Psychosocial factors as predictors of quality of life in chronic portuguese patients

Background - Chronic illnesses are diseases of long duration and generally of slow progression. They cause significant quality of life impairment. The aim of this study was to analyse psychosocial predictors of quality of life and of subjective well-being in chronic Portuguese patients. Methods - Chronic disease patients (n = 774) were recruited from central Portuguese Hospitals. Participants completed self-reported questionnaires assessing socio-demographic, clinical, psychosocial and outcome variables: quality of life (HRQL) and subjective well-being (SWB). MANCOVA analyses were used to test psychosocial factors as determinants of HRQL and SWB. Results - After controlling for socio-demographic and clinical variables, results showed that dispositional optimism, positive affect, spirituality, social support and treatment adherence are significant predictors of HRQL and SWB. Similar predictors of quality of life, such as positive affect, treatment adherence and spirituality, were found for subgroups of disease classified by medical condition. Conclusions - The work identifies psychosocial factors associated with quality of life. The predictors for the entire group of different chronic diseases are similar to the ones found in different chronic disease subgroups: positive affect, social support, treatment adherence and spirituality. Patients with more positive affect, additional social support, an adequate treatment adherence and a feel-good spirituality, felt better with the disease conditions and consequently had a better quality of life. This study contributes to understanding and improving the processes associated with quality of life, which is relevant for health care providers and chronic diseases support.

Perceived health in the Portuguese population aged ? 35

OBJECTIVE To evaluate the exploratory relationship between determinants of health, life satisfaction, locus of control, attitudes and behaviors and health related quality of life in an adult population. METHODS Observational study (analytical and cross-sectional) with a quantitative methodological basis. The sample was composed oy 1,214 inhabitants aged ≥ 35 in 31 civil parishes in the County of Coimbra, Portugal, 2011-2012. An anonymous and voluntary health survey was conducted, which collected the following information: demographic, clinical record, health and lifestyle behaviors; health related quality of life (Medical Outcomes Study, Short Form-36); health locus of control; survey of health attitudes and behavior, and quality of life index. PearsonR17;s Linear Correlation, t-Student, Wilcoxon-Mann-Whitney; One-way ANOVA; Brown-ForsytheR17;s F; Kruskal-Wallis; Multiple Comparisons: Tukey (HSD), Games-Howell and Conover were used in the statistical analysis. RESULTS Health related quality of life was shown to be lower in females, in older age groups, in obese/overweight individuals, widows, unassisted, those living alone, living in rural/suburban areas, those who did not work and with a medium-low socioeconomic level. Respondents with poor/very poor self-perceived health (p < 0.0001), with chronic disease (p < 0.0001), who consumed < 3 meals per day (p ≤ 0.01), who were sedentary, who slept ≤ 6 h/day and had smoked for several years revealed the worst health results. Health related quality of life was positively related with a bigger internal locus, with better health attitudes and behaviors (physical exercise, health and nutritional care, length of dependence) and with different areas of life satisfaction. CONCLUSIONS Better health related quality of life was associated with certain social, psychological, family and health characteristics, a satisfactory lifestyle, better socioeconomic conditions and a good internal locus of control over health attitudes and behaviors.

CardioBengo study protocol: a population based cardiovascular longitudinal study in Bengo Province, Angola

Background: Cardiovascular diseases and other non-communicable diseases are major causes of morbidity and mortality, responsible for 38 million deaths in 2012, 75 % occurring in low- and middle-income countries. Most of these countries are facing a period of epidemiological transition, being confronted with an increased burden of non-communicable diseases, which challenge health systems mainly designed to deal with infectious diseases. With the adoption of the World Health Organization “Global Action Plan for the Prevention and Control of non-communicable diseases, 2013–2020”, the national dimension of risk factors for non-communicable diseases must be reported on a regular basis. Angola has no national surveillance system for non-communicable diseases, and periodic population-based studies can help to overcome this lack of information. CardioBengo will collect information on risk factors, awareness rates and prevalence of symptoms relevant to cardiovascular diseases, to assist decision makers in the implementation of prevention and treatment policies and programs. Methods: CardioBengo is designed as a research structure that comprises a cross-sectional component, providing baseline information and the assembling of a cohort to follow-up the dynamics of cardiovascular diseases risk factors in the catchment area of the Dande Health and Demographic Surveillance System of the Health Research Centre of Angola, in Bengo Province, Angola. The World Health Organization STEPwise approach to surveillance questionnaires and procedures will be used to collect information on a representative sex-age stratified sample, aged between 15 and 64 years old. Discussion: CardioBengo will recruit the first population cohort in Angola designed to evaluate cardiovascular diseases risk factors. Using the structures in place of the Dande Health and Demographic Surveillance System and a reliable methodology that generates comparable results with other regions and countries, this study will constitute a useful tool for the surveillance of cardiovascular diseases. Like all longitudinal studies, a strong concern exists regarding dropouts, but strategies like regular visits to selected participants and a strong community involvement are in place to minimize these occurrences.

