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LONG DESCRIBED AS A CITY 'DROWNING IN garbage,' Managua is ground zero in the fight against unsightly municipal solid waste in Nicaragua. The completion of a large-scale international development project [...]

Nurses need to understand the importance of oral hygiene because of its effects on the individual's quality of life. This requires thorough oral assessment, effective dental care and awareness of [...]

Hip and knee replacements are common orthopaedic procedures that can greatly improve patients' quality of life and provide relief from the pain caused by various musculoskeletal diseases. This article considers [...]

ABSTRACT The formal labour markets and economies of many cities in sub-Saharan Africa have been very weak for decades and this has led to significant adaptations in the nature of [...]

Urinary and faecal incontinence affect a significant proportion of the population. Both types of incontinence can limit activities of daily living, restrict the individual's ability to function in society and, [...]

Summary Ovarian cancer is the fourth most common cause of cancer death among women. It has a poor prognosis, with five-year survival rates of 40 per cent. This article discusses [...]

Summary Good nutrition is important in caring for patients with life-limiting illness, not only for meeting the body's physical requirements but also because of its associated social, cultural and psychological [...]

Summary This article provides an overview of the treatment options available for patients diagnosed with metastatic breast cancer. The article focuses on the four common organ sites affected by metastatic [...]

Summary Many people in the UK experience chronic pain. This can have a huge effect on a person's life, including their mood, work and family. Pain management programmes are proving [...]

Summary Skin conditions can adversely affect many aspects of patients' lives. The quality of life for people with skin conditions such as psoriasis, atopic eczema and acne can be significantly [...]

Byline: Sonja Drobnic (1), Barbara Beham (2), Patrick Prag (3) Keywords: Job quality; Life satisfaction; Quality of life; Europe; Cross-national comparison Abstract: Cross-national comparisons generally show large differences in life satisfaction of individuals within and between European countries. This paper addresses the question of whether and how job quality and working conditions contribute to the quality of life of employed populations in nine strategically selected EU countries: Finland, Sweden, the UK, the Netherlands, Germany, Portugal, Spain, Hungary, and Bulgaria. Using data from the European Quality of Life Survey 2003, we examine relationships between working conditions and satisfaction with life, as well as whether spillover or segmentation mechanisms better explain the link between work domain and overall life satisfaction. Results show that the level of life satisfaction varies significantly across countries, with higher quality of life in more affluent societies. However, the impact of working conditions on life satisfaction is stronger in Southern and Eastern European countries. Our study suggests that the issue of security, such as security of employment and pay which provides economic security, is the key element that in a straightforward manner affects people's quality of life. Other working conditions, such as autonomy at work, good career prospects and an interesting job seem to translate into high job satisfaction, which in turn increases life satisfaction indirectly. In general, bad-quality jobs tend to be more 'effective' in worsening workers' perception of their life conditions than good jobs are in improving their quality of life. We discuss the differences in job-related determinants of life satisfaction between the countries and consider theoretical and practical implications of these findings. Author Affiliation: (1) University of Hamburg, Allende-Platz 1, Hamburg, 20146, Germany (2) Humboldt-Universitat zu Berlin, Spandauer Str. 1, Berlin, 10178, Germany (3) University of Groningen, Grote Rozenstraat 31, Groningen, 9712 TG, The Netherlands Article History: Registration Date: 08/02/2010 Accepted Date: 08/02/2010 Online Date: 04/03/2010

