Difficulties In Daily Life Research Articles

Self-assessed health among Thai elderly

BackgroundThe ageing of the population is rapidly progressing in Thailand. Self-assessed health status can provide a holistic view of the health of the elderly. This study aims to identify the determinants of self-assessed health among older Thai people.MethodsThe data for this study were drawn from a national survey of older persons conducted in 2007. Stratified two-stage random sampling was used for data collection. The analysis was restricted to the population aged 60 and above. The study used univariate, bivariate, and multivariate analysis procedures to analyze the data. Bivariate analysis was used to identify the factors associated with self assessment of health status. After controlling for other variables, the variables were further examined using multivariate analysis (binary logistic regression) in order to identify the significant predictors of the likelihood of reporting poor health.ResultsOverall, 30,427 elderly people were interviewed in this study. More than half of the sampled respondents (53%) were aged 60-69 years and about one out of seven (13%) were aged 80 years or above. About three in five respondents (56%) reported that their health was either fair or very bad/bad. Logistic regression analysis found that age, education, marital status, working status, income, functional status, number of chronic diseases, and number of psychosocial symptoms are significant predictors in determining health status. Respondents who faced more difficulty in daily life were more likely to rate their health as poor compared to those who faced less such difficulty. For instance, respondents who could not perform 3 or more activities of daily living (ADLs) were 3.3 times more likely to assess their health as poor compared to those who could perform all the ADLs. Similarly, respondents who had 1, 2, or 3 or more chronic diseases were 1.8 times, 2.4 times, and 3.7 times, respectively, more likely to report their health as poor compared to those who had no chronic disease at all. Moreover, respondents who had 1-2, 3-4, or 5 or more psychosocial symptoms in the previous months were 1.6 times, 2.2 times, and 2.7 times, respectively, more likely to report poor health compared to those who did not have any psychosocial symptoms during the same period.ConclusionSelf-assessed poor health is not uncommon among older people in Thailand. No single factor accounts for the self-assessed poor health. The study has found that chronic disease, functional status, and psychosocial symptoms are the strongest determinants of self-assessed poor health of elderly people living in Thailand. Therefore, health-related programs should focus on all the factors identified in this paper to improve the overall well-being of the ageing population of Thailand.

Tracking the train of thought from the laboratory into everyday life: An experience-sampling study of mind wandering across controlled and ecological contexts

In an experience-sampling study that bridged laboratory, ecological, and individual-differences approaches to mind-wandering research, 72 subjects completed an executive-control task with periodic thought probes (reported by McVay & Kane, 2009) and then carried PDAs for a week that signaled them eight times daily to report immediately whether their thoughts were off task. Subjects who reported more mind wandering during the laboratory task endorsed more mind-wandering experiences during everyday life (and were more likely to report worries as off-task thought content). We also conceptually replicated laboratory findings that mind wandering predicts task performance: Subjects rated their daily-life performance to be impaired when they reported off-task thoughts, with greatest impairment when subjects' mind wandering lacked metaconsciousness. The propensity to mind wander appears to be a stable cognitive characteristic and seems to predict performance difficulties in daily life, just as it does in the laboratory.

A experiência de pacientes e cuidadores após acidente vascular encefálico: uma revisão narrativa da literatura

The lack of appropriate information has been associated with difficulties encountered by stroke survivors and their caregivers on the return to home phase. Their opinion about their genuine needs may help discharge planning and assist the rehabilitation process. This study aimed at understanding the experiences of these individuals and their caregivers. A review of narrative literature in the last 10 years, in the databases Lilacs, Scielo, Cochrane, Bireme and Medline, with their respective strategies was carried out. The selected articles identified: doubts about the disease, difficulties in daily life, family caregivers present adaptation inabilities and are unprepared for home care, positive and negative changes in family relationships, information and orientations in the hospital are inadequate and insufficient, and few studies focused on the role of the physiotherapist in this process. The analysis also recommends assistance and support programs for family caregivers at home, and indicates that the information can reduce their inabilities.

