Malnourished patients on hemodialysis improve after receiving a nutritional intervention

INTRODUCTION: Malnutrition is multifactorial and may be modified by nutritional intervention. We aimed to assess the impact of an intervention on the nutritional status of malnourished hemodialysis patients and their acceptance of a non-industrialized nutritional supplement. METHODS: 18 patients were studied, they were selected from a previous nutritional assessment where nutritional risk was defined as: subjective global assessment > 15 plus one criterion for malnutrition. The following variables were assessed: anthropometric parameters, subjective global assessment, dietary intake, six-minute walking test, quality of life (SF-36), and biochemical tests. Patients were randomized to either Control or Intervention Groups. The Intervention Group received a dietetic supplement during dialysis containing 355 kcal, prepared from simple ingredients. After three months, subjects from the Control Group and other patients also considered at nutritional risk underwent the same intervention. The study groups were compared after three months, and all patients were analyzed before and after the intervention. RESULTS: Fifteen men and three women, aged 56.4 ± 15.6 years-old, nine in each group, were studied. The Intervention Group showed an improvement in the subjective global assessment (p = 0.04). There were differences in role physical and bodily pain domains of SF-36, with improvement in the Intervention Group and worsening in the Control Group (p = 0.034 and p = 0.021). Comparisons before and after intervention for all patients showed improvement in the subjective global assessment (16.18 ± 4.27 versus 14.37 ± 4.20, p = 0.04), and in the six-minute walking test (496.60 ± 132.59 versus 547.80 ± 132.48 m; p = 0.036). The nutritional supplement was well tolerated by all patients, and it did not cause side effects. CONCLUSIONS: The nutritional intervention improved the subjective global assessment and quality of life of hemodialysis patients at short-term. A global intervention by a dietitian produced specific and nonspecific positive effects in the whole group. Nutritional supplementation was feasible, palatable, and had low cost. Its clinical impact and effectiveness need to be further assessed in a larger group of patients at long-term.

Nova estratégia de desenvolvimento para o Brasil: um enfoque de longo prazo

The foremost aim of the article is to propose a new development strategy for Brazil, replacing the neoliberal model presently used. In short, the point is to recover a long term vision of the economic policies. And for that it is indispensable to take into consideration the recent evolution of the Development Economics which considers the existence of market, instead of the availability of savings, as the main condition in economic development policies. The acceptance of the market as the basic condition for successful development policies has as one of its consequences the unacceptability of the process of globalization with its present characteristics.

Developing asset management in district heating and cooling business in a large energy company

The purpose of this Master´s Thesis is to develop asset management and its practices in case company. District heating and cooling systems operated by case company around Finland, Sweden, Poland and the Baltics form an enormous-sized asset base where some parts are starting to reach their end of life-cycles. Large-sized asset renewal actions are under discussion and maintenance spending is increasing. Financially justified decisions in changing business environment are needed. Asset management is one of the most important concepts for production organization which operates with capital-intensive production assets. Organizations profitability is highly dependent on assets´ performance. Such assets, like district heating and cooling systems, should be utilized as efficiently as possible within their life-cycles but also maintained and renewed optimally. In this qualitative thesis, empirical interview study was conducted to describe the current situation on how the assets are managed in the case company and to examine the readiness to implement a new, risk-based solution. Asset management revealed to be a very well-known concept. From proposed risk-based asset management point of view, several key observations were made. It was seen as a suitable solution, but further development will be needed. Based on the need and findings, several key processes and frameworks were created and also tested with a case study. Assets` condition monitoring should be improved, which would have a positive impact on event probability assessment. Risk acceptance is also a thing to be discussed further. When the evaluation becomes fluent in single investment cases, portfolio-level expansion should be considered and started. As a result, thesis proposes a solution how risk-based asset management could be performed practically in a capital-intensive case company in order to optimize the maintenance spending in a long run. Created practical framework is made universal: similar principles can be applied into multiple cases in case company but also in other energy companies. Risk-based asset management`s benefits could be utilized best in portfolio-level optimization where the capital would be invested to the most important objects from total risk point of view. Eventually, such approach would allow case company to optimize capital spending in a situation where funds are not adequate to cover all the mandatory needs and prioritization between the investment alternatives will truly be needed.