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jada.2010.08.022 Byline: Becky Dorner Abstract: It is the position of the American Dietetic Association that the quality of life and nutritional status of older adults residing in health care communities can be enhanced by individualization to less-restrictive diets. The American Dietetic Association advocates for registered dietitians to assess and evaluate the need for nutrition interventions tailored to each person's medical condition, needs, desires, and rights. Dietetic technicians, registered, assist registered dietitians in the assessment and implementation of individualized nutrition care. Health care practitioners must assess risks vs benefits of therapeutic diets, especially for older adults. Food is an essential component of quality of life; an unpalatable or unacceptable diet can lead to poor food and fluid intake, resulting in undernutrition and related negative health effects. Including older individuals in decisions about food can increase the desire to eat and improve quality of life. The Practice Paper of the American Dietetic Association: Individualized Nutrition Approaches for Older Adults in Health Care Communities provides guidance to practitioners on implementation of individualized diets and nutrition care.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jada.2010.08.023 Byline: Becky Dorner Abstract: It is the position of the American Dietetic Association that the quality of life and nutritional status of older adults residing in health care communities can be enhanced by individualization to less-restrictive diets. The Association advocates the use of qualified registered dietitians (RDs) to assess and evaluate the need for nutrition care according to each person's individual medical condition, needs, desires, and rights. Dietetic technicians, registered, provide support to RDs in the assessment and implementation of individualized nutrition care. Individual rights and freedom of choice are important components of the assessment process. An RD must assess each older adult's risks vs benefits for therapeutic diets. Older adults select housing options that provide a range of services from minimal assistance to 24-hour skilled nursing care. Food is an important part of any living arrangement and an essential component for quality of life. A therapeutic diet that limits seasoning options and food choices can lead to poor food and fluid intake, resulting in undernutrition and negative health effects. Including older individuals in decisions about food can increase the desire to eat and improve quality of life. The expansion of health care communities creates a multitude of options for RDs and dietetic technicians, registered, to promote the role of good food and nutrition in the overall quality of life for the older adults they serve.

Summary Continence care is a high priority during the rehabilitative process following stroke. Effective continence care can significantly improve the quality of life of patients and carets. A lack of [...]

Byline: Thomas E. Jordan (1) Keywords: Dublin; Mortality; Quality of life; Families; Parishes; Piped water Abstract: Inquiry into the quality of family life in seventeenth century Dublin is an attempt to understand conditions in the second largest city in the British Isles further, the era was one of convulsions in the body politic, social, and religious. The Scottish James I and VI (1556 1625) determined that the Irish province closest to Scotland, Ulster, would be settled = `planted' by Presbyterians. The process was undertaken at the expense of Ulster's tradition bound, gaelic population. Decades later, that policy of deliberate alienation led to the uprising in 1641 led by Sir Phelim O' Neill. A decade of violence was summated in an outbreak of bubonic plague from baleful Nature, and by the violent, swift campaign of Oliver Cromwell in 1649. Thirty years later, the Glorious Revolution of 1688, confirmed by the defeat of James II at the Boyne, consolidated power in Ireland in the hands of the Protestant ascendancy. Quality of life in the several decades of turmoil was destroyed for many, but Dublin was spared the physical destruction experienced at Drogheda to the north Dublin's deliverance was the work of Colonel Michael Jones and his victory at nearby Rathmines. Subsequently, Dublin's households flourished in the several parishes in some piped water was available, but mortality was always high. Author Affiliation: (1) University of Missouri - St. Louis, Saint Louis County, MO, USA Article History: Registration Date: 10/09/2009 Accepted Date: 07/09/2009 Online Date: 29/10/2009

In this article, we present a simple multidimensional approach to case-mix adjustment that can be used without sophisticated statistical or computer programs. The objectives are to synthesize and offer examples [...]

This paper examines the associations between different forms of support, who provides the support and the wellbeing of older adults in Germany. Particular attention is paid to the wellbeing differences associated with kin and non-kin providers and with emotional support and instrumental support. In addition, the quality of relationships with kin and non-kin is examined as a moderator of the association between social support and wellbeing. Data for 1046 respondents to the German Ageing Survey in 2oo2 were analysed to determine the combinations of emotional or instrumental support, kin or non-kin providers and relationship quality that best predicted wellbeing. Emotional support from kin and instrumental support from non-kin were both found to associate positively with wellbeing. Emotional support from non-kin providers did not associate with wellbeing, whereas instrumental support from kin providers had a negative association with one aspect of wellbeing. Higher relationship quality, whether with kin or non-kin, positively related to wellbeing. Interestingly, the negative impact of instrumental kin support was qualified by relationship quality. In other words, for people with high-quality- relationships, receiving instrumental support from kin did not decrease wellbeing. When the relationship with a family carer or supporter is characterised by high quality, the challenges of frailties in old age, such as decreasing capacities and an increasing need for social support, can be met without compromising wellbeing. KEY WORDS--positive and negative affect, emotional support, instrumental, family carers, kin and non-kin relationships. doi: 10.1017/S0144686X10000061

Summary Difficulty in sleeping can be a serious problem for people with learning disabilities, reducing their quality of life and increasing the incidence of challenging behaviour. Research into sleep has [...]

