The SARS (Severe Acute Respiratory Syndrome) pandemic in Hong Kong : effects on the subjective wellbeing of elderly and younger people

Objectives: This study examined the impact of the Severe Acute Respiratory Syndrome (SARS) outbreak in Hong Kong in 2003, on the subjective wellbeing (SWB) of elderly people and a younger comparative sample. The Personal Wellbeing Index (PWI), a contemporary instrument employed to measure SWB, was also examined for its psychometric performance to substantiate its use.

Method: A total of 302 older adults (age 65 + years) and 158 younger adults (age 35-46 years) were recruited from different districts. Data were collected by individual face-to-face interviews.

Result: While elderly people living in severely infected districts showed significantly lower levels of SWB, these levels and those of the younger sample were found to remain within the normative range. A major mitigating factor was an increased sense of community-connectedness. Other characteristics linked to low wellbeing levels included chronic illness, female gender, low education and unemployment. The living districts, characterized by varying extents of infection, had stronger associations with SWB than participants' age. The PWI demonstrated good psychometric performance and also more robustness with elderly people, including its sensitivity to the sense of population threat.

Conclusion: Psychological resilience was identified among both the elderly and younger age-groups in Hong Kong during the SARS pandemic. The PWI is verified as a suitable instrument for SWB measurements.

Entrepreneurial opportunities on the internet

This chapter highlights and discusses entrepreneurial opportunities on the Internet. It provides a brief introduction to entrepreneurship, examines the characteristics of entrepreneurs, and talks about cyber entrepreneurs. It includes a case study which demonstrates the opportunities and challenges of cyber entrepreneurship. The case study illustrates the ease of setting up a business on the Internet by the younger generation with little capital and resource requirement. It highlights the fact that an intensive marketing campaign, perseverance, and some technical knowledge are important traits of cyber entrepreneurs. The other issues apparent from the case study are an opportunistic mindset, innovation, and the ability to create value where there was none before.

Benefits and barriers to the consumption of a vegetarian diet in Australia

Objective: The aim of this study was to examine consumers' perceived benefits and barriers to the consumption of a vegetarian diet.

Design: Survey (written questionnaire) that included questions on perceived benefits and barriers to the consumption of a vegetarian diet.

Setting: South Australia.

Subjects: Six hundred and one randomly selected South Australians.

Results: The main perceived barriers to adopting a vegetarian diet were enjoying eating meat and an unwillingness to alter eating habits. This was the case for men, women and all age groups, although there were sex and age differences present in over half of the barrier items. For example, family food preferences were a greater problem for women than for men, while the oldest group was more likely to agree that humans are ‘meant’ to eat meat than the younger groups. The main benefits associated with vegetarian diets were health benefits: increased fruit and vegetable intake, decreased saturated fat intake, weight control. Animal welfare-related benefits and disease prevention were also important. Age and sex differences were apparent, although age differences were more important than sex differences.

Conclusions: The majority of respondents perceived there to be health benefits associated with the consumption of a vegetarian diet, but also, predictably, enjoyed eating meat. Given this, it is likely that interest in plant-based diets that contain some meat is higher than that in no-meat diets. An understanding of the perceived benefits and barriers of consuming a vegetarian diet will allow the implementation of strategies to influence meat and vegetarianism beliefs, dietary behaviour and, hence, public health.

Children's memory of recurring events: is the first event always the best remembered?

Three experiments were conducted to examine the effect of age (4-5 and 6-8 years) and retention interval on children's ability to remember separate occurrences of a repeated event that varied in terms of content (items, dialog, etc.) Experiment 1 explored children's ability to recall the first versus last occurrence of a series of six events, at either one week or six weeks delay. Experiments 2 and 3 explored children's ability to identify the position of items in terms of their order of presentation within the series across two retention intervals. Overall, the results revealed clear age differences in children's performance. In general, the 6- to 8-year+old children performed better on all tasks than the 4- to 5-year-old children. Further, the older children showed relatively good memory of the first and last items compared to the middle items, although the last items were more likely to be forgotten or misplaced in the sequencing tasks over time that the first items. For the younger children, the patterns of results were sometimes but not always consistent with that of the older children The relevance and generalisability of these findings to the legal setting are discussed as well as directions for future research.