Rationality in children: the first steps

Not all categorization is conceptual. Many of the experimental findings concerning infant and animal categorization invite the hypothesis that the subjects form abstract perceptual representations, mental models or cognitive maps that are not composed of concepts. The paper is a reflection upon the idea that conceptual categorization involves the ability to make categorical judgements under the guidance of norms of rationality. These include a norm of truth-seeking and a norm of good evidence. Acceptance of these norms implies willingness to defer to cognitive authorities, unwillingness to commit oneself to contradictions, and knowledge of how to reorganize one's representational system upon discovering that one has made a mistake. It is proposed that the cognitive architecture required for basic rationality is similar to that which underlies pretend-play. The representational system must be able to make room for separate 'mental spaces' in which alternatives to the actual world are entertained. The same feature underlies the ability to understand modalities, time, the appearance-reality distinction, other minds, and ethics. Each area of understanding admits of degrees, and mastery (up to normal adult level) takes years. But rational concept-management, at least in its most rudimentary form, does not require a capacity to form second-order representations. It requires knowledge of how to operate upon, and compare, the contents of different mental spaces.

Verkkopalveluiden jatkuvan ylläpidon kehittäminen: Case Aucor Oy ja WordPress

Verkkopalveluiden ylläpitovaiheessa halutaan varmistua, etteivät palveluun tehdyt muutokset aiheuta verkkopalvelussa virhetilanteita ja palvelu toimii moitteetta. Muutoksen hyväksyntätestaus voidaan tehdä regressiotestauksena vertaamalla palvelun tilaa ennen ja jälkeen muutoksen. Sisältöpainotteisessa verkkopalvelussa testaaminen keskittyy loppukäyttäjälle esitetyn sivun semanttiseen sekä visuaaliseen oikeellisuuteen sekä erilaisiin toiminnallisiin testeihin. Työssä tarkastellaan etenkin suositulla WordPress-julkaisujärjestelmällä toteutettujen verkkopalveluiden ylläpitoa. Keskeisenä osana julkaisujärjestelmillä toteutettujen verkkopalveluiden ylläpitoa on julkaisujärjestelmän ja sitä täydentävien lisäosien päivittämistä ajantasaisiin versioihin. Nämä päivitykset paitsi tuovat uusia ominaisuuksia verkkopalvelun kehittäjille, myös paikkaavat järjestelmän tietoturvahaavoittuvuuksia sekä korjaavat aiemmissa versioissa esiintyneitä virheitä. Tässä työssä kehitettiin kohdeyrityksen aiempia verkkopalveluiden ylläpitoprosesseja niissä tunnistettujen kehityskohteiden perusteella. Uudistettu kokonaisuus jakautuu kahteen kokonaisuuteen: päivitystarpeen seurantaan sekä päivitysten tekemiseen. Päivitystarpeen seurantaa varten kehitettiin uusi työkalu helpottamaan kokonaiskuvan hahmottamista. Päivitysten tekemisen osalta työssä keskityttiin automatisoidun regressiotestauksen kehittämiseen, missä tärkeimpänä testauskeinona käytetään verkkopalvelusta tallennettujen kuvankaappausten vertailuun perustuvaa visuaalista testausta. Uusien ylläpitoprosesseille määriteltiin myös seurannan kohteet uudistuksen onnistumisen ja jatkokehityksen arviointia varten.

