Characteristics of left ventricular diastolic dysfunction in the community: an echocardiographic survey

Objective: To determine the prevalence and predictors of left ventricular (LV) diastolic dysfunction in older adults. Design, setting and participants: A cross-sectional survey of 1275 randomly selected residents of Canberra, aged 60 to 86 years (mean age 69.4; 50% men), conducted between February 2002 and June 2003. Main outcome measures: Prevalence of LV diastolic dysfunction as characterised by comprehensive Doppler echocardiography. Results: The prevalence of any diastolic dysfunction was 34.7% (95% CI 32.1% to 37.4%) and that of moderate to severe diastolic dysfunction was 7.3% (95% CI 5.9% to 8.9%). Of subjects with moderate to severe diastolic dysfunction, 77.4% had an LV ejection fraction (EF) > 50% and 76.3% were in a preclinical stage of disease. Predictors of diastolic dysfunction were higher age (p < 0.0001), reduced EF (p < 0.0001), obesity (p < 0.0001) and a history of hypertension (p < 0.0001), diabetes (p = 0.02) and myocardial infarction (p = 0.003). Moderate to severe diastolic dysfunction with normal EF, although predominantly preclinical, was independently associated with increased LV mass (p < 0.0001), left atrial volume (p < 0.0001), and circulating amino-terminal pro-B-type natriuretic peptide concentrations (p < 0.0001), and with decreased quality of life (p < 0.005). Conclusion: Diastolic dysfunction is common in the community and often unaccompanied by overt congestive heart failure. Despite the lack of symptoms, advanced diastolic dysfunction with normal EF is associated with reduced quality of life and structural abnormalities that reflect increased cardiovascular risk.

Quality of Life in Chinese elderly people with depression

Background Depression is the most prevalent functional mental disorder of later life. It is estimated that about 5% of the elderly population of Hong Kong are suffering from depression. Aim To investigate the self-rated quality of life of community-dwelling elderly people diagnosed with depression, and to examine the relationships between quality of life and mental, physical health, functional status and social support. Methods and results A cross-sectional descriptive survey was conducted in psychiatric outpatient clinics. A convenience sample of 80 Chinese elderly people with a diagnosis of depressive disorder was recruited. Perception of quality of life was measured by the Hong Kong Chinese World Health Organization Quality of Life Scale-Brief Version. Participants' mental status, functional abilities, physical health condition, and social support status were assessed. Sixty-one (76.3%) participants were female. They were least satisfied with meaningfulness of life, life enjoyment, concentration and thinking, energy and work capacity. Functional abilities had a positive association with participants' perceived quality of life, level of depression and number of physical health conditions had a negative association. Participants had low ratings of quality of life when compared with healthy persons and persons with chronic physical problems. Findings are discussed in light of the socio-cultural environment in Hong Kong. Conclusion Comprehensive treatment and better control of depression, including different modes of medical and psychosocial intervention, could help to improve participants' perception of quality of life. A longitudinal study with a larger sample with various levels of depression and socio-demographic characteristics is recommended. Copyright © 2006 John Wiley & Sons, Ltd.

Successful use of recombinant factor VII in massive hemoptysis due to community-acquired pneumonia

Recombinant activated factor VII (rFVIIa) is a powerful hemostatic agent developed for use in hemophilia. It has been used increasingly in life-threatening hemorrhage in a variety of other settings in which conventional medical or surgical therapy is unsuccessful. This report describes the successful use of rFVIIa for pulmonary hemorrhage due to a focal bleeding source in a regional hospital where bronchial artery embolization or surgery were not available. rFVIIa may be a useful temporizing measure in the unstable patient with pulmonary hemorrhage without coagulopathic bleeding when conventional treatment. is not immediately available.