Experiência de mulheres com linfedema pós-mastectomia: significado do sofrimento vivido

O linfedema de braço acomete cerca de 40% das mastectomizadas, com esvaziamento axilar, aumentando o peso e volume do membro, causando prejuízos nas áreas profissional, doméstica, sexual e psicossocial. O objetivo deste estudo foi analisar a experiência de mulheres que apresentavam linfedema pós-mastectomia, tendo como finalidade compreender o sentido que estrutura, para elas, o significado do sofrimento vivido. Fundamentamo-nos na abordagem antropológico-interpretativa e os dados foram submetidos à análise de conteúdo temática. Participaram 14 mulheres que freqüentavam um núcleo de reabilitação de mastectomizadas, onde as autoras atuam profissionalmente. Para as participantes, o linfedema significou preocupação com o tratamento e sua manutenção, dificuldades no cotidiano e no trabalho, alterações emocionais, mudanças de hábitos, caracterizando-se como um problema estigmatizante. Identificaram instituições - ciência, trabalho, serviços de saúde e sociedade - que promoveram questionamentos, preconceito, isolamento, constrangimento. A família e o serviço de apoio que freqüentavam foram instituições que possibilitaram uma aproximação social.

Better design quality of public toilets for visually impaired persons: an all-round concept in design for the promotion of health

According to United Nations statistics, about one-thirtieth of the world's population is visually impaired. These visually impaired persons (VIPs) face a variety of difficulties in their daily lives. This is the case not only in countries with a shortage of resources or with relatively low living standards, but also in developed countries. Most of the time, such difficulties in daily life come from the misunderstanding of VIPs' wants and needs and in turn poor design quality. To enhance equal opportunities in society, promote public health and improve the design quality of the public environment and facilities, a project on how VIPs access public toilets has been under way since 2004. To maintain better design quality in public toilets, the FISH concept has been initiated. This design concept includes the design considerations of friendly, informative, safe, and hygienic. This paper reviews the wants and needs of VIPs that should be considered in using public toilets, and the help that they need to be given. Based on the findings of the project, this paper then discusses how better quality designs for public toilets to promote public health can be obtained by implementing FISH.

Association of Smoking Status with Oral-health-related Daily Life Difficulties among Japanese Male Workers

Association of Smoking Status with Oral-health-related Daily Life Difficulties among Japanese Male Workers

Trouble déficitaire de l'attention avec hyperactivité chez l'adulte

The Attention-Deficit and Hyperactivity Disorder is frequent and well known in childhood and in child psychiatry. However, this disorder is widely under-diagnosed in adults. There has been a greater interest in this disorder for several decades: Several studies have indicated a persistence of symptoms beyond childhood and adolescence in up to 66% of cases, which leads to a prevalence of 5% in the general population of adults. This disorder is diagnosed on clinical presentation. The diagnostic criteria in adults are facilitated if the first symptoms of this disorder are detected before the age of seven. The symptoms are similar to those observed in children, even thought attention deficits are more frequent than impulsiveness or psychomotor hyperactivity in this population. Very often, patients diagnose their disorder on their own via journals or Internet, and then they try to find a specialist. The DSM-IV and ICD-10 criteria for adults include several items typically found in children suffering from this disorder, and differentiate several subtypes. This paper tries to clarify the functioning of this disorder, with the objective of a better knowledge and treatment for patients who are seriously handicapped by their trouble. Whereas there is a gender ratio of 4:1 (males: females) in children, women are as much concerned as men in the adult forms. The daily life of patients suffering from hyperactivity is disturbed in nearly all fields, including work, relationships and leisure. The disorder can lead to severe consequences for patients and their environment, including loss of work, separations, accidents and chaotic lifestyles. Hyperactivity can be difficult to distinguish from some of the other psychiatric disorders - mostly borderline or dissocial behaviour -, such as bipolar or conduct disorders. However, it can also occur in co-morbidity of any one of these disorders, and this in up to 60% of the cases. Nevertheless, it is important to mention that this disorder is usually present before the onset of the other co-morbid disorders. Multiple etiological factors seem to be implicated in this disorder. Several studies have highlighted the possible contribution of perinatal, neurobiological, neuroanatomical, neuropsychological and genetic factors. The abnormality most explored is the imbalance between noradrenergic and dopaminergic systems. Similarly, genetic studies underline the aberrations found in the dopamine transporter gene and in the D2 and D4 receptor genes. For general practitioners, social workers, forensic institutions or courts, it is important to realise that these patients can beneficiate from an adequate and effective treatment. Pharmacological treatments are the same as the ones for children, they include méthylphénidate and atomoxetine but also antidepressants and antihypertonics. Beside pharmacotherapy, psycho-education can significantly improve symptoms and results in improving self-management of daily life difficulties.

