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PubMed1992

Controlled ecological life-support system. Use of plants for human life-support in space.

Scientists and engineers within NASA are conducting research which will lead to development of advanced life-support systems that utilize higher plants in a unique approach to solving long-term life-support problems in space. This biological solution to life-support, Controlled Ecological Life-Support System (CELSS), is a complex, extensively controlled, bioengineered system that relies on plants to provide the principal elements from gas exchange and food production to potable water reclamation. Research at John F. Kennedy Space Center (KSC) is proceeding with a comprehensive investigation of the individual parts of the CELSS system at a one-person scale in an approach called the Breadboard Project. Concurrently a relatively new NASA sponsored research effort is investigating plant growth and metabolism in microgravity, innovative hydroponic nutrient delivery systems, and use of highly efficient light emitting diodes for artificial plant illumination.

Aerospace Medicine↗
PubMed2003

Life expectancy for children with cerebral palsy and mental retardation: implications for life care planning.

OBJECTIVES: Physicians may be asked by attorneys or other patient advocates to help plan for the long-term needs of children with cerebral palsy (CP) and developmental disability (DD). The first step in such planning is to thoroughly examine the literature dealing with life expectancy in these populations. This review paper comprehensively reviews the literature relating to survival in children with cerebral palsy and developmental disability. STUDY SELECTION: A Medline data search was completed using the terms cerebral palsy, life expectancy, survival, as well as other pertinent terms. Further articles were gleaned from bibliographies of pertinent literature. DATA SYNTHESIS: Certain key disabilities can be used to accurately predict life expectancy in children with cerebral palsy and mental retardation. These include: (1) presence and severity of mental retardation, (2) inability to speak intelligible words, (3) inability to recognize voices, (4) inability to interact with peers, (4) severity of physical disability, (5) use of tube feeding, (6) incontinence, and (7) presence and severity of seizures. CONCLUSIONS: Literature review definitively shows that children with CP and DD have a diminished life expectancy, which can be assessed based on simple clinical examination findings.

Cerebral Palsy↗
PubMedDate not supplied

[Impact of olanzapine on quality of life of patients with schizophrenia: one-year follow-up with the Seville Quality of Life Questionnaire].

INTRODUCTION: Our objective is to present the impact on quality of life of long-term olanzapine treatment in a significant number of schizophrenics as determined by the Seville Quality of Life Questionnaire (SQLQ), an instrument that addresses the aspects that particularly affect these patients, and to evaluate the sensitivity of this instrument to the changes induced by this treatment. METHODS: Three hundred and seventy two patients with the diagnosis of schizophrenia as per the ICD-10 classification were evaluated in a 1 year prospective study after switching to olanzapine. The SQLQ, Lehman's structured interview and short version of the discapacity assessment scale were used to evaluate patient's subjective experience; in addition, other instruments were used to evaluate psychopathology. RESULTS: Significant increases in the scores of the favorable scale and decreases in the unfavorable scale of the SQLQ were found. There were also significant improvements in quality of life as measured with Lehman's structured interview. This improvement continued until the end of the 1 year follow-up after switching to olanzapine. Both instruments show a good correlation. Changes in psychopathology were also remarkable, including the negative symptoms. CONCLUSIONS: The SQLQ has proven to be a sensitive instrument to measure quality of life in schizophrenic patients treated with olanzapine. It focuses on aspects that are relevant for patients that were frequently overlooked by treating physicians. This drug has been proven to have a favorable subjective impact upon patients, besides improving psychopathology.

Adolescent↗
PubMed1992

[Life quality of patients with muscular failure, using permanent respiratory support, seen from their point of view. 1. Information, choice and quality of life].

