“There’s a Catch-22”. The complexities of pain management for people with advanced dementia nearing the end of life: a qualitative exploration of physicians’ perspectives

Background: Pain management is a cornerstone of palliative care. The clinical issues encountered by physicians when managing pain in patients dying with advanced dementia, and how these may impact on prescribing and treatment, are unknown. Aim: To explore physicians’ experiences of pain management for patients nearing the end of life, the impact of these on prescribing and treatment approaches, and the methods employed to overcome these challenges. Design: Qualitative, semi-structured interview study exploring: barriers to and facilitators of pain management, prescribing and treatment decisions, and training needs. Thematic analysis was used to elicit key themes. Settings/Participants: Twenty-three physicians, responsible for treating patients with advanced dementia approaching the end of life, were recruited from primary care (n=9), psychiatry (n=7) and hospice care (n=7). Results: Six themes emerged: diagnosing pain, complex prescribing and treatment approaches, side-effects and adverse events, route of administration, importance of sharing knowledge and training needs. Knowledge exchange was often practised through liaison with physicians from other specialties. Cross-specialty mentoring, and the creation of knowledge networks were believed to improve pain management in this patient population. Conclusions: Pain management in end-stage dementia is complex, requiring cross-population of knowledge between palliative care specialists and non-specialists, in addition to collateral information provided by other health professionals and patients’ families. Regular, cost- and time-effective mentoring and ongoing professional development are perceived to be essential in empowering physicians to meet clinical challenges in this area.

Transportation Policy Strategies for Iowa to Advance the Quality of Life, 2004

Building on the policy directions advanced in the publication "Policy Strategies for Iowa in Making Major Road Investments", this report defines each policy issue and discusses how transportation can play a role in addressing it. Perspectives from several focus group meetings conducted in nine communities in Iowa are discussed. The report also examines available data pertaining to the issues. Finally, the report presents several specific recommendations dealing with issues on economic development, safety, choice of transportation modes, and financing transportation in the future. The recommendations are directed at proving the Iowa Transportation Commission with the best possible insights to be used in making investment decisions that will impact the quality of life in Iowa in future years.

The Comfort of life depends upon Conversation – Puheen ja keskustelun ihanteet 1700-luvun englantilaisessa miehille ja naisille suunnatussa käytöskirjallisuudessa

Tutkielmassani tarkastellaan 1700-luvun englantilaisten käytösoppaiden antamia ohejeita ihanteellisesta kohteliaasta puheesta ja keskustelusta. Kohtelias käytöskulttuuri oli kehittynyt 1700-luvun kuluessa kaikenkattavaksi kulttuuriseksi ideologiaksi, jonka tärkein ilmaisumuoto oli keskustelu. Tutkielmassani pyrin selvittämään valitsemani neljän 1700-luvun englantilaisten käytösoppaan antamia ohjeita ihanteellisesta keskustelusta ja puheesta. Kaksi opasta on suunnattu miehille ja kaksi vastaavasti naisille. Tarkastelen naisille ja miehille suunnattujen 1700-luvun englantilaisten käytösoppaiden antamia ohjeita ihanteellisesta keskustelusta ja puheesta. Tärkeäksi näkökulmani kannalta muodostuu ajan kohtelias käytöskoodisto ja sen suhde puheeseen. Pohdin työssäni kohteliaisuuden suhdetta puheeseen ajan käytöskirjallisuuden kautta. Millaista kohtelias puhe niiden mukaan oli ja millaisia ideologisia sisältöjä sekä tavoitteita se sisälsi. Tuon esiin myös kohteliaisuuden suhdetta 1700-luvun englantilaisen yläluokan elämään ja sen vaikutukseen yhteiskunnassa. Pohdin erityisesti sitä millaiseksi käytösoppaat kuvasivat miesten ja naisten ihanteellista puhetta sekä keskustelua. Millaisina puhujina oppaat näkivät miehen ja naisen? Erosiko miesten ja naisten puhe jotenkin toisistaan? Käytösoppaiden tapaan nähdä sukupuolet vaikuttaa vahvasti 1700-luvun Englannissa vallinneet käsitykset sukupuolten rooleista ja sukupuolten eroista. Toisaalta kohtelias käytöskulttuuri antaa ihanteelliselle keskustelulle ja puheelle oman kehyksensä. 1700-luvun englantilaiset käytösoppaat korostavat kohteliaan puheen roolia ihmiselämän ja sosiaalisten suhteiden kannalta. Se oli tärkein keino, jolla eliitti pystyi omaa asemaansa perustelevat ja jonka avulla yhteisöön kuuluminen arvioidaan. Kohtelias puhe vaati harjoittajiltaan paljon ja se vaatikin harjaantumista. Käytösoppaat näkevät miehen ja naisen hyvin erilaisina keskustelijoina. Molemmat pyrkivät puheellaan miellyttämään muita ja olemaan osa kohteliasta yhteisöä, mutta miesten ja naisten saamat puhujanroolit ovat hyvin erilaisia. Ihanteellinen maskuliininen puhe henkilöityy kohteliaaseen herrasmieheen, joka kohtelee puheellaan kanssaihmisiä hyväntahtoisesti ja yhdenvertaisesti. Käytösoppaat rajaavat kohteliaan herrasmiehen ideaalin ulkopuolelle naismaisia ja moraalittomia käytösmalleja maskuliinisuuden sekä kohteliaisuuden suojelemiseksi. Naisille puolestaan käytösoppaat antavat rajoitetun roolin kohteliaassa yhteisössä, jonka toiminnot ohjautuvat tämän oman maineen, mutta myös miehisen kunnian ja tarpeiden kautta. Toisaalta naisten puhe on kohteliaan keskustelun kannalta myös tärkeää ja se saa erityisen roolin avioliitossa.

