Health Dissertation ideas - Applied Musculoskeletal Podiatry The WritePass Journal

Health Dissertation ideas - Applied Musculoskeletal Podiatry Introduction Pathology that causes metatarsalgia Health Dissertation ideas Applied Musculoskeletal Podiatry ). Patients often describe their feeling of â€Å"lump† on the foot’s bottom. Significantly, these symptoms may rise when the infected carries out a weight-bearing activity. Reports indicate that closed-toed shoes, particularly the tight-fitting ones can lead to increase in symptoms, and patients report relief after they remove or change their shoes (Summers, 2010). Relief may also be experienced when the patient massages their foot or moves the toes around. Aetiology of this condition and how it would be recognised clinically Research has established that Morton’s neuroma is unique in terms of clinical diagnostic requirements or needs (Drury, 2011). This is because although patients frequently report symptoms such as numbness, there is evidence that sensory deficit may or may not be found when the patient goes through examination. Drury (2011) observes that there may be a demonstration of splaying or divergence of the digits when clinical presentation is carried out, and that more often than not little or no edema or inflammation can be observed clinically. Typically, reproducing pain with palpation to the intermetatarsal space is a normal activity, but care must be taken to put the pressure in the space, and avoid the metatarsal heads. There have been various clinical strategies to assist clinicians effectively diagnose Morton’s neuroma. Schreiber et al (2011); Faraj and Hosur (2010) report that patients may demonstrate a Mulder’s sign, which is provoked by squeezing the forefoot and conducting application of plantar and dorsal pressure. In other words, clinical test for Morton’s neuroma has all along been to   compress the foot by applying pressure to the medical and lateral aspects of the foot at the metatarsophangeal joints, which in turn puts pressure on nerves (Pastides, El-Sallakh and Charalambides, 2010: 503). A positive clinical test outcome involves a pop or click that can be felt and heard at the same time. This pop or click is usually painful to the patient. There is a possibility of replicating symptoms of Morton’s neuroma in a process involving Gauthier’ test, where the forefoot is squeezed and medial to lateral pressure is applied (Beltran et al., 2010). Mayo Clinic (2010) has subsequently described a test consisting of hyperextending the toes and rolling the thumb of the examiner in the area of symptoms, a process that may identify a tender, thickened, and longitudinal mass of flesh. Clinical findings also indicate that Morton’s neuroma may also show Tinel’s sign as well as Valleix phenomenon (Berry, Gonzalez and Bowman, 2012). The other pathway for detecting Morton’s neuroma is diagnostic testing. This process involves plain radiography, ultrasound, and magnetic resonance imaging (Summers, 2010). Radiographs are routinely ordered to rule out musculoskeletal pathology, even though rise in proximity of the adjacent metatarsal heads is believed to result in increased pressure of the intermetatarsal nerve. Furthermore, Hause (2010) found no significant correlation between radiographic findings and the clinical presence of neuromas. In addition, there is the recommendation to use ultrasound in the diagnostic evaluation of the interspaces (Hause, 2010). Drury (2011: 19) observes that there is a likelihood of a neuroma appearing as an ovoid mass with hypoechoic signal-mass to the long axis of the metatarsals. . Adams (2010), however, advises that although MRI is a useful diagnostic tool, it should always be reserved for atypical presentations or to eliminate multiple neuromas. Significantly, neuroma can be best identified on T1 weighted images, and it’s likely to come out as a well-demarcated mass with minimal signal intensity.   