What does the community think about lifespan extension technologies? The need for an empirical base for ethical and policy debates

Objectives: This paper examines public understandings of possibilities for increasing life expectancy, interest in taking up lifespan-extending interventions, and motivations influencing these intentions. Methods: Structured interviews were conducted with 31 adults, aged 50 and over. Results: Participants believed that technological advances would increase life expectancy but questioned the value of quantity over quality of life. Life in itself was not considered valuable without the ability to put it to good use. Participants would not use technologies to extend their own lifespan unless the result would also enhance their health. Conclusions: These findings may not be generalisable to the general public but they provide the first empirical evidence on the plausibility of common assumptions about public interest in 'anti-ageing' interventions. Surveys of the views of representative samples of the population are needed to inform the development of a research agenda on the ethical, legal and social implications of lifespan extension.

Measuring community strength and social capital

In 2001/02 five case study communities in both metropolitan and regional urban locations in Australia were chosen as test sites to develop measures of community strength on four domains: natural capital; produced economic capital; human capital; and social and institutional capital. Secondary data sources were used to develop measures on the first three domains. For the fourth domain social and institutional capital primary data collection was undertaken through sample surveys of households. A structured approach was devised. This involved developing a survey instrument using scaled items relating to four elements: formal norms; informal norms; formal structures; and informal structures which embrace the concepts of trust, reciprocity, bonds, bridges, links and networks in the interaction of individuals with their community inherent in the notion social capital. Exploratory principal components analysis was used to identify factors that measure those aspects of social and institutional capital, with confirmatory analysis conducted using Cronbach's Alpha. This enabled the construction of four primary scales and 15 sub-scales as a tool for measuring social and institutional capital. Further analyses reveals that two measures anomie and perceived quality of life and wellbeing relate to certain primary scales of social capital.

Community-Based Study of the Association of High Myopia in Children with Ocular and Systemic Disease

Purpose. High myopia in childhood is associated with important ocular and systemic conditions. However in the UK, high myopia in early childhood is not specifically identified in current ophthalmology, optometry, or orthoptic protocols for screening, referral, or investigation. An ongoing study in the West Midlands, UK, is investigating high myopia presenting to community health care clinics with the aim of compiling guidelines for assessment and subsequent referral. Methods. Children with high myopia were identified from community optometric and orthoptic sources and invited for an ophthalmology and optometry examination to ascertain possible ocular or systemic disease. Results. High myopia with no associated ocular or systemic condition was present in 15 (56%) of the children. In seven children (25%), associated ocular problems were found including unrecognized retinal dystrophies and amblyopia. Systemic disorders associated with high myopia were found in five children (19%) and included Sticklers syndrome, Weill-Marchesani syndrome, and homocystinuria. In one child, the diagnosis made before this study was found to be incorrect, and in another child, the results were inconclusive. In two cases, the diagnosis of a systemic condition in the child led to the identification of the disease in at least one relative. Conclusions. There is a high prevalence of ocular and systemic abnormality in young children seen in the community. Optometric and ophthalmologic assessment of children less than 10 years with myopia ≥5 D is likely to identify significant ocular or systemic disease, a proportion of which will respond to medical intervention. Detection and prompt referral of these cases by community health care services may be expected to prolong vision and possibly life expectancy.

Learning for life:educational provision at Cadbury, 1831-1981

Cadbury showed concern for the welfare of its labour force in a variety of ways and not least in the provision of educational and educative-recreational facilities. The firm regarded the education of employees as having a positive effect on the efficiency of the business at the same time as being of benefit to the individual, the local community and the nation. The life-long education of people was seen as essential for personal fulfilament, social improvement, economic competitiveness and the proper functioning of democratic procedures. The educational system built up at Cadbury, and the philosophy on which it was founded, acquired both a domestic and international reputation. Its main components were the day continuation education of juniors; the Bournville Works Evening Institute; vocational and non-vocational scholarships; emphasis on the primary importance of general education as a basis for life, work and technical training; stress on equality of educational opportunity for females; and leisure and sporting amenities which the firm felt to be educative in the sense that they contributed to personal psychological and physical development and social skills. The system was primarily shaped and constructed in the first three decades of the twentieth century and went into decline and eventual demise in the 1960's and 1970's as a result of economic pressures, social changes, enhanced state arrangements for education, shifts in Cadbury management thinking and the merger with Schweppes in 1969.

