Self-rated oral health and associated factors in Brazilian elders

Objective: Self-rating provides a simple direct way of capturing perceptions of health. The objective of this study was to estimate the prevalence and associated factors of poor self-rated oral health among elders. Methods: National data from a cross-sectional population-based study with a multistage random sample of 4786 Brazilian older adults (aged 65-74) in 250 towns were analysed. Data collection included oral examinations (WHO 1997) and struct-ured interviews at elderly households. The outcome was measured by a single five-point-response-scale question dichotomized into `poor` (fair/poor/very poor) and `good` (good/very good) self-rated oral health. Data analyses used Poisson regression models stratified by sex. Results: The prevalence of poor self-rated oral health was 46.6% (95% CI: 45.2-48%) in the whole sample, 50.3% (48-52.5) in men and 44.2% (42.4-46) in women. Higher prevalence ratios (PR) were found in elders reporting unfavourable dental appearance (PR = 2.31; 95% CI: 2.02-2.65), poor chewing ability (PR = 1.64; CI: 1.48-1.8) and dental pain (PR = 1.44; CI: 1.04-1.23) in adjusted analysis. Poor self-perception was also associated with being men, black, unfavourable socioeconomic circumstances, unfavourable clinical oral health and with not using or needing a dental prosthesis. Conclusion: Assessment and understanding of self-rated oral health should take into account social factors, subjective and clinical oral symptoms.

Förändrade intimitetsformer bland äldre i det senmoderna samhället

Changing forms of intimacy among older people in late modern society The purpose of this paper is to draw attention to a neglected reality in Swedish social research: New romantic relationships in later life. Our theoretical points of departure are the transformation of intimacy and the transition from a culture of marriage to a culture of divorce. We ask if the transformation of intimacy has reached later life and investigate late life divorce, attitudes to and choice of union form in late life heterosexual relationships, relationship history and the importance of a relationship for life satisfaction. The results, which are based both on demographic data and a survey to 60–90 year old Swedes (n=1225), show that changing relationship patterns in late modern Sweden have reached older people. In romantic relationships initiated in later life LAT is the preferred union form, followed by cohabitation, while marriage is a rare choice. In some respects this makes older people an avant-garde in the investigation of alternative union forms. The results also show the importance of romantic relationships for life satisfaction in later life – independent of union form. Finally we criticize Swedish census data, which is based on civil status, for giving a somewhat distorted image of older people’s family and romantic lives.    

Usual clinical practice for early supported discharge after stroke with continued rehabilitation at home : an observational comparative study

Introduction: Based on randomised controlled trials, evidence exists that early supported discharge (ESD) from the hospital with continued rehabilitation at home has beneficial effects after stroke; however, the effects of ESD service in regular clinical practice have not been investigated. The purpose of the current study was to compare ESD service with conventional rehabilitation in terms of patient outcomes, caregiver burden at 3 and 12 months and the use and costs of healthcare during the first year after stroke. Material and methods: This study was a subgroup analysis of a longitudinal observational study of patients who received care in the stroke unit at Karolinska University Hospital in Sweden. Patients who met the inclusion criteria for ESD in previous experimental studies were included. The patients were referred to available rehabilitation services at discharge, and comparisons between those who received ESD service (the ESD group, n = 40) and those who received conventional rehabilitation (the NoESD group, n = 110) were performed with regard to independence in activities of daily living (ADL), the frequency of social activities, life satisfaction, and caregiver burden and the use and costs of healthcare during the first year after stroke. Results: At 3 and 12 months, no differences were observed with regard to patient outcomes; however, ESD was associated with a lower caregiver burden (p = 0.01) at 12 months. The initial length of stay (LOS) at the hospital was 8 days for the ESD group and 15 days for the NoESD group (p = 0.02). The median number of outpatient rehabilitation contacts was 20.5 for the ESD group (81% constituting ESD service) and 3 for the NoESD group (p<0.001). There was no difference between the groups with regard to overall healthcare costs. Conclusions: ESD service in usual clinical practice renders similar health benefits as conventional rehabilitation but a different pattern of resource use and with released capacity in acute stroke care.