A study of the reality of daily life among patients with osteoarthritis of the hip undergoing conservative treatment

Summary In Japan, osteoarthritis of the hip secondary to acetabular hypoplasia has a high prevalence. For long periods of their life, patients receive conservative treatment, but so far no survey has been done. Because the progression of the symptoms is slow with gradually increased pain and increased limitation of the range of motion during 10–30 years, the disease is characterized by its long-term course after the diagnosis is established. Three hundred and thirty patients receiving conservative treatment were assessed to describe the reality of the patients experiencing difficulty in their activities of daily life. The 30 items in five domains were focused on whether the patients felt that the contents of the items were difficult in their daily life. For many of the items, severity of disease was found to be correlated to level of difficulty in daily life for patients with OA in either one or both hips.

Impairment of memory and attention in the elderly

The second half of the last century saw an increase in the proportion of elderly and aged people and the numbers of these groups are expected to increase in the near future [3]. This demographic tendency is sometimes termed “population aging.” It occurs in most European countries, including Russia. In Russia it is associated mainly with decreases in the mean duration of life and high mortality among young and middle-aged people. One of the most common neurological symptoms in the elderly is memory loss. The epidemiological study PROMETEI [Translator’s note: Prometheus] was performed in 2004‐2005 in 33 cities in 30 regions of Russia. This showed that at least 80% of people over 60 years attended neurologists for various reasons and reported complaints of decreased memory. It should be borne in mind that the study recorded only active, spontaneously reported (without leading questions from the doctor) complaints of forgetfulness leading to significant difficulties in daily life or serving as the grounds for prescription of medication. This indicates that neurologists encounter clinically significant memory disorders in elderly patients on an essentially daily basis. Causes of memory impairments in the elderly. Memory loss is a non-specific symptom seen in many brain diseases. Old age undoubtedly predisposes to the development of impaired memory functions. This is associated with a whole series of changes occurring with age. Firstly, the brain undergoes a number of structural, neurophysiological, and neurochemical changes during the process of physiological aging, which themselves may be the cause of weakening of the functions of memory, attention, and other cognitive functions. Secondly, aging is associated with decreases in neuronal plasticity ‐ the ability of cerebral neurons to change their functional properties in response to changing environmental conditions. This leads to decreases in the compensatory capacity of the brain in various pathological states. Finally, old age is a powerful and independent risk factor for the development of a number of vascular and degenerative conditions which are accompanied by memory impairments [9, 12].

