Biomedical subjects

Joav Merrick

Publications and source records attributed to Joav Merrick.

At least 127 records · Page 7Linked to original sources

PubMed2003

Quality of life theory II. Quality of life as the realization of life potential: a biological theory of human being.

This review presents one of the eight theories of the quality of life (QOL) used for making the SEQOL (self-evaluation of quality of life) questionnaire or the quality of life as realizing life potential. This theory is strongly inspired by Maslow and the review furthermore serves as an example on how to fulfill the demand for an overall theory of life (or philosophy of life), which we believe is necessary for global and generic quality-of-life research. Whereas traditional medical science has often been inspired by mechanical models in its attempts to understand human beings, this theory takes an explicitly biological starting point. The purpose is to take a close view of life as a unique entity, which mechanical models are unable to do. This means that things considered to be beyond the individual's purely biological nature, notably the quality of life, meaning in life, and aspirations in life, are included under this wider, biological treatise. Our interpretation of the nature of all living matter is intended as an alternative to medical mechanism, which dates back to the beginning of the 20th century. New ideas such as the notions of the human being as nestled in an evolutionary and ecological context, the spontaneous tendency of self-organizing systems for realization and concord, and the central role of consciousness in interpreting, planning, and expressing human reality are unavoidable today in attempts to scientifically understand all living matter, including human life.

Human Development↗

PubMed2003

Quality of life theory III. Maslow revisited.

In 1962, Abraham Maslow published his book Towards a Psychology of Being, and established a theory of quality of life, which still is considered a consistent theory of quality of life. Maslow based his theory for development towards happiness and true being on the concept of human needs. He described his approach as an existentialistic psychology of self-actualization, based on personal growth. When we take more responsibility for our own life, we take more of the good qualities that we have into use, and we become more free, powerful, happy, and healthy. It seems that Maslow's concept of self-actualization can play an important role in modern medicine. As most chronic diseases often do not disappear in spite of the best biomedical treatments, it might be that the real change our patients have for betterment is understanding and living the noble path of personal development. The hidden potential for improving life really lies in helping the patient to acknowledge that his or her lust for life, his or her needs, and his or her wish to contribute, is really deep down in human existence one and the same. But you will only find this hidden meaning of life if you scrutinize your own life and existence closely enough, to come to know your innermost self.

Behavioral Medicine↗

PubMed2003

Measurement of quality of life VII. Statistical covariation and global quality of life data: the method of weight-modified linear regression.

Existing standard statistical procedures do not seem to fulfill the needs of the researcher in global quality-of-life (QOL) research, because the most interesting question seems to be the exact size of statistical covariations. A method is necessary if we are to isolate the most important factors connected to quality of life among the thousands of possible factors in life. We have developed a new procedure we call "weight-modified linear regression". Unfortunately as demonstrated in the discussion, the procedure is not totally without problems and weaknesses. In spite of the critique, we believe the procedure to be valid for the purpose of estimating the size of the covariation in population studies including psychometric measures of global quality of life. As we need to be certain that the procedure is valid, we hereby invite the scientific community to give us further critique of the method and suggestions for its improvement.

Humans↗

PubMed2003

Health needs of adults with intellectual disability relevant for the family physician.

People with developmental disability, mental retardation, or intellectual disability are living longer and becoming prone to age-related health problems and diseases of old age much like the general population. This worldwide trend is also seen in Israel, where today 39.8% of persons with intellectual disability in residential care are 40 years old and above. There is a need for service and staff providers to receive training; a need for more research and better service for this aging population. This review presents health concerns for older persons with different levels of intellectual disability, health concerns in persons with Down syndrome, and persons with epileptic seizures and cerebral palsy in relation to general practice and family medicine. The review is concluded with recommendations on health and aging in adults with intellectual disabilities and the call for formalized training in the topic for specialists in family medicine.

Adult↗

PubMed2003

Late termination of pregnancy. Professional dilemmas.

Abortion is an issue as long as history and hotly debated in all societies and communities. In some societies and countries it is legal, while other countries have no legal basis, and some countries have made it a crime. Today up to 90% of abortions take place in the first trimester, about 9% in the second trimester, and the rest in the third trimester. This paper deals with the issue of late termination of pregnancy, the practical medical aspects, legal issues, international aspects, and the dilemma for the professional. In early history, abortion was accepted by clergy and societies, but in recent history it is more restricted and in some countries prohibited. It does not seem that restriction leads to a lower abortion rate, but rather an active contraceptive policy, campaign, and availability to prevent pregnancies that are unwanted. In countries where abortion is restricted, the trend has been an increase in illegal abortion that leads to unsafe abortion with complications, permanent injuries, and maternal mortality. Unsafe and illegal abortion is a public health concern that governments should try to prevent and instead find ways to strengthen their commitments toward better and safer health and family planning services for women. Late termination of pregnancies is an issue of grave concern with many practical medical aspects, ethical questions, and professional dilemmas. This is especially of concern because of the viability of the fetus and should only take place in order to prevent harm to the physical and mental health of the mother or due to an anomaly or disability of the fetus.

