Leavers, planners and dwellers : the decision to leave the parental home

Leaving the parental home is one of the most common events in the life course of individuals. It is a normal and natural thing to happen to virtually everyone at some time. However, despite the generality of the event, the transition is not the same for all. Furthermore, the generality of the event says nothing about changes in the patterns in home-leaving behaviour over time. During the past several decades, interesting shifts in the timing and arrangements of the transition have occurred. The question, central to this study, runs: What are the factors that influence the transition from living at home to living independently?In the literature, there are mainly two perspectives dominating theoretical thinking about the determinants affecting departure from the parental home: an economic and a cultural one. First, in many previous demographic and economic studies, the search for an explanation of the changes in leaving home focused on the impact of the situational context on the individual's behaviour, i.e. the financial situation and the situation on the housing market, which constitute the young adult's opportunity structure. A second research tradition that has addressed the event of leaving home typically emphasises the normative context and the role of social norms which are believed to regulate the timing and arrangement of important life course transitions. This study aimed to determine more precisely the relative impact of each of these two factors. Furthermore, this study tried to find out whether, beside economic, housing and normative factors, additional aspects play a role in the decision to leave home, thus providing a more complete picture of the variety of factors that should be taken into account. An explorative analysis of written material collected among 300 students provided the necessary data to discover young adults' additional considerations in the matter of leaving home. These considerations appeared to deal with more practical and social-emotional aspects, and were briefly denoted as the Hotel-Mama factor. Apart from that, the qualitative material was used to obtain quantifiable information about the kind of normative expectations that are related to leaving home.It is well known that since the 1950s remarkable social and economic changes have taken place in Dutch society, which undoubtedly have also affected the circumstances and opportunities of young adults. As one of our hypotheses emphasises the role of the opportunity structure in the decision to leave home, we start this study with a description of the relevant social and cultural changes, and a sociological assessment of the profound impact of these transformations on the social and economic position of young adults in general and on their opportunities to leave the parental home in particular (see chapter 2). This gives a solid base to our hypothesis that changes in home-leaving behaviour are related to economic and housing market opportunities. The presumed effect of the normative context is addressed in chapter 2 as well. Also, the temporal changes in leaving home that took place in the period between 1950 and 1980 and during the 1980s are reflected upon. The discussion results in the further elaboration and formulation of the research questions.To illustrate how fluctuations in the situational context may be reflected in patterns of leaving home, chapter 4 examines at the aggregate level the shifts in behavioral patterns that occurred in the Netherlands during the 1980s, and relates them to the changing circumstances of this period. Three successive national Housing Demand Surveys (WBOs), conducted at the end of 1981, 1985 and 1989, provided the necessary data. It was concluded that although fluctuations in the situational context were indeed reflected in behavioral patterns, it was also evident that not all young adults react to a specific set of opportunities in the same way. Limited opportunities do not necessarily lead to a postponement of the transition, but in many instances rather to an adjustment of behavioral choices instead.Both the discussion in chapter 2 and the results of chapter 4 made it clear that, nothwithstanding the useful insights a macro-level approach generates, it may sometimes be difficult or hazardous to draw firm conclusions regarding the effect of specific factors when analysing them on the aggregate level. It was therefore argued that a micro-level should be adopted, in which the decision to leave the parental home and its determinants are studied at the individual level.In chapter 3, the Theory of Reasoned Action and its modifications are discussed and the theoretical model underlying this study, which is a modified version of the Theory of Planned Behaviour is presented. In order to use this theoretical model, it was necessary to specify the relevant consequences and the normative expectations that are related to leaving home. The qualitative method employed to identify prevailing perceptions on this subject is discussed in chapter 5.Chapter 6 describes the process of setting up a cross-sectional survey among 1012 young adults of 18-26 years old, and the measurement and construction of relevant variables. The results of the analyses of the survey data are reported in chapters 7 and 8. By comparing the personal situation and subjective considerations of leavers, planners and dwellers, we tried to find evidence that the defined variables affect the decision to leave home as hypothesised (chapter 7). Chapter 8 aims to detect the most important determinants in this decision, either in the first stage (the stage of intention-formation), or in the second stage (in which the intention is effectuated into actual behaviour). The analyses revealed that the normative expectations of the parents play a decisive role in the first stage. Financial considerations are most important in the second stage. Particularly the subjective assessment of one's income situation appeared to be a crucial element. The type of housing young adults aimed at further affected their probability of leaving, with cheap 2 and 3 room accommodation clearly reducing a person's opportunities of finding a place to live and of leaving the parental home, and a quest for a single room or four room housing facilitating the transition. There is no convincing evidence that Hotel-Mama considerations affect the decision to leave home or to stay home.Chapter 9 concludes this study with a summary overview of the research design and an evaluation of the main findings, followed by a discussion of their implications for policy, theory and research.</p

How Can Doctors Help Their Patients to Return to Work?