Background. To compare the effect of two modes of delivering a falls prevention service in reducing the rate of falls and improving quality of life, activity levels, and physical status among older adults with a history of recent falls. Methods. A randomized controlled trial was conducted with a total of 107 participants with blinded baseline and follow-up assessments. The participants were older community-dwelling adults referred for a falls prevention service located in Brisbane, Australia. The intervention was a multiple component falls prevention service delivered in either in a domiciliary or center-based mode of delivery. Both programs were similar apart from setting and consisted of three components, a balance and strength component, falls prevention education, and functional tasks. Physical and psychosocial assessments were administered at baseline, 8-week follow-up and 6-month follow-up. Falls data were collected by monthly telephone contact and by interview at 8 weeks and 6 months. Results. The center-based service demonstrated significantly better results in preventing falls over the home-based service. Clients in the center-based arm of the trial experienced fewer total falls and this group also had a greater reduction in the total number of fallers after the intervention. Conclusion. This research demonstrates that delivering a similar service in different settings--home based or center based--impacts upon the effectiveness of the service. Community-dwelling older adults with a history of falls should be provided with center-based programs in preference to home-based programs where they are available. doi: 10.1093/gerona/glq054

Summary This article focuses on the role of the nurse in the care and management of older people with dry and wet age-related macular degeneration. It provides an overview of [...]

Summary Pulmonary arterial hypertension (PAH) is a devastating disease that has a considerable effect on quality of life and eventually leads to right heart failure. The past ten years have [...]

Byline: Ruut Veenhoven (1) Keywords: Quality-of-life; Life expectancy; Happiness; Evolution; Progress Abstract: Human society has changed much over the last centuries and this process of 'modernization' has profoundly affected the lives of individuals currently we live quite different lives from those forefathers lived only five generations ago. There is difference of opinion as to whether we live better now than before and consequently there is also disagreement as to whether we should continue modernizing or rather try to slow the process down. Quality-of-life in a society can be measured by how long and happy its inhabitants live. Using these indicators I assess whether societal modernization has made life better or worse. Firstly I examine findings of present day survey research. I start with a cross-sectional analysis of 143 nations in the years 2000--2008 and find that people live longer and happier in today's most modern societies. Secondly I examine trends in modern nations over the last decade and find that happiness and longevity have increased in most cases. Thirdly I consider the long-term and review findings from historical anthropology, which show that we lived better in the early hunter-gatherer society than in the later agrarian society. Together these data suggest that societal evolution has worked out differently for the quality of human life, first negatively, in the change from a hunter-gatherer existence to agriculture, and next positively, in the more recent transformation from an agrarian to an industrial society. We live now longer and happier than ever before. Author Affiliation: (1) Faculty of Social Sciences, Erasmus University Rotterdam, P.O. Box 1738, 3000DR, Rotterdam, Netherlands Article History: Registration Date: 04/12/2009 Accepted Date: 10/11/2009 Online Date: 30/12/2009 Article note: Earlier versions of this paper have been published in: Yew-Kwang Ng & Lok Sang Ho (Eds.) 'Happiness and Public Policy, Theory, Case studies and Implications' Palgrave-Macmillan, New York, 2006, pp. 19--44 and in the European Psychologist, 2005, 10:330--343.

Byline: Chau-kiu Cheung (1), Kwok Leung (1) Keywords: Quality of life; Quality of work life; Societal quality of life; Social change; Adaptation; Need fulfillment; Buffering Abstract: A notable way that social change affects personal quality of life would rely on the person's experience with social change. This experience may influence societal quality of life and quality of work life, which may in turn affect personal quality of life. Additionally, the experience of social change is possibly less detrimental to personal quality of life later in the presence of higher existing personal quality of life. These influences over time become transparent through a three-wave panel study of 531 working people in Hong Kong, China. Findings show that although social change experienced did not generally impair subsequent quality of life, it tended to be more detrimental to the person with lower quality of life before. In addition, social change experienced tended to erode societal quality of life and quality of work life experienced, which appeared to be predictors of personal quality of life. Hence, there are possible ways for social change to predict personal quality of life. Author Affiliation: (1) City University of Hong Kong, Kowloon, Hong Kong Article History: Registration Date: 04/05/2009 Received Date: 26/11/2008 Accepted Date: 03/05/2009 Online Date: 23/05/2009