Sixteen patients with neuromuscular disease receiving long-term assisted ventilation participated in a combined questionnaire/interview investigation with the purpose of illustrating: 1. What information the patient had received prior to institution of the respirator treatment, 2. The difficult choice which had to be made, 3. Whether life as a severely disabled person with assisted ventilation is worth living, and 4. The factors on which successful respirator treatment depends. It is concluded that the general information on use of assisted ventilation should be implemented at an early stage, preferably before problems of respiratory insufficiency occur, and that information should be carried out by people other than merely professionals and be as broad and truthful as possible in order to provide the disabled person with sufficient foundation and sufficient time to consider his personal choice of potential respirator treatment. Further, it is concluded that life for these sixteen ventilator-dependent persons definitely is worth living. The fact that the respirator implies the prospect of longer life, partly freed from symptoms of hypoventilation, means that they have got strength and time for education, work, family and dreams. No correlation was found between the success of the respirator treatment and the patients' sense of achieved quality of life and factors such as age, family-/working situation, extent of disability etc., and professionals should not attach importance to such factors in the selection of "suitable" patients for assisted ventilation.

Adolescent↗
PubMed2004

The interplay between women's life course work patterns and financial planning for later life.

In order to gain a comprehensive understanding of the interplay between women's life course work patterns and their financial planning for later life, we examined data from semi-structured interviews with retired women (n = 28) aged 59 to 92. The majority of women disrupted their careers at some point in time, for an average of 14 years, primarily for child-rearing responsibilities. We found that financial preparedness and income security in later life are structured by women's life course work patterns. However, individuals also have the ability to shape their own lives and many of the women took the initiative to acquire financial knowledge irrespective of their work situation. Financial-planning advice that participants gave to future generations of older women was also explored and centred on the importance of saving, avoiding debt, maintaining financial independence, and planning ahead.

Age Factors↗
PubMed2006

Withdrawal of life-sustaining therapy after sudden, unexpected life-threatening illness or injury: interactions between patients' families, healthcare providers, and the healthcare system.

BACKGROUND: Withdrawal of life-sustaining therapy in intensive care units is increasing. Patients' families are intimately involved in this process because the patients are usually unable to participate. Little is known about family members' interactions with healthcare providers and the healthcare system during this process. OBJECTIVE: To describe the interactions between patients' family members, healthcare providers, and the healthcare system during withdrawal of life-sustaining therapy after a sudden, unexpected illness or injury. METHODS: The investigation was part of a larger interpretative phenomenological study. Nineteen families (56 family members) who participated in the process of withdrawal of life-sustaining therapy for a family member were interviewed and observed. An inductive approach to data analysis was used to discover units of meaning, clusters, and categories. RESULTS: The families' experiences involved a variety of dimensions, including issues with healthcare providers (bonds and consistency with nurses and physicians, physicians' presence, information, coordination of care, family meetings, sensitivity to time, and preparation for the dying process) and issues with the healthcare system (parking, struggles with finding privacy, and transfers of patients). CONCLUSIONS: Patients' families need information, guidance, and support as the families participate in the process of withdrawal of life-sustaining therapy. The results of this study have important implications for clinical practice and future research.

Attitude of Health Personnel↗
PubMedDate not supplied

A new approach for quality of life assessment in cardiac patients: rationale and validation of the Quality of Life Systemic Inventory.

OBJECTIVE: To validate an interview-like questionnaire measuring quality of life, based on the subject's capacity to reach personal goals in different life domains. DESIGN: One group repeated measures for test-retest reliability (two-week interval) and correlational approach for concurrent validity. PARTICIPANTS: A total of 171 normal subjects (95 males and 76 females) was interviewed. Mean age was 43.6 years. OUTCOME MEASURES: The Quality of Life Systemic Inventory (QLSI), the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Marlowe and Crowne Social Desirability Scale, the Buss and Durkee Hostility Inventory, the Carver and Sheerer self-efficacy scale and the Derogatis Stress Profile were used. RESULTS: The quality of life score (a gap score representing the difference between a subject's actual state and personal goal) has a high test-retest reliability of 0.838. The two other scores (goal and potential for conflict) also have good test-retest reliability: 0.858 for both. Intercorrelations between scores are low-gap-goal, 0.293; gap-conflict, 0.172; and goal-conflict, 0.115--suggesting their distinctiveness. Correlations between scores and social desirability are also low-gap, 0.106; conflict, -0.024; and goal, -0.128. Finally, correlations with other psychological variables such as depression, anxiety, self-efficacy and stress are moderate to low, showing that the questionnaire measures dimensions different from these variables. CONCLUSIONS: The QLSI has good test-retest reliability, and scores are not much influenced by social desirability despite the fact that the test is used in an interview setting. The questionnaire may be administered in small groups or face-to-face situations. It yields a wealth of clinical information and is easily used in research. Furthermore, patients much prefer this interactive exchange to the long self-administered questionnaires.