Roman concept of mental capacity to make end-of-life decisions

When assessing decisional competence of patients, psychiatrists have to balance the patients' right to personal autonomy, their condition and wishes against principles of medical ethics and professional discretion. This article explores the age-old legal and ethical dilemmas posed by refusal of vital medical treatment by patients and their mental capacity to make end-of-life decisions against the background of philosophical, legal and medical approaches to these issues in the time of the Younger Pliny (c62–c113 CE). Classical Roman discourse regarding mental competency and "voluntary death" formed an important theme of the vast corpus of Greco-Roman writings, which was moulded not only by legal permissibility of suicide but also by philosophical (in modern terms, moral or ethical) considerations. Indeed, the legal and ethical issues of evaluating the acceptability of end of life decisions discussed in the Letters are as pertinent today as they were 2000 years ago. We may gain valuable insights about our own methodologies and frames of reference in this area of the law and psychiatry by examining Classical Roman approaches to evaluating acceptability of death-choices as described in Pliny's Letters and the writings of some of his peers.

Is the link between nutrients and foods understood? The case of fibre and folate

Objectives: To assess and contrast awareness of the link between dietary fibre and folate and their major food sources (fruit, vegetables, bread and cereals).

Design and setting: Mailed questionnaire investigating changes made to dietary intake of fibre, folate, fruit, vegetables, bread and cereals in the previous six months.

Setting: The survey was conducted between June and November 1998 in the Australian Capital Territory.

Subjects: One thousand one hundred and twenty-six adults randomly selected from the electoral roll.

Results: More women than men in both older (50 + years) and younger (18–49 years) age groups reported increasing their consumption of folate, fibre, fruit and vegetables in the prior six months. In contrast, more men than women reported increased consumption of bread, cereals, rice and pasta in the previous six months. For food categories and fibre, less than 4% of respondents were unsure about changes in these food habits. However, 26% of men and women were ‘not sure’ about changes to folate intake. Similar proportions of men and women (about 33%) reported consuming more fruit, vegetables or cereal-based foods over the prior six months, yet only 6% of these men and 14% of these women reported consuming more folate. In contrast, 44% of men and 51% of women who reported consuming more plant foods also reported consuming more dietary fibre.

Conclusions: The results suggested that subjects, particularly the younger age group, had a poor understanding of the relationship between folate intake and its major food sources. The understanding of the relationship between fibre intake and its food sources appeared substantial, but confusion about specific food sources was still evident. These outcomes question the effectiveness of nutrition education used to date, particularly for the current priority of increasing folate intake in younger women in the new, ‘health claims’ environment.

Five-year changes in school recess and lunchtime and the contribution to children’s daily physical activity

Objective To investigate the longitudinal changes in children's recess and lunchtime physical activity levels and in the contribution of recess and lunchtime to daily physical activity levels over 5 years among 5–6- and 10–12-year olds.

Methods Data were drawn from two longitudinal studies that were conducted in metropolitan Melbourne, Australia. Boys and girls (n=2782) aged 5–6 years and 10–12 years participated in baseline (T0) measures. Physical activity (n=2490) was measured every 60 s for eight consecutive days using hip-mounted accelerometry. Subsequent measurements were taken at 3-year (T1; n=773) and 5-year (T2; n=634) follow-up. Physical activity intensities were derived using age-adjusted cut-points. Sedentary time was defined as 100 counts/min. Longitudinal data were analysed using three-level (time, child, school) multilevel analyses, stratified by sex and cohort, and adjusted for potential confounding variables.

Results Significant decreases in recess and lunchtime moderate and vigorous physical activity were observed (p<0.001), with larger decreases occurring in the older cohort. Associated increases were observed in sedentary time over time (p<0.01). Although the contribution of recess to daily moderate intensity physical activity increased in the younger cohort over time (p<0.001), significant decreases were observed in the older cohort (p<0.001).

Conclusion Physical activity levels during recess and lunchtime decreased in both cohorts over time. Decreases in the contribution of recess and lunchtime to older children's daily physical activity were also observed. Interventions are needed in both primary and secondary schools to promote physical activity levels during recess and lunchtime, particularly during the early years of secondary school.

Reliability, validity, and responsiveness of the Western Ontario and McMaster Universities osteoarthritis index for elderly patients with a femoral neck fracture

Background: The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) has been extensively evaluated in groups of patients with osteoarthritis, yet not in patients with a femoral neck fracture. This study aimed to determine the reliability, construct validity, and responsiveness of the WOMAC compared with the Short Form-12 (SF-12) and the EuroQol 5D (EQ-5D) questionnaires for the assessment of elderly patients with a femoral neck fracture.