Abortion, Induced↗

PubMed2003

Quality of life as medicine. II. A pilot study of a five-day "quality of life and health" cure for patients with alcoholism.

Alcoholism can be understood as a self-treatment for existential pain. A 5-day treatment was designed to relieve this psychological pain and existential anxiety, and thereby diminish the need for self-treatment with alcohol. The basic principle behind the treatment was holistic, restoring the quality of life (QOL) and relationship with self, which according to the life mission theory happens when life-denying views are corrected and inner emotional conflicts are solved. The method in this treatment was a course with teachings in philosophy of life, psychotherapy, and body therapy. The synergy attained was considerable and the outcome demonstrates that in the course of 1 week, people have time to revise essential life-denying views and to integrate important, unfinished life events involving negative feelings. This was demonstrated by an improved QOL and a decrease in their dependency and need for alcohol abuse. In the week before, after the 5-day course, and again after 1 and 3 months, the 16 participants completed the SEQOL questionnaire on QOL and health. This was a pilot study based on a pre-experimental design, without a control group and without clinical control. Common for the group were a low QOL, numerous health problems, and alcohol dependency in spite of treatment with Antabus (disulfiram). The study showed an increase in QOL from 57.6% before the course to 69.4% 3 months after the course, or an improvement in QOL of 11.8%. There was a 24.0% improvement in self-perceived mental health, and satisfaction with health in general was improved by 11.1%. The total sum of health symptoms in the group was reduced from 59% of maximum to 33%. It is concluded that for this small and motivated group with alcohol problems, it was possible to improve QOL and health in only 5 days with a holistic treatment that combined philosophy of life, psychotherapy, and body therapy, but the results are not final. Further research is needed.

Alcoholism↗

PubMed2003

Lifestyle, quality of life, and health.

This study was performed in order to investigate the connection between lifestyle, quality of life, and health status by way of a questionnaire-based survey. The questionnaire was mailed in February 1993 to 2,460 persons aged between 18 and 88, randomly selected from the CPR (Danish Central Register), and 7,222 persons from the Copenhagen Perinatal Birth Cohort 1959-61. A total of 1,501 persons between the ages of 18 and 88 years and 4,626 persons between the ages of 31 and 33 years returned the questionnaire (response rates 61.0% and 64.1%, respectively). Variables investigated in this study were: alcohol consumption, tobacco consumption, type of diet, amount of exercise taken, quality of life, self-assessed health status, and number of medical complaints from which respondent suffered. The results showed that health has a stronger correlation to quality of life (r = 0.5, p < 0.0001) than it has to lifestyle (r = 0.2, p < 0.0001). It is concluded that preventable diseases could be more effectively handled through a concentrated effort to improve quality of life rather than through an approach that focuses solely on the factors that are traditionally seen to reflect an unhealthy lifestyle.

Adolescent↗

PubMed2003

The birth of a child with disability. Coping by parents and siblings.

When a child is born, the life of the family changes significantly and each of its members must adapt to the new situation. When the child is born with a disability, in addition to regular adaptation, the family must cope with stress, grief, disappointments, and challenges, which may lead to a serious crisis or even disruption of family life. Parents must coordinate assessments, evaluations, and various treatments while maintaining contact with many professionals and numerous institutions or services. They find themselves faced with important decisions on behalf of the child, decisions on management of the child with disability, and economic decisions that will affect the whole family. This paper reviews the literature on the topic of coping when a child with disability is born and also studies the question as to whether a connection exists between parental orientation toward feelings of guilt and the family relationships system. The event of a child born with a disability is always a tragedy for the family, but early intervention and support may help the family to adjust and become positively involved in the care and development of the child, even if that child is different and in need of special treatment.

Adaptation, Psychological↗

PubMed2003

Long-term effects of activity status in the elderly on cardiorespiratory capacity, blood pressure, blood lipids, and body composition: a five-year follow-up study.