In summary, clinical diagnostic approach to identify Morton’s neuroma can be achieved by ensuring that examination and diagnostic testing has ruled out any other etiologies of symptoms. Conservative treatment intervention for Morton’s neuroma No best treatment interventions have been identified in the literature for treatment of Morton’s neuroma. Conservative intervention for Morton’s neuroma is considered to be one of the best treatments alternatives for the condition. However, some of the common conservative treatment options involve changing shoe type, use of metatarsal pads, and use of non-steroidal anti-inflammatory drugs, administering sclerosing alcohol injections, and surgically transposing the offending nerve (Summers, 2010). Many doctors and physical therapists have recommended that patients are put to rest for a specific period of time, and reduce activities that may elicit pain (Pastides, El-Sallakh and Charalambides, 2012). Injections as an intervention Various clinical studies have exposed the need to consider injection as a better treatment option for Morton’s neuroma over other non-surgical treatment options available. In a study conducted by Drury (2010) different conservative treatment measures often produce similar results. In a small randomised prospective study of 23 patients, the researchers compared reduction in neuroma pain when supinatory or pronatory insoles are used. In the study, there was no explicit inclusion or exclusion criteria other than clinical diagnosis, and no participant or evaluator was considered blind to the intervention allocations. The study had 13 percent of the participants (two patients) drop out after one month into the experiment. After 12 months, pain in the supination and pronation insole groups reduced by 50 percent and 45 percent, respectively- a reduction considered insignificant. In another study, a physically active 25-year-old female with diagnosed symptomatic Morton’s neuroma was put through a massage therapy sessions. The six-session massage therapy involved a 60-75 minute weekly massage exercise involving postural alignment in addition to localised foot and leg treatment. The patient was also put to complete at-home daily exercise, with a weekly monitoring of change by the therapist who reassessed the patient’s posture and ensuring the client fills out a pain survey based on a Visual Analog Scale. The results indicated progressive change on the side of the client in terms of pain character. Specific patient report indicates that the pain character changed from burning and stabbing to dull and pulsing sensation after three sessions. There was also a reduction in pain during exercise. Although this study suggests that massage therapy is a significant treatment for Morton’s neuroma, its weakness is based on the fact that the treatment only involved one client. No study has indicated the effectiveness of the method on a larger randomised control studies. In a prospective randomised study involving 82 patients, the researchers compared steroid injections alone based on shoe modifications (Berry, Gonzalez and Bowman 2012). Some of the recorded primary outcomes were patient satisfaction, which is basically the presence or absence of pain, the pain intensity, and return of pain afterwards. The results of the study indicated that steroid injections yielded better outcome in terms of patient satisfaction, compared with other conservative options such as shoe   modifications alone. In this study, 23 percent of shoe-modification patients achieved complete satisfaction after one month of intervention. This was significantly lower than the 50 percent of patients who experienced significant pain reduction after one month of steroid injection. After six months, 28.6 percent of the participants experienced satisfaction with shoe modification, significantly lower than 73.5 percent satisfaction amongst those who had received injection. Although the difference was significant lower after one year with 63 percent satisfaction with shoe modification and 82 percent with injection, the reduction could have occurred because patients were allowed to cross over after six months. The researchers observed that no complications were reported, although the study was limited by a high cross-over rate from shoe modification group to injection group after 6moths. Some studies have investigated other techniques such as the use of sclerosing effects of alcohol (Pastides, El-Sallakh and Charalambides, 2012; Schreiber, 2011; Beltran, 2010; Pace, Scammell and Dhar, 2010), where delivery is done by multiple injections guided by ultrasound techniques over time. Improvements were reported in term of clients’ satisfaction with no long-term adverse effects   in various case series. It is mostly recommended that even as an injection is