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Many children and their families have experienced "hard times" because of the current economic conditions. Five cases are presented in which neurologic illness in children was related to changes in the family's economic circumstances. Pediatricians are encouraged to look carefully at the impact of changing economic conditions upon child health.
The effect of life-change events on perceptual augmentation-reduction was studied in 72 subjects (40 men, 32 women). In three experiments the kinesthetic figural aftereffect was measured prior to and after either a physical fitness program, a course in yoga, or training in Transcendental Meditation. Each program lasted a minimum of 8 wk. Subjects completing fitness training, all of whom were initially classified as augmenters, became reducers by the end of their program. Subjects enrolled in yoga and meditation courses remained relatively stable in their perceptual tendencies.
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The purpose of this qualitative study was to explore how meanings adult daughters attached to their parent's death influenced the duration of their grief. The sample consisted of 67 adult daughters, ages 35 to 69 years, who had lost a parent 1 to 3 years earlier. Respondents were asked to explore their perceptions about their parent's death, their lifelong parent-daughter relationship, and any lifestyle changes that occurred after a parent's death. Categories were identified from the interview questions, and themes within each category were developed from the interview data. Results indicated that how respondents experienced a parent's death--including their guilt, regrets, or anticipatory grief, shifts in other family relationships, and changes in lifestyle--influenced the duration of their grief. The findings suggest that the subjective experience of grief may be an important area for further research as well as for assessment and intervention.
Research has documented that caring for a family member with dementia is stressful and burdensome. However, difficult life experiences such as fear, loss, and grief may help persons move beyond a concern for self toward a larger perspective and concern for others. Both positive and negative experiences can promote positive movement toward growth and development. This movement has been described as self-transcendence, or the ability to look beyond the self and present difficulties, to extend concern to others, and to find personal meaning and wholeness in the context of life-changing events. The family caregiving experience with its inherent difficulties might provide the impetus for such a movement toward self-transcendence. The purpose of this article is to examine the concept of self-transcendence, explore its linkages to the caregiving experience, and suggest potential strategies to assist family caregivers to achieve self-transcendence.
The author elicited the lived experience of 19 oldest-old adults (13 women, all White, mean age 90.7 years, range 85-98 years) who lived alone in the rural Midwest to describe their everyday activities, concerns and struggles, and adaptive strategies. In-depth interviews (59 total) were audiotaped, transcribed, and analyzed in an interpretive phenomenological tradition of thematic analysis, interpretation of paradigm cases, and interpretation of exemplars. Participants described how historical, cultural, and environmental contexts shaped their everyday thoughts, activities, and what was meaningful to them. Findings can guide health care professionals to evaluate and develop community services and help significant others (family, friends, neighbors) understand what oldest-old rural adults need to remain at home.
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Learned helplessness is the psychological state that results when an individual who is unable to exercise reasonable mastery in one situation incorrectly assumes that he or she is then unable to exercise reasonable control in other situations as well. This may complicate the delivery of health interventions since the individual with learned helplessness may assume that no care provider or treatment intervention can be of assistance. Elderly patients with Alzheimer's disease and other dementias are not immune to this stance of learned helplessness. This paper presents one possible psychosocial rehabilitation approach, the Project SMART (Stress Management and Relaxation Training) program, to the problem of learned helplessness. Based on the skills of adaptive stress-resistant problem solvers, Project SMART can be adapted to the needs of the elderly demented. The clinical and research implications are discussed.