Qualidade de vida na demência : estudo sobre a perceção de Qualidade de Vida em pessoas com demência, seus familiares e cuidadores profissionais em contexto de Internamento

RESUMO: Introdução: Ao fenómeno do envelhecimento está associado uma maior incidência de doenças crónicas e incapacitantes. Atualmente é consensual, a preocupação com a Qualidade de Vida (QdV) nesta faixa etária, acrescendo importância quando falamos em QdV em demência, dada a complexidade dos sintomas, morbilidades e co-morbilidades que se verificam nesta síndrome. Objetivo: O presente estudo tem como objetivo principal avaliar a perceção da QdV em pessoas com demência, seus familiares e cuidadores profissionais, de forma a identificar dimensões que mereçam uma maior atenção na definição de programas de intervenção em situação de institucionalização. Metodologia: Este estudo é de caráter descritivo transversal com componente qualitativa e quantitativa. A população compreende as pessoas com demência do Centro Psicogeriátrico Nª Sª de Fátima (CPNSF). A amostra foi constituída pelas residentes do CPNSF com diagnóstico de demência e classificação total de Mini Mental State Examination (MMSE) ≥ 10. As variáveis em análise foram: QdV, avaliada pela escala QOL-AD versão portuguesa, perfil sociodemográfico das pessoas com demência, familiares e cuidadores profissionais, por inquérito por questionário; Grau de defeito cognitivo, dependência funcional e sintomatologia depressiva das pessoas com demência, verificado por MMSE, índice de Barthel e Escala de Depressão Geriátrica (GDS-15). Foi ainda acedido ao entendimento pessoal sobre o construto de QdV, através de entrevista semiestruturada dirigida a todos os participantes. Resultados: Com base nos resultados obtidos foi possível determinar que as pessoas com demência, associam QdV a fatores como saúde física, humor/disposição, condições de vida, cognição, família, satisfação com a vida, dinheiro. Foram observadas relações negativas com sintomatologia depressiva e funcionalidade para as atividades instrumentais de vida diária. Os familiares associam positivamente QdV a bem-estar geral relacionado com as dimensões física, psicológica e relações sociais, e negativamente com o estado cognitivo e sintomatologia neuropsiquiátrica. Os cuidadores profissionais associam QdV das pessoas com demência a questões relacionadas com condições e satisfação com a vida, bem-estar físico, suporte emocional relações sociais e funcionalidade para as atividades instrumentais básicas de vida diária. Não foi possível correlacionar a QOL-AD com a dimensão funcionalidade por não existir nesta escala um item que inclua este conceito. Conclusão: Este estudo confirma que pessoas com demência, têm capacidade para aceder e avaliar aspetos da sua própria QdV, sendo que tendem a pontuar com valores mais elevados a sua QdV quando comparados com familiares e cuidadores profissionais.--------------- ABSTRACT:Background:: Aging is associated with higher incidence of chronic and debilitating illnesses. The study of quality of life in aging population has been an increasingly discussed topic. Quality of life in dementia is a particular challenging field given the complexity of symptoms, morbilities and co-morbilities that occur in this syndrome. Objective: This study aims to evaluate the perception of quality of life in elderly people with dementia and their families, in order to identify dimensions that should be prioritized in intervention programs aimed at increasing quality of life in persons with dementia living in institutions. Methodology: This study used a is cross-sectional descriptive mixed methods approach. The population comprises people with dementia in Psychogeriatric Center Nossa Senhora de Fátima (CPNSF). The sample consisted of the residents of CPNSF diagnosed with dementia and total score of Mini Mental State Examination (MMSE) ≥ 10. The variables analyzed were: quality of life, assessed by QOL-AD scale Portuguese version, socio-demographic profile of people with dementia, family members and professional caregivers, by questionnaire survey; Degree of cognitive impairment, functional dependence and depressive symptoms of people with dementia, using respectively MMSE, Barthel index and Geriatric Depression Scale (GDS-15). The personal understanding of the QoL construct was also assessed, through semi-structured interviews to all participants Results: The results supported that people with dementia, related quality of life to factors such as physical health, mood / disposition, living conditions, cognition, family, life satisfaction, and money. Negative relations were observed with depressive symptoms and functionality for the instrumental activities of daily living. The family members associate quality of life positively with overall well-being related to the physical, psychological and social relationships, and negatively with cognitive status and neuropsychiatric symptoms. Professional caregivers associate quality of life of people with dementia-related issues conditions and satisfaction with life, physical well-being, social relationships and emotional support functionality to the basic instrumental activities of daily living. It was not possible to correlate the QOL-AD with the size feature does not exist on this scale for an item that includes this concept. Conclusion: This study supports the idea that people with dementia are able to assess and evaluate aspects of their own quality of life, and tend to rate their quality of life higher than family and professional caregivers.