used as the chosen treatment option, other supplementary management options such as shoe adjustments and calf-stretching exercises should also be implemented concurrently. However, in case the conservative interventions fail to work, many patients may be advised to undergo surgery to remove the neuroma or just to release pressure from ligaments. Studies have, however, indicated that 15 to 20 percent of these surgeries will not relieve the patient from pain, and may also lead to various complications such as local post-surgery infections, scar tissue, and damage of soft tissues which may affect normal foot functions. It has also been established that there is a possibility of neuroma recurring after the surgery. Conclusion Whilst the exact cause of Morton’s neuroma is not known, the common belief is that it is caused by hypermobility of the metatarsals. This may also be aggravated by repetitive motions involving grinding of nerve bundle. The common symptoms are patients describing their feeling of â€Å"lump† on the foot’s bottom. These symptoms may increase when the patient engages in weight-bearing activity. Research has established that symptoms that may be associated with Morton’s neuroma may not necessarily mean a person is suffering from the complication. This is why clinical diagnosis is often recommended. One of the most common clinical strategies that may be beneficial to clinicians diagnosing Morton’s neuroma is patients demonstrating Mulder’s sign. A positive clinical test outcome involves a pop or click that can be felt and heard at the same time. Clinical findings also indicate that Morton’s neuroma may also show Tinel’s sign as well as Valleix phenomenon (Berry, Gonzalez and Bowman, 2012). Although there are various conservative therapies used to manage Morton’s neuroma complications including rest, weight loss, and exercise for muscle strengthening, orthotics, massage therapy, physiotherapy, and manipulation, these methods are found to be very effective. It’s against this backdrop that injection is found to be a more effective way of managing the complication as reported by clients’ satisfaction studies. Injection may involve steroid injection, local anaesthetic injections or sclerosant injections. Injections have been found to yield better outcome in terms of patient satisfaction, compared with other conservative options such as shoe modifications alone. It has also been established that there are no complications reported in injections. Medical practitioners, however, recommend that patients may be advised to undergo surgical intervention in case conservative interventions fail to yield desired results. References Adams WR. (2010). Morton’s neuroma. Clin Podiatr Med Surg., (2)7: 535-545. Beltran LS, Bencardino J, Ghazikhanian V, Beltran J. (2010). Entrapment neuropathies III; lower limb. Semin Musculoskelet Radiol, 14: 501-111. Berry K, Gonzalez P, and Bowman RG. (2012). Physical Medicine and Treatment for Morton Neuroma. Available from: http://emedicine.medscape.com/article/308284-overview [Accessed November 17, 2014.]. Bronfort G, Haas M, Evans R, et al. (2010). Effectiveness of manual therapies: the UK evidence report, Chiropractic Osteopathy, 18(3):1–33 Drury AL. (2011). Use of homeopathic injection therapy in treatment of Morton’s neuroma. Altern Ther Health Med, 2(1) 17-48. Faraj A, and Hosur A. (2010). The outcomes after using two different approaches for excision of Morton’s neuroma. Chinese Medical Journal, 12 (3): 2195- 2198. Hauser R. (2011). A retrospective observational study on Hackett-Hemwall dextrose prolotherapy for unresolved foot and toe pain at an outpatient charity clinical in rural Illinois. J of Prolotherapy 2 (3): 543-551. Mayo Clinic. (2010). Morton’s Neuroma. [Accessed September 16, 2010]. Available from: mayoclinic.com/health/mortons-neuroma/DS00468. Published Updated October 5, 2010. Pastides P, El-Sallakh S, Charalambides C. (2012) Morton’s neuroma: A clinical versus radiological diagnosis. Foot Ankle Surg, 18: 22-4. Pace A, Scammell B, Dhar S. (2010). The outcome of Morton’s neurectomy in the treatment of metatarsalgia. Int Orthop, 3 (4):511-5. Schreiber K, Khodaee M, Poddar S, Tweed EM. (2011). Clinical Inquiry. What is the best way to treat Morton’s neuroma? Int Orthop, 60: 157-158. Summers A. (2010). Diagnosis and treatment of Morton’s neuroma. Emerg Nurse, 1(8): 16-17.

