Chronic respiratory diseases and quality of life in elderly nursing home residents

Few studies have assessed the quality of life (QOL) related to chronic respiratory diseases in the elderly. In the framework of the geriatric study on the health effects of air quality in elderly care centers (GERIA) study, a questionnaire was completed by elderly subjects from 53 selected nursing homes. It included various sections in order to assess respiratory complaints, QOL (World Health Organization QOL (WHOQOL)-BREF), and the cognitive and depression status. The outcome variables were the presence of a score lower than 50 (<50) in each of the WHOQOL-BREF domains (physical health, psychological health, social relationships, and environmental health). Chronic bronchitis, frequent cough, current wheezing, asthma, and allergic rhinitis were considered as potential risk factors. The surveyed sample was (n = 887) 79% female, with a mean age of 84 years (SD: 7 years). In the multivariable analysis, a score of <50 in the physical domain was associated with wheezing in the previous 12 months (odds ratio (OR): 2.03, confidence interval (CI): 1.25-3.31) and asthma (OR: 1.95, CI: 1.12-3.38). The psychological domain was related with a frequent cough (OR: 1.43, CI: 0.95-2.91). A score of <50 in the environmental domain was associated with chronic bronchitis (OR: 2.89, CI: 1.34-6.23) and emphysema (OR: 3.89, CI: 1.27-11.88). In view of these findings, the presence of respiratory diseases seems to be an important risk factor for a low QOL among elderly nursing home residents.

Investigating assistive technology to support memory for people with cognitive impairments

Technologies such as automobiles or mobile phones allow us to perform beyond our physical capabilities and travel faster or communicate over long distances. Technologies such as computers and calculators can also help us perform beyond our mental capabilities by storing and manipulating information that we would be unable to process or remember. In recent years there has been a growing interest in assistive technology for cognition (ATC) which can help people compensate for cognitive impairments. The aim of this thesis was to investigate ATC for memory to help people with memory difficulties which impacts independent functioning during everyday life. Chapter one argues that using both neuropsychological and human computing interaction theory and approaches is crucial when developing and researching ATC. Chapter two describes a systematic review and meta-analysis of studies which tested technology to aid memory for groups with ABI, stroke or degenerative disease. Good evidence was found supporting the efficacy of prompting devices which remind the user about a future intention at a set time. Chapter three looks at the prevalence of technologies and memory aids in current use by people with ABI and dementia and the factors that predicted this use. Pre-morbid use of technology, current use of non-tech aids and strategies and age (ABI group only) were the best predictors of this use. Based on the results, chapter four focuses on mobile phone based reminders for people with ABI. Focus groups were held with people with memory impairments after ABI and ABI caregivers (N=12) which discussed the barriers to uptake of mobile phone based reminding. Thematic analysis revealed six key themes that impact uptake of reminder apps; Perceived Need, Social Acceptability, Experience/Expectation, Desired Content and Functions, Cognitive Accessibility and Sensory/Motor Accessibility. The Perceived need theme described the difficulties with insight, motivation and memory which can prevent people from initially setting reminders on a smartphone. Chapter five investigates the efficacy and acceptability of unsolicited prompts (UPs) from a smartphone app (ForgetMeNot) to encourage people with ABI to set reminders. A single-case experimental design study evaluated use of the app over four weeks by three people with severe ABI living in a post-acute rehabilitation hospital. When six UPs were presented through the day from ForgetMeNot, daily reminder-setting and daily memory task completion increased compared to when using the app without the UPs. Chapter six investigates another barrier from chapter 4 – cognitive and sensory accessibility. A study is reported which shows that an app with ‘decision tree’ interface design (ApplTree) leads to more accurate reminder setting performance with no compromise of speed or independence (amount of guidance required) for people with ABI (n=14) compared to a calendar based interface. Chapter seven investigates the efficacy of a wearable reminding device (smartwatch) as a tool for delivering reminders set on a smartphone. Four community dwelling participants with memory difficulties following ABI were included in an ABA single case experimental design study. Three of the participants successfully used the smartwatch throughout the intervention weeks and these participants gave positive usability ratings. Two participants showed improved memory performance when using the smartwatch and all participants had marked decline in memory performance when the technology was removed. Chapter eight is a discussion which highlights the implications of these results for clinicians, researchers and designers.