Nuorten aikuisten asenteet mobiilimarkkinointia kohtaan

Melkein koko maailma on kytketty toisiinsa mobiililaitteiden, kuten matkapuhelinten tai tablettien, avulla. Laitteen henkilökohtaisuus ja sen mukana oleminen aina ja kaikkialla tuo yrityksille ennennäkemättömän mahdollisuuden palvella asiakasta koska ja milloin vain. Kuluttajat eivät ole kuitenkaan usein motivoituneita käyttämään matkapuhelimiaan kauppatapahtumiin. Mobiilimarkkinoinnin onnistumisen kannalta on tärkeää ymmärtää niitä syitä, jotka johtavat positiivisiin asenteisiin mobiilimarkkinointia kohtaan, ja tätä kautta sen hyväksyntään. Tämän tutkielman tarkoituksena on selittää suomalaisten nuorten aikuisten asenteita mobiilimarkkinointia kohtaan ja tutkia niihin vaikuttavia tekijöitä. Tuloksia vertaillaan Yhdysvalloista ja Kiinasta kerättyyn aineistoon, jonka tutkimusmalliin tämä työ perustuu. Tutkimuksen teoreettinen viitekehys pohjautuu perustellun toiminnan teoriaan (engl. theory of reasoned action, TRA), jonka avulla asenteiden nähdään johtavan toimintaan. Tutkimusmallin selittävät muuttujat johdettiin teknologian hyväksymismallista (engl. technology acceptance model, TAM) ja useista aiemmista tutkimuksista. Primääridata (N=1045) kerättiin Turun yliopiston opiskelijoista elektronisen kyselylomakkeen avulla. Tulosten mukaan suomalaisten nuorten aikuisten asenteet mobiilimarkkinointia kohtaan ovat positiivisia. Tärkeimmät asenteisiin vaikuttavat tekijät ovat teknologian koettu hyödyllisyys ja helppokäyttöisyys, kiintymys omaan matkapuhelimeen, innovatiivisuus suhteessa mobiiliin teknologiaan ja huoli yksityisyydestä mobiililla alalla. Tekijät vaihtelevat hieman eri maiden välillä. Yritys voi hyödyntää mm. seuraavia markkinointitoimintoja saadakseen kuluttajan osallistumaan mobiilimarkkinointiin: yksilöidyt, mielenkiintoiset ja arvoa tuovat viestit, tunkeilevien viestien vähentäminen ja kannusteiden lisääminen. Tulevaisuuden tutkimuksen kannalta olisi hyödyllistä laajentaaotoskehystä yliopisto-opiskelijoiden ulkopuolelle.

The functional fit between collaborative software and work systems:Qualification of work system needs to software functionality

The study develops an approach that tries to validate software functionality to work systems needs in SMEs. The formulated approach is constructed by using a SAAS based software i.e., work collaboration service (WCS), and SMEs as the elements of study. Where the WCS’s functionality is qualified to the collaboration needs that exist in operational and project work within SMEs. For this research constructivist approach and case study method is selected because the nature of the current study requires an in depth study of the work collaboration service as well as a detailed study of the work systems within different enterprises. Four different companies are selected in which fourteen interviews are conducted to gather data pertaining. The work systems method and framework are used as a central part of the approach to collect, analyze and interpret the enterprises work systems model and the underlying collaboration needs on operational and project work. On the other hand, the functional model of the WCS and its functionality is determined from functional model analysis, software testing, documentation and meetings with the service vendor. The enterprise work system model and the WCS model are compared to reveal how work progression differs between the two and make visible unaddressed stages of work progression. The WCS functionality is compared to work systems collaboration needs to ascertain if the service will suffice the needs of the project and operational work under study. The unaddressed needs provide opportunities to improve the functionality of the service for better conformity to the needs of enterprise and work. The results revealed that the functional models actually differed in how operational and project work progressed within the stages. WCS shared similar stages of work progression apart from the stages of identification and acceptance, and progress and completion stages were only partially addressed. Conclusion is that the identified unaddressed needs such as, single point of reference, SLA and OLA inclusion etc., should be implemented or improved within the WCS at appropriate stages of work to gain better compliance of the service to the needs of the enterprise an work itself. The developed approach can hence be used to carry out similar analysis for the conformance of pre-built software functionality to work system needs with SMEs.

