Lifestyle Reasons Research Articles

Post‐CPAP sleepiness – a specific syndrome?

Following treatment with continuous positive airway pressure (CPAP), some patients with obstructive sleep apnoea (OSA) remain sleepy despite effective CPAP and attention to other diagnoses that can provoke sleepiness. It is unclear if this residual sleepiness is an irreversible result of their previous OSA and merits consideration for pharmacological treatment or simply because of the many and varied causes of sleepiness normally found in the community. We have measured levels of sleepiness, using the Epworth Sleepiness Score (ESS), in 572 patients on CPAP and compared them with a control group of 525 subjects from a community survey, which would have included the usual lifestyle reasons for sleepiness as well as any undiagnosed sleep disorders. There was no difference in the percentage of patients with an ESS >10 in the CPAP group compared with the controls (16.1 versus 14.3, P = 0.54). Thus, although there clearly are sleepy patients within the CPAP group, the prevalence is no higher than in the community. We question whether so-called 'post-CPAP sleepiness' should be regarded as any more abnormal and worthy of treatment than a 'normal' population. Post-CPAP sleepiness as a specific disorder may not exist.

The last human: a guide to twenty-two species of extinct humans

This book tells the story of human evolution, the epic of Homo sapiens and its colorful precursors and relatives. The story begins in Africa, six to seven million years ago, and encompasses twenty known human species, of which Homo sapiens is the sole survivor. Illustrated with spectacular, three-dimensional scientific reconstructions portrayed in their natural habitat developed by a team of physical anthropologists at the American Museum of Natural History and in concert with experts from around the world, the book is both a guide to extinct human species and an astonishing hominid family photo album. The Last Human presents a comprehensive account of each species with information on its emergence, chronology, geographic range, classification, physiology, lifestyle, habitat, environment, cultural achievements, co-existing species, and possible reasons for extinction. Also included are summaries of fossil discoveries, controversies, and publications. What emerges from the fossil story is a new understanding of Homo sapiens. No longer credible is the notion that our species is the end product of a single lineage, improved over generations by natural selection. Rather, the fossil record shows, we are a species with widely varied precursors, and our family tree is characterized by many branchings and repeated extinctions. Exhibition information: Photographs of most of the reconstructions that appear in this book will be featured in exhibits appearing in the new Hall of Human Origins at the American Museum of Natural History in New York City. The opening of the Hall is planned for November 2006.

Reasons for Retirement and the Influence of Retirement on the Life Adjustment amongst Hong Kong Elite Athletes

LANGUAGE NOTE | Document text in English; abstract also in Chinese.
 In recent years, there is a growing interest amongst researchers regarding athletes’ retirement. While research in this area in western countries is slowly building, research in Hong Kong athletes has gained little attention. The present study examined Hong Kong elite athletes’ reasons for retirement and the influence of the retirement reasons on their perception of general life satisfaction and adjustment quality which reflected how well they adapted to their post-retirement life. Analysis of self-administered questionnaires from 75 retired athletes suggested that important reasons for their retirement were difficulties in coordinating sport and study or working demands, and physiological (e.g., injury, age) and financial reasons. Most of them perceived the transition out of sport as a smooth experience. Financial, physiological and burnout (tired of the lifestyle) reasons for retirement were found to be significantly negatively associated with athletes’ general life satisfaction. The more they retired due to the three kinds of reasons, the less satisfied they felt toward their current life.
 近年來對於運動員退役的研究越來越多，特別是在西方國家，但是對於香港運動員退役的研究相對較少。本研究調查了香港精英運動員退役的原因及這些原因對他們適應退役後生活的狀況及總體生活滿意度的影響。根據75份問卷分析發現大多數香港精英運動員退役是由於難以協調運動訓練與工作或學習的時間，以及生理和經濟的原因。較多受訪者認為退役轉型的過程較為順利。研究還發現，出於經濟原因、生理原因(例如：傷病、年齡)、和厭倦運動訓練生活而退役，對於運動員退役後總體生活滿意度，有顯著的影響。而出於這三種原因而退役的運動員，對自己的總體生活滿意度則較低。

Training emergency medicine doctors for rural and regional Australia: can we learn from other countries?