Developing a national index of subjective wellbeing: the Australian unity wellbeing index

The Australian Unity Wellbeing Index has been designed as a new barometer of Australians' satisfaction with their lives, and life in Australia. It is based on, and develops, the theoretical model of subjective wellbeing homeostasis. The Index comprises two sub-scales of Personal and National Wellbeing. Data were collected through a nationally representative sample of 2,000 people in April/May 2001.Factor analysis confirmed the integrity of the two sub-scales and, confirming empirical expectation, the average level of life satisfaction was 75.5 percent of the scale maximum score. Group comparisons revealed that all age groups maintained their Personal Index score within the normal range. In addition,people in country areas were more satisfied with their personal lives than city-dwellers,but less satisfied about the national situation, and people who had recently experienced a strong positive event evidenced arise in wellbeing, whereas those who had experienced a strong negative event evidenced wellbeing in the low-normal range. It is argued that these data generally support homeostatic theory. However, an unusual result was that females were more satisfied with their own lives than males. A tentative argument is advanced that this may represent a constitutional difference. It is concluded that the Australian Unity Wellbeing Index has potential as a valid, reliable and sensitive instrument to monitor national wellbeing.

Factors associated with successful ageing

This research explored the extent to which adaptability, self-acceptance, religiosity, attitudes to ageing, and flexibility are associated with seven criteria of successful ageing (health, activity, life satisfaction, personal growth, positive relationships, autonomy, and purpose in life). Also considered was the level of importance participants assigned to these criteria. The participants were 200 females and 140 males aged between 70 and 95 years. Structural equation modelling was employed to determine significant paths between the variables. Direct and mediating effects of older adults’ importance ratings for different criteria of successful ageing were analysed. The main factors associated with successful ageing were self-acceptance and flexibility, both of which contributed significantly to almost all of the criteria examined. Importance ratings did not play a mediating role. It was concluded that self-acceptance and flexibility might enhance the process of successful ageing and could be targeted in programmes that assist older adults to adjust to life changes.

Subjective wellbeing as an affective-cognitive construct

The affective content of Subjective Wellbeing (SWB) was investigated in two separate studies. Study 1 involved a representative sample of 478 participants from across Australia aged between 18 and 72 years. This study tested the circumplex model of affect and then determined the minimum set of affects that explain variance in SWB. The model was supported, with most affects congregated around the valence axis. Overall, 64% of the variance in SWB was explained by six Core Affects, indicating that SWB is a highly affective construct. Study 2 tested the relative strength of Core Affect (content, happy and excited), in three separate models of SWB incorporating cognition (seven discrepancies)
and all five factors of personality. Using a sample of 854 participants aged been 18 – 86 years, structural equation modeling was used to compare an affective-cognitive driven model of SWB, with a personality driven model of SWB and a discrepancy driven model of SWB. The results provide support for an affective-cognitive model which explained 90 percent of the variance in SWB. All models confirm that the relationship between SWB, Core Affect and Discrepancies is far stronger than the relationship between personality and SWB. It is proposed that Core Affect and Discrepancies comprise the essence of SWB. Moreover, Core Affect is the driving force behind individual set-point levels in SWB homeostasis.

Core affect and subjective wellbeing: a rebuttal to Moum and Land

This paper is a rebuttal to the reviews of Moum and Land. Publication has been facilitated by Journal policy (see Instructions to authors ‘Procedure when the authors and reviewers disagree’ on the Journal website) which details the procedure to be followed in the case of disputed manuscripts. Our reply is in two parts. The first concerns issues of theory and the second issues of methodology. Each point of critique raised by the reviewers has been answered and shown either to be false or irrelevant. We contend that our original conclusion still stands. Subjective wellbeing is dominated by Core Affect.

An investigation into the cross-cultural equivalence of the personal wellbeing index

The Personal Wellbeing Index (PWI) is being developed for the cross-cultural measurement of subjective wellbeing (SWB). This paper reports the findings of its utility with the Hong Kong Chinese and Australian populations. An item on affect, ‘satisfaction with own happiness’ was also investigated to determine whether it should be added to the index. Three-hundred and sixty participants (180 per country), with equal representation from groups aged 18–35, 35–64 and 65 years and above, were recruited from each country. The PWI demonstrated good psychometric performance in terms of its reliability, validity and sensitivity, which are comparable in both countries. The item ‘satisfaction with own happiness’ was found to contribute significantly to the scale’s psychometric performance in Australia but not in Hong Kong. Cultural differences in the perception of the concepts ‘satisfaction’ and ‘happiness’ were suggested as an explanation for this finding. The PWI data are also consistent with homeostasis theory, which proposes that each person’s SWB level is maintained within a limited positive range. For the Australian population, their mean SWB level fell within the established Western range of 70–80, on a scale from 0 to 100. The Hong Kong population, however, fell below this range. Cultural response bias was identified as a plausible explanation for the differences between the Hong Kong and Australian samples.