The role of self-presentation in adolescent health risk behaviours

Self-presentation has been identified as playing a key role in the perfonnance of various potentially hazardous health behaviours such as substance abuse, eating disorders and reckless behaviours (Leary, Tchividjian, & Kraxberger, 1994; Martin & Leary, 2001; Martin, Leary, & O'Brien, 2001). The present study investigated the role of selfpresentation on adolescent health-risk behaviours. Specifically, this study examined the prevalence of adolescent identified health-risk behaviours rooted in self-presentational motives in youths aged 13-18 years. The current study also identified the specific images associated with these behaviours desired by youth, and the targets of these behaviours. Also, the relationship between these behaviours, and several trait measures (social physique anxiety, public-self consciousness, fear of negative evaluations, selfpresentational efficacy) of self-presentation were examined. Finally, the gender differences in health risk behaviours and self-presentational concerns were examined. Participants in the present study were 96 adolescent students, 34 male and 62 female, recruited from various private schools across Southern Ontario. Students ranged in age from 13 to 18 years for both males (M age = 15.81 years, SD = 1.49) and females (M age = 14.89 years, SD = 1.17) and ranged from grades 8 through 13. Results of the current study suggested that Canadian adolescents between the ages of 13 and 18 years participated in health risk behaviours for self-presentational purposes. Drinking alcohol, skipping school, and performing stunts and dares were identified as the most common health risk behaviours performed for self-presentational purposes by both males and females. Appearing fun and cool were the most commonly reported desired images while appearing brave and mature were the least reported. The most desired target group cited was same sex friends, followed by other sex friends. Trait measures of self-presentational concerns identified females as being higher in public self-consciousness, and social physique anxiety than males. Males were found to be higher in self-presentational efficacy than females. The total number of health risk behaviours was predicted by selfpresentational efficacy and social physique anxiety for males, and social physique anxiety for females. Findings of the current study suggest that Canadian adolescents' health risk behaviours are rooted, in part, in self-presentational motives. Thus far, an educational approach to health interventions has been favoured and/or adopted by teachers, health promoters, and educators (Jessor, 1992). Implications of the current study suggest that although educational interventions are beneficial in presenting the associated risks with certain activities and/or behaviours, one reason this type of approach may be ineffective in changing adolescent behaviour over the long run is that it does not address the strong and prominent influences of interpersonal motives on health damaging behaviour. It is evident that social acceptance and public image are of importance to adolescents, and the desire to make the "right" impression and to achieve peer approval and acceptance often override health and safety concerns (Jessor, 1992). Thus, a self-presentational approach focusing on changing the images associated with the behaviours may be more successful at deterring adolescent health risk behaviours.

Adolescent girls and mathematics: classroom performance, attitudes toward mathematics and perceptions of parental attitudes /

The purpose of this study was to determine the extent to which gender differences exist in student attitudes toward mathematics and in their performance in mathematics at the Grade Seven and Eight level. The study also questioned how parents influence the attitudes of this grade level of male and female students toward mathematics. Historically, the literature has demonstrated gender differences in the attitudes of students toward mathematics, and in parental support for classroom performance in mathematics. This study was an attempt to examine these differences at one senior public school in the Peel Board of Education. One hundred three Grade Seven and Eight students at a middle school in the Peel Board of Education volunteered to take part in a survey that examined their attitudes toward mathematics, their perceptions of their parents' attitudes toward mathematics and support for good performance in the mathematics classroom, parental expectations for education and future career choices. Gender differences related to performance levels in the mathematics classroom were examined using Pearson contingency analyses. Items from the survey that showed significant differences involved confidence in mathematics and confidence in writing mathematics tests, as well as a belief in the ability to work on mathematics problems. Male students in both the high and low performance groups demonstrated higher levels of confidence than the females in those groups. Female students, however, indicated interest in careers that would require training and knowledge of higher mathematics. Some of the reasons given to explain the gender differences in confidence levels included socialization pressures on females, peer acceptance, and attribution of success. Perceived parental support showed no significant differences across gender groups or performance levels. Possible explanations dealt with the family structure of the participants in the study. Studies that, in the past, have demonstrated gender differences in confidence levels were supported by this study, and discussed in detail. Studies that reported on differences in parental support for student performance, based on the gender of the parent, were not confirmed by this study, and reasons for this were also discussed. The implications for the classroom include: 1) build on the female students' strengths that will allow them to enjoy their experiences in mathematics; 2) stop using the boys as a comparison group; and 3) make students more aware of the need to continue studying mathematics to ensure a wider choice of future careers.