Community pharmacists' engagement with public health in Great Britain

Objective - The objective of the research was to examine to what extent community pharmacists in Great Britain believed that their job was concerned with local public health issues. Methods - The project (Pharmacy and Public Health)received ethical approval from the Research Ethics Committee of the School of Life and Health Sciences at Aston University. After piloting, in August 2006 a self-completion postal questionnaire was sent to practicing community pharmacists in Great Britain (n=1998), with a follow-up to non-responders 4 weeks later. A final response rate of 51% (n=1023/1998) was achieved. Results - Respondents were asked to indicate their answer to the question “to what extent is your present job concerned with local public health issues?” on a three-point scale – “highly”, “slightly” or “not at all” concerned with public health. They were also asked to indicate whether they were pharmacy owners, employee pharmacists or self-employed locum pharmacists. Less than half (43%,n=384/898) of respondents answering both questions believed that their job was highly concerned with public health. A relationship was observed between employment status and the level to which a respondent believed that their job was concerned with public health (chi-square test with P=0.001). Over half of pharmacy owners (51%, n=68/134) considered that their job was highly concerned with public health compared to44% (n=193/443) of employee pharmacists and38% (n=123/321) of locum pharmacists. Conclusion - This research suggests that community pharmacists in Great Britain are not ‘fully engaged’ with public health. Pharmacy owners may feel more enfranchised in the public health movement than their employees and locums. Indeed, one-in-ten locums reported that their job was not at all concerned with public health which, as locum pharmacists constitute over a third of actively employed community pharmacists, could be limiting factor in any drive to strengthen the public health function of community pharmacists.

Development and psychometric tests of the Chinese-version low vision quality of life questionnaire

Background/Aims: To develop and assess the psychometric validity of a Chinese language Vision Health related quality-of-life (VRQoL) measurement instrument for the Chinese visually impaired. Methods: The Low Vision Quality of Life Questionnaire (LVQOL) was translated and adapted into the Chinese-version Low Vision Quality of Life Questionnaire (CLVQOL). The CLVQOL was completed by 100 randomly selected people with low vision (primary group) and 100 people with normal vision (control group). Ninety-four participants from the primary group completed the CLVQOL a second time 2 weeks later (test-retest group). The internal consistency reliability, test-retest reliability, item-internal consistency, item-discrimination validity, construct validity and discriminatory power of the CLVQOL were calculated. Results: The review committee agreed that the CLVQOL replicated the meaning of the LVQOL and was sensitive to cultural differences. The Cronbach's α coefficient and the split-half coefficient for the four scales and total CLVQOL scales were 0.75-0.97. The test-retest reliability as estimated by the intraclass correlations coefficient was 0.69-0.95. Item-internal consistency was >0.4 and item-discrimination validity was generally <0.40. The Varimax rotation factor analysis of the CLVQOL identified four principal factors. the quality-of-life rating of four subscales and the total score of the CLVQOL of the primary group were lower than those of the Control group, both in hospital-based subjects and community-based subjects. Conclusion: The CLVQOL Chinese is a culturally specific vision-related quality-of-life measure instrument. It satisfies conventional psychometric criteria, discriminates visually healthy populations from low vision patients and may be valuable in screening the local community as well as for use in clinical practice or research. © Springer 2005.

