Monthly Archives: September 2011

The Health and Social Care Bill Part 2. Resources

 

At the time of writing, the government’s Health and Social Care Bill is at the stage of the second reading at the House of Lords. I’ve collected a few useful resources for further reading below.

The Department of Health Website: This page features information about the Health and Social Care Bill as well as a number of important links to other resources.

The Royal College of Psychiatrists: The RCPsych webpage contains links to their responses to the Health and Social Care Bill

The Royal College of Physicians: Details of the responses of the Royal College of Psychiatrists to the Health and Social Care Bill

The Royal College of Obstetricians and Gynaecologists: The RCOG webpage contains links to their response to the Health and Social Care Bill

Number 10: The Number 10 website contains a page detailing Prime Minister David Cameron’s perspective on the Health and Social Care Bill.

Implementing the Health and Social Care Bill: There is a website which focuses on implementation ofthe Health and Social Care Bill by Local Authorities.

Equality and Human Rights Commission: The website for the Equality and Human Rights Commission contains a page outlining the possible implications of a recent legal case for the Health and Social Care Bill.

Monitor: Monitor’s statement on the Health and Social Care Bill.

NICE: A webpage outlining the evidence that NICE gave to the Public Bill Committee regarding the Health and Social Care Bill.

The BMA Website: The BMA website has a page on the Health and Social Care Bill which includes links to pages explaining how the House of Lords works.

Going To Work: The TUC has organised a photo mosaic in response to the Health and Social Care Bill illustrating the varied organisational responses to the Bill.

Scottish Parliament: The Scottish Parliament’s response to the Health and Social Care Bill.

The King’s Fund: The King’s Fund is a charity with a focus on improving the health service. This page contains links to the King’s Fund’s response to the Health and Social Care Bill at various stages of its progress.

The Nuffield Trust: ‘The Nuffield Trust is described as ‘an authoritative and independent source of evidence-based research and policy analysis for improving health care in the UK’. Their webpage includes a video interview.

Wikipedia: The online encyclopedia has information on the Bill which at the time of writing was well organised with a clear structure and links for further reading.

Mind: Mind has a page on the Health and Social Care Bill.

The National Rheumatoid Arthritis Society: 40 charities including the NRAS produced the ‘Listen Up’ response to the Health and Social Care Bill.

OnMedica: The OnMedica website has a detailed article by Joanne Makosinski (Editor at HES magazine)

Lord Owen: On this webpage Lord Owen identifies a number of resources relevant to the Health and Social Care Bill.

The Wellcome Trust: The Wellcome Trust’s response to the Health and Social Care Bill.

Patients Association: The Patients Association response to the Health and Social Care Bill.

TheyWorkForYou.Com: Webpage detailing the House of Commons debate on the Health and Social Care Bill.

NMC Review: A brief but useful summary of the Health and Social Care Bill.

Head of Legal: A legal commentary on one part of the Health and Social Care Bill.

 

Appendix – Related Blog Posts

The Health and Social Care Bill. Part 1.  The Big Society Connection

An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Purpose In Life Across the Lifespan

The term ‘Purpose in Life’ refers to a sense of meaning which relates to other people. While people may have their own interpretation of ‘Purpose in Life’, this interpretation is informed by the research literature in this area. Thus the authors of validated rating scales have used this understanding in the construction of these instruments (see Appendix 2). Starting with this understanding ‘Purpose in Life’ is strongly associated with a number of positive health benefits (the reader is again referred to Appendix 2 for further information). In the course of examining the health research literature on ‘Purpose in Life’ across the lifespan (see Appendix 1) I now conclude with some generalisations based on the literature review.