Compare and Analyse Essay Example | Topics and Well Written Essays - 2500 words

Compare and Analyse - Essay Example This has been caused by a sudden advancement in times and seasons. The times when general technology as well and information technology was left for the media alone, no longer exist (Wherle, 2009, pg76). Currently, almost everyone in the world is an IT expert since people have the idea of how to use a technology. However, it should be considered that this is the main aspect of life, that has witnessed a continuous advancement, hence emergence of the term technology development. Documentaries have been made using technology. Bob Dylan’s â€Å"Don’t look back† and Michael’s â€Å"Roger and Me†, are some to the documentaries that portrays a sense of a well used technology (Pennebaker, 1968, pg65). This essay compares the two documentary’s use of technology. Where, apart from the message in the movies, technology has proved a phenomenon to put into considering when watching this movie. First, it is noted here that, the media portrays a gap between message and medium, where Dylan’s’ manager by the name Albert Grossman who is the movie producer airs his client. Many will take this incident as a bad omen, however to him; he literally does it without thinking or rather taking it as a bad omen. Notably, during the cutting and editing of the documentary, it is clear as per the presentations that Grossman’s presence is felt (Eason, 2010, pg26). As much as this might be considered as an artistic job, the truth is that it portrayed a flattering idea at the edge. In this context, it can be noted that the question of centralization became centrally framed; this is evident prior to the presentation of each character. The film is made to be viewed in a very different phenomenon. The sound of observational documentary such as Don’t Look Back is muddy that makes it difficult for a person to differentiate particular person speech and the general uproar. In essence, the quality of the sound in the documentary is wanting since it is difficult to distinguish a

Standard Deviation Essay Example | Topics and Well Written Essays - 2500 words

Standard Deviation - Essay Example When the data points are spread apart and the bell-shaped curve is flat, the standard deviation -- and the variation -- is great. Standard deviation with regard to finance can be defined as "Statistical measure that shows the likelihood of an investment to yield above- or below-average returns over a period of time. For example, if hypothetical XYZ Fund has an average annual total return of 11% and a standard deviation of 6.00, which means XYZ Fund's performance is likely to vary from a low of 5% to a high of 17%. Calculated by the fund, standard deviation is only relative to the asset class being measured." (2) The standard deviation of investment returns is widely accepted as the best, and perhaps only commonly used indicator of portfolio risk in the investment management business. However, its usefulness is actually quite limited. In fact, relying on it can often produce misleading and inaccurate conclusions. Although standard deviation does provide some insight, and in many circumstances is in fact meaningful but there are a number of flaws associated with relying on the standard deviation of returns as a risk measure. The bigger flaw with standard deviation is that it isn't intuitive. ... Although standard deviation does provide some insight, and in many circumstances is in fact meaningful but there are a number of flaws associated with relying on the standard deviation of returns as a risk measure. The bigger flaw with standard deviation is that it isn't intuitive. Sure, a standard deviation of seven is obviously higher than a standard deviation of five, But are those high or low figures Because a fund's standard deviation is not a relative measure-which means it's not compared with other funds or with a benchmark-it is not very useful to you without some context. Another limitation to standard deviation lies with the underlying data. Most investors will recall normal distribution from their introduction to statistics course. This bell curve underlies all of the assumptions about standard deviation. If the underlying data is not normally distributed, then the standard deviation is likely to give misleading results. It's worth noting that a number of studies show that investment returns are not normally distributed. There are some drawbacks to using standard deviation as a measure of risk, however. It interprets any difference from the average, above or below, as bad. This runs contrary to the way most investors feel about returns. Few investors fret about their portfolios doubling; most only worry about the downside--their returns being below average. There is another theory which is called Utility Theory. "This theory gives us a way to measure investor's preferences for wealth and the amount of risk they Aftab 04 are willing to undertake in the hope of attaining greater wealth. This makes it possible to develop a theory of portfolio optimization. Thus utility theory lies at the heart of modern portfolio theory." (3) Definition of