The Catharanthus roseus 16-hydroxytabersonine O-methyltransferase involved in vindoline biosynthesis /

Madagascar periwinkle (Catharanthus roseus) produces the well known and remarkably complex dimeric anticancer alkaloids vinblastine and vincristine that are derived by coupling vindoline and catharanthine monomers. This thesis describes the novel application of carborundum abrasion (CA) technique as a tool for large scale isolation of leaf epidermis enriched proteins. This technique was used to facilitate the purification to apparent homogeneity of 16-hydroxytabersonine-16-0-methyltransferse (l60MT) that catalyses the second step in the 6 step pathway that converts tabersonine into vindoline. This versatile tool was also used to harvest leaf epidermis enriched mRNAs that facilitated the molecular cloning of the 160MT. Functional expression and biochemical characterization of recombinant 160MT enzyme showed that it had a very narrow substrate specificity and high affinity for 16-hydroxytabersonine, since other closely related monoterpene indole alkaloids (MIAs) did not act as substrates. In addition to allowing the cloning of this gene, CA technique clearly showed that 160MT is predominantly expressed in Catharanthus leaf epidermis, in contrast to several other OMTs that appear to be expressed in other Catharanthus tissues. The results provide compelling evidence that most of the pathway for vindoline biosynthesis including the 0- methylation of 16-hydroxytabersonine occurs exclusively in leaf epidermis, with subsequent steps occurring in other leaf cell types. Small molecule O-methyltransferases (OMTs) (E.C. 2.1.1.6.x) catalyze the transfer of the reactive methyl group of S-adenosyl-L-methionine (SAM) to free hydroxyl groups of acceptor molecules. Plant OMTs, unlike their monomeric mammalian homologues, exist as functional homodimers. While the biological advantages for dimer fonnation with plant OMTs remain to be established, studies with OMTs from the benzylisoquinoline producing plant, Thalictrum tuberosum, showed that co-expression of 2 recombinant OMTs produced novel substrate specificities not found when each rOMT was expressed individually (Frick, Kutchan, 1999) . These results suggest that OMTs can fonn heterodimers that confer novel substrate specificities not possible with the homodimer alone. The present study describes a 160MT model based strategy attempting to modify the substrate specificity by site-specific mutagenesis. Our failure to generate altered substrate acceptance profiles in our 160MT mutants has lead us to study the biochemical properties ofhomodimers and heterodimers. Experimental evidence is provided to show that active sites found on OMT dimers function independently and that bifunctional heterodimeric OMTs may be fonned in vivo to produce a broader and more diverse range of natural products in plants.

An educator's perspective of Dr. Feingold's K-P (Kaiser- Permanents) elimination diet for hyperkinetic children and others

Do evaluation of the literature and a regional observational report support Dr. Feingold's claim that the K-P (Kaiser-Permanente) elimination diet improves the behaviours of hyperkinetic children, and others? Dr. Feingold suggests that some hyperkinetic children, and other children as well, are genetically predisposed to intolerance of food additives, particularly food colours and flavours. He claims that the K-P diet, that eliminates salicylates and artificial food colours and flavours, improves the hyperkinetic child's behaviour, muscle co-ordination, and scholastic performance. Public acceptance of the K-P diet has outstripped acceptance in the medical and scientific communities. Evaluation of available data and additional studies are needed to arrive at a conclusion of acceptance or rejection of the K-P diet for hyperkinetic children and others. My interest in the K-P elimination diet for hyperkinetic children is educational. My experience as an elementary school teacher in special education and in the classroom from K-8 has taught me that attentiveness is crucial to learning. Hyperkinesis appears to impair a child's ability to attend. Learning problems appear, followed by behavioural and social problems. l If we accept the possibility of a relationship between diet and attentiveness, and attentiveness and school behaviours, then the diet-behaviour link could be of lay importance. For instance, if a diet such as the K-P diet could do what is claimed, substantial benefits could accrue to the child. One could, for example, improve a child's behaviours. One could identify attending disturbances early in the child's education, possibly minimizing, or eliminating future difficulties in school. Finally, the greatest benefit may be the fulfillment of the basic goal of our Ontario schools, that the eh~ld-,lIla1p.evelop happily and competently within our educational framework. 2 This thesis reports evidence from the literature and from a regional observational investigation to determine the possibility of a link between the behaviours of children and Dr. Feingold's K-P elimination diet. The literature research examines (1) Dr. Feingold's concept of H-LD, (2) his K-P elimination diet, and (3) the response from three sectors, medicine, science, and the public. The regional investigation examines the observed behaviours of nine children in Regional Niagara during a nine-month period on the K-P diet.

