PubMed1992

Personal goals of older adults: issues in assessment and prediction.

This study identifies dimensions of individual difference in the content of older adults' personal goals and examines demographic, loss-related, and contextual influences on these goals. Results are based on the responses of 179 elders to a 112-item inventory designed to tap achievement, maintenance, disengagement, and coping goals in 16 life domains. Factor analyses yielded 10 dimensions that describe themes of global motivation, concerns about support and desired pace, and complexity of life. Demographic disadvantages and age-related transitions were related to greater desire for disengagement, support, and stability. Elders who were married and healthy were more likely to report a desire for an energetic life-style. Results are discussed in terms of implications for future research on elders' goals as a context for understanding the meaning of self-evaluation and environmental influences on aging.

Achievement↗
PubMed2003

Variations in patterns of developmental transitions in the emerging adulthood period.

The assumption of adult roles has largely been examined as status changes in school attendance, leaving the parental home, and marriage. Nevertheless, levels of autonomy and individuation vary considerably within these states. This study obtained such information through narrative behavioral descriptions within financial, residential, romantic, and family formation domains covering ages 17 to 27 years. Analyses of data from 240 members of a community-based longitudinal study investigated the association of trajectories in these domains with family socioeconomic status, parental divorce, gender, and race. Findings indicated that subgroup differences were not generally attributable to educational enrollment. Both within and between domains, many individuals showed dramatic changes in the assumption of adult roles, returning to more dependent, other-determined roles for short or even extended periods.

Adolescent↗
PubMed1991

The emotional phases of marital separation: an empirical investigation.

The emotional process of marital separation was investigated via the application of Bowlby's theory of loss. Physical separation was found to entail the three phases--wish to recover the lost object, disorganization, and reorganization--proposed by Bowlby. Length of time separated appeared the most powerful factor in emotional resolution. The clinical implications of the findings are discussed.

Adaptation, Psychological↗
PubMed2004

Fitness benefits of prolonged post-reproductive lifespan in women.

Most animals reproduce until they die, but in humans, females can survive long after ceasing reproduction. In theory, a prolonged post-reproductive lifespan will evolve when females can gain greater fitness by increasing the success of their offspring than by continuing to breed themselves. Although reproductive success is known to decline in old age, it is unknown whether women gain fitness by prolonging lifespan post-reproduction. Using complete multi-generational demographic records, we show that women with a prolonged post-reproductive lifespan have more grandchildren, and hence greater fitness, in pre-modern populations of both Finns and Canadians. This fitness benefit arises because post-reproductive mothers enhance the lifetime reproductive success of their offspring by allowing them to breed earlier, more frequently and more successfully. Finally, the fitness benefits of prolonged lifespan diminish as the reproductive output of offspring declines. This suggests that in female humans, selection for deferred ageing should wane when one's own offspring become post-reproductive and, correspondingly, we show that rates of female mortality accelerate as their offspring terminate reproduction.

Adult↗
PubMed2001

Forced externalization of control in people with diabetes: a qualitative exploratory study.

AIM: The purpose of this study was to explore and describe the patients' perceptions of the Diabetic Disease State and its complications using an ethnographic method. BACKGROUND: Diabetes mellitus is an extensively researched and studied disease, however, relatively little attention has been given to the lived experience of chronic illness. METHODS: A purposive sample of 18 people with diabetes was derived from a diabetes register database. Data were collected by semistructured interviews, which were tape-recorded and transcribed. The transcripts were analysed together with the researchers' observational notes, using open coding procedures to identify main categories. Discussion of the results is made in the theoretical context of the locus of control (LOC) framework. FINDINGS: Three main categories emerged from the data: information-knowledge of illness; the psychological burden of diabetes; rationalizing. A further subcategory, reality avoidance, was identified. The findings showed that these people with diabetes experience and describe complex psychological effects and coping mechanisms in having a chronic illness. CONCLUSIONS: The findings also suggested that participants in this study might have felt that the control of their chronic condition had been externalized to the health care professionals responsible for their care.

Adaptation, Psychological↗
PubMed2001

You can do it if you set your mind to it: a qualitative study of patients with coronary artery disease.