Becoming a grandparent is a typical life event usually first experienced in late middle adulthood. Grandparenthood may offer a sense of completion, a sense of satisfaction, or provide an opportunity [...], Health-related quality of life (HRQOL) was explored in a sample of 119 custodial grandparents. A latent profile analysis identified three groups of grandparents along a continuum of good to poor HRQOL, with most custodial grandparents reporting Short Form-12 Health Survey (version 2) scores significantly below U.S. population means. Grandparent and grandchild characteristics that predicted grandparent HRQOL were identified. Grandchild health problems, number of grandchildren in custody, and grandparent education contributed to a moderate reduction in HRQOL. A large reduction in HRQOL was predicted by depression. Differences in depression were reported between groups, with grandparents with poor HRQOL also reporting clinically significant depression, grandparents with fair HRQOL reporting marginally clinically significant depression, and grandparents with good HRQOL reporting no depression. In a qualitative analysis, grandparent conceptualization of what they need to do to maintain and improve their health was explored for each group. Findings from the quantitative analysis indicate variation in grandparent health and mental health status and suggest that services should be tailored to address grandparent needs. The qualitative analysis highlights the importance of religion and spirituality to grandparents, the economic concerns of grandparents, and the need for transdisciplinary services. KEY WORDS: custodial grandparents; grandparent health; health-related quality of life

Summary Psychosis is a symptom of serious mental illness that is usually associated with adult life, but a significant group of people develop it in adolescence. Psychosis in adolescence is [...]

Summary Healthcare practitioners working with people with dementia are often asked by the carer: 'When will my partner need to go to a nursing home?' This article presents an overview [...]

Summary While faecal incontinence is a common problem, many people may be embarrassed to admit having the condition. An understanding of the various factors that contribute to faecal incontinence can [...]

Summary Functional bowel disorders encompass a number of symptoms including abdominal, pelvic and/or anal pain, bloating, nausea, disturbed bowel function, faecal urgency or incontinence, straining to evacuate bowels, incomplete emptying [...]

Built capital combines with social, personal and natural capital to contextualize people's quality of life. Although this last concept has strongly tested academic reasoning, it is often presented simply and as a fait accompli in strategic planning documents. This article questions these pragmatic 'top-down' scripts by engaging the self-determination theory of motivation. It argues the transience of hedonic or material reward and posits a much higher plane of eudemonic fulfilment. The key to self-determination and, thus, an agreeable quality of life lies in an individual's acquisition of competence, autonomy and relatedness. From this bridgehead and via a macro-level analysis, the article identifies contemporary economic, environmental and social challenges to the achievement of quality of life, ones that are likely to need individual resourcefulness and resilience to overcome. The account concludes that, instead of proffering cookie-cutter or one-size-fits-all formulae, authorities may consider ways of helping individuals help themselves to a better quality of life based on a precept that life is, in part, what you make it and does not rely on material wealth alone. In this way, it could be possible to substitute other forms for material capital to improve environmental and social sustainability. Keywords: Hedonic and eudemonic welfare; hierarchy of needs; quality of life; self-determination theory; strategic planning, INTRODUCTION Strategic planning schemes regularly posit liveability, lifestyle or quality of life as part of their vision for urban development. In Australia, for example, the recent South East Queensland Regional [...]