Methods: Reliability was tested by assessing the Cronbach alpha. Construct validity was determined with the Pearson correlation coefficient. Change scores were calculated from ten weeks to twelve months of follow-up. Standardized response means and floor and ceiling effects were determined. Analyses were performed to compare the results for patients less than eighty years old with those for patients eighty years of age or older.

Results: The mean WOMAC total score was 89 points before the fracture in the younger patients and increased from 70 points at ten weeks to 81 points at two years postoperatively. In the older age group, these scores were 86, 75, and 78 points. The mean WOMAC pain scores before the fracture and at ten weeks and two years postoperatively were 92, 76, and 87 points, respectively, in the younger age group and 92, 84, and 93 points in the older age group. Function scores were 89, 68, and 79 points for the younger age group and 84, 71, and 73 points for the older age group. The Cronbach alpha for pain, stiffness, function, and the total scale ranged from 0.83 to 0.98 for the younger age group and from 0.79 to 0.97 for the older age group. Construct validity was good, with 82% and 79% of predefined hypotheses confirmed in the younger and older age groups, respectively. Responsiveness was moderate. No floor effects were found. Moderate to large ceiling effects were found for pain and stiffness scales at ten weeks and twelve months in younger patients (18% to 36%) and in the older age group (38% to 53%).

Conclusions: The WOMAC showed good reliability, construct validity, and responsiveness in both age groups of elderly patients with a femoral neck fracture who had been physically and mentally fit before the fracture. The instrument is suitable for use in future clinical studies in these populations.

Subjective quality of life, perceived control and dispositional optimism among older people

Objectives: To examine whether the subjective quality of life (QOL) of elderly people is held under homeostatic control, and to investigate the role of perceived control and dispositional optimism in the maintenance of subjective QOL.
Method: 100 older people (M=75.6 years) and a control group of 107 younger people (M=20.1 years) completed a self-report survey.
Results: Both groups had a level of subjective QOL within the normal range. The older group reported higher levels of secondary control and optimism, but similar levels of primary control, as the younger group. Primary control and optimism predicted subjective QOL for both groups. Secondary control was a significant predictor (or the younger group, however it was only marginally significant for the older group. Optimism accounted for the most subjective QOL variance for both groups.
Conclusions: The finding that the subjective QOL of the older group lay within the normative range supports the proposal that their subjective QOL is being successfully maintained under bomeostatic control. However, they appear to have an increased reliance on secondary control. The fact that dispositional optimism captures the predictive variance of perceived control, is an important finding adding to the understanding of subjective QOL maintenance.

Gait termination in young and older adults : effect of stopping stimulus probability and stimulus delay

Sixteen young (25±2.6 years) and 16 older individuals (69±4.4 years) walked normally then terminated walking rapidly. A visual stopping stimulus was presented 10 ms following ground contact (short delay) and in another condition, at 450 ms prior to toe-off (long delay). Stimulus probability was either high (80% of trials) or low (10%). The younger group stopped faster (463 vs. 574 ms) despite also walking faster (1.29 vs. 1.17 m s⁻¹). Longer delay decreased one-step responses but older participants used significantly more (slower) two-step stopping, which increased stopping time and distance. The additional step may have been pre-planned to maintain medial–lateral stability.

Ageing effects on visual reaction time in a single task condition and when treadmill walking

Visual reaction time (RT) was measured in 10 older men (mean age, 71.1 years) and gender-matched controls (mean age, 26.3 years) when standing (single task) and when walking on a motor-driven treadmill (dual task). There were 90 quasirandomly presented trials over 15 min in each condition. Longer mean and median RTs were observed in the dual task compared to the single task. Older males had significantly slower mean and median RTs (315 and 304 ms, respectively) than the younger group (273 and 266 ms, respectively) in both task conditions. There were no age or condition effects on with in-subject variability. Both groups showed a trend of increasing RT over the 90 single task trials but when walking only the younger group slowed. These novel findings demonstrate high but sustained attention by older adults when walking. It is proposed that the motor task's attentional demands might contribute to their slower preferred walking speed.