The use of life;

"Pocket classics edition."

On the Social Aspects of Unemployment: The Case of Life Satisfaction

Unemployment is related to economic, political and social aspects. One of the least analysed social aspects is the relationship between unemployment and the (individual) perceived levels of well-being, such as life satisfaction or happiness. This chapter complements previous work on the subject, using a panel-data econometrics methodology to analyze the relationship between unemployment and life satisfaction in a wide range of countries worldwide. The results confirm that unemployment has a negative effect, statistically significant, on life satisfaction, either for men or for women.

The Effects of Age, Ethnicity, Sexual Dysfunction, Urinary Incontinence, Masculinity, and Relationship with the Partner on the Quality of Life of Men with Prostate Cancer

Prostate cancer, the leading cause of cancer in men, has positive survival rates and constitutes a challenge to men with its side effects. Studies have addressed the bivaritate relationships between prostate cancer treatment side effects masculinity, partner relationship, and quality of life (QOL). However, few studies have highlighted the relationships among prostate cancer treatment side effects (i.e., sexual dysfunction, urinary incontinence), masculinity, and relationship with the partner together on QOL in men. Most studies were conducted with predominately Caucasian sample of men. Miami is a unique multiethnic setting that hosts Cuban, Columbian, Venezuelan, Haitian, other Latin American and Caribbean communities that were not represented in previous literature. The purpose of this study was to examine relative contributions of age, ethnicity, sexual dysfunction, urinary incontinence, masculinity, and perception of the relationship with the partner on the quality of life in men diagnosed with prostate cancer. Data were collected using self administered questionnaires measuring demographic variables, sexual and urinary functioning (UCLA PCI), masculinity (CMNI), partner relationship (DAS), and QOL (SF-36). A total of 117 partnered heterosexual men diagnosed with prostate cancer were recruited from four urology clinics in Miami, Florida. Men were 67.47 (SD = 8.42) years old and identified themselves to be of Hispanic origin (54.3 %, n = 63). Findings demonstrated that there was a significant moderate negative relationship between urinary and sexual functioning of men. There was a significant strong negative association between men’s perceived relationship with partner and masculinity. There was a weak negative relationship between the partner relationship and QOL. Hierarchal multiple regression showed that the partner relationship (β = -.25, t (91) = -2.28, p = .03) significantly contributed overall to QOL. These findings highlight the importance of the relationship satisfaction in the QOL of men with prostate cancer. Nursing interventions to enhance QOL for these men should consider strengthening the relationship and involving the female partner as an active participant.

The influence of HIV, HCV and inhibitors on the quality of life and behavior of the disease in patients with haemophilia: An observational study

Inhibitors are the main complication in the treatment of haemophilia. A high percentage of adult patients were infected in past decades by HIV and HCV through factor concentrates. This study compared the quality of life of patients with hemophilia (QoL) and illness behavior in adult patients with haemophilia according to the development of inhibitors and HIV or HCV co-infection. This is an observational clinical study. 69 adult patients with haemophilia participated. We used A36 Hemophilia-QoL and IBQ questionnaires to measure the QoL and illness behavior, respectively. The dependent variables were type and severity of haemophilia, type of treatment, development of inhibitors, HIV and HCV infection, or both. We observed significant differences in the perception of QoL and illness behavior in patients according to the development of inhibitor and coinfection with HIV-HCV. We obtained four groups: the first and second group, which comprise 67% of the sample, exhibit behavior patterns indicating good adaptation to the disease and good QoL. The other two groups, which comprise 33% of the sample show behavior that is not well adapted to the disease, and poor quality of life. The development of inhibitors itself does not influence the quality of life and illness behavior in patients with haemophilia. Patients infected with HIV or HCV do not have a worse illness behavior compared to those uninfected. The development of inhibitors and HIV-HCV co-infection has a negative impact on quality of life and illness behavior in patients with haemophilia.

