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      Learning to live with Parkinson’s disease in the family unit: an interpretative phenomenological analysis of well-being

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          Abstract

          We investigated family members’ lived experience of Parkinson’s disease (PD) aiming to investigate opportunities for well-being. A lifeworld-led approach to healthcare was adopted. Interpretative phenomenological analysis was used to explore in-depth interviews with people living with PD and their partners. The analysis generated four themes: It’s more than just an illness revealed the existential challenge of diagnosis; Like a bird with a broken wing emphasizing the need to adapt to increasing immobility through embodied agency; Being together with PD exploring the kinship within couples and belonging experienced through support groups; and Carpe diem! illuminated the significance of time and fractured future orientation created by diagnosis. Findings were interpreted using an existential-phenomenological theory of well-being. We highlighted how partners shared the impact of PD in their own ontological challenges. Further research with different types of families and in different situations is required to identify services required to facilitate the process of learning to live with PD. Care and support for the family unit needs to provide emotional support to manage threats to identity and agency alongside problem-solving for bodily changes. Adopting a lifeworld-led healthcare approach would increase opportunities for well-being within the PD illness journey.

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          On the incomplete architecture of human ontogeny. Selection, optimization, and compensation as foundation of developmental theory.

          P B Baltes (1997)
          Drawing on both evolutionary and ontogenetic perspectives, the basic biological-genetic and social-cultural architecture of human development is outlined. Three principles are involved. First, evolutionary selection pressure predicts a negative age correlation, and therefore, genome-based plasticity and biological potential decrease with age. Second, for growth aspects of human development to extend further into the life span, culture-based resources are required at ever-increasing levels. Third, because of age-related losses in biological plasticity, the efficiency of culture is reduced as life span development unfolds. Joint application of these principles suggests that the life span architecture becomes more and more incomplete with age. Degree of completeness can be defined as the ratio between gains and losses in functioning. Two examples illustrate the implications of the life span architecture proposed. The first is a general theory of development involving the orchestration of 3 component processes: selection, optimization, and compensation. The second considers the task of completing the life course in the sense of achieving a positive balance between gains and losses for all age levels. This goal is increasingly more difficult to attain as human development is extended into advanced old age.
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            If it changes it must be a process: study of emotion and coping during three stages of a college examination.

            This natural experiment provides substantial evidence for the following major themes, which are based on a cognitively oriented, process-centered theory of stress and coping: First, a stressful encounter should be viewed as a dynamic, unfolding process, not as a static, unitary event. Emotion and coping (including the use of social support) were assessed at three stages of a midterm examination: the anticipation stage before the exam, the waiting stage after the exam and before grades were announced, and after grades were posted. For the group as a whole there were significant changes in emotions and coping (including the use of social support) across the three stages. Second, people experience seemingly contradictory emotions and states of mind during every stage of an encounter. In this study, for example, subjects experienced both threat emotions and challege emotions. The complexity of emotions and their cognitive appraisals reflects ambiguity regarding the multifaceted nature of the exam and its meanings, especially during the anticipation stage. Third, coping is a complex process. On the average, subjects used combinations of most of the available forms of problem-focused coping and emotion-focused coping at every stage of the exam. Different forms of coping were salient during the anticipation and waiting stages. Problem-focused coping and emphasizing the positive were more prominent during the former, and distancing more prominent during the latter. Finally, despite normatively shared emotional reactions at each stage, substantial individual differences remained. Using selected appraisal and coping variables, and taking grade point averages (GPA) into account, approximately 48% of the variances in threat and challenge emotions at the anticipation stage was explained. Controlling for variance due to the grade received, appraisal, and coping variables accounted for 28% of the variance in positive and negative emotions at the outcome stage. Including grade, 57% of the variance in positive emotions at outcome and 61% of the negative emotions at outcome were explained.
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              The Incidence of Parkinson's Disease: A Systematic Review and Meta-Analysis

              Background: Parkinson's disease (PD) is a common neurodegenerative disorder. Epidemiological studies on the incidence of PD are important to better understand the risk factors for PD and determine the condition's natural history. Objective: This systematic review and meta-analysis examine the incidence of PD and its variation by age and gender. Methods: We searched MEDLINE and EMBASE for epidemiologic studies of PD from 2001 to 2014, as a previously published systematic review included studies published until 2001. Data were analyzed separately for age group and gender, and meta-regression was used to determine whether a significant difference was present between groups. Results: Twenty-seven studies were included in the analysis. Meta-analysis of international studies showed rising incidence with age in both men and women. Significant heterogeneity was observed in the 80+ group, which may be explained by methodological differences between studies. While males had a higher incidence of PD in all age groups, this difference was only statistically significant for those in the age range 60-69 and 70-79 (p < 0.05). Conclusion: PD incidence generally increases with age, although it may stabilize in those who are 80+.
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                Author and article information

                Contributors
                +44(0)121 2044050 , r.l.shaw@aston.ac.uk
                Journal
                Med Health Care Philos
                Med Health Care Philos
                Medicine, Health Care, and Philosophy
                Springer Netherlands (Dordrecht )
                1386-7423
                1572-8633
                30 June 2016
                30 June 2016
                2017
                : 20
                : 1
                : 13-21
                Affiliations
                [1 ]ISNI 0000 0004 0422 0975, GRID grid.11485.39, , Cancer Research UK, ; London, UK
                [2 ]ISNI 0000 0004 0376 4727, GRID grid.7273.1, School of Life and Health Sciences, , Aston University, ; Birmingham, B4 7ET UK
                Author information
                http://orcid.org/0000-0002-0438-7666
                Article
                9716
                10.1007/s11019-016-9716-3
                5318469
                27364754
                b3c05568-1cc8-4cc8-9de5-30dd9cabbcc5
                © The Author(s) 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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                Scientific Contribution
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                © Springer Science+Business Media Dordrecht 2017

                Medicine
                parkinson’s disease,lifeworld,caregiver,diagnosis,disease management,qualitative research
                Medicine
                parkinson’s disease, lifeworld, caregiver, diagnosis, disease management, qualitative research

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