My first impression from a brief review of the literature was that the research focus on Purpose in Life was directed to early and late life with ‘middle’ adulthood being significantly under-represented. Indeed when looking at adulthood excluding adolescence, older adults and illness focused studies there was only one relevant paper*. Why might this be? One hypothesis is that researchers interested in ‘Purpose in Life’ assume that this construct is most important in the early and late years. Why might this be? One reason might be that in adulthood people have careers which provide them with a sense of purpose – that is meaning which relates to others. In adolescence, people are forming their identity and just starting out with part-time work whilst older adults will be more likely to have retired from work. So on one hand the question is what are the factors that help a person to find a sense of purpose in adolescence? On the other hand in older adults what is the relationship of ‘Purpose in Life’ to resilience to illness or to quality of life? However what is even more interesting is that ‘Purpose in Life’ doesn’t seem to figure very prominently in research involving the middle group. In this group, why wouldn’t we expect it to play a role in resilience to illness or to employment?

If we return to the literature in adolescence and early adulthood, we find that having a strong sense of ‘Purpose in Life’ is influenced by factors which include the employment status of the head of the household. Could it be that there is a close relationship between employment and ‘Purpose in Life’. If we return to the definition above then it makes sense. To be employed is to be rewarded for undertaking work that is useful to society. To take this further, continuing in this work for a prolonged period may be more likely if the person’s core values are aligned with the nature of the work. Furthermore the second part of the definition relates to others. Here it could be suggested that capitalism takes care of the relationship of that person’s meaningful activity to other people. In a crude sense, if resources are invested into work but it doesn’t satisfy the demands of the marketplace then that work cannot be supported for any significant length of time. Therefore the economics of the marketplace ensure that meaningful work carried out over a long period of time meets the needs of others in society. The dynamics of this relationship between the person and society are subtly altered in voluntary sector organisations and interestingly some of the research below suggests that purpose in life ratings are higher in men in unpaid work compared with paid work in one study at least. However this would imply that when the needs of society are sufficiently high in one area it can counterbalance the drive for individual meaningful activity. The relationships are less than straightforward however given the multiple layers of intermediate steps between the work and the satisfied needs that can arise through increasingly complex arrangements in the marketplace.

The other question is why is there an increased focus in older adults on this construct? Perhaps the important theme is once again employment. Maybe some researchers perceive that older adult participants in their studies may have moved from employement to retirement with a refocusing of their relationship to society. When there is a strong sense of ‘Purpose in Life’ it gives insights into meaning which are independent of employment and which can help others who are having difficulty in finding a sense of purpose. However what is also evident from the literature review is that in older adults ‘Purpose in Life’ is examined in relation to constructs such as resilience and quality of life and may be helpful in constructing a lifestyle approach to improved health and wellbeing. The research in this area is no doubt important given the various positive findings that have been identified and the reviews below suggest that there is still significant scope in asking the same questions in all three age groups  in order to better understand the characteristics of this construct and its many complex associations across the lifespan .

* Although Medline was used, this database contains references that are focused on wellbeing as well as illness models and so this cannot explain the relative paucity of papers for this population.

Appendix 1

Purpose in Life in Adolescence and Early Adulthood

Having a purpose in life appears to have a number of positive health benefits based on some of the research discussed in previous posts (see below). One form of existential psychotherapy – logotherapy developed by Victor Frankl operates on the assumption that many of the difficulties can be overcome if a person is able to find their own meaning in life whilst at the same time avoiding the many barriers to finding this meaning. Meaning however is subtly different from purpose with the latter suggesting a meaning imbued with direction and action (although these concepts are open to interpretation). Having a purpose in life is very personal and might be expected to vary across a person’s life journey as well as across and within cultures. In some senses then it might be difficult to develop a sophisticated understanding of Purpose in Life in research studies which involve a large number of people not because the averaging of these characteristics in the population is unhelpful (as this is necessary to tease out the relationship with other variables) but rather because these are complex constructs not easily represented by multiple binary responses to questions. However these are the acknowledged limitations of such approaches and so bearing this in mind I will look briefly at some of the literature examining purpose in life in the early phase of the lifespan.