Using an end-of-life care pathway in acute stroke: a mixed methods study of decision-making and care experiences

Background: The evidence base on end-of-life care in acute stroke is limited, particularly with regard to recognising dying and related decision-making. There is also limited evidence to support the use of end-of-life care pathways (standardised care plans) for patients who are dying after stroke. Aim: This study aimed to explore the clinical decision-making involved in placing patients on an end-of-life care pathway, evaluate predictors of care pathway use, and investigate the role of families in decision-making. The study also aimed to examine experiences of end-of-life care pathway use for stroke patients, their relatives and the multi-disciplinary health care team. Methods: A mixed methods design was adopted. Data were collected in four Scottish acute stroke units. Case-notes were identified prospectively from 100 consecutive stroke deaths and reviewed. Multivariate analysis was performed on case-note data. Semi-structured interviews were conducted with 17 relatives of stroke decedents and 23 healthcare professionals, using a modified grounded theory approach to collect and analyse data. The VOICES survey tool was also administered to the bereaved relatives and data were analysed using descriptive statistics and thematic analysis of free-text responses. Results: Relatives often played an important role in influencing aspects of end-of-life care, including decisions to use an end-of-life care pathway. Some relatives experienced enduring distress with their perceived responsibility for care decisions. Relatives felt unprepared for and were distressed by prolonged dying processes, which were often associated with severe dysphagia. Pro-active information-giving by staff was reported as supportive by relatives. Healthcare professionals generally avoided discussing place of care with families. Decisions to use an end-of-life care pathway were not predicted by patients’ demographic characteristics; decisions were generally made in consultation with families and the extended health care team, and were made within regular working hours. Conclusion: Distressing stroke-related issues were more prominent in participants’ accounts than concerns with the end-of-life care pathway used. Relatives sometimes perceived themselves as responsible for important clinical decisions. Witnessing prolonged dying processes was difficult for healthcare professionals and families, particularly in relation to the management of persistent major swallowing difficulties.

The role of oxidative stress as an underlying mechanism in life-history trade-offs