Behavioural characteristics in phylogenetics : a case study using black fly (Diptera: Simuliidae) cocoon spinning behaviour

1-1 is torically, the predominan t method of reconstructing phylogenies has been through the use of morphological characters. There are new techniques now gaining acceptance, including molecular techniques al1d chromosomal information. Altl10ugh the study of behaviour has been used in a comparative framework, these analyses have, historically, been based on intuition. Hennig (1966) devised a neV\' method of reconstructing phylogenies which provided a 110ncircular method for formulating, testing and refining phylogenies. Subsequent s)Tstematists had virtually abandoned ecological and beha\lioural data as primary indicators of phylogenetic relationships (Brooks and McLennan 1991). Therefore, in a modern cladistic framework (sensu Hennig) the analysis of behavioural traits remains underrepresented as a method of reconstructing phylogenies. This thesis will reconstruct the phylogeny for species of black flies (Diptera: Simuliidae), using two steps. The first step is to thoroughl)' understand and explain the cocoon spinning in black fly larvae. There have bee115 previous descriptions of cocoon spinning, but all were incomplete or erroneous. The advances in technology, including video recorders and VCRs, have allowed this behaviour to be analyzed in great detail in 20 different species. A complete description of the cocoon spinning of Simulium \littatum is given. This description will be used as a template for the other species observed. The description and understanding of cococ)n spinning was the first step in undertaking a phylogenetic analysis using this behaviour. The behaviour was then broken down and analyzed, revealing 23 characters, 3 either qualitative and quantitative in nature. These characters were assessed in a cladistic framework (sensu Hennig) and a phylogenetic tree was reconstructed with a e.I of 0.91 and an R.I. of 0.96. This phylogenetic tree closely resembles a previously established pllylogenetic tree produced from morphological and cytological information. The importance of this result is the indication that, contrary to some authors, behavioural characters, if used properly, can add very informative characters to a data set.

Ethnic conflicts and international politics : an analysis of the communal regional, and global dimensions of the Cyprus problem

The thesis assesses the impact of international factors on relations between Greek and Turkish Cypriots during and after the Cold War. Through an analysis of the Cyprus problem it explores both why external actors intervene in communal conflicts and how they influence relations between ethnic groups in plural societies. The analytical framework employed throughout the study draws on contributions of International Relations theorists and students of ethnic conflict. The thesis argues that, as in the global political system, relations between ethnic groups in unranked communal systems are anarchic; that is, actors within the system do not recognize a sovereign political authority. In bipolar communal systems dominated by two relatively equal groups, the struggle for security and power often leads to appeals for assistance from external actors. The framework notes that neighboring states and Great Powers may heed calls for assistance, or intervene without a prior request, if it is in their interest to do so. The convergence of regional and global interests in communal affairs exacerbates ethnic conflicts and precludes the development of effective political institutions. The impact of external intervention in ethnic conflicts has the potential to alter the basis of communal relations. The Cyprus problem is examined both during and after the Cold War in order to gauge how global and regional actors and the structure of their respective systems have affected relations between ethnic groups in Cyprus. The thesis argues that Cyprus's descent into civil war in 1963 was due in part to the entrenchment of external interests in the Republic's constitution. The study also notes that power politics involving the United States, Soviet Union, Greece and Turkey continued to affect the development of communal relations throughout the 1960s, 70s, and, 80s. External intervention culminated in July and August 1974, after a Greek sponsored coup was answered by Turkey's invasion and partition of Cyprus. The forced expulsion of Greek Cypriots from the island's northern territories led to the establishment of ethnically homogeneous zones, thus altering the context of communal relations dramatically. The study also examines the role of the United Nations in Cyprus, noting that its failure to settle the dispute was due in large part to a lack of cooperation from Turkey, and the United States' and Soviet Union's acceptance of the status quo following the 1974 invasion and partition of the island. The thesis argues that the deterioration of Greek-Turkish relations in the post-Cold War era has made a solution to the dispute unlikely for the time being. Barring any dramatic changes in relations between communal and regional antagonists, relations between Greek and Turkish Cypriots will continue to develop along the lines established in July/August 1974. The thesis concludes by affirming the validity of its core hypotheses through a brief survey of recent works touching on international politics and ethnic conflict. Questions requiring further research are noted as are elements of the study that require further refinement.