Changes in weight and waist circumference over 9 years in a Scottish population

Objective: To document patterns of measured weight and waist circumference (WC) change and the increase in overweight and obesity over a 9-year period. Subjects/Methods: A total of 1044 subjects from two age-defined cohorts aged 39 and 59 in 1991. Height, weight and WC were measured in 1991, 1995 and 2000 and body mass index (BMI) was calculated. Pattern of weight and WC change was studied over approximately 9 years. Results: The prevalence of overweight and obesity increased markedly and the younger cohort showed greater increases in weight and WC than the older cohort. There was no significant difference in mean BMI and/or mean 9-year weight change between men and women in either age cohort, and mean weight gain was similar for all occupational groups. Only 20% of subjects maintained a stable weight (plusminus2 kg), while 42.2 and 17.6% gained greater than 5 and 10 kg over the 9-year period, respectively. The rate of weight gain appeared to be relatively steady over the 9 years among younger subjects but declined in the older subjects in the second half of the observation period. Conclusions: Health promotion strategies to prevent weight gain need to be population-based, targeting all social and age groups, but particularly those in their early middle-age.

Age and walking speed effects on muscle recruitment in gait termination

During gait termination at normal walking speed, older adults more frequently employ two-step responses, increasing their stopping distance and stopping time more than younger controls. This study investigated ageing effects on lower limb muscle recruitment patterns during stopping at three walking speeds. Twelve young male (26±3.7 years, range 19–30) and 12 gender-matched older participants (72±4.3 years, range 65–82) terminated walking at normal, medium and maximum speed. A visual stopping stimulus was presented 10 ms following either left or right heel-contact with no stimulus (catch) on 30% of trials. Electromyographic (EMG) activity was recorded from the tibialis anterior (TA), soleus (SOL), biceps femoris (BF), vastus lateralis (VL) and gluteus medius (GM). Older males more frequently (46% of trials) took two-steps to stop than young males (20%). The stance leg muscles responded significantly faster than the swing leg, and with increased speed, fewer swing limb muscles contributed to stopping. Older males were slower to respond with the stance leg, at 215 ms following the stimulus compared with 176 ms for the younger group. They also recruited fewer swing leg muscles with less frequent activation of the soleus and gluteus medius. Failure to activate muscles would provide less extensor torque to maintain the centre of gravity anterior to the forward base of support. This would decrease the total force opposing horizontal velocity in order to bring the body to rest and, as a consequence, encourage an additional step prior to stopping.

Replication of hepatitis B in HBsAg-positive siblings

Persistent hepatitis B virus (HBV) replication is important for progression of chronic liver diseases. To understand whether there is a trend of HBV replication in siblings or not, 1850 relatives of patients with hepatocellular carcinoma (HCC) were examined prospectively for liver function test, viral markers and HBV DNA. The prevalence of HBsAg in the parents', siblings', children's and grandchildren's generations were 43.4%, 57.2%, 35.5% and 32.1%, respectively. The prevalence of hepatitis B e antigen (HBeAg) in sibling's generation (mean age 44.4 years) was 19%, which is higher than that of asymptomatic HBsAg carriers. For siblings in the children's generation, the prevalence of HBeAg in hepatitis B surface antigen (HBsAg) carriers declined from 40% in the eldest siblings to 19% in the youngest siblings. In 75 families clustered with three or more HBsAg carrier siblings, the mean age for seven families of which all siblings remained HBeAg + was younger, whereas the mean age for 35 families of which all siblings had cleared HBeAg was older. For the remaining 33 families, in only 10 families had the older siblings cleared the HBeAg earlier than the younger siblings. Twenty families showed that younger siblings cleared the HBeAg earlier than the older or middle siblings. We concluded that HBV replication in HCC relatives cannot be explained by familial tendency alone. A significant number of younger siblings appeared to have a shorter HBV replication phase than their older siblings. The possible role of this in maternal–fetal transmission is discussed.

Children's conception of police authority when responding to requests for assistance

Children (five to six and seven to eight years old) were presented with scenarios in which various adults (a police officer, a teacher, and an unspecified adult) requested assistance from a child. Six scenarios were presented (two per adult) with half involving a reasonable request (requiring little effort from the child) and the others unreasonable. For each scenario, the participants stated: (i) whether the child in the story should comply with the adult's request, (ii) the reason for the compliance decision, (iii) the consequences of non-compliance, and (iv) the legitimacy of the adult's request. Compliance and perceived legitimacy of the request was highest for the police officer compared to the teacher, with both figures commanding greater compliance than the unspecified adult. Children's justifications suggested that the positive relationship between obedience and social status was due (albeit in part) to fear of punishment for non-compliance, particularly in the younger age group.