Socio-demographic and Health Aspects Associated with the Quality of Life in the Elderly of the Family Health Strategy. An Analytical Study

to analyze the association between the socio-demographic and health aspects to the quality of life (QOL) of elderly peoplelinked to the ESF.

Physical activity and osseointegration: "step forward" to improve the quality of life of a trans-femoral amputee person

Lower limb amputation is an event that inevitably changes the lifestyle of the person with a significant impact on quality of life. The socket-type prosthesis entails that the residual limb is in direct contact with the socket which often implies numerous disadvantages. Osseointegrated prosthesis is a solution that avoids skin problems because not include the presence of the socket. In this type of prosthesis, a stem is surgically inserted inside the medullary canal and connected with the external prosthetic limb. Therefore, this thesis aims to highlight and explore the main strengths and problems of osseointegrated prostheses and to examine the role of physical activity, with attention to functional capacity and bone quality. The objectives of the thesis will be developed through 5 studies: (I) A gait analysis of a 44 years-old male patient who underwent surgery for the implantation of an osseointegrated prosthesis; (II) A systematic review to investigate the state of stump bone quality in patients with limb amputations; (III) A systematic review of the technologies involved in such devices has been carried out to identify the most fruitful ones in improving bone quality; (IV) A systematic review investigating the topic of physical activity and bone turnover biomarkers; (V) A systematic review to investigate the effects of physical activity interventions combined with drug treatments on bone biomarkers in people with osteopenia and osteoporosis. The integrated prosthesis is a good solution for people with lower limb amputation who cannot use their traditional socket-type prosthesis. Although many objectives have already been achieved, there are still many aspects that we can improve. These include the creation of a multidisciplinary path that support patients along their path, with particular attention to the pre-surgery and the post-rehabilitation phase that is still lacking even if of fundamental impact in determining the quality of life.

Physical activity as a tool to improve the quality of life for individuals with hip or knee osteoarthritis

Total hip and knee replacements (THR/TKR) are considered the gold standard surgical treatments for end-stage osteoarthritis (OA), effectively alleviating pain, enhancing joint mobility and quality of life (QoL). Maintaining an active lifestyle and regular physical activity (PA) is crucial for these patients, as it can increase bone density and stability of joint prosthesis. This thesis aims to: (1) systematically review recommendations from healthcare professionals; (2) explore interventions promoting an active lifestyle post-THR and TKR; (3) investigate the primary causes of stiffness post-TKR; (4) design an exercise protocol to enhance QoL post-THR and TKR; (5) evaluate orthopedic surgeons' attitudes toward PA for patients post-THR/TKR; and (6) assess changes in QoL after a specifically designed PA intervention. The initial review revealed consensus on permissible sports activities post-surgery, but few studies addressed interventions targeting PA behaviors. Subsequently, findings highlighted key factors contributing to post-TKR stiffness, including mispositioned components, psychological distress, and obesity. Building on these insights, a PA intervention was implemented, followed by a survey investigating orthopedic surgeons' attitudes towards PA, which demonstrated a general positive attitude. Lastly, a pilot randomized controlled trial demonstrated significant enhancements in QoL, physical function, and clinical outcomes following a three-month adapted PA intervention. Future research should focus on raising awareness among individuals and healthcare professionals, fostering engagement in PA programs, and promoting active lifestyles. PA represents a valuable strategy for mitigating the burden of chronic diseases on society.

[association Between Physical And Psychosocial Impacts Of Oral Disorders And Quality Of Life Among The Elderly].

This study sought to evaluate the association between the impact of oral disorders in terms of physical/psychosocial dimensions and quality of life among the elderly. It involved a cross-sectional study conducted among the elderly (65-74 years) in 2008/2009. The social impact was assessed using the Oral Health Impact Profile (OHIP 14) and the quality of life using the SF 12 Short-Form Health Survey. Descriptive, univariate and multivariate (logistic regression) analysis was conducted with correction for the design effect, using SPSS(r)18.0 software. Of the 800 individuals approached, 736 elderly individuals participated (TR = 92%), with a mean age of 67.77 years, the majority of whom showed no impact based on the measurement of the prevalence of OHIP. The functional limitation dimension of the OHIP was associated with the physical domain of the SF12, irrespective of the other variables investigated. However, the seriousness of OHIP and its psychological discomfort and disability dimensions was associated with the mental domain of the SF12. The conclusion reached is that some impacts of oral disorders were associated with unsatisfactory quality of life in the physical and mental domains.