Getting back to work is important for most patients but doctors are often unsure how best to help. The article reviews evidence for the effectiveness of the interventions now available

The Relation of Menarcheal Age to Anthropometric Profiles in Korean Girls

The aim of this study was to represent the trend of early menarche and to assess the association of age at menarche with anthropometric profiles of Korean children and adolescents. A cross sectional survey was conducted with 13,371 girls aged 10 to 18 yr, recruited nationwide from April, 2005 to March, 2006. Height, weight and waist circumference of the subjects were measured; and the subjects self-reported their ages at menarche. We found that the menarcheal girls were taller (P<0.05 for the girls between 10 and 14 yr) and heavier (P<0.05 for the girls between 10 and 18 yr) than non-menarcheal ones. Menarcheal girls also showed higher body mass index (BMI), and greater waist circumference than non-menarcheal ones. Significant differences were represented according to the age at menarche in terms of BMI, waist circumference, % body fat mass, waist hip ratio and neck circumference as well as height and weight (P<0.05). In conclusion, girls who matured early were taller and heavier in early adolescence than those who matured later

Urinary endogenous sex hormone levels and the risk of postmenopausal breast cancer

To assess the relation between urinary endogenous sex steroid levels and the risk of postmenopausal breast cancer, a nested case–cohort study was conducted within a large cohort (the DOM cohort) in the Netherlands (n¼9 349). Until the end of follow-up (1 January 1996), 397 postmenopausal breast cancer cases were identified and a subcohort of 424 women was then taken from all eligible women. Women using hormones were excluded, leaving 364 breast cancer cases and 382 women in the subcohort for the analyses. Concentrations of oestrone, oestradiol, testosterone, 5a-androstane-3a, 17b-diol and creatinine were measured in first morning urine samples, which had been stored since enrolment at -201C. A Cox proportional Hazards model was used, with Barlow’s adjustment for case–cohort sampling, to estimate breast cancer risk in quartiles of each of the, creatinine corrected, hormone levels, the lowest quartile being the reference group. Women with higher levels of all four of the hormones were at increased risk for postmenopausal breast cancer (highest vs lowest quartile: incidence rate ratio for oestrone (IRRoestrone=2.5, 95% CI: 1.6–3.8; IRRoestradiol=1.5, 95% CI: 1.0–2.3; IRRtestosterone=1.6, 95% CI: 1.0–2.4; IRR5a-androstane-3a, 17b-diol=1.7, 95% CI: 1.1–2.7). In conclusion, women with higher excretion levels of both oestrogens and androgens have an increased risk of breast cancer

“My Lung Disease Won’t Go Away, it’s There to Stay”: Profiles of Adaptation to Functional Limitations in Workers with Asthma and COPD

Purpose Earlier research has shown that adaptation (i.e., the way in which employees cope with limitations resulting from their disease) is associated with sick leave. Our aim was to investigate signs of adequate or inadequate adaptation in employees with asthma and COPD. Methods A Q-methodological study was carried out among 34 workers with asthma or COPD. Results Four adaptation profiles were distinguished: the eager, the adjusted, the cautious, and the worried workers. The adaptation profiles provide insight into the different ways in which workers with asthma and COPD cope with their illness at work. Conclusions The adaptation profiles serve as a starting point for the design of appropriate (occupational) care. The eager workers experience little difficulties at work; the cautious workers may need assistance in learning how to accept their disease; the worried workers need reassurance, and may need reactivation; the adjusted workers deserve extra attention, and, when necessary, advice on how to live with their asthma or COPD

Effects of shared medical appointments on quality of life and cost-effectiveness for patients with a chronic neuromuscular disease. Study protocol of a randomized controlled trial