Adult↗
PubMed1993

Geriatric rehabilitation. 3. Mid- and late-life effects of early-life disabilities.

This self-directed learning module highlights mid- and late-life effects of early-life disabilities. It is part of the chapter on geriatric rehabilitation in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This article contains information on how to evaluate, prevent, and manage late complications seen in adults and older adults with cerebral palsy, spina bifida, spinal cord injury, multiple sclerosis, juvenile rheumatoid arthritis, and early-life amputations, including psychosocial and other quality-of-life issues. New advances in post-polio syndrome are also covered.

Adult↗
PubMed1998

Patient and physician roles in end-of-life decision making. End-of-Life Study Group.

This study is a cross-sectional descriptive survey of randomly selected primary care patients and physicians regarding patient, physician, and family roles in end-of-life decision making. The subjects included 329 adult outpatients and 272 practicing physicians. Physicians were more likely than patients to believe the patient alone was responsible for making end-of-life decisions. Patients were more likely than physicians to believe the physician should provide a recommendation in addition to facts to help the patient make end-of-life decisions. We conclude that patients prefer a more active role for physicians in both decision making and discussion of end-of-life care than do physicians themselves.

Adult↗
PubMedDate not supplied

WHOQOL-Hindi: a questionnaire for assessing quality of life in health care settings in India. World Health Organization Quality of Life.

BACKGROUND: Quality of life is becoming an important component of overall assessment in health care settings. However, satisfactory instruments are not available for use in India. METHODS: Qualitative and quantitative work was conducted at the Delhi centre as a part of the WHOQOL (World Health Organization Quality of Life) project at 15 centres in developing and developed countries to construct a new quality of life instrument (WHOQOL). The pilot field trial at Delhi was conducted on 304 adult subjects using the 236-item questionnaire. RESULTS: Based on the pilot field trial data, item reduction could be done to develop a 100-item version (WHOQOL-100, Hindi). The items are distributed into 4 domains (physical; psychological, social and environmental health) and 25 facets. Each facet has four items, rated on a five-point scale. The initial psychometric properties of this instrument are satisfactory. A 26-item short version has also been developed (WHOQOL-Bref, Hindi). CONCLUSION: The WHOQOL-100, Hindi appears to be a suitable instrument for comprehensively assessing quality of life in health care settings. WHOQOL-Bref, Hindi can be used for intervention studies including drug trials.

Factor Analysis, Statistical↗
PubMed1976

Life changes and myocardial infarction. How useful are life change measurements?

Although statistically significant, the relation between certain life changes and imminent myocardial infarction appears to be quantitatively weak. Of particular importance are events connected with employment. However, the summation of life changes has not proved to be of use in the prediction of imminent myocardial infarction. For patients with ischemic heart disease, variations in life change measures have proved to be of use in the prediction of changes in catecholamine output and in prognosis. When genetic factors are held constant, as in monozygotic twin pairs vulnerable to ischemic heart disease, more life changes in one partner may indicate a greater risk of unexpected sudden cardiac death in this partner than in the other twin. The self-rating of the severity of each experienced event has proved more useful than "standard weights" in the retrospective discrimination of myocardial infarction patients. Further clinical and epidemiological studies are needed in this field. For the future, the following recommendations are made: The studies should be prospective. The individual's habitual level and actual level of the change should be recorded. The severity of events should be self-rated. Risk variables, known to be of importance to the development of MI should be recorded. They are for instance smoking habits, blood pressure, serum lipids and genetic predisposition. Psychological variables should be mentioned separately in this connection.