It is generally recognized that physical activity levels in the elderly do not remain constant over time, and typically there is a marked reduction in physical activities in the elderly. The long-term benefits of regular physical training programs in the elderly are still not fully understood. This is a study of 55 elderly healthy subjects (over 65 years old) and re-evaluated for the effects of different physical activity patterns (sedentary, moderately active, and highly active) on several physiological parameters (pre- and post-training) after a 5-year period (5.30 +/- 1.14 years). Measurements included: body composition, blood lipid profiles, resting systolic and diastolic blood pressure, maximal oxygen uptake, and pulmonary function. Results indicated a larger decrease in maximal oxygen uptake (VO2max) in the group of elderly sedentary individuals (1.5 +/- 0.5 l/min) compared to the moderately active (1.7 +/- 0.6 l/min) and the highly active groups (1.9 +/- 0.4 l/min). An active lifestyle was not sufficient to increase the physiological function of an individual. This study could not clearly demonstrate favorable differences for the physically active groups over the sedentary group with regard to several important physiological factors over the 5-year follow-up and it appears that the recommendation for, and the initiation of, adopting active lifestyles may not be sufficient on their own to significantly increase an individual's physiological functioning.

Aged↗

PubMed2003

Psychoactive drugs and quality of life.

This study was performed on a representative sample of the Danish population in order to investigate the connection to the use of psychoactive drugs and quality of life (QOL) by way of a questionnaire-based survey. The questionnaire was mailed in February 1993 to 2,460 persons aged between 18 and 88, randomly selected from the CPR (Danish Central Register), and 7,222 persons from the Copenhagen Perinatal Birth Cohort 1959-61. A total of 1,501 persons between the ages 18 and 88 years and 4,626 persons between the ages 31 and 33 years returned the questionnaire (response rates of 61.0% and 64.1%, respectively). Variables investigated in this study were ten different psychotropic drugs and quality of life. Our study showed that over half the Danish population had used illegal psychotropic drugs. The most commonly used was cannabis (marijuana) though experience of this drug appeared not to co-vary with QOL to any significant extent. Cocaine, amphetamine, and psilocybin had been used by 1.2 to 3.3% of the population and this varied with QOL to a clear albeit small extent. LSD has been used by 1.2% of the population and the users had a QOL score 10% lower than those who had never used psychotropic drugs. The group with the lowest quality of life was found to be persons who had used heroin, morphine, methadone, and a mixture of alcohol and tranquilizers (10-20% below the group with the highest quality of life).

Adolescent↗

PubMed2003

Long-term effects of maternal medication on global quality of life measured with SEQOL. Results from the Copenhagen Perinatal Birth Cohort 1959-61.

The Copenhagen Perinatal Birth Cohort 1959-61 is a prospective longitudinal perinatal study that included all deliveries (over 20 weeks gestation, birthweight over 250 g) that took place at the University Hospital (Rigshospitalet) in Copenhagen, Denmark during the period of September 21, 1959 to December 21, 1961 and used in this follow-up study to investigate the connection between maternal medication during pregnancy and the quality of life of the child 31 to 33 years later. The latest follow-up study from the cohort was performed in 1993 and 7,222 of the surviving children were identified (now aged between 31 and 33 years) and contacted with a nonanonymous questionnaire on several aspects of quality of life issues. There were 4,626 usable responses (f = 2,489, m = 2,131) corresponding to a response rate of 64.1%. Of the 12 groups of medication taking during pregnancy we found, before controlling (using multiple linear regression), that analgesics, chemotherapy, and psychopharmacological showed links with the quality of life in the child 31 to 33 years later. Barbiturate use (95% was phenemal) showed significant connection to quality of life. After controlling for social and pregnancy factors there was no correlation between quality of life and medication taken by the mother during pregnancy. From this study it is concluded the fetal exposure to the drugs examined showed no measurable long-term effects on quality of life.

Adult↗

PubMed2003

Long-term effects of maternal smoking on quality of life. Results from the Copenhagen Perinatal Birth Cohort 1959-61.

The Copenhagen Perinatal Birth Cohort 1959-61 is a prospective longitudinal perinatal study that included all deliveries (over 20 weeks gestation, birthweight over 250 g) that took place at the University Hospital (Rigshospitalet) in Copenhagen, Denmark during the period of September 21, 1959 to December 21, 1961 and used in this follow-up study to investigate the connection between maternal smoking during pregnancy and the quality of life of the child 31 to 33 years later. The latest follow-up study from the cohort was performed in 1993 and 7,222 of the surviving children were identified (now aged between 31 and 33 years) and contacted with a nonanonymous questionnaire on several aspects of quality of life issues. There were 4,626 usable responses (f = 2,489, m = 2,131) corresponding to a response rate of 64.1%. The children whose mothers were nonsmokers or smoked less than three cigarettes a day had a quality of life that was 2.7% better than those children whose mothers had smoked over ten cigarettes per day. At first glance these figures seem small; however, when compared with other early life factors we see that mothers smoking more than ten cigarettes per day is one of the most important early predictors in our study for the quality of life (QOL) of the child as an adult. As most people in our study have a QOL rating between 55% and 85%, 2.7% is about 10% of normal variation. It seems that exposure to tobacco smoke during pregnancy has a small but significant effect on the quality of life in later adult life. However, the underlying causal factor for this reduction in quality of life remains unclear. Nevertheless, pregnant mothers should be made aware of the potential long-term effects smoking can have on their children.