Coping for Difficulty in Daily Life on Patients with Cardiomyopathy

Coping for Difficulty in Daily Life on Patients with Cardiomyopathy

Central Auditory Processing Effects Induced by Solvent Exposure

Various studies have demonstrated that organic solvent exposure may induce auditory damage. Studies conducted in workers occupationally exposed to solvents suggest, on the one hand, poorer hearing thresholds than in matched non-exposed workers, and on the other hand, central auditory damage due to solvent exposure. Taking into account the potential auditory damage induced by solvent exposure due to the neurotoxic properties of such substances, the present research aimed at studying the possible auditory processing disorder (APD), and possible hearing difficulties in daily life listening situations that solvent-exposed workers may acquire. Fifty workers exposed to a mixture of organic solvents (xylene, toluene, methyl ethyl ketone) and 50 non-exposed workers matched by age, gender and education were assessed. Only subjects with no history of ear infections, high blood pressure, kidney failure, metabolic and neurological diseases, or alcoholism were selected. The subjects had either normal hearing or sensorineural hearing loss, and normal tympanometric results. Hearing-in-noise (HINT), dichotic digit (DD), filtered speech (FS), pitch pattern sequence (PPS), and random gap detection (RGD) tests were carried out in the exposed and non-exposed groups. A self-report inventory of each subject's performance in daily life listening situations, the Amsterdam Inventory for Auditory Disability and Handicap, was also administered. Significant threshold differences between exposed and non-exposed workers were found at some of the hearing test frequencies, for both ears. However, exposed workers still presented normal hearing thresholds as a group (equal or better than 20 dB HL). Also, for the HINT, DD, PPS, FS and RGD tests, non-exposed workers obtained better results than exposed workers. Finally, solvent-exposed workers reported significantly more hearing complaints in daily life listening situations than non-exposed workers. It is concluded that subjects exposed to solvents may acquire an APD and thus the sole use of pure-tone audiometry is insufficient to assess hearing in solvent-exposed populations.

An examination of depression through the lens of spinal cord injury: Comparative prevalence rates and severity in women and men

This study describes the prevalence of probable major depressive disorder (MDD) as well as other depressive disorders (ODD) and severity of depressive symptoms in a national sample of women with spinal cord injury (SCI) and compares them with a case-matched sample of men with SCI. A sample of 585 women was drawn and case-matched with men from the SCI Model System National SCI Database according to level/completeness of injury, follow-up year, and age. The outcome measure of depression was the Patient Health Questionnaire. Prevalence rates for women were 7.9% for probable MDD and 9.7% for ODD; rates for men were 9.9% and 10.3%, respectively. Logistic regression revealed that women who were divorced or at year 1 follow-up had a higher odds of having probable MDD (odds ratio [OR], 3.4 and 2.9, respectively). Employed women and men had significantly lower odds of probable MDD (OR, 0.274 and 0.358, respectively). Statistically significant differences were not found in gender comparisons for either probable MDD or symptom severity, which also were not associated with injury characteristics. The most significant, and unexpected, research finding is the absence of gender differences in probable MDD and symptom severity. Results challenge notions that depression will necessarily follow SCI; that injury characteristics determine the development and severity of depression; and that women experience a greater burden of depression than men. The main clinical implication is that depression screening and referral should be a routine feature of health care for women living with SCI, as well as for their male counterparts. Furthermore, nearly one fourth of women and men reported experiencing some or greater difficulty in daily life and relationships in the absence of probable depressive disorder, warranting monitoring of subsyndromal depression as well.

Apport de l’évaluation écologique des troubles exécutifs dans la sclérose en plaques

Multiple sclerosis (MS) is a major cause of neurological disability among young adults. The cognitive disorders are the second cause of alteration of quality of life after physical handicap and are often responsible for loss of social-occupational adaptability. The prevalence of cognitive disorders is 40 to 65%. The alteration of executive functions predominates whereas instrumental functions are generally preserved. The assessment of these disorders is often underestimated by the usual battery of neuropsychological tests. However, the link between psychometric results and executive difficulties of daily life is uncertain. To evaluate the sensitivity of an ecological test compared to standard psychometric tests in assessment of executive disorders in MS. Twenty subjects with clinically definite MS were matched for age, sex and pre-morbid intellectual level with control subjects. A battery of neuropsychological and ecological tests was applied to all subjects. The performances on these tests formed a global score of executive function (SFE). The "paper and pencil" multiple errands test was used as the ecological test to examine planning and goal-oriented behavior. We also assessed fatigue and depression with the Fatigue Severity Scale and the Beck Depression Inventory. There was no significant differences between MS patients and controls in neuropsychological executive tests, except for verbal fluencies (p=0.01). The performances were significantly decreased in the MS group for the multiple errands test (p=0.01). 75% of MS subjects have a pathological score for this test. There was a significant link between the performances with this test and SFE (p=0.009). Executive disorders are underestimated in MS. However, we suggest that an ecological approach is more reliable than standard neuropsychological tests to estimate the cognitive difficulties in daily life in MS subjects. The results of our study favor further research to ascertain the usefulness of ecological assessment in MS.