A key aspect underpinning life-history theory is the existence of trade-offs. Trade-offs occur because resources are limited, meaning that individuals cannot invest in all traits simultaneously, leading to costs for traits such as growth and reproduction. Such costs may be the reason for the sub-maximal growth rates that are often observed in nature, though the fitness consequences of these costs would depend on the effects on lifetime reproductive success. Recently, much attention has been given to the physiological mechanism that might underlie these life-history trade-offs, with oxidative stress (OS) playing a key role. OS is characterised by a build-up of oxidative damage to tissues (e.g. protein, lipids and DNA) from attack by reactive species (RS). RS, the majority of which are by-products of metabolism, are usually neutralised by antioxidants, however OS occurs when there is an imbalance between the two. There are two main theories linking OS with growth and reproduction. The first is that traits like growth and reproduction, being metabolically demanding, lead to an increase in RS production. The second involves the diversion of resources away from self-maintenance processes (e.g. the redox system) when individuals are faced with enhanced growth or reproductive expenditure. Previous research investigating trade-offs involving growth or reproduction and self-maintenance has been equivocal. One reason for this could be that associations among redox biomarkers can vary greatly so that the biomarker selected for analysis can influence the conclusion reached about an individual’s oxidative status. Therefore the first aim of my thesis was to explore the strength and pattern of integration of five biomarkers of OS (three antioxidants, one damage and one general oxidation measure) in wild blue tit (Cyanistes caeruleus) adults and nestlings (Chapter 2). In doing so, I established that all five biomarkers should be included in future analyses, thus using this collection of biomarkers I explored my next aims; whether enhanced growth (Chapters 3 and 4) or reproductive effort (Chapter 5) can lead to increased OS levels, if these traits are traded off against self-maintenance. I accomplished these aims using both a meta-analytic and experimental approach, the latter involving manipulation of brood size in wild blue tits in order to experimentally alter growth rate of nestlings and provisioning rate (a proxy for reproductive expenditure) of adults. I also investigated the potential for redox integration to be used as an index of body condition (Chapter 2), allowing predictions about future fitness consequences of changes to oxidative state to be made. A growth – self-maintenance trade off was supported by my meta-analytic results (Chapter 4) which found OS to be a constraint on growth. However, when faced with experimentally enhanced growth, animals were typically not able to adjust this trade-off so that oxidative damage resulted. This might support the idea that energetically expensive growth causes resources to be diverted away from the redox system; however, antioxidants did not show an overall reduction in response to growth in the meta-analysis suggesting that oxidative costs of growth may result from increased RS production due to the greater metabolism needed for enhanced growth. My experimental data (Chapter 3) showed a similar pattern, with raised protein damage levels (protein carbonyls; PCs) in the fastest growing blue tit chicks in a brood, compared with their slower growing sibs. These within-brood differences in OS levels likely resulted from within-brood hierarchies and might have masked any between-brood differences, which were not observed here. Despite evidence for a growth – self-maintenance trade off, my experimental results on blue tits found no support for the hypothesis that self-maintenance is also traded off against reproduction, another energetically demanding trait. There was no link between experimentally altered reproductive expenditure and OS, nor was there a direct correlation between reproductive effort and OS (Chapter 5). However, there are various factors that likely influence whether oxidative costs are observed, including environmental conditions and whether such costs are transient. This emphasises the need for longitudinal studies following the same individuals over multiple years and across a wide range of habitats that differ in quality. This would allow investigation into how key life events interact; it might be that raised OS levels from rapid early growth have the potential to constrain reproduction or that high parental OS levels constrain offspring growth. Any oxidative costs resulting from these life-history trade-offs have the potential to impact on future fitness. Redox integration of certain biomarkers might prove to be a useful tool in making predictions about fitness, as I found in Chapter 2, as well as establishing how the redox system responds, as a whole, to changes to growth and reproduction. Finally, if the tissues measured can tolerate a given level of OS, then the level of oxidative damage might be irrelevant and not impact on future fitness at all.

Nitrogen vs argon: what is the most effective atmosphere for shelf-life extension of buckler sorrel leaves?

Buckler sorrel (Rumex induratus Boiss. & Reut.) is an underutilized leafy vegetable with peculiar sensory properties and potential as a gourmet food. In the food industry, different packaging methods have been used for shelf-life extension, but it is important to know how the quality of minimally processed vegetable is affected by these treatments. Recently, nitrogen and argon have been used for food packaging. Nitrogen is low soluble in water and other food constituents and does not support the growth of aerobic microbes. In turn, argon is biochemically active and appears to interfere with enzymatic oxygen receptor sites. In this study, modified atmospheres enriched with nitrogen and argon were evaluated for shelf-life extension of buckler sorrel leaves. Wild samples were gathered in Bragança, Portugal, considering local consumers’ sites and criteria. Healthy and undamaged leaves were selected, rinsed in tap water, and a portion was immediately analyzed (non-stored control). The remaining fresh material was packaged in polyethylene bags under nitrogen- and argon-enriched atmospheres and a conventional control atmosphere (air). All packaged samples were stored at 4 ºC for 12 days and then analyzed. The headspace gas composition was monitored during storage. Different quality attributes were evaluated, including visual (colour), nutritional (macronutrients, individual sugars and fatty acids) and bioactive (hydrophilic and lipophilic molecules and antioxidant properties) parameters. Different statistical tools were used; the one-way analysis of variance (ANO VA) was applied for analyse the differences among treatments and a linear discriminant analysis (LDA ) was used to evaluate the effects on the overall postharvest quality. The argon-enriched atmosphere better prevent the samples yellowing. The proximate composition did not change significantly during storage. Samples in control atmosphere revealed higher protein and ash contents and lower levels of lipids. The non-stored control samples presented the higher amounts of fructose, glucose and trehalose. The storage time increased the palmitic acid levels and decreased the content in α-linolenic and linoleic acids. The γ- e δ-tocopherols were higher after the 12 days of cold storage. Probably, the synthesis of these lipophilic compounds was a plant strategy to fight against the abiotic stress induced by storage. Higher levels of total phenolics and flavonoids and increased reducing power and β-carotene bleaching inhibition capacity were also found in the stored control samples. Once again, this result may be attributed to the intrinsic plant-protection mechanisms. Overall, the argon atmosphere was more suitable for quality preservation and shelf-life extension of buckler sorrel.