Australia is a country with a relatively small rural population dispersed over an enormous area. Issues similar to how best to deliver health services and recruit health professionals to rural areas exist in other countries. For professional and lifestyle reasons, most specialist doctors (including emergency medicine specialists), choose to live and work in major metropolitan centres. Outside the major Australian cities, most presentations to emergency departments are dealt with by 'non-specialist' doctors, often with limited specialist back up. Recruitment of suitably trained medical staff is increasingly difficult. There is increasing reliance on overseas trained doctors from widely varying backgrounds. In Canada and New Zealand, family medicine trained emergency medicine doctors are a significant proportion of the workforce in rural and regional emergency departments. To undertake a detailed investigation of the non-specialist emergency medicine doctors in Australia, and examine strategies to secure a more highly trained emergency medicine workforce for rural and regional Australia. A survey was undertaken of 230 doctors working in 57 rural and regional Australian emergency departments. Consultations and interviews were held with 53 key clinicians, educators and administrators. There were no training or education standards for doctors working in smaller Australian emergency departments. There was considerable instability in the workforce with many planning to leave their current position or reduce their involvement in emergency medicine. The vast majority felt a need to undertake further emergency medicine training. There was little agreement among stakeholders as to how emergency medicine should be taught, or services delivered in rural and regional Australia. There is need in Australia to offer a specific postgraduate qualification in emergency medicine for doctors wishing to practise emergency medicine outside major city hospitals. Ideally, such a course would be largely taught in rural and regional hospitals and would contain additional elements relevant to rural practice. The Canadian and New Zealand emergency medicine qualifications may be useful models.

Trials and Tribulations of Hotel Ownership in Blackpool: Highlighting the Skills Gaps of Owner-Managers

The research reported on in this paper suggests that people who buy hotels in Blackpool are doing so for a cluster of lifestyle reasons. Few have classic entrepreneurial ambitions to make a lot of money and own a chain of hotels. Many have a lifelong ambition to own a hotel, or some business that gives them greater control of their lives, or because they think they will enjoy the life of hotel ownership. The vast majority of these interviewees had sold a domestic property to buy the hotel, and few had any work experience of hotel work, or even the hospitality sector. This lack of experience of the operational requirements of the business was further compounded by a lack of management skills, or small business experience. As a consequence, the professional skills of hotel management are often below par and hotel ownership changes hands at an unacceptable rate. Sometimes this results in outright business failure, but more often, is the result of individuals feeling that the reality of hotel ownership has not matched their dreams. The low skill base of the almost permanent cadre of new owners creates problems for tourism authorities keen to develop the quality profile of visitor experiences. There is limited development of the hotel stock as individual properties change hands on a regular basis and no one owner stays long enough to refurbish the property. The low skill base of owners can also limit the quality tourism experiences of services provided.

Budgetary Implications of, and Motives for, Converting to Organic Farming: Case Study Farm Business Evidence from Great Britain

ABSTRACT This paper explores the financial implications of converting to organic farming in Great Britain through a case study of farmers considering conversion in 2002. Most study farmers were motivated to convert for financial, not ideological or life-style reasons; organic meat production was the most common planned enterprise, although those choosing to produce milk, vegetables and cereals were also studied in depth. At the time of study, organic beef and sheep meat production was particularly profitable. It was found that, in these product sectors, a large improvement in Family Farm Income would result if organic production was introduced on the case study farms. With few exceptions, a fall in Family Farm Income during the conversion period would not be an obstacle to farmers changing to organic methods. Fixed cost changes would also not deter conversion but expensive investment in new livestock and appropriate buildings would be required by some of those businesses studied. These findings are, however, dependent upon the price premia assumptions used and, whilst these premia have dropped slightly since the time of study, this would lessen the financial shortfall during the conversion period. There is also the possibility that reversion to conventional agricultural production might occur, perhaps at a faster rate than the original conversion process that was taking place around the turn of the century.