The Nature of Subjective Cognitive Complaints of Older Adults

The current study investigated the nature of subjective cognitive complaints of older adults in relation to a broad array of individual cognitive functions known to decline with age. A 60-item questionnaire was developed to examine: (1) whether older adults experience problems with these cognitive functions (problems with cognition); (2) the extent to which these problems have changed over time (changes in cognition); and (3) whether these cognitive decrements interfere with their daily functioning (difficulties with cognition). The cognitive functions examined were attention, processing speed, working memory, executive function, and memory. One hundred eight-two community-dwelling adults (aged 65-92 years) completed the questionnaire. While participants reported problems with, and changes in, each cognitive function, working memory was recorded as most problematic and demonstrated the most change. Yet, although older adults experience problems with cognition and report changes in cognitive functioning over time, these did not necessarily produce difficulties in daily life. This points to the existence of support mechanisms that may assist older adults in cognitively demanding situations.

Impaired Manual Dexterity and Neuromuscular Dysfunction in Patients with Hand-Arm Vibration Syndrome

Manual dexterity and hand functional difficulties in daily life in hand-arm vibration syndrome (HAVS) were investigated in 29 male patients with HAVS and 30 male controls without occupational exposure to hand-arm vibration. Manual dexterity was assessed by measuring the performance time of picking up and transferring 30 red beans, one by one, from one plate to another. Vibrotactile perception thresholds at 125 Hz and grip strength were also examined. Hand functional difficulties in daily life were surveyed with a questionnaire. The HAVS patients had an increased vibrotactile threshold, decreased grip strength, and low performance in transferring beans. Low performances with transfer times over 53 s (2SD from the mean in the controls) were found in 66% of the HAVS patients and 3% of the controls. Bean transfer times in the patients were correlated with an increasing vibrotactile threshold and decreasing grip strength. The transfer times of the patients were also associated with hand functional difficulties such as picking up coins, turning the pages of a newspaper, buttoning clothes, and pouring from a teapot. The patients with a prolonged transfer time over 60 s (3SD from the mean in the controls) were most likely to have hand functional difficulties. The present findings suggest that measurement of the bean transfer time will serve to assess manual dexterity among HAVS patients, and that impaired manual dexterity in patients may be associated with impaired sensory feedback and muscular dysfunction in the fingers and hands.

男子中学生・高校生の口臭と歯の着色に関する意識調査

This study investigated the oral health awareness of aesthetic problems among adolescents. In 2002, a questionnaire survey on oral malodor and teeth stains was conducted at a junior and senior high school for males in Tokyo. The subjects were 783 students. The following results were obtained. (1) The rate of students who were concerned about other persons' oral malodor was significantly higher for the students in the senior high school than in the junior high school. The attitudes toward oral malodor varied depending on whether the target was family or friends. (2) Forty percent of junior high school students and first-year senior high school students answered that they had been conscious about their oral malodor. The rate was 60% for second- and third-year senior high school students. There was a significant difference between the two groups. (3) Thirty-five percent of the students who were conscious about their oral malodor felt some difficulties in daily life such as communication with other persons. (4) Fifty percent of the students replied that they had been conscious about their teeth stains. However, most of them felt no difficulties in daily life. From these results, it was revealed that almost half of the junior and senior high school students had been concerned about oral malodor and teeth stains. It is necessary to provide adequate dental health education on oral malodor and teeth stains for students through school oral health promotion activities as well as in dental clinics.