INTERGENERATIONAL SUPPORT AND WELL-BEING OF OLDER ADULTS IN CHANGING FAMILY CONTEXTS

This dissertation consists of three papers that examine the complexities in upward intergenerational support and adult children’s influence on older adults’ health in changing family contexts of America and China. The prevalence of “gray divorce/repartnering ” in later life after age 55 is on the rise in the United States, yet little is known about its effect on intergenerational support. The first paper uses the life course perspective to examine whether gray divorce and repartnering affect support from biological and stepchildren differently than early divorce and repartnering, and how patterns differ by parents’ gender. Massive internal migration in China has led to increased geographic distance between adult children and aging parents, which may have consequences for old age support received by parents. This topic has yet to be thoroughly explored in China, as most studies of intergenerational support to older parents have focused on the role of coresident children or have not considered the interdependence of multiple parent-child dyads in the family. The second paper adopts the within-family differences approach to assess the influence of non-coresident children’s relative living proximity to parents compared to that of their siblings on their provision of support to parents in rural and urban Chinese families. The study also examines how patterns of the impact are moderated by parents’ living arrangement, non-coresident children’s gender, and parents’ provision of support to children. Taking a multigenerational network perspective, the third paper questions if and how adult children’s socioeconomic status (SES) influences older parents’ health in China. It further examines whether health benefits brought by adult children’s socioeconomic attainment are larger for older adults with lower SES and whether one of the mechanisms through which adult children’s SES affects older parents’ health is by changing their health behaviors. These questions are highly relevant in contemporary China, where adult children have experienced substantial gains in SES and play a central role in old age support for parents. In sum, these three papers take the life course, the within-family differences, and the multigenerational network perspective to address the complexities in intergenerational support and older adults’ health in diverse family contexts.

Newly qualified teachers’ needs of support for professional competences in four European countries: Finland, the United Kingdom, Portugal, and Belgium

The first few years in the teaching profession are usually demanding. Although initial teacher education forms an essential foundation for teachers’ work, it cannot fully prepare new teachers for the complexities of working life. This study focuses on investigating the need for professional development support among newly qualified teachers to determine what their professional learning needs are and how these needs differ among teachers from four different countries: Finland, the United Kingdom (England), Portugal and Belgium (Flanders). The research data was collected via a questionnaire from 314 teachers, each with less than five years of teaching experience, and both closed and open-ended questions were included. The quantitative data was analysed using descriptive statistics and factor analysis to identify the latent variables associated with their needs. Answers to the open-ended questions were used to gain deeper insight into the newly qualified teachers’ situation. The results indicate that new teachers need support, especially regarding conflict situations and in differentiating their teaching. In addition, when analysing the profiles of eight support-need latent variables, all of the teachers in the different countries viewed supporting students’ holistic development as the most important area. Although the results of this study cannot be generalised, they provide an important overview of new teachers’ learning needs that should be taken into account when planning and organising support for them. (DIPF/Orig.)

The Impact of Childhood Sexual Abuse on Later Parenting Self-Perceptions: The Moderating Effect of Family Support

Childhood sexual abuse has been found to be a risk factor for developing negative parenting self-perceptions later in life. Given this established relationship, it is crucial to investigate factors that may mitigate negative outcomes, such as family support. The present study used secondary analysis of a dataset of 265 predominantly African-American and low-income mothers. This study examined differences in parenting self-perceptions among mothers who experienced childhood sexual abuse and those who did not. Analyses revealed that mothers who experienced childhood sexual abuse did not differ in terms of parenting self-perceptions from non-sexually-abused mothers. After controlling for depression, there was no moderating effect of family support; however, a main effect for family support was observed. The results indicate that depression plays a larger role in mothers’ parenting self-perceptions than childhood sexual abuse, and that family support is beneficial for all mothers, regardless of sexual abuse status. Clinical implications are discussed.