AIMS OF THE STUDY: To gain increased knowledge and understanding of what it means to be afflicted with coronary artery disease (CAD) and how it affects the life/lifestyle of the individual. BACKGROUND: Research has documented that education, counselling and behavioural interventions are important elements of cardiac rehabilitation and compliance with treatment. Compliance is generally better with medical treatment than with recommended lifestyle changes. Another influencing aspect is locus of control, i.e. people's own understanding of control is the foundation for the decisions patients make more or less consciously regarding compliance with caring/nursing, treatment and lifestyle changes. METHODS: Eight individuals with diagnosed coronary artery disease were interviewed about their life situation, and the opportunities and obstacles they encountered in making lifestyle changes. These interviews were transcribed and then analysed using a hermeneutic approach. FINDINGS: The findings included three areas: (1) The causes of coronary artery disease describing different factors, such as heredity, lifestyle and demands. (2) Difficulties in the work of rehabilitation, which was explained in terms of informants' feelings of confusion, uncertainty and sadness. (3) Successful rehabilitation consisted of two factors: the personality of the individual patient and external support. CONCLUSIONS: Patients may comply well with follow-up visits but less with lifestyle changes. By identifying different 'characteristics', 'prerequisites' and 'difficulties' that describe patients' compliance, it should be possible to make treatment more individual. Nurses have a significant role in supporting these patients since they are more accessible than physicians. Nurses also have a responsibility to work together with patients to empower them, in order to make their lifestyle changes and self-care activities manageable.

Aged↗
PubMed2004

Chronic illness self-management: taking action to create order.

BACKGROUND: This paper presents research that was framed by our early understandings about the ways that people incorporate the consequences of illness into their lives. The word 'transition' has been used to describe this process. We believed self-management to be central to the transition process but this assertion required further research, hence this paper. AIM: The research aimed at understanding the way in which people who lived with chronic illness constructed the notion of self-management. While the participants of this study were living with arthritis, the focus was on understanding the meaning of self-management rather than the experience of living with the symptoms of arthritis. APPROACH: Data were generated when nine people living with arthritis were invited to write an autobiography about their life and experiences of living with illness. Two telephone interviews were recorded with each participant and then the research group (researchers and participants) convened for a discussion meeting. FINDINGS: In contrast to health professionals who identify self-management as structured education, participants identified self-management as a process initiated to bring about order in their lives. Creating a sense of order, or self-management, had four key themes (i) Recognizing and monitoring the boundaries, (ii) Mobilizing the resources, (iii) Managing the shift in self-identity, (iv) Balancing, pacing, planning and prioritizing CONCLUSIONS: People learned about their responses to illness through daily life experiences and as a result of trial and error. They reconfigured their daily lives and reconstructed their self-identity by exploring their personal limitations or boundaries. Self-management of chronic illness has been considered as both structure and process, however it is the process of self-management that we contend is central to the experience of transition. RELEVANCE TO CLINICAL PRACTICE: Clinical nursing intervention for people with a long term illness may be enhanced when self-management is approached from a broad, contextual perspective and self-management processes are integrated into clinical practice. The challenge is for nurses to embrace processes in nursing practice that will facilitate interactions with clients without obstructing the diversity of perspectives, create an environment conducive to learning and engage individuals in identifying self-management strategies that have meaning in their lives.

Activities of Daily Living↗
PubMed2003

A lifecourse study of risk for hyperinsulinaemia, dyslipidaemia and obesity (the central metabolic syndrome) at age 49-51 years.

AIMS: Suboptimal maternal nutrition and catch-up growth in early childhood predispose to insulin resistance and other components of metabolic syndrome in later life. A central metabolic syndrome (CMS) has been identified comprising obesity, dyslipidaemia and insulin resistance. This study was designed to investigate determinants of risk for CMS. METHODS: Persons born in Newcastle in May and June 1947 (n = 358) were followed to 1996-1998. A lifecourse approach was used to estimate the proportion of variance in a summary measure of CMS at age 49-51 years accounted for by factors operating at different stages of life. RESULTS: After adjustment for other early life variables, childhood catch-up growth in men accounted for significant variation in the CMS score independent of adult lifestyle. In adulthood, exercise level in men and smoking in both genders were independently associated with CMS. Over two-thirds of explained variation in the CMS score in women, and almost half in men, was accounted for exclusively by factors measured in adulthood. CONCLUSIONS: While risk for CMS in men is compounded by early life disadvantage, promotion of a healthier adult lifestyle and a reduction in the number of people taking up smoking would appear to be the public health interventions most likely to reduce the prevalence of CMS in middle age.

Body Mass Index↗