Adult↗
PubMed2000

Perspectives on care at the close of life. Initiating end-of-life discussions with seriously ill patients: addressing the "elephant in the room".

Discussions about end-of-life issues are difficult for clinicians to initiate. Patients, their families, and clinicians frequently collude to avoid mentioning death or dying, even when the patient's suffering is severe and prognosis is poor. In addition to determining from observational research when and where communication problems exist, much can be learned from in-depth discussions with patients, family members, and physicians who are facing these issues together. Using segments of interviews with a patient with advanced pulmonary fibrosis, his son, and his primary care physician, this article illustrates and explores some of these communication issues, including the who, what, when, why, and how of end-of-life discussions. Studies from the medical literature, the patient's and physician's particular experience together, and the author's clinical experience provide practical insights into how to address these issues. Initiating end-of-life discussions earlier and more systematically could allow patients to make more informed choices, achieve better palliation of symptoms, and have more opportunity to work on issues of life closure. JAMA. 2000;284:2502-2507.

Aged↗
PubMedDate not supplied

Early life events and their consequences for later disease: a life history and evolutionary perspective.

Biomedical science has little considered the relevance of life history theory and evolutionary and ecological developmental biology to clinical medicine. However, the observations that early life influences can alter later disease risk--the "developmental origins of health and disease" (DOHaD) paradigm--have led to a recognition that these perspectives can inform our understanding of human biology. We propose that the DOHaD phenomenon can be considered as a subset of the broader processes of developmental plasticity by which organisms adapt to their environment during their life course. Such adaptive processes allow genotypic variation to be preserved through transient environmental changes. Cues for plasticity operate particularly during early development; they may affect a single organ or system, but generally they induce integrated adjustments in the mature phenotype, a process underpinned by epigenetic mechanisms and influenced by prediction of the mature environment. In mammals, an adverse intrauterine environment results in an integrated suite of responses, suggesting the involvement of a few key regulatory genes, that resets the developmental trajectory in expectation of poor postnatal conditions. Mismatch between the anticipated and the actual mature environment exposes the organism to risk of adverse consequences-the greater the mismatch, the greater the risk. For humans, prediction is inaccurate for many individuals because of changes in the postnatal environment toward energy-dense nutrition and low energy expenditure, contributing to the epidemic of chronic noncommunicable disease. This view of human disease from the perspectives of life history biology and evolutionary theory offers new approaches to prevention, diagnosis and intervention.

Biological Evolution↗
PubMed2003

Effects of reminiscence and life review on late-life depression: a meta-analysis.

AIM: To assess the effectiveness of reminiscence and life review on late-life depression across different target groups and treatment modalities. METHOD: Twenty controlled outcome studies were retrieved from Psychlit, Medline and Dissertation Abstracts. For each study a standardised effect size, d, was calculated and a random-effects meta-analysis was conducted. RESULTS: An overall effect size of 0.84 (95% Confidence Intervals (CI)=0.31-1.37) was found, indicating a statistically and clinically significant effect of reminiscence and life review on depressive symptomatology in elderly people. This effect is comparable to the effects commonly found for pharmacotherapy and psychological treatments. The effect was larger in subjects with elevated depressive symptomatology (d=1.23) as compared to other subjects (d=0.37). Other characteristics of the subjects or interventions were not found to be related to increased or decreased effect sizes. DISCUSSION: Reminiscence and life review are potentially effective treatments for depressive symptoms in the elderly and may thus offer a valuable alternative to psychotherapy or pharmacotherapy. Especially in non-institutionalised elderly people-who often have untreated depression-it may prove to be an effective, safe and acceptable form of treatment. Randomized trials with sufficient statistical power are necessary to confirm the results of this study.

Aged↗
PubMed1990

Earth analogs for Martian life. Microbes in evaporites, a new model system for life on Mars.