Quality of life after first-ever stroke: An interviewbased study from Blantyre, Malawi

Background In post-stroke patients, impairment of quality of life (QOL) has been associated with functional impairment, age, anxiety, depression, and fatigue. Good social support, higher education, and better socioeconomic status are associated with better QOL among stroke survivors. In Africa, studies from Nigeria and Tanzania have reported on post-stroke QOL. Aim The aim of this study was to describe QOL more than six months after first-ever stroke in Malawi. Methods This was an interview-based study about a stroke-surviving cohort. Adult patients were interviewed six or twelve months after their first ever stroke. HIV status, modified stroke severity scale (mNIHSS) score, and brain scan results were recorded during the acute phase of stroke. At the time of the interviews, the modified Rankin scale (mRS) was used to assess functional outcome. The interviews applied the Newcastle Stroke-specific Quality of Life Measure (NEWSQOL). All the data were analysed using Statview™: the X2 test compared proportions, Student’s t-test compared means for normally distributed data, and the Kruskal-Wallis test was used for nonparametric data. Results Eighty-one patients were followed up at least six months after the acute stroke. Twenty-five stroke patients (ten women) were interviewed with the NEWSQOL questionnaire. Good functional outcome (lower mRS score) was positively associated with better QOL in the domains of activities of daily living (ADL)/self-care (p = 0.0024) and communication (p = 0.031). Women scored worse in the fatigue (p = 0.0081) and cognition (p = 0.048) domains. Older age was associated with worse QOL in the ADL (p = 0.0122) domain. Seven patients were HIV-seroreactive. HIV infection did not affect post-stroke QOL. Conclusion In Malawi, within specific domains, QOL after stroke appeared to be related to patients’ age, sex, and functional recovery in this small sample of patients.

The Sword and the Pen: Life Writings by Militant-Authors of the Việt Minh and Front de Libération Nationale (FLN)

This dissertation examines four life writings by militant-authors of the Việt Minh and Front de la Libération Nationale (FLN): Ngô Văn Chiêu’s Journal d’un combattant Viet-Minh (1955), Đặng Văn Việt’s De la RC 4 à la N 4: la campagne des frontières (2000), Si Azzedine’s On nous appelait fellaghas (1976), and Saadi Yacef’s two-volume La Bataille d’Alger (2002). In describing the Vietnamese and Algerian Revolutions through the perspectives of combatants who participated in their respective countries’ national liberation struggles, the texts reveal that four key factors motivated the militants and led them to believe that independence was historically inevitable: (1) a philosophical, political, and ideological framework, (2) the support of multiple segments of the local population, (3) the effective use of guerrilla and psychological warfare, and (4) military, moral, and political assistance provided by international allies. By fighting for the independence of their countries and documenting their revolutionary experiences, the four militant-authors leave their mark on the world using both the sword and the pen.

Life-cycle portfolio choice with liquid and illiquid financial assets

Traditionally, quantitative models that have studied households׳ portfolio choices have focused exclusively on the different risk properties of alternative financial assets. We introduce differences in liquidity across assets in the standard life-cycle model of portfolio choice. More precisely, in our model, stocks are subject to transaction costs, as considered in recent macroliterature. We show that when these costs are calibrated to match the observed infrequency of households׳ trading, the model is able to generate patterns of portfolio stock allocation over age and wealth that are constant or moderately increasing, thus more in line with the existing empirical evidence.

"I’ll call you when we are ready" (One family’s experience of critical care and end of life decision making)