Reconstruction of the Bicuspid Aortic Valve

Abicuspid aortic valve (BAV) occurs in 2% of the population and is a common reason for significant aortic regurgitation, particularly in the third and fourth decades of life.1 In these young patients, the choice of valve substitute is difficult. With a mechanical valve, the linearized risk of thromboembolic complications and anticoagulation-related hemorrhage is low,2 but the cumulative risk may be substantial due to a long life expectancy. Many young individuals do not wish a coumadin-based anticoagulation for lifestyle reasons. A biologic prosthesis, on the other hand, is associated with suboptimal durability in younger patients.3 Thus, for patients with a regurgitant bicuspid aortic valve, repair appears an attractive alternative to replacement. Bicuspid aortic valve anatomy is also associated with aortic dilation in more than 50% of individuals.4 Aortic dilation may induce or aggravate aortic valve regurgitation, and there is increasing evidence that a diameter of more than 4.5 cm may be associated with impaired long-term prognosis.5 Elimination of a dilated ascending aorta may also serve the purpose of stabilizing a valve repair procedure.6 Thus, any reconstructive procedure on a bicuspid aortic valve should address aortic pathology, if present. We have developed a differentiated approach to these procedures that has worked well in more than 180 patients operated over an 11-year period. Department of Thoracic and Cardiovascular Surgery, University Hospital of Saarland, Homburg/Saar, Germany. Address reprint requests to H.-J. Schafers, MD, Dept. of Thoracic and Cardiovascular Surgery, University Hospitals of Saarland, 66421 Homburg/ Saar, Germany. E-mail: h-j.schaefers@uniklinikum-saarland.de

Locational Decisions and Residential Preferences of Taiwanese Immigrants in Australia

Since the 1980s, the increase of Asian migrants in large cities has contributed significantly to the cultural landscape of Australia, especially in the city suburbs. Based on the Census and in-depth interviews of 103 Taiwanese migrants, this research examines the location decisions and residential preferences of Taiwanese migrants in Sydney, Brisbane and Melbourne. The reasons for choosing the state, the particular city, and specific area of residence are probed into. The survey shows that migrants moved to Australia mainly for children’s education, lifestyle and political instability reasons. The main reasons for choosing to settle in Sydney were favourable business opportunities, and the northern part of Sydney was preferred. Those who chose Brisbane are attracted by the good climate there, and the residents preferred the Sunnybank area. Melbourne was chosen for the good education it offers, and areas on transportation lines near good schools are selected. Choice of residence was based mainly on their needs and their resources which may change over time. In general, they always choose to locate in close proximity to their family, friends and Taiwanese communities. Their locational choice depends on income and housing budget, proximity to good schools and shopping centers, and information from friends or earlier migrants. Based on such factors, this study clearly demonstrates that the Taiwanese immigrants are fundamentally different from early Chinese settlers who once aimed to settle at Chinatown locations.

Investigating the relationship between affluence and elective caesarean sections

The proportion of women delivering by caesarean section has increased dramatically in England and many westernised countries. It has been suggested that one important reason for this increase is the growing proportion of women opting for elective caesareans for lifestyle reasons, a trend that is, it is argued, most common among the affluent. We investigated the hypothesis that affluent women are more likely to deliver by elective caesarean section. Logistic regression modelling was used to analyse data from half a million women who delivered in English NHS hospitals between 1996 and 2000. We found that women living in the most affluent areas of England were significantly more likely to have an elective caesarean section than their deprived counterparts.

