Elaine Dunn

Starting, Ceasing, and Replacing Leisure Activities over the Life-Span

Aggregate (sample-wide) and intrapersonal patterns of leisure behavior (starting, ceasing and replacing leisure activities) are examined as a function of successive developmental periods of the lif...

Perceived control in relation to socioeconomic and behavioral resources for health

Perceived control is a personality characteristic that contributes to well-being, but few studies have attempted to integrate the functions of perceived control with those of other determinants of health. This research tested two hypotheses about the functions of perceived control: (a) individual differences in perceived control would account for socioeconomic differences in self-rated health status; (b) performance of health-related behaviors would account for the health benefits of perceived control. Using data from adult, nonproxy respondents in the National Population Health Survey of Canada (1995; n = 11, 110), confirmatory factor analysis supported a measurement model of self-rated health status composed of two correlated factors: physical health (i.e., chronic conditions. restricted activities, self-rated general health, physical functional capacity) and mental health (i.e., distress, depression). Structural equation modeling supported the first hypothesis, but not the second, regarding perceived control as a determinant of self-rated physical and mental health. Health-related behaviors partially mediated age differences in self-rated health, but different behaviors functioned in this way for men than for women. The findings suggest that psychological process, that of perceiving control over life events, underlies social inequality in health. Health-related behaviors appear not to serve as the primary mechanism through which perceived control influences health.

Integrating ceasing participation with other aspects of leisure behaviour.

The paper focuses on one aspect of non-participation, namely ceasing participation in leisure activities. In the first part of the paper, the phenomenon is examined from a conceptual perspective. A...

Intraoperative clinical practice and risk of early complications after cataract extraction in the United States, Canada, Denmark, and Spain

OBJECTIVE To examine variation in intraoperative clinical practice and rates of adverse events after cataract surgery across four different healthcare systems. DESIGN Multicenter cohort study. PARTICIPANTS Patients were recruited from ophthalmic clinics in the United States (n = 75); in the Province of Manitoba, Canada (n = 12); in Denmark (n = 17); and the City of Barcelona, Spain (n = 10). In all, 1420 patients undergoing first eye cataract surgery were enrolled, with preoperative, perioperative, and postoperative clinical data collected on 1344 patients (95%). MAIN OUTCOME MEASURES Occurrence of 23 specified intraoperative and early postoperative adverse events was measured. Four-month postoperative visual acuity outcome also was measured. RESULTS Phacoemulsification was performed in two thirds of the extractions in the United States and Manitoba, in one third in Denmark, and in 3% in Barcelona (P < 0.001). More than 96% of extractions in North America and Denmark were performed with the patient under local anesthesia, whereas general anesthesia was used for 38% of extractions in Barcelona (P < 0.001). Rates of intraoperative adverse events were 11% to 12.8% in Manitoba, Denmark, and Barcelona and significantly lower in the United States (6%), mainly because of a lower rate of capsular rupture (P < 0.01). Significantly higher rates of early postoperative events were seen in the United States (18.8%) and Manitoba (20.4%) compared to Denmark (7.9%) and Barcelona (5%) (P < 0.001). The differences among sites in rates of events could not be explained by differences in recorded patient characteristics or surgical techniques. The occurrence of perioperative events was significantly associated with a worse 4-month visual outcome. CONCLUSION The observed variation in clinical practice might represent a general trend of a slower diffusion of new medical technology in Europe compared with that of North America. Rates of intraoperative and early postoperative events varied significantly across sites.

Is constrained leisure an internally homogeneous concept

Abstract The internal homogeneity or differentiation of the concept of constrained leisure is investigated by assessing similarities and differences in patterns of the importance of 12 constraints items in relation to two distinct indicators of this general concept (ceasing participation in a former activity, and desire to participate in a new activity) rather than the single measure typical of previous research. By using data from two similar public recreation surveys, the findings show that the strength and relative importance of 12 items as reasons and barriers were generally the same, except that the cost of equipment was more frequently identified as a deterrent to beginning participation, whereas being physically unable to participate was more frequently identified as a reason for ceasing participation. These results were confirmed by internal replication when the data were broken down by selected activities and respondents’ age. The findings indicate that constrained leisure must be viewed as an in...

Variation in indications for cataract surgery in the United States, Denmark, Canada, and Spain: results from the International Cataract Surgery Outcomes Study

BACKGROUND/AIMS International comparisons of clinical practice may help in assessing the magnitude and possible causes of variation in cross national healthcare utilisation. With this aim, the indications for cataract surgery in the United States, Denmark, the province of Manitoba (Canada), and the city of Barcelona (Spain) were compared. METHODS In a prospective multicentre study, patients scheduled for first eye cataract surgery and aged 50 years or older were enrolled consecutively. From the United States 766 patients were enrolled; from Denmark 291; from Manitoba 152; and from Barcelona 200. Indication for surgery was measured as preoperative visual status of patients enlisted for cataract surgery. Main variables were preoperative visual acuity in operative eye, the VF-14 score (an index of functional impairment in patients with cataract) and ocular comorbidity. RESULTS Mean visual acuity were 0.23 (USA), 0.17 (Denmark), 0.15 (Manitoba), and 0.07 (Barcelona) (p<0.001). When restricting the sample to eyes with normal retina and macula, no significant difference between United States and Denmark was observed (p>0.05). Mean VF-14 scores were 76 (USA), 76 (Denmark), 71 (Manitoba), and 64 (Barcelona) (p<0.001). CONCLUSION Similar indications for cataract surgery were found in the United States and Denmark. Significantly more restricted indications were observed in Manitoba and Barcelona. Possible explanations for the results are discussed, including differences in sociodemographic characteristics, access to care, surgeons’ willingness to operate, and patient demand.