No description available.

Until recently, long-term effects of a critical illness (CI) have received little attention from intensive care staff, who have traditionally measured outcome from an intensive care unit (ICU) by morbidity and mortality. However, it is now acknowledged that CI is a continuum that begins before ICU and continues to impact on a patient�s quality of life after they have been discharged home. Measuring health related quality of life (HRQOL) is a complex matter due to its multifaceted, subjective and dynamic nature. There has been a lack of consensus in the literature regarding the most appropriate methodological approaches and measuring instruments to use. This disparity has impeded comparison between studies. The aim of this thesis was to review the literature between January 1998 and December 2003 that focused on HRQOL for patients after a CI to identify and summarise themes and key outcomes. There were two main areas of focus - the methods used to measure the effects of the CI, and evaluation of the patient outcomes. An electronic search for relevant articles was conducted using the common clinical research databases and key words such as health related quality of life, outcomes and critical illness. Reference lists from these articles and conference proceedings were reviewed to identify further studies. There were 74 primary papers identified that reflected a number of subcategories including general ICU, Acute Respiratory Distress Syndrome (ARDS), and elderly patients. There were four categories of instruments used in the literature including those that measured acuity of illness, physical functioning, psychological functioning and HRQOL. The majority of studies used more than one measuring instrument, most of which had been previously validated. Results from the studies were diverse, but it is apparent that physical and psychological recovery from a CI may be a slow and varied process. Most studies were observational; only one randomised control study examined the benefits of a physical exercise program for patients post-hospital discharge. In general, there was no evidence of how to translate the study findings into some form of structured program to assist the patient with any identified problems. To enhance continuum of care, integration of ICU, hospital and rehabilitation services could target identified physical and psychological problems to assist patient recovery. However, strong evidence on the benefits of initiatives such as inpatient follow-up, outpatient clinics and use of ICU diaries is yet to be demonstrated.

Until recently, long-term effects of a critical illness (CI) have received little attention from intensive care staff, who have traditionally measured outcome from an intensive care unit (ICU) by morbidity and mortality. However, it is now acknowledged that CI is a continuum that begins before ICU and continues to impact on a patient�s quality of life after they have been discharged home. Measuring health related quality of life (HRQOL) is a complex matter due to its multifaceted, subjective and dynamic nature. There has been a lack of consensus in the literature regarding the most appropriate methodological approaches and measuring instruments to use. This disparity has impeded comparison between studies. The aim of this thesis was to review the literature between January 1998 and December 2003 that focused on HRQOL for patients after a CI to identify and summarise themes and key outcomes. There were two main areas of focus - the methods used to measure the effects of the CI, and evaluation of the patient outcomes. An electronic search for relevant articles was conducted using the common clinical research databases and key words such as health related quality of life, outcomes and critical illness. Reference lists from these articles and conference proceedings were reviewed to identify further studies. There were 74 primary papers identified that reflected a number of subcategories including general ICU, Acute Respiratory Distress Syndrome (ARDS), and elderly patients. There were four categories of instruments used in the literature including those that measured acuity of illness, physical functioning, psychological functioning and HRQOL. The majority of studies used more than one measuring instrument, most of which had been previously validated. Results from the studies were diverse, but it is apparent that physical and psychological recovery from a CI may be a slow and varied process. Most studies were observational; only one randomised control study examined the benefits of a physical exercise program for patients post-hospital discharge. In general, there was no evidence of how to translate the study findings into some form of structured program to assist the patient with any identified problems. To enhance continuum of care, integration of ICU, hospital and rehabilitation services could target identified physical and psychological problems to assist patient recovery. However, strong evidence on the benefits of initiatives such as inpatient follow-up, outpatient clinics and use of ICU diaries is yet to be demonstrated.

No description available.

<p>  </p> <p>Interpersonal relationships play a central role in well-being in adulthood. Built upon the life course and within-family perspectives, this dissertation investigates the generational origin of interpersonal relationships via socialization (i.e., intergenerational transmission of interpersonal relationship quality) and its consequences on well-being across generations in later-life families. </p> <p><br></p> <p>Despite a large body of literature on parents’ socialization of children leading to similar social development generationally, this literature has been criticized for lacking attention to socialization effects after childhood and issues of heterogeneity and selectivity. To advance knowledge in these aspects, drawing from theories of socialization and the life course, I examined the transmission of older mothers’ relationship quality with their mothers and fathers to their relationship quality with their own adult children in midlife in Chapter 2. I further studied how intergenerational transmission varies by relational dimension (closeness, tension) and adult children’s gender (sons, daughters). The evidence for intergenerational transmission of parent-child relationship quality found in this study complements family socialization literature by revealing the cumulative socialization influences in later-life families. The differential patterns of intergenerational transmission highlight social learning as a selective process based on the positivity or negativity of the relational dimension and the moderating role of social structural position (i.e., gender) in shaping the patterns of intergenerational transmission.</p> <p><br></p> <p>Built upon the core idea of intergenerational transmission, the aim of Chapter 3 is to broaden the study of social relationships and well-being from the family network lens by examining how intergenerational transmission of mother-child and friendship quality facilitates older generation’s interpersonal relationship quality to affect offspring’s psychological well-being. Although the implication of interpersonal relationship quality for well-being has been well-documented, prior literature has largely focused on the effect of one’s own relationship quality on psychological well-being. To advance knowledge on this issue, I examined the effects of older mothers transmitting the quality of their relationships with their own mothers and friends to adult children’s relationships with their friends and with the mothers themselves on adult children’s depressive symptoms. I further investigated how adult children’s gender shaped the ways in which mothers’ relationship quality affected adult children’s well-being. My findings support intergenerational transmission of interpersonal relationship quality as a mechanism by which mothers’ interpersonal relationship quality affects adult children’s well-being. The differential effect by adult children’s gender highlights the critical role gender plays in shaping the consequences of intergenerational transmission of interpersonal relationship quality on offspring’s well-being. </p> <p><br></p> <p>In summary, this dissertation applies the life course and within-family perspectives to studying intergenerational transmission of interpersonal relationship quality as a way by which the lives of family members are linked in aging families and the consequences of this interconnectedness for well-being across generations. Furthermore, it highlights the important role social structural position (i.e., gender) plays in shaping patterns and consequences of intergenerational transmission. </p>