Byline: Andrew M. H. Siu (1), Daniel T. L. Shek (2) Keywords: Social problem solving; Depression; Anxiety; Family functioning; Well-being Abstract: Social problem solving is the cognitive-affective-behavioral process by which people attempt to resolve real-life problems in a social environment, and is of key importance in the management of emotions and well-being. This paper reviews a series of studies on social problem solving conducted by the authors. First, we developed and validated the Chinese version of the Social Problem-Solving Inventory Revised (C-SPSI-R) which demonstrated very good psychometric properties. Second, we identified the scope of stressful social situations faced by young adults and their self-efficacy in facing such situations (N = 179). Young adults were generally confident about their basic social skills but found it much more stressful to relate to family members, handle conflicts, handle negative behaviors from others, self-disclose to others, and to express love. Third, in two separate studies, we found that social problem solving was closely linked to measures of depression (n = 200), anxiety (n = 235), and family well-being (N = 1462). Measures of anxiety and depression were found to be significantly related to aspects of social problem solving in expected directions and expected strength. In another study, higher parental social problem solving behavior and lower avoidance behavior were found to be related to indicators of family well-being, including better overall family functioning, and fewer parent--adolescent conflicts. Author Affiliation: (1) Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hunghom, Hong Kong, People's Republic of China (2) Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hunghom, Hong Kong, People's Republic of China Article History: Registration Date: 22/09/2009 Accepted Date: 05/04/2009 Online Date: 02/10/2009

Byline: Phoenix K. H. Mo (1), W. S. Mak Winnie (2) Keywords: Health promoting practice; Health practice; Quality of life; Hong Kong Abstract: The importance of a healthy lifestyle is receiving increasing attention due to its impact on health and well-being. However, very few studies have been done on health promoting practices of the general public in Hong Kong. The present study aimed to identify the patterns of health promoting practices of the general public in Hong Kong, to compare health promoting practices across gender and education levels, and to examine the relationship between health promoting practices and quality of life. A total of 941 community adults were recruited using a randomized household survey design. Results revealed that a large proportion of participants reported practicing various types of health promoting behavior related to healthy food choice, engaging in stress management strategies, and refraining from health compromising behavior such as smoking and drinking excessively. Female participants were more likely to choose healthy food, refrain from smoking and drinking alcohol excessively, and take vitamin supplements, whereas male participants were more likely to exercise regularly. Both men and women with higher levels of education were more likely to report not smoking, not drinking alcohol excessively, and participating in social activities. Women with higher levels of education were also more likely to engage in relaxing activities but less likely to report exercising regularly and sleeping sufficiently. Hierarchical regression analyses revealed that stress management and social relations significantly predicted better quality of life for both male and female participants, and types of preventive health behavior were significant predictors of quality of life for female participants only. Results highlighted the importance of advocating health promoting practices among the general public in Hong Kong. Implications for future practice were discussed. Author Affiliation: (1) Institute of Work, Health and Organisations, University Boulevard, 8 William Lee Buildings, Science and Technology Park, Nottingham, NG7 2RQ, UK (2) Department of Psychology, Chinese University of Hong Kong, 3/F Sino Building, Shatin, Hong Kong Article History: Registration Date: 22/09/2009 Accepted Date: 05/04/2009 Online Date: 13/10/2009 Article note: An erratum to this article can be found at http://dx.doi.org/10.1007/s11205-009-9544-4

The long life expentancy of the elderly motivates interest in their quality of life. Our study analyzes vital satisfaction as a global indicator of the three dimensions (physical, mental, and social) of the quality of life in relation to health. The subjects were 310 women, with an average age of 71.22 years old (SD 6.72), with minimum education, and active aging. The reliability was examined with the COOP-WONCA Charts and the Nottingham Health Profile. The results show that vital satisfaction significantly correlates with the three dimensions of health, in particular with the mental domain. KEYWORDS quality of life, health status, elderly women, vital satisfaction DOI: 10.1080/08952840903488872

