End-of-Life Decisions and Advanced Old Age

Article

The subversion of the good life (enlightened rebelliousness for the 21st century: a critical perspective on the work of Bolívar Echeverría)

El debate sobre el modelo civilizatorio de la modernidad de Occidente, consu economía concentradora y excluyente, y su matriz económico energética petrolera y extractivista no sustentable, ha reavivado en los escenarios políticos y académicos de la salud la discusión de la propuesta del buen vivir inscrita en las nuevas constituciones de Bolivia y Ecuador. Ante la crisis social, sanitaria y ambiental producida por la imposición de una economía de la muerte, y la consiguiente multiplicación de modos de vivir malsanos, se discuten aquí las tesis de Bolívar Echeverría sobre la base material de la vida y la cultura, como una herramienta para evaluar históricamente los desempeños de los gobiernos de las izquierdas realmente existentes, y trabajar un modelo de transición histórica y el indispensable remozamiento de la conciencia crítica desde una visión radicalmente renovadora, pero que mire la realidad sin dogmatismo, sin estridencias míticas y con un sentido de profunda autocrítica.

The bubbles or the boiling pot? An ecosystemic approach to culture, environment and quality of life

For the diagnosis and prognosis of the problems of quality of life, a multidisciplinary ecosystemic approach encompasses four dimensions of being-in-the-world, as donors and recipients: intimate, interactive, social and biophysical. Social, cultural and environmental vulnerabilities are understood and dealt with, in different circumstances of space and time, as the conjugated effect of all dimensions of being-in-the-world, as they induce the events (deficits and assets), cope with consequences (desired or undesired) and contribute for change. Instead of fragmented and reduced representations of reality, diagnosis and prognosis of cultural, educational, environmental and health problems considers the connections (assets) and ruptures (deficits) between the different dimensions, providing a planning model to develop and evaluate research, teaching programmes, public policies and field projects. The methodology is participatory, experiential and reflexive; heuristic-hermeneutic processes unveil cultural and epistemic paradigms that orient subject-object relationships; giving people the opportunity to reflect on their own realities, engage in new experiences and find new ways to live better in a better world. The proposal is a creative model for thought and practice, providing many opportunities for discussion, debate and development of holistic projects integrating different scientific domains (social sciences, psychology, education, philosophy, etc.).

Future directions in Australian social policy : new ways of preventing risk

Future directions in Australian social policy: new ways of preventing risk, no. 49: growth.
The papers presented in this issue of Growth aim to explore the scope for new directions in social policy in the light of critical shifts in working life, household relations and the economy.

The changing face of the Australian teaching profession : new generations and new ways of working and learning

Today’s workforce is characterised by an increasing mix of people with varying career aspirations, work motivators and job satisfiers. This paper discusses the intergenerational nature of today’s workforce, which is currently dominated by the age groups commonly referred to as Baby Boomers and Generation X. The Baby Boomers defined and redefined work during the last quarter of the twentieth century, but as they track towards retirement, GenXers’ valued work patterns and their career and life aspirations are increasingly dominating. This paper draws on a body of literature about a younger generation of workers and the current world of work in today’s knowledge society, and discusses possible implications for the teaching profession, particularly for attracting and retaining young people as teachers.

Ways of the philosopher : what Plato didn't say

Socrates' search is for direction in life, for how one should live. For him, an unexamined life is not worth living. The suggestion in this thesis is that Plato follows Socrates in asking the extremely relevant and practical question that seeks to discover the sort of life worthy of the human individual. For Plato, the answer involves the pursuit of knowledge and wisdom, it is, in short, to do philosophy. Socrates regards genuine philosophy as active and dialectical. Plato accepts the challenge of conveying this through the written word. Implicit in his dialogues is the idea that human wisdom is a fusion of the spiritual and the rational. The philosophic life is realised in practice by following the three interdependent ways of the philosopher, these are the ways of dialectics, death and love. These identify the philosophic life with a critically detached, yet passionate attitude to the world. However, this practical teaching is guided and informed by Plato's metaphysics, in particular his idea of the Good. A major task of this thesis is to show how the idea of the Good is relevant to ordinary human conduct.

Not all roads lead to Rome - a review of quality of life measurement in diabetes

Aims Quality of life (QoL) is recognized widely as an important health outcome in diabetes, where the burden of selfmanagement places great demands on the individual. However, the concept of QoL remains ambiguous and poorly defined. The aim of our review is to clarify the measurement of QoL in terms of conceptualization, terminology and psychometric properties, to review the instruments that have been used most frequently to assess QoL in diabetes research and make recommendations for how to select measures appropriately.

Methods A systematic literature search was conducted to identify the ten measures most frequently used to assess QoL in diabetes research (including clinical trials) from 1995 to March 2008.

Results Six thousand and eight-five abstracts were identified and screened for instrument names. Of the ten instruments most frequently used to assess ‘QoL’, only three actually do so [i.e. the generic World Health Organization Quality of Life (WHOQOL) and the diabetes-specific Diabetes Quality of Life (DQOL) and Audit of Diabetes-Dependent Quality of Life (ADDQoL)]. Seven instruments more accurately measure health status [Short-Form 36 (SF-36), EuroQoL 5-Dimension (EQ-5D)], treatment satisfaction [Diabetes Treatment Satisfaction Questionnaire (DTSQ)] and psychological well-being [Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS), Well-Being Questionnaire (W-BQ), Problem Areas in Diabetes (PAID)].