Why do residents leave general surgery? The hidden problem in today’s programs

Much has been written and discussed about the reasons for reduced interest in surgery, but few institutions have chosen to examine the loss or attrition of general surgery residents from their own programs. In preparation for an upcoming Residency Review Committee analysis of our program, we took the opportunity to examine the reasons for attrition in our own institution. During the years 1990 to 2003, 120 categorical residents were admitted into our general surgery residency program. Residents who matched into preliminary positions or non-5-year categorical positions were not included in this study. During this period of time, 20 residents (9 female and 11 male) left the program for a variety of reasons. The folders of those 20 residents along with all of the correspondence pertaining to each resident were reviewed in detail. Our overall attrition rate during this 13-year period of time was 20 of 120 residents or 17%. This is comparable with the often-quoted figure of approximately 20% attrition in other general surgery programs. The reasons for leaving could be divided into 4 categories: (1) lifestyle, (2) opportunity for early specialization, (3) asked to leave the program because of emotional or performance difficulties, or (4) decided to leave medicine entirely. The largest group was related to lifestyle issues and comprised 13 of the total of 20 residents who left the program. Of this group of 13, 3 went into plastic surgery, 4 went into anesthesiology, 2 went into radiology, and the remaining 4 went into public health, internal medicine, pathology, and emergency medicine. Seven of these 13 individuals were women. Two individuals entered residency with the goal of specializing in plastic surgery. They both left their 5-year categorical general surgery positions after the third year when they were offered the opportunity to enter three-year plastic surgery fellowship positions. The third category was composed of 4 individuals who were asked to leave the program during this 13-year period because of performance or emotional problems, with 3 of these 4 being men. Only 1 person left medicine entirely, and he is now the vice-president of a successful software company. Of the total of 20 residents who left our program, 9 (45%) were female. Given that there were 33 females in our program during the subject period of time, these 9 females represent an attrition rate of 27%. The 11 males who left during this period represent, however, an attrition rate of only 13%. Although much concern has been expressed over the declining numbers of medical students interested in surgery, loss of residents after matching in general surgery is an equally significant problem. In our program over a 13-year period, 20 out 120 residents, or 17% dropped out or were released. The attrition rate for females (27%) was approximately twice that of males (13%), with 7 out of 9 females (78%) leaving for lifestyle reasons.

Reasons for considering leaving UK medicine: questionnaire study of junior doctors' comments

Objectives To study the reasons given by junior doctors trained in the United Kingdom for considering leaving UK medicine.Design Analysis of replies to postal questionnaire surveys.Setting United Kingdom.Participants 1326 doctors...

Reasons for considering leaving UK medicine: questionnaire study of junior doctors' comments.

To study the reasons given by junior doctors trained in the United Kingdom for considering leaving UK medicine. Analysis of replies to postal questionnaire surveys. United Kingdom. 1326 doctors who qualified in 1999. Reasons for considering leaving. Of 1047 doctors who indicated that they would stay in medicine but not necessarily in the United Kingdom, 65% (682) gave reasons for leaving that concerned lifestyle, such as a preference for living outside the United Kingdom; 41% (433) gave reasons concerning working conditions in UK medicine; and 18% (184) gave positive work related reasons, such as wanting to work in developing countries. Of 279 doctors considering leaving medicine, 75% (210) cited working conditions, 23% (63) cited lifestyle reasons, and 9% (24) cited positive interests in a different career. Of the 169 doctors who said that they would probably or definitely leave the United Kingdom but remain in medicine, 78% (132) specified lifestyle reasons. Of the 42 who said that they would probably or definitely leave medicine, 67% (28) cited working conditions. The wish to work abroad, but to stay in medicine, was more common than the wish to leave medicine. The preference for a different lifestyle, particularly to live outside the United Kingdom, is not readily amenable to policy changes to the medical working environment. The smaller numbers of doctors who gave work experience as a reason for considering leaving medicine might be influenced to stay by improvements in working lives.

Correlates of antiretroviral treatment breaks.

To identify key relationships between the decision to take a break from antiretroviral treatments and potential clinical and social antecedents. An analysis of a self-completed survey of various clinical and social aspects of the lives of people living with HIV/AIDS (PLWHA) distributed nationally in Australia was carried out. The questionnaire was completed by a sample of 894 PLWHA. From this sample, three groups of interest were identified: a 'no break' group that had been using antiretrovirals continuously (n=378), a 'lifestyle break' group that had taken a break for purely lifestyle reasons on their last occasion (n=76), and a 'clinical break' group that had taken a break for purely clinical reasons on their last occasion (n=99). Clinical breaks were found to be longer than lifestyle breaks and involved more consultation with doctors. Differences were also found between the two break types in effects on the respondents' health and well-being. The clinical break group was further found to experience a higher level of health difficulties on a range of variables, while the lifestyle break group was younger, had a longer experience of HIV and its consequences, and engaged in greater participation in activities associated with both pleasure and risk. The analyses offer a pattern of health and social factors that places the HIV-positive individual, as a social actor, squarely within the experience of treatment interruptions. Understanding the social motivations and correlates of treatment interruption offers new challenges in maximizing the efficacy of health maintenance and support for PLWHA.