Adult↗

PubMed2003

Quality of life as medicine: a pilot study of patients with chronic illness and pain.

An intensive 5-day quality-of-life (QoL) session was constructed based on a psychosomatic model. The session was comprised of teaching on philosophy of life, psychotherapy, and body therapy. The three elements were put together in such a way that they mutually supported each other. The synergy attained was considerable. The pilot study demonstrated that in the course of only 1 week, patients had time to revise essential life-denying views and to integrate important, unfinished life events involving negative feelings. Consequently, the patients became more present in the body's blocked-off areas and subjectively healthier. Nineteen persons with chronic illness and pain (fibromyalgia, chronic tiredness, whiplash, mild depression, and problems involving pain in arms and legs including osteoarthritis), and unemployed for 5-7 years attended the course. In the week before and after the 5-day course, the participants completed the validated SEQOL (Self-Evaluation of Quality of Life Questionnaire) including questions on self-evaluated health and the unvalidated "Self-Evaluation of Working-Life Quality Questionnaire" (SEQWL). This pilot study was without a control group or clinical control. As far as diagnoses were concerned, the group was inhomogeneous. Common for the group was a low QoL, poor quality of working life QWL, and numerous health problems. The study showed an 11.2% improvement in QoL (p < 0.05), a 6.3% improvement in QWL (p < 0.05), and a 12.0% improvement in self-perceived physical health (p = 0.08). There was a 17.3% improvement in self-perceived psychological health (p < 0.05) and satisfaction with health in general improved by 21.4% (p < 0.05). Symptoms like pain were almost halved and several of the participants were free of pain for the first time in years. In conclusion it seemed that the combination of training in philosophy of life, psychotherapy, and body therapy can give patients a large, fast, and efficient improvement in QoL, QWL, and health. It is not known if these changes will be permanent and if all kinds of patients with different health problems will gain from this cure. Further research should be conducted.

Chronic Disease↗

PubMed2003

Validation of two global and generic quality of life questionnaires for population screening: SCREENQOL and SEQOL.

Population screening may harm quality of life (QoL), and traditional health-related QoL tools could be inadequate to evaluate this risk. Two global and generic QoL instruments were developed for studying the QoL consequences of screening (SCREENQOL), and QoL variation in a normal population (SEQOL). SCREENQOL and SEQOL (Self-Evaluation of Quality of Life Questionnaire) are self-administered questionnaires with items rated on 5-point Likert scales. SCREENQOL consists of 21 items measuring QoL across 6 different dimensions based upon validated QoL questionnaires. SEQOL consists of 317 items measuring QoL across 8 different dimensions, based on an integrative theory of QoL, a theoretical framework from a Danish QoL survey involving 7,222 persons 31 to 33 years old. For further validation, SEQOL and SCREENQOL were sent to 2,460 persons 18 to 88 years old randomly selected from the Danish Central Person Register together with Nottingham Health Profile (NHP) and Sickness Impact Profile (SIP). For SCREENQOL and SEQOL, test-retest reliability correlation was both >0.8, Cronbach's alpha was 0.65 and 0.75, correlation (r) to NHP was 0.67 and 0.49, to SIP 0.46 and 0.27, respectively (p < 0.05). Adjustment for health status made the correlation to SIP stronger among the sick (r = 0.68 and 0.41, respectively). For SCREENQOL and SEQOL, 61 and 111 respondents were needed to detect 3% difference in QoL. SCREENQOL and SEQOL are both valid as they show high levels of reliability, sensitivity, and consistency.

Mass Screening↗

PubMed2003

Elderly persons with intellectual disability: a study of clinical characteristics, functional status, and sensory capacity.

