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Thesis (M.S.)--University of Michigan, 2003. / Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 2001. / Includes bibliographical references.

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Most of the empirical research on later life well-being in Taiwan has focused on demographic, structural factors and resources flow, and tended to ignore the meaning and beliefs older Taiwanese assign to aging and the consequences. In light of dramatic social transformation and the changing nature of elderly support, the empirical test of the values and beliefs about later life and their effects may provide a significant viewpoint in understanding why some older adults in Taiwan are healthier and live longer than others. This project employs a national representative data drawn from the Survey of Health and Living Status of the Elderly in Taiwan in year 1996 and 1999. Beliefs about aging are conceptualized into several constructs and each is linked to three dimensions of health outcomes: physical health, mental health and mortality. In addition, I tested whether engagement in healthy habits, supportive social relationships, and greater involvement in social activities account for the associations. Results suggest that general higher levels of positive beliefs about aging are predictive of improved health and longevity over time. When I divide general beliefs into positive and negative domains, I find that positive beliefs improve health largely through life style factors. While, compared to positive beliefs, negative beliefs seem to exert stronger effects on health through pathways well beyond an individual's lifestyle. That is, pessimistic views on aging may be more detrimental to health because domains related to negative beliefs (e.g., "boredom and uselessness" and "financial insecurity") directly challenge an individual's desires to search for a sense of meaning, purpose and security later in life. Taken together, this study shows that positive beliefs about aging shape proactive behaviors and translate limited resources into opportunities, eventually leading to better health outcomes. In contrast, viewing aging in an unfavorable way may limit an individual's pursuit for a better life, and, in turn, impact health and well-being, regardless the actual resources possessed by the individuals. Therefore, this study suggests despite physically intact, generally active, and supportive relationships, the individual's subjective perception of aging is another important determinant in securing a healthy later life among elderly Taiwanese. / text

published_or_final_version / Medicine / Master / Master of Medical Sciences

BACKGROUND Inhalation therapy has proven to be the best way to control the asthma and chronic obstructive pulmonary disease symptoms. The most commonly used delivery system to control these symptoms is the metered-dose inhaler. The primary goal of this study is to demonstrate an association between incorrect inhaler use and patient age. METHODS This is a cross-sectional study, performed at Centro Médico Naval “Cirujano Mayor Santiago Távara”, in Callao, Peru, in 2014. Patients older than 18 years that used metered-dose inhalers were included. We used film recordings of patients using a metered-dose inhaler and compared their technique with the recommendations on the guidelines on the correct use of inhalers of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR). The main variables measured were age and incorrect inhaler use. The results were analyzed with the Chi squared test for bivariate analysis, and for multivariate analysis we used the Poisson regression model with robust variance. RESULTS We included 378 patients in the analysis; 167 were older than 60 years. An association was found between incorrect inhalator technique and age (p=0.014) (PR 1.19 95% CI 1.03 to 1.37). The highest prevalence of incorrect technique was found in the young adult population (88%). There was no association between the incorrect technique and the person who taught it (p=0.114). Finally, this study showed that 81.2% of the study population presented an incorrect inhalation technique. CONCLUSIONS The percentage of incorrect inhaler use, in the general population is high. Even if we found no association between an incorrect technique and the person who taught it; still, there is a high percentage of errors and it was even demonstrated that being instructed by a pulmonologist does not guarantee a correct performance of metered-dose inhaler inhalations. / INTRODUCCIÓN La terapia inhalatoria ha demostrado ser la más rápida y eficaz para el control del asma y la enfermedad pulmonar obstructiva crónica. El inhalador de dosis medida es el más usado por la población. El objetivo de este estudio es evidenciar la asociación entre la técnica inhalatoria incorrecta y la edad. MÉTODOS Estudio observacional, analítico, de corte transversal realizado en Perú durante 2014. Se incluyeron pacientes desde los 18 años que utilizaran inhalador de dosis medida. Se utilizó una lista de verificación de pasos establecidos por la Sociedad Española de Neumología y Cirugía Torácica y filmaciones para evaluar la técnica inhalatoria de los pacientes. Las variables principales fueron la edad y la mala técnica inhalatoria práctica. Para el análisis bivariado se utilizó la prueba Chi cuadrado y para el análisis multivariado regresión de Poisson con varianza robusta. RESULTADOS Se incluyeron 378 pacientes; 167 fueron mayores de 60 años. El estudio reveló que el 81,2% de la población presentó una incorrecta técnica inhalatoria. Se encontró asociación entre la edad y la técnica inhalatoria incorrecta (p=0,014) (PR 1,19 con IC 95% 1,03-1,37). El grupo etario con mayor frecuencia de técnica incorrecta fue el de adultos jóvenes (88%). CONCLUSIONES La frecuencia de uso incorrecto del inhalador en la población es alta y esta característica predomina en el grupo de adultos jóvenes. A pesar de no haber asociación entre la persona que enseña la técnica inhalatoria y el desempeño de la misma, se demostró que existe alta frecuencia de errores, incluso en aquellos pacientes instruidos por un médico especialista.