BACKGROUND: Differences in mortality and health experience across regions are well recognised and UK government policy aims to address this inequality. Methods combining life expectancy and health have concentrated on specific areas, such as self-perceived health and dementia. Few have looked within country or across different areas of health. Self-perceived health, self-perceived functional impairment and cognitive impairment are linked closely to survival, as well as quality of life. This paper aims to describe regional differences in healthy life expectancy using a variety of states of health and wellbeing within the MRC Cognitive Function and Ageing Study (MRC CFAS). METHODS: MRC CFAS is a population based study of health in 13,009 individuals aged 65 years and above in five centres using identical study methodology. The interviews included self-perceived health and measures of functional and cognitive impairment. Sullivan's method was used to combine prevalence rates for cognitive and functional impairment and life expectancy to produce expectation of life in various health states. RESULTS: The prevalence of both cognitive and functional impairment increases with age and was higher in women than men, with marked centre variation in functional impairment (Newcastle and Gwynedd highest impairment). Newcastle had the shortest life expectancy of all the sites, Cambridgeshire and Oxford the longest. Centre differences in self-perceived health tended to mimic differences in life expectancy but this did not hold for cognitive or functional impairment. CONCLUSION: Self-perceived health does not show marked variation with age or sex, but does across centre even after adjustment for impairment burden. There is considerable centre variation in self-reported functional impairment but not cognitive impairment. Only variation in self-perceived health relates to the ranking of life expectancy. These data confirm that quite considerable differences in life experience exist across regions of the UK beyond basic life expectancy.
PURPOSE: Cancer survivors are at increased risk for several comorbid conditions, and many seek lifestyle change to reduce dysfunction and improve long-term health. To better understand the impact of cancer on adult survivors' health and health behaviors, a review was conducted to determine (1) prevalent physical health conditions, (2) persistent lifestyle changes, and (3) outcomes of previous lifestyle interventions aimed at improving health within this population. METHODS: Relevant studies from 1966 and beyond were identified through MEDLINE and PubMed searches. RESULTS: Cancer survivors are at increased risk for progressive disease but also for second primaries, osteoporosis, obesity, cardiovascular disease, diabetes, and functional decline. To improve overall health, survivors frequently initiate diet, exercise, and other lifestyle changes after diagnosis. However, those who are male, older, and less educated are less likely to adopt these changes. There also is selective uptake of messages, as evidenced by findings that only 25% to 42% of survivors consume adequate amounts of fruits and vegetables, and approximately 70% of breast and prostate cancer survivors are overweight or obese. Several behavioral interventions show promise for improving survivors' health-related outcomes. Oncologists can play a pivotal role in health promotion, yet only 20% provide such guidance. CONCLUSION: With 64% of cancer patients surviving > 5 years beyond diagnosis, oncologists are challenged to expand their focus from acute care to managing the long-term health consequences of cancer. Although more research is needed, opportunities exist for oncologists to promote lifestyle changes that may improve the length and quality of life of their patients.
This article considers the manner that families come to accept the collapse of identity in a family member who has entered a medical crisis with no hope of returning from it. The transformation is regarded as a "right of passage" and is characterized in terms of both the conditions that bring about resistance to the passage as well as the sorts of symbolic activities that ultimately allow the transformation to occur. The theoretical source that is used to discuss both these issues is Kenneth Burke's (1969) theory of Dramatism, regarded herein as a template that guides both interpersonal action and experience. The primary text used to illustrate these points is the story of Karen Ann Quinlan, a young woman who fell into persistent vegetative state in 1975, as told by her parents. A general goal of this article is to illustrate some of the characteristics of Dramatism as a theory of interpersonal action, especially after the collapse of routine. More particularly, it is hoped that the analysis will aid health professionals in sense making and interacting with families in crisis.
Oesophageal cancer (OC) is a debilitating disease with significant social, psychological and physical impacts on health and lifestyle (Mills and Sullivan, 2000). The research presented in this paper uses a survey method, and reveals that patients require honest communication and more help with everyday living from nurses to facilitate recovery. Each patient is unique but commonalities can be established that improve experience and outcome. Three themes emerged from the data: food, activity and positivity. To meet long-term needs, the Oesophageal Patients Association is fundamental for patients and carers in order adapt to this major life-changing event.
Cystic fibrosis (CF) has long been thought of as a childhood disease but the life expectancy for those with CF has been steadily on the rise and now reaches well into adulthood. There has been little or no research on the psychosocial impact of CF on becoming an adult. This exploratory, qualitative study examined the perceptions of young adults with CF regarding the impact the disease has had on their lives, especially during the transition from adolescence to adulthood. The findings indicate concerns about health insurance and finances, as well as the achievement of independence and optimism for the future.