Byline: Elvira Cicognani (1), Luca Pietrantoni (1), Luigi Palestini (1), Gabriele Prati (1) Keywords: Emergency workers; Quality of life; Self-efficacy; Collective efficacy; Sense of community; Coping Abstract: This study, involving a sample of 764 emergency workers, investigates dimensions of quality of life at work (Compassion fatigue, Burnout and Compassion satisfaction), and their relationships with Coping strategies and some psychosocial variables (Sense of Community, Collective Efficacy and Self-efficacy). Results indicate the usefulness of distinguishing between positive and negative indicators of emergency workers' quality of life. Compassion satisfaction is positively correlated with efficacy beliefs, Sense of Community and the use of Active coping strategies. Burnout and Compassion fatigue are especially correlated with the use of dysfunctional coping strategies like distraction and self-criticism. Volunteer emergency workers enjoy a higher well being than full-time professional workers. Results and their implications for interventions aimed at increasing rescue workers' quality of life by enhancing psychosocial competences are discussed. Author Affiliation: (1) Department of Sciences of Education 'G.M. Bertin', University of Bologna, Via Filippo Re, 6, 40127, Bologna, Italy Article History: Registration Date: 05/01/2009 Received Date: 23/10/2008 Accepted Date: 05/01/2009 Online Date: 14/01/2009 Article note: This research was funded by the Italian Ministry of University and Scientific Research as Project of Relevant National Interest ('Individual and social competences in the management of critical events in the community. Proposal of an intervention model') (2005--2007) (Scientific Resp. Elvira Cicognani).

This study examined the end-of-life challenges, concerns, and care preferences of terminally ill elders and their family caregivers, with a focus on areas of congruence and incongruence. Ten elders and 10 family caregivers participated in separate, semi-structured, face-to-face interviews. Data analysis included team coding and thematic analysis, guided by an a priori set of categories based on the study questions. Shared challenges and concerns included experiencing decline, managing pain and discomfort, and living with uncertainty. There was also congruence regarding end-of-life care preferences, specifically the importance of quality care, treatment with dignity and respect, and avoiding unnecessary life-sustaining treatment. Areas of incongruence included the elders' difficulties in accepting dependence, their fears of becoming a burden, and desire to be prepared for death. Family caregivers were most concerned with providing adequate care to meet the elders' physical and spiritual care needs. Open family communication was associated with greater congruence. The authors discuss implications of these findings for research and intervention. doi: 10.2190/OM.60.3.e

Byline: Chang-Ming Hsieh (1) Keywords: Life satisfaction; Client satisfaction; Case management service; Mediating effect Abstract: This study explores the relationship between health, quality of care of geriatric case management and quality of life for the purpose of furthering the understanding of the relationship between quality of life and geriatric case management. Using survey data from a group of frail older adults, this study assesses the relative merit of two mediation hypotheses: one considering health as a mediator for quality of care of geriatric case management and quality of life, and the other considering quality of care of geriatric case management as a mediator for health and quality of life. The study findings show that quality of care of geriatric case management, measured by client satisfaction, was not a mediator between health and quality of life (measured by life satisfaction). There was a significant positive association between quality of care of geriatric case management and quality of life. Although the significant association between quality of care of geriatric case management and quality of life could not be mediated by either self-rated health or self-reported physical activity levels, it was completely mediated by health satisfaction. These findings provided preliminary empirical evidence to support a significant relationship between quality of care of geriatric case management and quality of life. Author Affiliation: (1) Jane Addams College of Social Work (M/C 309), University of Illinois at Chicago, 1040 West Harrison Street, Chicago, IL, 60607-7134, USA Article History: Registration Date: 06/10/2008 Received Date: 23/06/2008 Accepted Date: 05/10/2008 Online Date: 19/10/2008

Byline: Katarina Boye (1) Keywords: Well-being; Paid working hours; Housework hours; Gender; Gender attitudes; Social comparison; Europe Abstract: Absolute as well as relative hours of paid and unpaid work may influence well-being. This study investigates whether absolute hours spent on paid work and housework account for the lower well-being among women as compared to men in Europe, and whether the associations between well-being and hours of paid work and housework differ by gender attitudes and social context. Attitudes towards women's and men's paid work and housework obligations may influence how beneficial or detrimental it is to spend time on these activities, as may social comparison of one's own hours to the number of hours commonly spent among similar others. A group of 13,425 women and men from 25 European countries are analysed using country fixed-effects models. The results suggest that while men's well-being appears to be unaffected by hours of paid work and housework, women's well-being increases with increased paid working hours and decreases with increasing housework hours. Gender differences in time spent on paid work and housework account for a third of the European gender difference in well-being and are thus one reason that women have lower well-being than men have. Gender attitudes do not appear to modify the associations between hours and well-being, but there is a tendency for women's well-being to be higher the less housework they do compared to other women in the same family situation and country. However, absolute hours of paid work and housework appear to be more important to women's well-being than relative hours. Author Affiliation: (1) Swedish Institute for Social Research (SOFI), Stockholm University, 106 91, Stockholm, Sweden Article History: Registration Date: 30/12/2008 Accepted Date: 21/12/2008 Online Date: 22/01/2009