Work stress and attentional difficulties: An initial study on burnout and cognitive failures

Professional burnout is a stress-related disorder, having mental exhaustion due to work stress as its most important characteristic. Burned out individuals also often complain about attentional problems. However, it is currently not clear whether such complaints are based on true cognitive deficits or whether they merely reflect the way burned out individuals rate their own cognitive performance. To confirm the cognitive complaints we used a cognitive failure questionnaire (CFQ) to assess the level of self-reported attentional difficulties in daily life. We also measured performance on tasks of sustained attention and response inhibition (the SART and the Bourdon-Wiersma Test). We compared three groups: (1) a group of ‘burned out’ individuals (n=13) who stopped working due to their symptoms and sought professional treatment; (2) teachers at a vocational training institute (n=16) who reported high levels of burnout symptoms but continued to work; and (3) teachers from the same institute (n=14) who reported no burnout symptoms. The level of burnout symptoms was found to be significantly related to the number of cognitive failures in daily life, and to inhibition errors and performance variability in the attentional tasks. To our knowledge, explicit tests of objective cognitive deficits in burned out individuals have not been conducted before. Consequently, this is the first study to indicate that burnout is associated with difficulties in voluntary control over attention and that the level of such difficulties varies with the severity of burnout symptoms.

1-hexylcarbamoyl-5-fluorouracil + cyclophosphamide + tamoxifen versus CMF + tamoxifen in women with lymph node-positive breast cancer after primary surgery: A randomized controlled trial

We studied the usefulness of the oral 5-FU anti-cancer drug 1-hexylcarbamoyl-5-fluorouracil (HCFU) + cyclophosphamide (CPM) + tamoxifen (TAM) (HCT group) in comparison with CMF + TAM (CMFT group) in adjuvant therapy for breast cancer by a non-inferiority study based on a multi-institutional joint study. Clinical stage I, II primary breast cancers with histologically positive axillary lymph node metastasis were randomly assigned to the HCT group or the CMFT group after primary surgery. We registered 136 cases (HCT group 68 cases, CMFT group 68 cases). No significant difference in the 5-year overall survival rate (OS) and the 5-year disease-free survival rate (DFS) was found between the two groups. In the stratified analysis, DFS in cases in which the number of metastatic lymph nodes was 1-3 was significantly better in the HCT group (HCT group 84.3%, CMFT group 69.4%, log-rank test p=0.0496). No significant difference in the total incidence of adverse effects was found between the two groups, but there were significantly less adverse effects of grade 2 or over in the HCT group (p=0.034). The QOL survey at 3 months after surgery showed a significant decline of the QOL regarding lassitude, degree of difficulty in daily life, satisfaction with treatment and present mood in the CMFT group. Study results suggest that 2-year HCT therapy including the oral 5-FU anti-cancer drug HCFU is a useful adjuvant therapy which can replace CMFT therapy in early breast cancer cases with 3 or lower metastatic lymph nodes.

Victor Hugo, un temps pour rire (review)