In a study in Hong-Kong (n=378) researchers examined parent-adolescent conflict in relation to well-being including purpose in life.  The researchers assessed conflict and well-being values at two time points and thus generated evidence about the possibility directionality of the relationship. They concluded that the well-being values and parent-adolescent conflict operated bi-directionally. In other words conflict was likely to impact on well-being and a deterioration in well-being was likely to lead to conflict. In another Hong Kong study (n=429) the researchers identified a relationship between family functioning and adolescent well-being which again included purpose in life. This was further explored in a study which found that Purpose in Life was influenced by recollection of both maternal and paternal parenting styles. A study comparing adolescents with younger adults (n=136) provided evidence that a sense of Purpose in Life becomes stronger on moving from adolescence into adulthood. This purpose was characterised in another study (n=318) in which the researchers identified four profiles for purpose in youth as achieved, foreclosed, diffused and uncommitted.

A study in 147 adolescents and young adults found an association between religiosity and identity formation in adolescence in an American population. An American study looking at adolescents (11 to 19 years old) living in housing estates provided evidence that 9.7% of the variation in Purpose in Life scale scores was contributed to by three factors including the employment status of the head of the household, which was also amongst the factors contributing to 11% of variance in the hopelessness scale scores. The same group also looked at self-reported violence and again found a significant relationship with Purpose in Life scale scores. In another paper the authors suggest the importance of factors such as Purpose in Life for resilience to developing antisocial behaviours and identify family strengthening approaches as the most effective method for achieving this.

Thus purpose in life is influenced by a number of primary factors including family and social structures and becomes more developed on progressing through from adolescence to adulthood. Conflict within the family is influenced to a small extent by Purpose in Life and vice versa. Building on this understanding and the relationship of purpose in life to negative health and social outcome measures researchers have focused on approaches which strengthen this.

Purpose In Life in Adulthood

The following is a brief overview of the literature on Purpose in Life in adulthood. A search was conducted on Medline using the search term “purpose in life”. Abstracts were searched for those in which adulthood was the focus. Exclusion criteria – articles that examined the relationship between Purpose in Life and illness were excluded even if they involved an adult population. The search revealed a single paper. This study (n=830) looked at the relationship between workload and psychological well-being outcome measures in ‘white-collar workers’. The researchers found that in men but not women, paid work was associated with lower scores on the purpose in life score. The researchers were comparing paid and unpaid work.

What I found interesting from this search was that in comparison with adolescence and older adulthood there was a paucity of studies looking at purpose in life. Although this may be in part due to the limited search terms used this should also be reflected in searches for the other lifespan categories which are nevertheless well represented. One possible reason for this is that investigating purpose in life in the adult population is less interesting to researchers possibly because by adulthood this is well established. Although a number of studies include adult populations the researchers in these studies are asking questions about specific illnesses rather than looking at lifespan issues. Given the number of positive findings relating purpose in life outcomes to positive health outcomes in illness, the characterisation of Purpose in Life in health would appear to be a useful starting point for asking why these effect are being seen.

Purpose in Life in Older Adulthood

This is the third in a series of literature reviews of purpose in life across the lifespan. Medline was searched using the term “purpose in life” and retrieved papers were assessed for inclusion according to relevance. Studies which included older adults but focused on a specific illness or other population characteristic were excluded. The studies could be broadly categorised as those investigating physiological and psychological correlates of purpose in life and those examining the relationship between purpose in life and illness measures. The construct of mental QOL (Quality of Life) was significantly correlated with purpose in life in a Japanese study (paper freely available here). In a study of the oldest old there was strong correlation between a number of measures including purpose in life and resilience with the researchers referring to the constructs as representing inner strength. Another construct ‘proactive coping’ measured using the Proactive Coping Inventory was significantly correlated with purpose in life using a component of the Health and Wellbeing scale in an Australian cross-sectional study involving community dwelling older adults. Purpose in life was correlated with functioning using activities of daily living in older adults living in the community in another study. In a qualitative study examining older adult women’s views about purpose in life, this was found to be related to a number of themes and was experienced in daily activities. IL-6 receptor levels were significantly correlated with purpose in life scores in older adult women in one study. Purpose in life mediated the influence of a number of factors on quality of life in a study of older adults (n=420). Being a formal volunteer interacted with a number of factors influenced by purpose in life scores in one study of older adults.