Longer life expectancy is resulting in increasing numbers of elderly adults with intellectual disability (ID). There has been the question whether persons with ID demonstrate early signs of aging before the general population. The aim of this study was to determine if persons with ID (with and without Down syndrome) showed premature aging changes compared with a control group. Elderly persons (n = 24, average age of 61) from one residential care center in Israel and younger adults from another center (n = 37, average age of 45) were compared with elderly residents without ID in an independent living facility. The study considered demographic data, medical data, anthropometric measurements, body fat and body mass index, flexibility, and sensorimotor function tests. The results showed that the persons with ID had basically similar body composition to that of persons without ID, however, the functional performance of elderly adults with ID was more impaired. We postulate that the slower functioning responses may be explained by a less physically active lifestyle, that may accelerate the onset of disease and result in symptoms associated with aging that are detrimental to health. It is therefore important that persons with ID participate in physical activity and exercises in order to promote health and prevent disease.

Adult↗

PubMed2003

Ageing and intellectual disability in Israel: a study to compare community residence with living at home.

The present study was conducted to compare ageing phenomena in people with intellectual disabilities aged 40 years and above living in community residences (n = 29) with those living with their families (n = 31). The goals were to compare the health status between the two types of settings, to compare the health status between the study sample and the general Israeli population of the same age group, and to investigate whether deterioration occurs among the participants in activities of daily living (ADLs), cognitive ability and leisure activity. Health problems had already appeared by 40 years of age among the participants. The most frequent problems were visual impairment (33%), hearing impairments (20%) and heart problems (20%). Dental problems were found in 30%. The community-based residence group displayed more medical problems than people living at home, whereas individuals living at home had more dental problems. The functioning of the participants in the ADL areas was high, with no evident decline reported during the previous 5 years. Concerning leisure time, a decline in functioning in both residential groups was observed, and interestingly, the scores for social life and leisure activities were better for the community-based residential group. There is a need for better dental service provision for people with intellectual disabilities living at home. The data provided in the current study can serve as a preliminary base for the development of geriatric services for older adults with intellectual disabilities in the community and also provide a basis for further comparison with peers in the general population.

Activities of Daily Living↗

PubMed2003

Five clinical tests to assess balance following ball exercises and treadmill training in adult persons with intellectual disability.

BACKGROUND: Incidence rates of falling increase progressively with aging. Preventing or delaying the onset of functional decline is a crucial important goal, because more individuals with intellectual disability (ID) are living well into their sixth and seventh decades. The question of whether walking and ball exercises can effect balance performance has never been reported. This pilot study was conducted to determine the effects of therapeutic training on improving balance capabilities in adults with mild ID. METHODS: The study included 13 women and 4 men, aged 50-67 years (mean age 56.5 years) residing in a residential care center. Five clinical tests were used to determine the "real" picture of the locomotor function and balance before and after the training protocol. Baseline values were determined using 2 control groups of age-matched adults with and without ID. The tests included modified get-up-and-go, full turn, forward reach, sit-to-stand, and one-legged standing. Therapeutic training for 6 months included dynamic ball exercises and treadmill walking with a 2-3% positive inclination. RESULTS: Participants in the program showed little to no improvement in terms of their static and dynamic balance compared to their initial values. Thus, only 2 of the tests showed statistical significance. CONCLUSIONS: Lack of improvement was noted in both postural and balance control in adults with mild ID as a result of 6 months of intervention by means of ball exercise and treadmill training.

Aged↗

PubMed2003

Medical services for persons with intellectual disability in Israel.

BACKGROUND: The first school for children with intellectual disability (ID) was opened in Tel Aviv in 1929; the first boarding school for children with ID was established in Jerusalem in 1931; and the first center for assessment of children with ID established in Tel Aviv in 1936. With the establishment of the State of Israel in 1948, there was a total of four residential care centers providing services for 150 children with ID. OBJECTIVE: This paper will describe the history and development of the public health work with persons with intellectual disability from the birth of the State of Israel in 1948 until today, with a focus on medical and nursing care and ideas for future work with this population. DATA SOURCES: Studies and documents from the Office of the Medical Director, Division for Mental Retardation of the Ministry of Social Affairs in Israel. DATA EXTRACTION: The Division for Mental Retardation is in contact with approximately 23,000 persons of all ages. Residential care is provided to about 6,000 persons in 54 institutions countrywide. In addition, 2,000 persons receive residential care in hostels or protected apartments within the community. More than 50 other settings provide vocational and educational services to 15,000 persons--day-care kindergartens, day-treatment centers, sheltered workshops, or integrated care within the community. DATA SYNTHESIS: Data on the health profile, morbidity, and mortality of the residents in residential care centers are used to illustrate the medical and nursing work with this population. CONCLUSIONS: We recommend that the direction in Israel should be a combination of both community and institutional care for the population of persons with ID. We recommend the establishment of a subspecialty for physicians and nurses in intellectual disability and the establishment of a Health Division within the Ministry of Social Affairs to facilitate better service, education, and research.

Adolescent↗