Holes in my memories : a qualitative study of men affected by father absence

 This qualitative study explored adult men's experiences of father absence. Interviews with 21 men between the ages of 24 and 70 explored narratives of father absence and how the men perceived this influenced their life trajectory. Thematic analysis revealed that these men experienced a range of difficulties and challenges, including episodes of sadness and depression associated with loss and grief for the paternal relationship, self-esteem issues, feelings of anger and rejection, and difficulty forming trusting relationships particularly with other men. This study contributes to understanding mental health issues that can be associated with paternal absence for men.

The heart of the educator: aesthetic experience shaping knowledge, identity and passion

This chapter explores Dewey’s construct of aesthetic experience and the role that the aesthetic plays in knowing: knowing as a coherence of things to be known, developing one’s sense of identity in relation to that knowing, and the passions that emerge in an ‘aesthetic experience’ that lays the foundation for future knowing, identity and passions. Drawing on Dewey’s ideas, Girod, Rau and Schepige developed the construct ‘Aesthetic understanding’ to provide a theoretical lens for describing students’ experience of coming to know science content. This chapter develops the aesthetic understanding construct further into a methodological framework, called a Knowledge-Identity-Passion (KIP) Analysis, that can be applied to research exploring aesthetic experience in two ‘research moments’: the immediate effects of an aesthetic experience on knowledge, identity and passion; and the life trajectory that follows an aesthetic experience. A KIP analysis can be applied to research examining the effects and meanings attached to experiences through close analysis of knowledge, identity and passion, both individually and in relation to each other. To illustrate the power of a KIP analysis narratives of four science educators are provided. The practical applications and methodological possibilities and limitations of a KIP Analysis are then discussed.

Trajectory and predictors of quality of life in first episode psychotic mania

BACKGROUND: Little is known about the trajectory of quality of life (QoL) following a first episode of psychotic mania in bipolar disorder (BD). This 18-month longitudinal study investigated the trajectory of QoL, and the influence of premorbid adjustment and symptoms on 18-month QoL in a cohort of young people experiencing a first episode of psychotic mania. METHODS: As part of an overarching clinical trial, at baseline, sixty participants presenting with a first episode of psychotic mania (BD Type 1 - DSM-IV) completed symptomatic and functional assessments in addition to the Premorbid Adjustment Scale - General Subscale. Symptom measures were repeated at 18-month follow up. QoL was rated using the Quality of Life Scale (QLS) at designated time points. RESULTS: Mean QLS scores at initial measurement (8 weeks) were 61% of the maximum possible score, increasing significantly to 70% at 12 months, and 71.2% at 18-month follow-up. Premorbid adjustment and 18-month depressive symptoms were significantly associated with QoL at 18-month follow-up. LIMITATIONS: Study limitations include the small sample size, inclusion of participants with psychotic mania only, use of measures originally designed for use with schizophrenia spectrum disorders, and lack of premorbid or baseline measurement of QoL. CONCLUSIONS: Results suggest that QoL can be maintained early in BD, and reinforce the importance of assertively treating depressive symptoms throughout the course of this disorder. The emergence of a link between premorbid adjustment and poorer QoL in this cohort highlights the importance of assessing facets of adjustment when planning psychological interventions.

Recovering from an acute cardiac event – the relationship between depression and life satisfaction

Aims. This study sought to measure the rates and trajectory of depression over six months following admission for an acute cardiac event and describe the relationship between depression and life satisfaction.
Background. Co-morbid depression has an impact on cardiac mortality and is associated with the significant impairment of quality of life and well-being, impairments in psychosocial function, decreased medication adherence and increased morbidity.
Design. This was a descriptive, correlational study.
Method. The study was undertaken at a large public hospital in Melbourne. Participants were asked to complete a survey containing the cardiac depression scale (CDS) and the Personal Well-being Index.
Results. This study mapped the course of depression over six months of a cohort of patients admitted for an acute cardiac event. Significant levels of depressive symptoms were found, at a level consistent with the literature. A significant correlation between depressive symptoms as measured by the CDS and the Personal Well-being Index was found.
Conclusions. Depression remains a significant problem following admission for an acute coronary event. The Personal Wellbeing Index may be a simple, effective and non-confrontational initial screening tool for those at risk of depressive symptoms in this population. Relevance to clinical practice. Despite the known impact of depression on coronary heart disease (CHD), there is limited research describing its trajectory. This study makes a compelling case for the systematic screening for depression in patients with CHD and the importance of the nursing role in identifying at risk individuals.

Effects of early-life environment and epigenetics on cardiovascular disease risk in children: highlighting the role of twin studies

Cardiovascular disease (CVD) is the leading cause of death worldwide and originates in early life. The exact mechanisms of this early-life origin are unclear, but a likely mediator at the molecular level is epigenetic dysregulation of gene expression. Epigenetic factors have thus been posited as the likely drivers of early-life programming of adult-onset diseases. This review summarizes recent advances in epidemiology and epigenetic research of CVD risk in children, with a particular focus on twin studies. Classic twin studies enable partitioning of phenotypic variance within a population into additive genetic, shared, and nonshared environmental variances, and are invaluable in research in this area. Longitudinal cohort twin studies, in particular, may provide important insights into the role of epigenetics in the pathogenesis of CVD. We describe candidate gene and epigenome-wide association studies (EWASs) and transgenerational epigenetic inheritance of CVD, and discuss the potential for evidence-based interventions. Identifying epigenetic changes associated with CVD-risk biomarkers in children will provide new opportunities to unravel the underlying biological mechanism of the origins of CVD and enable identification of those at risk for early-life interventions to alter the risk trajectory and potentially reduce CVD incidence later in life.