The elderly : reminiscing, coping with loss, accepting death

This study investigated loss, death and dying, reminiscing, coping and the process of adaptation from the sUbjective perspective. A number of theories and models of death and dying were reviewed in the background literature search with the focus on reminiscing as a coping phenomenon. The format of the study was audio-taped interviews with ten sUbjects and the recording of their memories and reminiscing of life stories. The sUbjects were required to complete an initial questionnaire in a demographic data collection process. Two separate interviews consisted of a primary data collecting interview and a verification interview four to eight weeks later. An independent chart review completed the data collecting process. Data analysis was by the examination of the emerging themes in the subjects' personal narratives which revealed the sUb-categories of reminiscing, loss (including death and dying), acceptance, hope, love, despair and belief. Belief was shown to be the foundation and the base for living and reminiscing. Reminiscing was found to be a coping phenomenon, within the foundation of a belief system. Both living and reminiscing revealed the existence of a central belief or value with a great deal of importance attached to it. Whether the belief was of a spiritual nature, a value of marriage, tradition, a work ethic or belief in an abstract value such as fate,it gave support and control to the individuals' living and reminiscing process. That which caused despair or allowed acceptance indicated the sUbjects' basic belief and was identified in the story narrations. The findings were significant to health care in terms of education, increased dignity for the elderly and better understanding by society. The profiles represented an average age of 86.3 years with age showing no bearing on the life experiences associated with the emerging themes. Overwhelmingly, belief was shown to be the foundation in reminiscing. A Judeo-Christian cultural value base supported the belief in 90% of the sUbjects; however, different beliefs were clearly shown indicating that belief is central to all thinking beings, in everyday life and in reminiscing. Belief was not necessarily spiritual or a practised or verbalized religion. It was shown to be a way of understanding, a fundamental and single thread tying the individual's life and stories together. The benefits were the outcomes, in that knowledge of an individual's belief can optimize care planning for any age group, and/or setting. The strength of the study was the open question format and the feedback process of data verification. The unrestricted outcomes and non-specificity were significant in a world where dying is everybody's business.

The self-management approach of health education in the treatment of chronic illnesses

Health education is essential to the successful treatment of individuals with chronic illnesses. Self-management is a philosophical model of health education that has been shown to be effective in teaching individuals with chronic arthritis to manage their illness as part of their daily lives. Despite the proven results of arthritis self-management programs, some limitations of this form of health education were apparent in the literature. The present study attempted to address the problems of the self-management approach of health education such as reasons for lack of participation in programs and poor course outcomes. In addition, the study served to investigate the relationship between course outcomes and participation in programs with the theory upon which arthritis self-management programs are based, known as self-efficacy theory. Through a combination of qualitative and quantitative methodologies, data collection, and analysis, a deeper understanding of the self-management phenomenon in the treatment of chronic arthritic conditions was established. Findings of the study confirm findings of previous studies that suggest that arthritis self-management programs result in enhanced levels of self-efficacy and are effective in teaching individuals with arthritis to self-manage their health and health care. Findings of the study suggest that there are many factors that determine the choice of participants to participate in programs and the outcomes for the individuals who do choose to participate in programs. Some of the major determinants of enrollment and outcomes of programs include: the participant's personality, beliefs, attitudes and abilities, and the degree of emotional acceptance of the illness. Other determinants of course enrollment and outcomes included class size and length of time, timing of participation, and ongoing support after the program. The results of the study are consistent with the self-management literature and confirm the relationship between the underlying philosophies of adult education and Freire's model of education and self-management.