Contains fulltext : 96862.pdf (publisher's version ) (Open Access)BACKGROUND: Shared medical appointments are a series of one-to-one doctor-patient contacts, in presence of a group of 6-10 fellow patients. This group visits substitute the annual control visits of patients with the neurologist. The same items attended to in a one-to-one appointment are addressed. The possible advantages of a shared medical appointment could be an added value to the present management of neuromuscular patients. The currently problem-focused one-to-one out-patient visits often leave little time for the patient's psychosocial needs, patient education, and patient empowerment. METHODS/DESIGN: A randomized, prospective controlled study (RCT) with a follow up of 6 months will be conducted to evaluate the clinical and cost-effectiveness of shared medical appointments compared to usual care for 300 neuromuscular patients and their partners at the Radboud University Nijmegen Medical Center. Every included patient will be randomly allocated to one of the two study arms. This study has been reviewed and approved by the medical ethics committee of the region Arnhem-Nijmegen, The Netherlands. The primary outcome measure is quality of life as measured by the EQ-5D, SF-36 and the Individualized neuromuscular Quality of Life Questionnaire. The primary analysis will be an intention-to-treat analysis on the area under the curve of the quality of life scores. A linear mixed model will be used with random factor group and fixed factors treatment, baseline score and type of neuromuscular disease. For the economic evaluation an incremental cost-effectiveness analysis will be conducted from a societal perspective, relating differences in costs to difference in health outcome. Results are expected in 2012. DISCUSSION: This study will be the first randomized controlled trial which evaluates the effect of shared medical appointments versus usual care for neuromuscular patients. This will enable to determine if there is additional value of shared medical appointments to the current therapeutical spectrum. When this study shows that group visits produce the alleged benefits, this may help to increase the acceptance of this innovative and creative way of using one of the most precious resources in health care more efficiently: time. TRIAL REGISTRATION: DutchTrial Register http://www.trialregister.nlNTR1412

A study of a couple with type 2 diabetes: dyadic adjustment and psychological morbidity

Objective: this study assessed dyadic adjustment and psychological morbidity in type 2 diabetic patients and their partners, focusing on the role of gender. Methods: 214 diabetic patients and their partners participated in the cross-sectional study and were assessed on psychological morbidity (HADS) and marital adjustment (RDAS). Data was analyzed using dyadic analysis, a statistical process that studies the patient/partner dyads simultaneously. Results: results revealed that the negative relationship between dyadic adjustment and psychological morbidity in female patients was stronger than in male diabetic patients or in partners of male diabetic patients. On the other hand, the relationship between dyadic adjustment and psychological morbidity in partners of diabetic men was stronger than the same relationship in partners of diabetic women. Conclusion: since gender is a moderator, it is important to attend to the different needs of female and male patients and the education of diabetic patients should be centered on the patient/partner dyad.Fundação para a Ciência e a Tecnologia (FCT

Does trust in health care influence the use of complementary and alternative medicine by chronically ill people?

BACKGROUND: People's trust in health care and health care professionals is essential for the effectiveness of health care, especially for chronically ill people, since chronic diseases are by definition (partly) incurable. Therefore, it may be understandable that chronically ill people turn to complementary and alternative medicine (CAM), often in addition to regular care. Chronically ill people use CAM two to five times more often than non-chronically ill people. The trust of chronically ill people in health care and health care professionals and the relationship of this with CAM use have not been reported until now. In this study, we examine the influence of chronically ill people's trust in health care and health care professionals on CAM use. METHODS: The present sample comprises respondents of the 'Panel of Patients with Chronic Diseases' (PPCD). Patients (≥25 years) were selected by GPs. A total of 1,625 chronically ill people were included. Trust and CAM use was measured by a written questionnaire. Statistical analyses were t tests for independent samples, Chi-square and one-way analysis of variance, and logistic regression analysis. RESULTS: Chronically ill people have a relatively low level of trust in future health care. They trust certified alternative practitioners less than regular health care professionals, and non-certified alternative practitioners less still. The less trust patients have in future health care, the more they will be inclined to use CAM, when controlling for socio-demographic and disease characteristics. CONCLUSION: Trust in future health care is a significant predictor of CAM use. Chronically ill people's use of CAM may increase in the near future. Health policy makers should, therefore, be alert to the quality of practising alternative practitioners, for example by insisting on professional certification. Equally, good quality may increase people's trust in public health care