Living well to the end:a phenomenological analysis of life in extra care housing

OBJECTIVES: To understand older adults' experiences of moving into extra care housing which offers enrichment activities alongside social and healthcare support. DESIGN: A longitudinal study was conducted which adopted a phenomenological approach to data generation and analysis. METHODS: Semi-structured interviews were conducted in the first 18 months of living in extra care housing. Interpretative phenomenological analysis was used because its commitment to idiography enabled an in-depth analysis of the subjective lived experience of moving into extra care housing. Themes generated inductively were examined against an existential-phenomenological theory of well-being. RESULTS: Learning to live in an extra care community showed negotiating new relationships was not straightforward; maintaining friendships outside the community became more difficult as capacity declined. In springboard for opportunity/confinement, living in extra care provided new opportunities for social engagement and a restored sense of self. Over time horizons began to shrink as incapacities grew. Seeking care illustrated reticence to seek care, due to embarrassment and a sense of duty to one's partner. Becoming aged presented an ontological challenge. Nevertheless, some showed a readiness for death, a sense of homecoming. CONCLUSIONS: An authentic later life was possible but residents required emotional and social support to live through the transition and challenges of becoming aged. Enhancement activities boosted residents' quality of life but the range of activities could be extended to cater better for quieter, smaller scale events within the community; volunteer activity facilitators could be used here. Peer mentoring may help build new relationships and opportunities for interactive stimulation. Acknowledging the importance of feeling-empathic imagination-in caregiving may help staff and residents relate better to each other, thus helping individuals to become ontologically secure and live well to the end.

Valued occupational roles and life satisfaction among south Florida HIV-infected and non-infected homosexual males: An exploratory study

A study was conducted in order to describe and understand the occupational role behavior of gay men with particular interest on understanding the impact of an HIV diagnosis on their roles and life satisfaction. A 137-item questionnaire was developed for this study and distributed through various gay community groups in south Florida. The process resulted in ranked description of 24 valued occupational roles of gay men (n = 80) along with a general understanding of potential shifts that may occur in those roles as a result of becoming infected with HIV. The study concludes that a diagnosis of HIV infection impacts gay men both by altering their value for particular roles and by darkening the images they hold of their future. The study also identified key factors which may contribute to the greater life satisfaction of gay men including greater confidence in personal knowledge of HIV, a more optimistic outlook an life, the use of stronger coping styles, and perceiving stronger social support and lower stress. ^

Students' recollections of participating in a first year residential learning community experience

The purpose of this qualitative study was to gain an understanding of what participation in a first year residential learning community meant to students 2–3 years after their involvement in the program. Various theories including environmental, student involvement, psychosocial and intellectual, were used as a framework for this case study. Each of the ten participants was a junior or senior level student at the time of the study, but had previously participated in a first year residential learning community at Florida International University. The researcher held two semi-structured interviews with each participant, and collected data sheets from each. ^ The narrative data produced from the interviews were transcribed, coded and analyzed to gain insights into the experiences and perspectives of the participants. Member checking was used after the interview process. A peer reviewer offered feedback during the data analysis. The resulting data was coded into categories, with a final selection of four themes and 15 sub-themes, which captured the essence of the participants' experiences. The four major themes included: (a) community, (b) involvement, (c) identity, and (d) academics. The community theme is used to describe how students perceived the environment to be. The involvement theme is used to describe the students' participation in campus life and their interaction with other members of the university community. The identity theme is used to describe the students' process of development, and the personal growth they underwent as a result of their experiences. The academics theme refers to the intellectual development of students and their interaction around academic issues. ^ The results of this study showed that the participants valued greatly their involvement in the First Year Residents Succeeding Together program (FYRST) and can articulate how it helped them succeed as students. In describing their experience, they most recall the sense of community that existed, the personal growth they experienced, the academic development process they went through, and their involvement, both with other people and with activities in their community. Recommendations are provided for practice and research, including several related to enhancing the academic culture, integrating faculty, utilizing peer influence and providing further opportunities to create a seamless learning environment. ^

The effect of a breakfast program on nutritional status, quality of life, and health care use among frail homebound older adults