A review of the relationship between socioeconomic position and the early-life predictors of obesity

A range of important early-life predictors of later obesity have been identified. Children of lower socioeconomic position (SEP) have a steeper weight gain trajectory from birth with a strong socioeconomic gradient in child and adult obesity prevalence. An assessment of the association between SEP and the early-life predictors of obesity has been lacking. The review involved a two-stage process: Part 1, using previously published systematic reviews, we developed a list of the potentially modifiable determinants of obesity observable in the pre-natal, peri-natal or post-natal (pre-school) periods; and part 2, conducting a literature review of evidence for socioeconomic patterning in the determinants identified in part 1. Strong evidence was found for an inverse relationship between SEP and (1) pre-natal risk factors (pre-pregnancy maternal body mass index (BMI), diabetes and pre-pregnancy diet), (2) antenatal/peri natal risk factors (smoking during pregnancy and low birth weight) and (3) early-life nutrition (including breastfeeding initiation and duration, early introduction of solids, maternal and infant diet quality, and some aspects of the home food environment), and television viewing in young children. Less strong evidence (because of a lack of studies for some factors) was found for paternal BMI, maternal weight gain during pregnancy, child sleep duration, high birth weight and lack of physical activity in young children. A strong socioeconomic gradient exists for the majority of the early-life predictors of obesity suggesting that the die is cast very early in life (even pre-conception). Lifestyle interventions targeting disadvantaged women at or before child-bearing age may therefore be particularly important in reducing inequality. Given the likely challenges of reaching this target population, it may be that during pregnancy and their child's early years are more feasible windows for engagement.

Depression screening and referral in cardiac wards: A 12-month patient trajectory

Background: Depression is common among patients with coronary heart disease (CHD) and has a major impact on their quality of life, morbidity and mortality. Aim: The aim of this study was to map the 12-month psychosocial outcomes of patients with CHD who were screened positive for depression in an acute cardiac ward.

Methods: A prospective cohort study was conducted of the psychosocial trajectory (depression, anxiety, wellbeing, social support, mental health service access) of 212 patients with CHD who were screened for depression after being admitted to acute cardiac wards of a major metropolitan hospital. Outcomes were assessed before hospital discharge and at one, three, six and 12 months post-discharge.

Results: Linear mixed models identified that those patients screened at ‘moderate to high’ risk of depression at baseline had higher levels of depression (F(1,173)=53.93, p<0.0001) and anxiety (F(1,180)=67.01, p<0.001), and lower levels of wellbeing (F(1,186)=42.47, p<0.001) and social support (F(1,177)=25.40, p<0.0001), compared to those at ‘no to low’ risk of depression. Levels of depression and wellbeing remained fairly constant over the 12-month trajectory. Surgical and medical treatment groups were of similar psychological composition over the 12-month period.

Conclusions: These findings attest to the effectiveness and predictive validity of a simple nurse-administered screening tool designed to identify depression in hospital patients with CHD and also indicate that a screening and referral tool alone is not sufficient to achieve optimal disease management. A collaborative care model involving family members and integrated pathways to primary care is recommended.

A visual-numeric approach to clustering and anomaly detection for trajectory data

This paper proposes a novel application of Visual Assessment of Tendency (VAT)-based hierarchical clustering algorithms (VAT, iVAT, and clusiVAT) for trajectory analysis. We introduce a new clustering based anomaly detection framework named iVAT+ and clusiVAT+ and use it for trajectory anomaly detection. This approach is based on partitioning the VAT-generated Minimum Spanning Tree based on an efficient thresholding scheme. The trajectories are classified as normal or anomalous based on the number of paths in the clusters. On synthetic datasets with fixed and variable numbers of clusters and anomalies, we achieve 98 % classification accuracy. Our two-stage clusiVAT method is applied to 26,039 trajectories of vehicles and pedestrians from a parking lot scene from the real life MIT trajectories dataset. The first stage clusters the trajectories ignoring directionality. The second stage divides the clusters obtained from the first stage by considering trajectory direction. We show that our novel two-stage clusiVAT approach can produce natural and informative trajectory clusters on this real life dataset while finding representative anomalies.

Caring for people with diabetes at the end of life

End-of-life care planning is assuming global significance. While general end-of-life care guidelines apply to diabetes, there are some diabetes-specific issues that need to be considered. These include the usual long trajectory to end-of-life care that enables clinicians and people with diabetes to proactively discuss when to change the focus of care from preventing diabetes complications (tight control) to a palliative approach. Palliative care aims to promote comfort and quality of life and reduce the unnecessary burden of care on individuals and their families. The aim of this paper is to discuss common disease trajectories and their relationship to diabetes care, outline strategies for proactively discussing these issues and suggest indications that palliative care is warranted.