No description available.

Objective: To analyze the change in health-related quality-of-life (HRQoL) in patients with Parkinson’s disease (PD) and to identify different classes of HRQoL decline. Methods: A longitudinal cohort study was performed to assess clinical parameters (unified PD rating scale, Beck Depression Inventory) and HRQoL data (EuroQol, Parkinson’s Disease Questionnaire [PDQ]-39) at baseline, 3, 6, 12, 24, and 36 months. A total of 145 patients with PD were consecutively recruited in the county of Northern Hessia, Germany, between January and June 2000. A latent growth mixture model was applied to analyse the heterogeneity in HRQoL trajectories. Results: We successfully applied latent mixture growth modeling in order to identify different classes of HRQoL trajectories in PD. Three growth models were developed and each resulted in a four-class model of distinct patterns using the generic EuroQol instruments’ outcomes (EuroQol-5 Dimensions and visual analogue scale) and the disease-specific PDQ- 39. The four classes were defined by individual trajectory characteristics. Classes one and two represented trajectories with moderate declines over 36 months, but with different initial intercepts. Class three consisted mainly of patients who passed away during the observation period and therefore had a large HRQoL decline. Class four was characterized by a low level of HRQoL at baseline and a significant subsequent decline. Conclusions: The findings provide a more elaborate understanding of the variability in HRQoL reduction in PD over time. The classification of different HRQoL subgroups may help to explain the response of PD patients to the natural history of the disease. Future research will enable the identification of HRQoL responder subgroups on different treatment regimens.

Despite an increased interest in autism over the last decades, little research exists about life outcomes of autistic adults. The earliest follow-up studies of autistic individuals suggested that self- understanding and conscious efforts to change could be crucial factors in successfully reaching good life outcomes. However, these initial suggestions have not been further investigated. Therefore, this exploratory qualitative study examined the lives of eight highfunctioning autistic adults aged 25 to 63, from their own perspectives, through in-depth, semistructured interviews, to consider the relation of self-understanding and conscious efforts to change—in this study referred to as intentional personal development—to their life outcomes. All participants demonstrated a level of self-understanding beyond what would be predicted by current theoretical models of autism. Their self-understanding was assessed through participants’ self-definitions, meaning-making of life experiences, and understanding of emotions. In their self-definitions, the participants emphasized their abilities and personality characteristics, rather than their disabilities. For their self-defining memories, as indicators of their meaning making of life experiences, most participants chose positive experiences related to their personal development. Their autobiographical accounts revealed that most participants possess a large iii repertoire of emotion words, supporting an understanding of emotions. When a good life outcome is defined traditionally—as being employed, living independently, and having social relationships—this study, contrary to expectations, did not provide overwhelming evidence for the significant role of intentional personal development in achieving this. However, when a good life outcome is defined in terms of achieving personal excellence, then the study did provide confirmation of intentionality as important to attaining good life outcomes. This study therefore suggests that traditional life outcome measures are inadequate for assessing the life outcomes of autistic individuals because such measures do not take into account the individuals’ own sense of satisfaction with themselves and with their lives.

Despite an increased interest in autism over the last decades, little research exists about life outcomes of autistic adults. The earliest follow-up studies of autistic individuals suggested that self- understanding and conscious efforts to change could be crucial factors in successfully reaching good life outcomes. However, these initial suggestions have not been further investigated. Therefore, this exploratory qualitative study examined the lives of eight highfunctioning autistic adults aged 25 to 63, from their own perspectives, through in-depth, semistructured interviews, to consider the relation of self-understanding and conscious efforts to change—in this study referred to as intentional personal development—to their life outcomes. All participants demonstrated a level of self-understanding beyond what would be predicted by current theoretical models of autism. Their self-understanding was assessed through participants’ self-definitions, meaning-making of life experiences, and understanding of emotions. In their self-definitions, the participants emphasized their abilities and personality characteristics, rather than their disabilities. For their self-defining memories, as indicators of their meaning making of life experiences, most participants chose positive experiences related to their personal development. Their autobiographical accounts revealed that most participants possess a large iii repertoire of emotion words, supporting an understanding of emotions. When a good life outcome is defined traditionally—as being employed, living independently, and having social relationships—this study, contrary to expectations, did not provide overwhelming evidence for the significant role of intentional personal development in achieving this. However, when a good life outcome is defined in terms of achieving personal excellence, then the study did provide confirmation of intentionality as important to attaining good life outcomes. This study therefore suggests that traditional life outcome measures are inadequate for assessing the life outcomes of autistic individuals because such measures do not take into account the individuals’ own sense of satisfaction with themselves and with their lives.