Casualisation of the nursing workforce in Australia: driving forces and implications.

This article provides an overview of the extent of casualisation of the nursing workforce in Australia, focusing on the impact for those managing the system. The implications for nurse managers in particular are considerable in an industry where service demand is difficult to control and where individual nurses are thought to be increasingly choosing to work casually. While little is known of the reasons behind nurses exercising their preference for casual work arrangements, some reasons postulated include visa status (overseas trained nurses on holiday/working visas); permanent employees taking on additional shifts to increase their income levels; and those who elect to work under casual contracts for lifestyle reasons. Unknown is the demography of the casual nursing workforce, how these groups are distributed within the workforce, and how many contracts of employment they have across the health service--either through privately managed nursing agencies or hospital managed casual pools. A more detailed knowledge of the forces driving the decisions of this group is essential if health care organisations are to equip themselves to manage this changing workforce and maintain a standard of patient care that is acceptable to the community.

Testosterone metabolism, dose–response relationships and receptor polymorphisms: selected pharmacological/toxicological considerations on benefits versus risks of testosterone therapy in men

In this review selected toxicological problems related to testosterone therapy in hypogonadal men are discussed. Applying ‘classical’ pharmacological/toxicological findings (e.g. animal studies on short- and long-term toxicity) to clinical situations is not very helpful. Molecular biological knowledge and especially evaluation of epidemiological studies, as well as intervention studies, on testosterone therapy in hypogonadal men are more useful. Potential risks include overdosage for lifestyle reasons, e.g. excessive muscle building and reduction of visceral obesity, when erythrocytosis occurs concomitantly. Modern galenic formulations of testosterone administration (e.g. transdermal gel, suitable testosterone esters for intramuscular application and newer oral preparations) avoid supraphysiological serum concentrations, therefore significantly reducing the toxicological risk. A hypothetical model of the toxicological risks of testosterone therapy is given that is based on the influence of testosterone metabolism (aromatization vs. reduction) of the respective parameter/target chosen. Finally, the great influence of polymorphisms of the androgen receptor on the assessment of toxicological risk and on the individualization of androgen therapy is shown. Already existing national, continental and international guidelines or recommendations for the testosterone therapy should be harmonized.

Returning and New Montana Migrants: Socio‐economic and Motivational Differences

This paper examines return migrants and new migrants to Montana: Who are they? Why do they move? Do return migrants move for different reasons than new migrants? Data from the 1994–1997 Montana Poll, a representative survey of Montana households, are used. A comparison of socio‐economic differences of return and new migrants shows that the two migrant types are very similar in terms of education, income, and age. This stands in contrast to the findings of others who maintain that return migrants are negatively selected with respect to education. Logistic regressions were employed to identify the effect of age and place ties on reasons for moving. Return migrants and new migrants move to Montana for very similar reasons, with family being the most important primary reason for moving. Moving for lifestyle reasons, such as environmental quality and urban amenities, were found to systematically change with age. This could explain why people return to a place they left earlier in life. While other research on return migration compared return migrants and other migrants who left the same place of origin, this paper offers a comparison of return migrants and other migrants who seek out the same destination. Results from the Montana Poll suggest that the same destination attracts return migrants and new migrants with similar socio‐economic characteristics who move there for very similar reasons.