The prospect of life on Mars today is daunting. Especially problematic for a potential life form is a lack of water, particularly in a liquid state; extremely cold temperatures; ultraviolet and ionizing radiation; and soil oxidants. Yet, "oases" where life might persist have been suggested to occur in rocks (in analogy with endolithic microorganisms described from deserts around the world), in polar ice caps (in analogy with snow and ice algae) and in possible volcanic regions (in analogy with chemoautotrophs living in deep sea hydrothermal vents); all are critically examined. Microorganisms are known to be able to survive in salt crystals, and recently it has been shown that organisms can metabolize while encrusted in evaporites. Because evaporites are thought to occur on Mars and can attenuate light in the UV range while being far more transparent to radiation useful for photosynthesis (400-700 nm), and because of the properties of these "endoevaporitic" organisms, I propose that such communities provide a new model system for studying potential life on Mars. On the basis of this model, I suggest possibilities for site selection for future exobiological experiments on Mars.

Atmosphere↗
PubMed1985

Growth rate and life span in Drosophila V. The effect of prolongation of the period of growth on the total duration of life (J.H. Northrop, 1917)--revisited.

Sixty-eight years ago Northrop observed a constant life span in Drosophila after a progressive increase of the duration of development of the flies achieved by using a yeastless nutrient medium to which he added yeast with a progressively increasing delay. This evidence against the more recent concept of an increased life span following an experimentally decreased developmental rate has generally been ignored due, presumably, to the imprecise methodology employed by Northrop at a time that Drosophila research was just commencing. We describe here a study that aimed at re-examining and extending Northrop's work by developing the flies in either a yeastless or a lightly yeasted medium. While in a yeastless medium development of flies was virtually arrested until yeast was added, in the yeasted medium a slow growth of the larvae was possible before yeast was added. With another method, larval growth rate was reduced over the entire developmental period by adding a relatively low amount of yeast in four portions and with various delays between portions (the first portion being added without delay). Our study confirmed the "Northrop-effect", i.e. the absence of an effect on life span from increased duration of development by a virtual arrest of growth of the larvae for a number of days. Further, it showed that manipulation of growth rate by portioning the yeast amount did not unequivocally support the concept that a lower growth rate leads to an increased life span.

Animals↗
PubMedDate not supplied

Quality of life cards - a novel way to measure quality of life in the elderly.

Taking into account the multiple factors/dimensions that contribute to the concept of quality of life (QoL), a pack of cards (80 cards) was developed and validated in 30 elderly patients, fifteen from the continuing care setting and fifteen from the day hospital. Twenty of the 80 cards contained words or statements indicating positive or negative affect, 20 cards were based on positive or negative life experience and 40 cards dealt with satisfaction or happiness or dissatisfaction or unhappiness relating to areas of personal or family life. The score obtained using the QoL cards correlated significantly (r = -0.96, P < 0.0001) with the score obtained on the delighted-terrible scale and with a result obtained using an analogue scale (r = 0.93, P < 0.0001). Test to retest reliability in 11 patients revealed an 'r' value of 0.99 (P < 0.0001). In addition, high correlations were noted between the total score obtained using the 80 QoL cards and the subscale scores for 'affect', 'life experience' and 'satisfaction/happiness' in the 30 patients studied initially and in the 20 patients studied subsequently.

Journal Article↗
PubMed2005

Early life linguistic ability, late life cognitive function, and neuropathology: findings from the Nun Study.

The relationships between early life variables, cognitive function, and neuropathology were examined in participants in the Nun Study who were between the ages of 75 and 95. Our early life variable was idea density, which is a measure of linguistic ability, derived from autobiographies written at a mean age of 22 years. Six discrete categories of cognitive function, including mild cognitive impairments, were evaluated, using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) battery of cognitive tests. Neuropathologic data included Braak staging, neurofibrillary tangle and senile plaque counts, brain weight, degree of cerebral atrophy, severity of atherosclerosis, and the presence of brain infarcts. Early-life idea density was significantly related to the categories of late-life cognitive function, including mild cognitive impairments: low idea density was associated with greater impairment. Low idea density also was significantly associated with lower brain weight, higher degree of cerebral atrophy, more severe neurofibrillary pathology, and the likelihood of meeting neuropathologic criteria for Alzheimer's disease.

Age Factors↗