The factors, which affect demand Essay Example for Free

The factors, which affect demand Essay Demand is the quantity of goods or services consumers will buy at a particular price, at a particular time period. Market demand refers to the sum of individual demand for a good or service. It is assumed that the demand being represented is effective demand- the ability of consumers not just to want, but be able to buy the product. Quantity demanded is the inverse function of price, however there are other factors which influence the level of demand. Factors influencing individual demand differ from the factors influencing market demand. The price of other goods and services affects the demand for a product. If a product has close substitutes, then the responsiveness of demand to change in price is high. The level of income of an individual also influences demand (especially effective demand). The higher ones income the number of wants to be satisfied. People on higher incomes spend more money on goods and services in absolute terms, but less in proportional terms due to their lower average propensity to consume. Personal preference and trends in fashion also dictate the level of individual demand. The size of the population, age composition, distribution of people by sex, and socio-economic status influence the market demand. Big businesses study the composition of the population to best establish their most viable market place. Both consumer expectations and the level of technological progress influence market demand. These factors may affect demand either positively or negatively, resulting in an expansion or contraction of demand. The following model works on the assumption that aside from price all other factors will be kept constant. When the demand curve shifts to the right or left this results in consumers willing to buy more/less of the product at every possible price. A shift in the demand curve could be resulting from changes in tastes, real income, population size and composition, consumer expectations or technological progress. These factors often work simultaneously to increase or decrease demand. However these factors do not apply similarly to all goods. The demand for generic brand products decreases as income rises. The price elasticity of demand refers to the responsiveness of quantity demanded to a change in price. Elasticity is represented by the mathematical formula where the change in quantity demanded is divided by the change in price. If the resulting coefficient is less than one, the product is said to be inelastic. Thus, if prices change by a greater proportion than quantity demanded, the product is inelastic. This applies to basic goods and services, necessities such as bread, and habit-forming goods such as cigarettes. A good is unit elastic if the coefficient of the equation is equal to one. Thus the proportional change in price is equal to the proportional change in quantity demanded. If the proportional change in quantity is greater than the change in price, then the product is said to be elastic. These goods and services are usually quite durable, and high priced such as furniture. There are usually lots of close substitutes, and the industry of the good or service is very competitive. These concepts of elasticity can be visually represented by the gradient or slant of the demand curve. The steeper a curve, the greater the inelasticity, as changes in quantity demanded is quite small. The elasticity of a product is important to governments and producers in making economic decisions. For producers, the elasticity of a product determines any possible price changes. If a product is elastic for example, a price rise may lead to lower total revenue as demand sharply drops. Over the long term businesses try to overcome elasticity by building consumer goodwill and brand loyalty through advertising. Governments, likewise exploit elasticity to maximise total revenue. Governments usually impose high taxes on relatively inelastic goods such as alcohol and tobacco. Despite the higher cost of the product, the demand remains relatively similar, and thus governments earn more from their taxation policy. Both demand and elasticity work in conjunction to influence the decision making process of business and government. They are subject to change due to a number of external factors, yet help in maintaining equilibrium in the  market. Graphs *demand curve *expansion and contraction in demand *shifts in the demand curve *elasticity

Glory :: Movie Film Review Glory Essays

Glory Glory captures the heroism of Colonel Robert Gould Shaw and the first black regiment in the Civil War, the Massachusetts "Fighting" Fifty-fourth. An extremely talented cast and crew earned three Academy Awards (cinematography, sound and supporting actor) and five nominations for their work in Glory. The outstanding cinematography, sound, score and acting recreate the events leading up to the Union attack on Fort Wagner on July 18th 1863. Matthew Broderick portrays the young Bostonian abolitionist Col. Robert G. Shaw who takes command of the Fifty-fourth, following the Emancipation Proclamation. Shaw along with Cabot Forbes (Cary Elwes) leads a band of ex slaves, servants and other black volunteers including a rebellious runaway slave Trip (Denzel Washington), Shaw's educated childhood friend Thomas Searles (Andre Braugher), and a former grave digger Rawlins (Morgan Freeman). Together these men face the adversity of a racist Union Army, struggling to prove themselves worthy of their government issued blue uniforms. After months of training and exploitation for physical labor, the Fifty- fourth gains the opportunity to fight in an attack on Fort Wagner on the beaches of South Carolina. Poised to dispel the belief that blacks would not be disciplined under fire, the Fifty-fourth leads the almost suicidal attack on Ft. Wagner. There Col. Shaw valiantly falls and the Fifty-fourth, suffering great losses, displayed the courage that persuaded the Union to enlist many more black soldiers. Matthew Broderick delivers a noteworthy performance in the role of Col. Shaw, which Leonard Maltin calls his most ambitious part. In an interview for the New York Times, Broderick spoke of his method acting, "The first step [in preparing for the role of Robert Gould Shaw in Glory] was to try to learn as much as I could about the real person. That was mostly from letters, photographs, descriptions and a poem by Emerson. The thing I had to do was bring myself into that situation. I didn't want to be an imitation of what I thought Shaw must have been like." Broderick's acting talent has been noted on Broadway as well as in films. Broderick won a Tony Award for his performance in "Brighton Beach Memoirs" in 1983, a year after his film debut in Max Dugan Returns. (Maltin, 102) But it was his role as a computer hacker in War Games and his role as a handsome young teen touring Chicago in Ferris Bueller's Day Off that alerted moviegoers to his talent. Denzel Washington has received critical acclaim for his role as Trip (as well as an Oscar for Best Supporting Actor). Denzel commented on the role of Trip in an interview with the New York Times.