Reviewed by: Victor Hugo, un temps pour rire Isabel K. Roche Friedemann, Joë. Victor Hugo, un temps pour rire. Paris: Librairie A.-G. Nizet, 2001. Pp. 191. ISBN2-7078-1265-x In this study, Joë Friedemann seeks to develop our understanding of an important but extremely fluid aspect of the Hugolian corpus: that of le rire. While critical attention has been fruitfully devoted to the related but divergent concepts of fantasy, humor, and the grotesque, the phenomenon of laughter in Hugo's body of work and its implications have not been the focus of detailed exploration. Friedemann argues that laughter, as expressed through a variety of modalités rieuses, has its own distinct importance and serves as a source of Hugo's philosophical and metaphysical questioning. Additionally, certain ideological dimensions of laughter that will be later transformed into theory by Baudelaire, Freud, Bergson, and Bakhtine are intuitively illustrated in the Hugolian text, spanning his fiction, philosophical and critical writings, and poetry. Adopting a method of investigation already employed in his previous analyses of laughter (such as Le Rire dans l'univers tragique d'Elie Wiesel, Nizet, 1981), Friedemann's point of departure is an inventory of the lexicon of laughter and its derivatives in Hugo's work. He then proposes a chronological study of texts in which le phénomène rieur is the most striking, tracing the ideological evolution and maturation of Hugo's conception of laughter. The first chapter, "Han d'Islande : un premier "humour" hugolien," looks at the ways in which le rire for Hugo was, from its earliest manifestations, multi-dimensional and included both penetrating observation and an understanding of its own seriousness. Indelibly associated with the independence of the creative process, laughter encompasses in Han d'Islande an impressive register of nuances (from the ironic to the burlesque) that announce the complex awareness that will be developed in Hugo's subsequent writing. In the second and third chapters of the study ("Vers le non-comique: Bug-Jargal et Le Dernier Jour d'un condamné" and "Notre-Dame de Paris: De la Fête des fous à la damnation"), Friedemann situates Hugo's next three fictional endeavors in relation to his ideological evolution as there is a movement first away from comic laughter in Bug-Jargal and Le Dernier Jour d'un condamné and then towards a bipolar conception of laughter in Notre-Dame de Paris, in which two distinct registers of introverted and extroverted laughter coexist. The fourth chapter, "Les Misérables: vers la sagesse," understands laughter in Hugo's longest and best-known novel as a response of despair against the arbitrariness of existence, as an inflection of hope that bridges the distance between the difficulties of daily life and aspirations towards the sublime. In the fifth chapter ("'Cet inquiétant rire de l'art': William Shakespeare et les œuvres critiques"), Friedemann mines Hugo's often-dismissed critical text William Shakespeare for a broader definition of the laughing phenomenon. While acknowledging the flaws inherent to the overarching arguments of William Shakespeare, Friedemann maintains that Hugo nonetheless succeeds in presenting a coherent vision of his conception of laughter, one in which laughter is increasingly viewed as the point of [End Page 206] struggle between the visible and the invisible, the knowable and the unknowable, and is imbued with metaphysical and mythical significance. The sixth chapter, "L'Homme qui rit: du non-rire-masque au rire des profondeurs," presents L'Homme qui rit as the culmination of Hugo's fictional exploration of laughter, as it serves as both the source and the result of all truths and allows for visionary expansion. In the final chapter (" 'Rire avec l'infini': l'apport de la poésie"), Friedemann enlarges the scope of his study so as to take into account manifestations of laughter in Hugo's poetry, seeking to trace the laughing theme in Hugo's totalizing poetic exploration of the relationship between man and the divine so as to define its conceptual foundation. Can Victor Hugo be considered a "comic" author? This is the question that Friedemann asks and endeavors to answer in the conclusion to his study. For while many of Hugo's works contain humorous...

特別養護老人ホームにおける痴呆性高齢者の意思決定と医療の現状

Medical decision-making involving elderly people with dementia often troubles care providers in Japan. Meanwhile, little attention has been paid to the routine medical care of nondementia illnesses in such patients. To understand the current situation surrounding the issue, we conducted a postal survey with nursing home directors across the nation. A self-administered questionnaire was sent to 1,117 randomly selected nursing homes, one third of all such facilities in Japan, and 502 (44.9%) responded. Of the respondents, 291 (58.0%) said more than a half of their residents have difficulties in daily life because of dementia. Less than 20% of the facilities said that they routinely confirm residents' preferences in writing when they are admitted concerning each of the following items; terminal care, medical information disclosure, leaving a will, funerals and application for the guardian system. 206 (41.0%) facilities have difficulties in finding a hospital for the elderly with dementia when necessary. The Mann-Whitney U test showed no significant relation between facilities' characteristics and their difficulties in finding a hospital that would admit demented patients. At present, a number of nursing homes confirm their residents' preferences only some time after they are admitted. However, the way of confirming seems inappropriate under the circumstances in which more than a majority of residents have difficulties in daily life due to dementia. Though more than a half of nursing homes have difficulties in finding a hospital that would admit dementia patients, no significant relation was found between the difficulties and the facility-hospital relation. The problem seems to lie in the acceptance mechanism of hospitals.