A Swedish 5-year longitudinal study looking at the very old, the researchers found that purpose in life (measured with the Purpose in Life Test (PIL)) decreased over time and that the decrease was significantly correlated with female gender and depression at baseline. The same group also identified an inverse correlation between purpose in life and depression in a cross-sectional analysis. In another Swedish study of people aged 85 years and over, the researchers found that attitudes towards the person’s own health strongly influenced the purpose in life scores. Late-life depression was correlated with loss of purpose in life in a large Japanese study (n=10969). Purpose in life was significantly correlated with a reduction in cognitive decline a large 7-year longitudinal study (paper freely available here and reviewed here). Purpose in life was one of the factors significantly associated with caregiver distress in people caring for older adults at home. High scores of purpose in life were significantly associated with reduced mortality in a study of older adults (paper freely available here – also see another paper freely available here). The physical extent of movement referred to as ‘life space’ was examined in one study of older adults where the researchers found a significantly correlation between increasing extent of movement and purpose in life.

Appendix 2 – Blog Articles on Purpose in Life

Purpose in Life. An Overview of the Literature – Part 1

Purpose in Life. An Overview of the Literature – Part 2. Scales

Purpose in Life. An Overview of the Literature – Part 3. Depression

Purpose in Life. An Overview of the Literature – Part 4. Purpose in Life Across the Lifespan: Adolescence and Early Adulthood

Purpose in Life. An Overview of the Literature – Part 5. Purpose in Life Across the Lifespan: Adulthood

Purpose in Life. An Overview of the Literature – Part 6. Purpose in Life Across the Lifespan: Older Adulthood

Having a Purpose in Life and the Risk of Cognitive Decline

Having a Purpose in Life Reduces the Risk of Death

Purpose in Life and Rheumatoid Arthritis

An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

 

 

Brodmann Area 12: A Brief Overview of the Literature

A search for articles on Brodmann Area 12 was undertaken in Medline using the search terms “Brodmann Area 12″. Whilst at the time of writing, this search retrieved 97 results I could find only 4 papers of relevance suggesting that Brodmann Area 12 is a relatively under-researched area or that the search was not sufficiently sensitive to pick up relevant papers. However although the search was relatively simple, for other Brodmann Areas this simple search strategy has resulted in a much larger number of relevant articles suggesting that the populations of papers that are being selected from are disproportionately smaller in the case of Brodmann Area 12. I note that the search often returned abstracts referring to other Brodmann Areas but where the number 12 had been used elsewhere (e.g the number of subjects) distracting from the search query.

Turning to the retrieved papers the authors of this paper look back at Brodmann’s 1909 paper and find that he didn’t identify Brodmann Area 12 although he did in later works. The authors also note that Brodmann Area 12 is believed to play an important role in Frontotemporal Dementia. The theme is reiterated in this paper where the author comments on the function of the Brodmann Area classificiation.  In one study grey matter loss was found in areas including Brodmann Area 12 in those with ‘pathological sweet tooth’ and Frontotemporal Lobar Degeneration compared with a group of healthy controls. In another study, Neuropeptide Y-like immunoreactivity (NPYLI) was found to be increased in Brodmann Area 12 and a number of other areas in people who had been diagnosed with Huntington’s Disease.

In summary, a search for papers on Brodmann Area 12 returns relatively few papers suggesting either that this area does not have a physiologically significant function or that it does but the focus for research has been on other areas although the reasons for this are unclear.

An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.