Purpose: To describe a standardized observation protocol to determine if nursing home (NH) staff offer choice to residents during 3 morning activities of daily living (ADL) and compare the observational data with deficiency statements cited by state survey staff. Design and Methods: Morning ADL care was observed in 20 NHs in 5 states by research staff using a standardized observation protocol. The number of observations in which choice was not offered was documented for 3 morning ADL care activities and compared with deficiency statements made by surveyors. Results: Staff failed to offer choice during morning ADL care delivery for at least 1 of 3 ADL care activities in all 20 NHs. Observational data showed residents were not offered choice about when to get out of bed (11%), what to wear (25%), and breakfast dining Location (39%). In comparison, survey staff issued only 2 deficiencies in all 20 NHs relevant to choice in the targeted ADL care activities, and neither deficiency was based on observational data. Implications: Survey interpretative guidelines instruct surveyors to observe if residents are offered choice during daily care provision, but standardized observation protocols are not provided to surveyors to make this determination. The use of a standardized observation protocol in the survey process similar to that used by research staff in this study would improve the accuracy and transparency of the survey process. Key Words: Survey process, Choice, Assessment, Observational protocol, Quality of life

This study aims to investigate the impact of caregiving on the health status and quality of life (QOL) of primary informal caregivers (PCGs) of elderly care recipients in Hong Kong. A total of 246 PCGs and 492 matched noncaregiver (NCG) controls were identified in a population-based cross-sectional study through random telephone dialing. Their health status and QOL were assessed based on structured questionnaires and Short Form 36 (SF-36) Health Survey. Multiple conditional logistic regression analysis showed that compared with NCGs, PCGs had significantly increased risks for reporting worse health, more doctor visits, anxiety and depression, and weight loss. Female PCGs were more likely to report chronic diseases, symptoms, and insomnia. PCGs, particularly women, had significantly lower scores in all eight domains of SF-36 Health Survey. High caregiver burden score (Zarit Burden Scale) was positively associated with adverse physical and psychological health and poorer QOL. The results indicate that PCGs, particularly women, bad an adverse physical and psychological health profile and poorer QOL compared with NCGs. Key Words: Caregiver--Caregiver burden--Elderly care recipients.

Infant care is no longer purely a private family matter. As more mothers return to paid employment in their child's first year, governments develop provisions to support working parents with very young children. Statutory parental leave and flexible working provisions for fathers are expanding rapidly, particularly in Europe. The author compares fathers' patterns of leave-taking across twenty-four countries from 2003 to 2007 to present new types of father-care-sensitive leave models. Findings show that fathers' use of statutory leave is greatest when high income replacement (50 percent or more of earnings) is combined with extended duration (more than fourteen days). Father-targeted schemes heighten usage. Although studies are limited, parental leave has the potential to boost fathers' emotional investment in and connection with infants. Differential access to statuary leave raises the possibility of a new polarization for infants: being born into either a parental-leave-rich or -poor household and, indeed, country. Keywords: parental leave; paternity leave; working parents; child care; fatherhood; infants

Although academic and clinical psychology do not often embrace, lifespan developmental constructs and theories can enrich the process of psychotherapy. Particularly in the last third of life, when social institutions and societal expectations provide less guidance and constraint, access to understandings about the lifespan may be especially useful. A life structure model of 20-year eras and periods of stability and evaluation/transformation can bring structure when life appears amorphous. Recognition of the ways that people of different ages experience time, and lifetime, can increase empathy and promote client's understanding of their own changes. Three dimensions of development--the ethic of care, the acquisition of integrity, and the building of an individuated and mature ego--can bring increased depth, vitality, fullness, and enjoyment to the last third of life. Therapists' ability to detect and articulate their client's developmental needs and process can enhance the work and further client's growth. KEYWORDS aging, lifespan development, psychotherapy, women