Conclusions No single measure can suit every purpose or application but, when measures are selected inappropriately and data misinterpreted, any conclusions drawn are fundamentally flawed. If we value QoL as a therapeutic goal, we must ensure that the instruments we use are both valid and reliable. QoL assessment has the proven potential to identify ways in which treatments can be tailored to reduce the burden of diabetes. With careful consideration, appropriate measures can be selected and truly robust assessments undertaken successfully.

The impact of hypoglycaemia on quality of life and related patient-reported outcomes in Type 2 diabetes : a narrative review

As a common side effect of insulin treatment for diabetes, hypoglycaemia is a constant threat and can have far-reaching and potentially devastating consequences, including immediate physical injury as well as more pervasive cognitive, behavioural and emotional effects. Moreover, as a significant limiting factor in achieving optimal glycaemic control, exposure to hypoglycaemia can influence diabetes self-management.

Although hypoglycaemia is known to occur in Type 2 diabetes, its morbidity and impact on the individual are not well recognized. The aim of the current review is to examine published evidence to achieve a synthesis of the scope and significance of the potential detriment caused by hypoglycaemia to individuals with Type 2 diabetes. The implications of these observations for treatment and research have also been considered.

A narrative review was performed of empirical papers published in English since 1966, reporting the effect of hypoglycaemia on quality of life and related outcomes (including generic and diabetes specificquality of life, emotional well-being and health utilities) in Type 2 diabetes.

Research demonstrates the potential impact of hypoglycaemia on the lives of people with Type 2 diabetes, from an association with depressive symptoms and heightened anxiety, to impairment of the ability to drive, work and function in ways that are important for quality of life. Few studies consider hypoglycaemia as an explanatory variable in combination with quality of life or related primary endpoints. As a consequence, there is a pressing need for high-quality research into the overall impact of hypoglycaemia on the lives of people with Type 2 diabetes.

Playing to Create New Ways of Playing: A Child with Prader-Willi Syndrome

This investigation evaluates the possibility of constructing new ways of playing for a child with Prader-Willi syndrome, by means of occupational therapy. It is a qualitative study which makes use of the case study methodology, whose starting point is the clinical intervention as data collect field. It also presents a short revision of the literature to subside discussions and reflections. It was observed that through the playing experience the occupational therapist led the child to know his own limitations and possibilities, by making him discover new ways of doing activities. Observing the therapist and learning with her, the patient experienced different situations throughout the therapeutic relationship, what enabled him to experiment them in his everyday life. Finally, this study aims at showing the clinical reasoning of an occupational therapist with a view to demonstrate Brazilian therapeutical conduct.

How to grow the peanut : and 105 ways of preparing it for human consumption /

Cover title.

Music in everyday living and learning; ways of integrating music with other experiences, a report.

Mode of access: Internet.

Mirror neurons in the tree of life, development and evolution of sensorimotor matching responses

Mirror neurons in the tree of life rappresenta lo sviluppo e l' evoluzione del sistema dei neuroni specchio nei primati umani, non - umani e di alcune specie di uccelli, utilizzando metodi cooptati dalla filosofia della biologia e la biologia teorica, per integrare dati relativi al sistema nervoso e al comportamento delle specie in esame.

The measurement properties of the menorrhagia multi-attribute quality-of-life scale:a psychometric analysis

Menorrhagia, or heavy menstrual bleeding (HMB), is a common gynaecological condition. As the aim of treatment is to improve women's wellbeing and quality of life (QoL), it is necessary to have effective ways to measure this. This study investigated the reliability and validity of the menorrhagia multi-attribute scale (MMAS), a menorrhagia-specific QoL instrument. Participants (n = 431) completed the MMAS and a battery of other tests as part of the baseline assessment of the ECLIPSE (Effectiveness and Cost-effectiveness of Levonorgestrel-containing Intrauterine system in Primary care against Standard trEatment for menorrhagia) trial. Analyses of their responses suggest that the MMAS has good measurement properties and is therefore an appropriate condition-specific instrument to measure the outcome of treatment for HMB. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

A comparative study of life history and gene flow in darters (Pisces: Percidae)

Gene flow, or the exchange of genes between populations, is important because it determines the evolutionary trajectory of a species, including the relative influences of genetic drift and natural selection in the process of population differentiation. Gene flow differs among species because of variation in dispersal capability and abundances across taxa, and historical forces related to geological or lineage history. Both history and ecology influence gene flow in potentially complicated ways, and accounting for their effects remains an important problem in evolutionary biology. This research is a comparative study of gene flow and life-history in a monophyletic group of stream fishes, the darters. As a first step in disentangling historical and ecological effects, I reconstructed the phylogenetic relationships of the study species from nucleotide sequences in the mtDNA control region. I then used this phylogeny and regional glaciation history to infer historical effects on life-history evolution and gene flow in 15 species of darters. Gene flow was estimated indirectly, using information from 20 resolvable and polymorphic allozyme loci. When I accounted for historical effects, comparisons across taxa revealed that gene flow rates were closely associated with differences in clutch sizes and reproductive investment patterns. I hypothesized that differences in larval dispersal among taxa explained this relationship. Results from a field study of larval drift were consistent with this hypothesis. Finally, I asked whether there was an interaction between species' ecology and genetic differentiation across biogeographically distinct regions. Information from allozymes and mtDNA sequences revealed that life history plays an important role in the magnitude of species divergence across biogeographic boundaries. These results suggested an important association between life histories and rates of speciation following an allopatric isolation event. This research, along with other studies from the literature, further illustrates the enormous potential of North American freshwater fishes as a system for studying speciation processes. ^