The population of older adults is rapidly increasing, creating a need for community services that assist vulnerable older adults in maintaining independence and quality of life. Recent evidence confirms the importance of food and nutrition in reaching this objective. The Elderly Nutrition Program (ENP) is part of a system of federally funded community based programs, authorized through the Older Americans Act. ENP services include the home-delivered meals program, which targets frail homebound older adults at nutritional risk. Traditionally, ENP services provide a noon meal 5 days/week. This study evaluated the impact of expanding the home-delivered meals service to include breakfast + lunch, on the nutritional status, quality of life and health care utilization of program participants. ^ This cross-sectional study compared 2 groups. The Breakfast group (n = 167) received a home-delivered breakfast + lunch, 5 days/week. The Comparison group (n = 214) received lunch 5 days/week. Participants, recruited from 5 ENP programs, formed a geographically, racially/ethnically diverse sample. Participants ranged in age from 60–100 years, they were functionally limited, at high nutritional risk, low income, and they lived alone and had difficulty shopping or preparing food. Participant data were collected through in-home interviews and program records. A 24-hour food recall and information on participant demographics, malnutrition risk, functional status, health care use, and applicable quality of life factors were obtained. Service and cost data were collected from program administrators. ^ Breakfast group participants had greater energy/nutrient intakes (p < .05), fewer health care contacts (p < .05), and greater quality of life measured as food security (p < .05) and fewer depressive symptoms (p < .05), than comparison group participants. These benefits were achieved for $1.30/person/day. ^ The study identified links from improvements in nutritional status to enhanced quality of life to diminished health care utilization and expenditures. A model of health, loneliness, food enjoyment, food insecurity, and depression as factors contributing to quality of life for this population, was proposed and tested (p < .01). ^ The breakfast service is an inexpensive addition to traditional home-delivered meals services and can improve the lives of frail homebound older adults. Agencies should be encouraged to expand meals programs to include a breakfast service. ^

Dietary adequacy in community-dwelling older Chinese adults living in South Florida

A challenge facing nutrition care providers and the Chinese community is how to improve and maintain dietary adequacy (DA) and quality of life (QoL) in older Chinese Americans. Little is known about the factors contributing to DA and the relationships between DA and QoL among community-dwelling older Chinese adults in South Florida. A DA model and a QoL model were hypothesized. ^ Structured interviews with 100 Chinese Floridians, ages ≥60, provided data to test the hypothesized models, using structured equation modeling. Participants (mean age ± SD = 70.9 + 6.8 years) included 59% females, 98% foreign-born, 23% non-English speakers, and 68% residents of Florida for 20 years or more. The findings supported the study hypotheses: an excellent goodness-of-fit of the DA model (χ2/DF (7) = .286; CFI = 1.000; TLI = 1.704; NFI = .934; RMSEA < .001, 90% CI < .0001 to < .001; SRMR = .033; AIC = 30.000; and BIC = 66.472) and an excellent goodness-of-fit of the QoL model (χ2/DF (6) = .811; CFI = 1.000; TLI = 1.013; NFI = .979; RMSEA < .001, 90% CI < .001 to .116; SRMR = .0429; AIC = 34.869; and BIC = 73.946). ^ The DA model consisted of a structure of four indicators (i.e. Body Mass Index, food practices, diet satisfaction, and appetite) and one intervening variable (i.e. combining nutrient adequacy with nutritional risk). BMI was the strongest, most reliable indicator of DA with the highest predictability coefficient (.63) and the ability to differentiate between participants with different DA levels. The QoL model consisted of a two-dimensional construct with one indicator (i.e. physical function) and one intervening variable (i.e. combining loneliness with social resources, depression, social function, and mental health). Physical function had the strongest predictability coefficient (.89), while other indicators contributed to QoL indirectly. When integrating the DA model to the QoL model, DA appears to influence QoL via indirect pathways. ^ It is necessary to include a precise measure of BMI as the basis for assessing DA in this population. Important goals of dietary interventions should be improving physical function and alleviating social and emotional isolation. ^