The purpose of this paper is to explore through narrative accounts one family's expérience of critical care, after the admission of a family member to an Intensive Care Unit (ICU) and their subséquent death five weeks later. Numerous studies support the need for effective communication and clear information to be given to the family. In this instance it was évident from their stories that there were numerous barriers to communication, including language and a lack of insight into the needs of the family. Many families do not understand the complexities of nursing care in an ICU so lack of communication by nursing staff was identified as uncaring behavior and encounters. Facilitating a family's proximity to a dying patient and encouraging them to participate in care helps to maintain some sensé of personal control. Despite a commitment to involving family members in care, which was enshrined in the Unit Philosophy, relatives were banished to the waiting room for hours. They experienced feelings of powerlessness and helplessness as they waited with other relatives for news following investigations or until 'the doctor had completed his rounds'. Explanations of "we must make 'the patient' comfortable" was no consolation for those who wished to be involved in care. The words "I'il call you when we are ready" became a mantra to the forgotten families who waited patiently for those with power to admit them to the ICU. Implications are this family felt they were left alone to cope with the traumatic expériences leading up to and surrounding the death. They felt mainly supported by the priest, who not only administered the last rites but provided spiritual support to the family and dealt sensitively with many issues. Paternalism in décision making when there is a moral obligation to ensure that discussions on end of life dilemmas are an inclusive process with families, doctors, nurses was not understood, therefore it caused conflict within the family over EOL décision making. The family felt that the opportunity to share expériences through telling and retelling their stories would enable them to reconfigure the past and create purpose in the future.

Age-Dependent Fragility and Life-Cycle Cost Analysis of Timber and Steel Distribution Poles Subjected to Hurricanes

Power distribution systems are susceptible to extreme damage from natural hazards especially hurricanes. Hurricane winds can knock down distribution poles thereby causing damage to the system and power outages which can result in millions of dollars in lost revenue and restoration costs. Timber has been the dominant material used to support overhead lines in distribution systems. Recently however, utility companies have been searching for a cost-effective alternative to timber poles due to environmental concerns, durability, high cost of maintenance and need for improved aesthetics. Steel has emerged as a viable alternative to timber due to its advantages such as relatively lower maintenance cost, light weight, consistent performance, and invulnerability to wood-pecker attacks. Both timber and steel poles are prone to deterioration over time due to decay in the timber and corrosion of the steel. This research proposes a framework for conducting fragility analysis of timber and steel poles subjected to hurricane winds considering deterioration of the poles over time. Monte Carlo simulation was used to develop the fragility curves considering uncertainties in strength, geometry and wind loads. A framework for life-cycle cost analysis is also proposed to compare the steel and timber poles. The results show that steel poles can have superior reliability and lower life-cycle cost compared to timber poles, which makes them suitable substitutes.

Positive Impact of Peer Mentorships in the Project Panther LIFE Program

FIU’s Project Panther LIFE is a program that allows students with Intellectual Disabilities to have a full college experience. Project Panther LIFE students receive support from their Academic Mentors and Peer Coaches during the academic year. This study examines the positive impacts of peer relationships between Panther LIFE students and their mentor support system.

Parental Adjustment to Disability, Stress Indicators and the Influence of Social Support

Research into families of children and young people with disability maintain that parents or caregivers seem to experience higher levels of global stress than parents of children without disabilities, thereby presenting a high risk of developing disorders in their health and quality of life. The aim of this study is to understand the differences in parental stress and social support among groups of parents whose children have different disabilities in the context of parental adjustment to disability. Considering that adjustment is related to the effectiveness with which the family uses its resources and the support of their social network, we intend to analyse the differences of stress and social support among groups of parents of children with different problems and to clarify the relationships between the variables under study in order to adapt family intervention strategies. For this purpose a comparative, descriptive-correlational study was undertaken. The convenience sample included 152 parents of children with different disabilities (82 with intellectual disability, 37 with motor problems and 33 with autism) supported by schools and institutions in Viseu. The instruments used were: a Portuguese version of the Parenting Stress Index (Abidin, 1995), the Social Support Questionnaire – short version (Pinheiro & Ferreira, 2001) and a Parental Questionnaire (demographic and family data). Data were collected in schools and institutions that support people with disabilities, located in the Municipality of Viseu (Portugal). The results revealed significant differences between groups of parents in the partial results of parental stress, specifically in the Hyperactivity/Distract (DI), Acceptability (AC) and Adaptability (AD), dimensions of the Child Domain subscale (CD stress) and the Role Restriction (RO), dimension of Parent Domain subscale (PD stress). With regard to social support dimensions, we found significant differences between parents in the extent and availability of the social support network (SSQN).