This essay represents an attempt to bring together literature from a variety of sources and develop it into an explanation and rationale for studying widowed women. Four factors are important in this regard: (1) the disproportionate number of widows vis-à-vis widowers, (2) the problems faced by widows and their accentuation as a result of prevailing societal norms and values, (3) the differences in response and adaptation to widowhood by sex, and (4) the more negative consequences, experienced by widowed women as compared to divorced women. Widows are more likely than other persons who have lost a spouse to work through the loss outside the context of remarriage and to develop single lifestyle adaptations with fewer available resources. The importance of social supports--both formal and informal--are paramount to their successful outcomes. To date these supports are weak and ineffective.
OBJECTIVE: This study examined the relationship of depressive symptoms to psychosocial and lifestyle variables in postpartum women. DESIGN: The Mothers' Overweight Management Study (MOMS) was a randomized, weight-gain prevention trial. Baseline data are presented on the Beck Depression Inventory (BDI), Perceived Stress Scale, Social Support Questionnaire, smoking status, body weight, waist circumference, and step counts. SUBJECTS/SETTING: The study was conducted at the Special Supplemental Feeding Program for Women, Infants, and Children (WIC). Women (N = 151) had to be over the age of 18 years and have a child under two years of age to participate. RESULTS: Fifty-one percent of the women (mean age = 27 years; mean of 30 weeks postpartum) reported depressive symptoms (27% mild, 21% moderate, and 3% severe). Overall, stress scores were high (Mean = 27.2) and activity levels low (Mean steps = 5984). Mean body mass index was 30.2. Neither body weight nor steps walked were related to depressive symptoms in the bivariate or regression analyses. However, stress and social support were related to symptoms. Women without symptoms reported significantly less stress than the mild and moderate/ severe symptom groups (Means = 23.4, 29.6, and 32.7, respectively, p <.001). Mean social support satisfaction was significantly higher for non-depressed women compared to women in the moderate/severe symptom range (Means = 5.9 and 4.7 respectively, p <.001). Stress and current smoking status explained 46% of the variance in depressive symptoms. CONCLUSIONS: These data emphasize the need for stress management and other tools such as increasing activity levels to prevent or lessen depressive symptoms.
The historical trauma response is a constellation of characteristics associated with massive cumulative group trauma across generations, similar to those found among Jewish Holocaust survivors and descendants. Trauma response features include elevated mortality rates and health problems emanating from heart disease, hypertension, alcohol abuse, and suicidal behavior. This article explores gender differences in the historical trauma response among the Lakota (Teton Sioux) and the correlation with health and mental health statistics. The theory of a Lakota historical trauma response is first explained. Traditional gender roles are described in combination with modifications engendered by traumatic Lakota history. Then, data from a study on Lakota historical trauma are presented, including gender differences in response to an experimental intervention aimed at facilitating a trauma resolution process. The data revealed significant gender differences. The sample of women presented initially with a greater degree of conscious affective experience of historical trauma. In contrast, the men reported more lifespan trauma associated with boarding school attendance and appeared to be at an earlier stage of grief. However, at the end of the intervention, women's experience of survivor guilt--a significant trauma response feature-decreased while men's consciousness of historical trauma and unresolved grief increased. Degree of traditional presentation-of-self, including phenotype, appeared to interact with gender to place male participants at greater risk for being traumatized over the lifespan and perhaps subsequently utilizing more rigid defenses against the conscious experience of the trauma with the exception of survivor guilt. The article concludes with a discussion of health and mental health implications for prevention and treatment of the trauma response which could positively impact the health status of the Lakota. Recommendations for future research are suggested.
This study examined two issues related to the distinction between unitary and multidimensional models of alcoholism treatment outcome. First, does treatment outcome vary along a variety of relatively independent dimensions? Second, how important is abstinence to improved health and psychosocial adjustment? A sample of 266 alcoholics were evaluated at intake and 1 year following inpatient treatment using an extensive battery of assessments. Correlational analysis and factor analysis provided limited support for both the unidimensional and multidimensional approaches. A synthetic measure of posttreatment drinking showed a clear linear relationship between level of consumption and lack of improvement in medical status, biological function, life stress and psychopathology. The findings are discussed in terms of the methodological difficulties in treatment evaluation and the need for more systematic research on the effect of posttreatment drinking on multiple dimensions of outcome status.