Co-movements between US and UK stock prices: the roles of macroeconomic information and time-series varying conditional correlations

This paper provides evidence on the sources of co-movement in monthly US and UK stock price movements by investigating the role of macroeconomic and financial variables in a bivariate system with time-varying conditional correlations. Crosscountry communality in response is uncovered, with changes in the US Federal Funds rate, UK bond yields and oil prices having similar negative effects in both markets. Other variables also play a role, especially for the UK market. These effects do not, however, explain the marked increase in cross-market correlations observed from around 2000, which we attribute to time variation in the correlations of shocks to these markets. A regime-switching smooth transition model captures this time variation well and shows the correlations increase dramatically around 1999-2000. JEL classifications: C32, C51, G15 Keywords: international stock returns, DCC-GARCH model, smooth transition conditional correlation GARCH model, model evaluation.

Matching and Sorting in a Global Economy

We develop a neoclassical trade model with heterogeneous factors of production. We consider a world with two factors, labor and .managers., each with a distribution of ability levels. Production combines a manager of some type with a group of workers. The output of a unit depends on the types of the two factors, with complementarity between them, while exhibiting diminishing returns to the number of workers. We examine the sorting of factors to sectors and the matching of factors within sectors, and we use the model to study the determinants of the trade pattern and the effects of trade on the wage and salary distributions. Finally, we extend the model to include search frictions and consider the distribution of employment rates.

Cooperatives and Contracting in Agriculture: The Case of West Liberty Foods, October 2005

The West Liberty Foods turkey cooperative was formed in 1996 to purchase the assets and assume operations of Louis Rich Foods (an investor-owned processing rm), which, at the time, announced the imminent shutdown of its West Liberty, Iowa, processing facility. We study the creation and performance of this �new generation� cooperative using eld interviews with grower members and company management. We describe changes, before and after the buyout, in the contractual apparatus used for procuring live turkeys, and in the communication requirements, work expectations, and nancial positions of growers. During the private ownership period, most of the inputs (except labor and facilities) were provided by the rm; there was substantial supervision of the growers' actions; growers faced little price and production risk; and growers' equity was due largely to ownership of land and other farm assets. Our interviews reveal that, after cooperative formation, growers were exposed to considerable additional risk; monitoring of growers by the rm was less intensive; grower time and effort commitments to turkey production increased substantially; and a signicant fraction of rm (cooperative) equity came from growers' willingness to leverage their farm and personal assets (and hence indirectly their existing relationships with local lenders). We argue that some of these changes are consistent with a nancial contract where asset pledging and its corollary risk generate higher work effort by growers and a reduction in agency rents. These economies likely compensate for an organizational deadweight loss traditionally associated with cooperative governance.

Speed of convergence of recursive least squares learning with ARMA perceptions

This paper fills a gap in the existing literature on least squareslearning in linear rational expectations models by studying a setup inwhich agents learn by fitting ARMA models to a subset of the statevariables. This is a natural specification in models with privateinformation because in the presence of hidden state variables, agentshave an incentive to condition forecasts on the infinite past recordsof observables. We study a particular setting in which it sufficesfor agents to fit a first order ARMA process, which preserves thetractability of a finite dimensional parameterization, while permittingconditioning on the infinite past record. We describe how previousresults (Marcet and Sargent [1989a, 1989b] can be adapted to handlethe convergence of estimators of an ARMA process in our self--referentialenvironment. We also study ``rates'' of convergence analytically and viacomputer simulation.

Voting with preferences over margins of victory

This paper analyzes a two-alternative voting model with the distinctive feature that voters have preferences over margins of victory. We study voting contests with a finite as well as an infinite number of voters, and with and without mandatory voting. The main result of the paper is the existence and characterization of a unique equilibrium outcome in all those situations. At equilibrium, voters who prefer a larger support for one of the alternatives vote for such alternative.The model also provides a formal argument for the conditional sincerity voting condition in Alesina and Rosenthal (1995) and the benefit of voting function in Llavador (2006). Finally, we offer new insights on explaining why some citizens may vote strategically for an alternative different from the one declared as the most preferred.

Understanding the effects of government spending on consumption

Recent evidence suggests that consumption rises in response to an increase in government spending. That finding cannot be easily reconciled with existing optimizing business cycle models. We extend the standard new Keynesian model to allow for the presence of rule-of-thumb consumers. We show how the interaction of the latter with sticky prices and deficit financing can account for the existing evidence on the effects of government spending.