Reconstructing child welfare through participatory and child centred professional practice

This questionnaire study examined the adjustment of 245 lone-parenting women following marital separation. A composite model included intrapsychic variables as intervening between demographic and contextual variables and adjustment (life satisfaction). Regression analyses showed that the demographic and contextual variables were partially mediated by the intrapsychic variables. The path model indicated that the intrapsychic variables (sense of coherence, control, depression, and grief) had a direct impact on life satisfaction and that there was an indirect path for depression through sense of coherence (SOC) and control. It was concluded that the intrapsychic variables had a more powerful relationship with women's post-separation life satisfaction than did the demographic/contextual variables. Social implications and recommendations for future policy are considered.

The impact of neurological illness on marital relationships

The current study investigated the impact of neurological illness on marital relationship satisfaction. Participants numbered 423 patients and 335 carers from motor neurone disease (MND), Huntington's disease (HD), Parkinson's, and multiple sclerosis (MS). The results demonstrated that patients and carers with HD had a significantly lower level of relationship satisfaction and sex life satisfaction than the other three illness groups. Further, patients with HD indicated a significantly higher level of relationship satisfaction than their carers. For MS and MND patients, social support predicted marital relationship satisfaction, and for Parkinson's patients, social support and sex life satisfaction predicted marital relationship satisfaction.

Does subjective well-being show a relationship between parents and their children?

The relationship between the subjective well-being of parents and their own 12–16-year-old children was explored in a Spanish sample of N = 266 families. A positive relationship was expected due to both a shared environment and the possibility of the genetic transmission of subjective well-being ‘set-points’. A positive significant relationship was found for the summated scale of satisfaction domains forming the Personal Well-being Index, and for the specific domains of health and security for the future. However, no relationship was found for the other five domains that make up this Index or for satisfaction with life as a whole. We conclude while these results provide some evidence for the expected influence of a shared environment, they have failed to provide evidence for high heritability of set-points for subjective well-being.

Positive development in emerging adulthood

Positive functioning in the developmental period of emerging adulthood has received little investigation. The current study investigated components of positive development using confirmatory factor analysis of Australian Temperament Project data collected from 1,158 young adults aged 19-20 years. Positive development constructs that have been theoretically conceptualised were examined to test core concepts. Five first-order constructs were identified in this sample: Civic Action and Engagement, Social Competence, Life Satisfaction, Trust and Tolerance of Others, and Trust in Authorities and Organisations. A second-order positive development factor defined by these constructs provided good fit for the data. This model of positive development in emerging adulthood can provide an outcome measure that can then be used to investigate the developmental processes and pathways involved.

The effect of tai chi on psychosocial well-being : a systematic review of randomized controlled trials

Objective : This systematic review aimed to critically appraise published clinical trials designed to assess the effect of Tai Chi on psychosocial well-being.

Data Sources : Databases searched included MEDLINE, CINAHL, EMBASE, HEALT, PsycINFO, CISCOM, the Cochrane Central Register of Controlled Trials of the Cochrane Library, and dissertations and conference proceedings from inception to August 2008.

Review Methods : Methodological quality was assessed using a modified Jadad scale. A total of 15 studies met the inclusion criteria (i.e. English publications of randomized controlled trials with Tai Chi as an intervention and psychological well-being as an outcome measure), of which eight were high quality trials. The psychosocial outcomes measured included anxiety (eight studies), depression (eight studies), mood (four studies), stress (two studies), general mental health three studies), anger, positive and negative effect, self-esteem, life satisfaction, social interaction and self-rated health (one study each).

Results : Tai Chi intervention was found to have a significant effect in 13 studies, especially in the management of depression and anxiety. Although the results seemed to suggest Tai Chi is effective, they should be interpreted cautiously as the quality of the trials varied substantially. Furthermore, significant findings were shown in only six high quality studies. Moreover, significant between group differences after Tai Chi intervention was demonstrated in only one high quality study (the other three significant results were observed in non-high quality studies). Two high quality studies in fact found no significant Tai Chi effects.

Conclusion : It is still premature to make any conclusive remarks on the effect of Tai Chi on psychosocial well-being.

Controlling subjective well-being

This thesis focused on the impact of disordered eating and obesity, and found that people with better self-esteem and personal control experience greater satisfaction with their lives overall. Although people reporting disordered eating reported lower self-esteem and obese people were less satisfied with their health, overall life satisfaction was maintained. The portfolio examined the Scientist-Practitioner Model (S-P) of psychology whereby practitioners perform dual roles as clinician and researcher. The clinical utility of the S-P model was then evaluated in four case studies.

Subjective well-being

This thesis challenges the orthodox view in the quality of life field by demonstrating, using different methodologies across multiple samples, that subjective judgments of life satisfaction are determined by an individual's affective style, rather than cognition or personality. This suggests that subjective wellbeing is a function of our Core Affect.