Returning and New Montana Migrants: Socio‐economic and Motivational Differences

This paper examines return migrants and new migrants to Montana: Who are they? Why do they move? Do return migrants move for different reasons than new migrants? Data from the 1994–1997 Montana Poll, a representative survey of Montana households, are used. A comparison of socio‐economic differences of return and new migrants shows that the two migrant types are very similar in terms of education, income, and age. This stands in contrast to the findings of others who maintain that return migrants are negatively selected with respect to education. Logistic regressions were employed to identify the effect of age and place ties on reasons for moving. Return migrants and new migrants move to Montana for very similar reasons, with family being the most important primary reason for moving. Moving for lifestyle reasons, such as environmental quality and urban amenities, were found to systematically change with age. This could explain why people return to a place they left earlier in life. While other research on return migration compared return migrants and other migrants who left the same place of origin, this paper offers a comparison of return migrants and other migrants who seek out the same destination. Results from the Montana Poll suggest that the same destination attracts return migrants and new migrants with similar socio‐economic characteristics who move there for very similar reasons.

Women and flexibility in the Scottish leisure industry

Both employers and employees may seek flexible employment patterns, but for different reasons – employees for lifestyle reasons and employers for financial and business imperatives. This paper focuses on the first of these issues, summarising the results of a comparative case study analysis of female work roles and participation in flexible working arrangements in three contrasting leisure providers. The research findings suggest that gender role segregation existing in generic, non‐leisure specific jobs – such as reception – may be constraining equal opportunities for women more than lack of family‐friendly (or flexible) employment policies.

Brimonidine 0.2% versus dorzolamide 2% each given three times daily to reduce intraocular pressure

PURPOSE: To evaluate the efficacy and safety of brimonidine compared with dorzolamide given three times daily as monotherapy in patients with primary open-angle glaucoma or ocular hypertension. METHODS: In a double-masked, multicenter, crossover comparison in 40 patients, qualified patients were washed out from their previous medication and randomized to dorzolamide 2% or brimonidine 0.2% for the first 6-week treatment period. Patients then were washed out for 2 weeks and started on the opposite medication for the second 6-week period. RESULTS: Baseline intraocular pressure for all 40 subjects (76 eyes) was 24.1 ± 2.0 mm Hg. This study found that the 8:00 am trough intraocular pressure after 6 weeks of therapy for dorzolamide was 20.7 ± 3.1 mm Hg and for brimonidine 20.8 ± 3.2 mm Hg ( P = .99). The peak intraocular pressure (2 hours after dosing) for dorzolamide was 18.6 ± 3.4 mm Hg and for brimonidine 17.8 ± 2.7 mm Hg ( P = .10 ). Dorzolamide caused more stinging upon instillation ( P < .01) and brimonidine more itching ( P = .01). No statistical differences existed between groups for systemic adverse events. Six patients, all on brimonidine, were discontinued from a treatment period early. Of these, two were discontinued for inadequate pressure control, two with dizziness and fatigue, one with ocular pain, and one for lifestyle reasons ( P = .07). CONCLUSIONS: This study found similar efficacy and safety between monotherapy treatment with dorzolamide or brimonidine when each was given three times daily to patients with ocular hypertension or primary open-angle glaucoma.

Women and the orthopaedic surgeon. Changing the relationship.

Women are disproportionately disabled by musculoskeletal conditions. For biologic and lifestyle reasons, musculoskeletal health is one of the areas of medicine in which the differences between men and women are most marked. Thus, an approach tailored to women, not just an approach based on what has worked for men, often is needed. How orthopaedists treat women will become an even more pressing issue in the years ahead. Demographic trends predict that the majority of senior citizens will be women in whom chronic conditions frequently involve a musculoskeletal problem. Even at earlier ages, women will present more frequently with musculoskeletal conditions because they participate in a broader range of sports and careers. The current study presents a lengthy list of action items that the orthopaedic surgeon should consider as he or she approaches the treatment of women. Many of these items involve anticipating musculoskeletal problems, and convincing patients to take appropriate preventive steps. Because so many patients are treated by physicians who are not orthopaedists for their musculoskeletal problems, a successful preventive approach presents orthopaedists with the opportunity to win the confidence and respect of a new generation of patients.