Education and the Subjective Quality of Life* Essay

Journal of Health and Social Behavior 1997, Vol. 38 (September):275-297 We examine whether education influences subjective quality of life. If it does, what are the mechanisms by which education affects well-being? We propose that educa- tion improves well-being because it increases access to nonalienated paid work and economic resources that increase the sense of control over life, as well as access to stable social relationships, especially marriage, that increase social support. We examine the relationship between education and a variety of indicators of subjective quality of life-depression, anxiety, anger, aches and pains, malaise, and dissatis- faction. Using two representative national samples collected in 1990 and 1995, we find that the well educated have lower levels of emotional distress (including depres- sion, anxiety, and anger) and physical distress (including aches and pains and malaise), but they do not have lower levels of dissatisfaction. Education reduces dis- tress largely by way of paid work, nonalienated work, and economic resources, which are associated with high personal control; but the extent to which it reduces distress by way of marriage and social support is much more modest. We contrast distress and dissatisfaction as indicators of the subjective quality of life. Does education matter to subjective quality of life? If it does, what are the mechanisms by which education affects well-being? We pro- pose that education is valuable to individual well-being because it provides access to the two primary determinants of well-being: non- *We are indebted to the National Institute on Aging for the grant (ROI AG12393) to John Mirowsky and Catherine Ross that supported the Aging, Status, and the Sense of Control (ASOC) data collection and analysis. We are indebted to the National Science Foundation for the grant (SES- 8916154) to Catherine Ross that supported the Work, Family, and Well-Being (WFW) data collec- tion. Sampling, pretesting, and interviewing for both surveys were conducted by the Survey Research Laboratory of the University of Illinois. We thank John Mirowsky for his statistical help, Barbara Reskin for her help with the comparison process theory of satisfaction, and JHSB reviewers for their suggestions. Address correspondence to: Catherine Ross, Department of Sociology, 300 Bricker Hall, 190 North Oval Mall, The Ohio State University, Columbus, OH 43210-1353; e-mail: ross. 131 @osu. edu. alienated paid work and supportive relation- ships. Compared to the poorly educated, we expect that well-educated persons have access to nonalienated paid work that increases the sense of personal control. Well-being comes, first, from nonalienated work in which people exert control over the labor process (Kohn 1976; Marx ([1884] 1964). Work that gives people the freedom from routinization, monot- ony, and external control on the one hand, and a chance to use their skills, develop as a per- son, and learn new things on the other, theo- retically increases subjective well-being, in part by increasing perceived control. Com- pared to the poorly educated, we also expect that well-educated individuals have access to stable social relationships, especially mar- riage, that increase social support. Well-being comes, second, from primary group ties and social bonds that increase supportive relation- ships with others, especially the personal secu- rity of marriage, and the sense of having other people to talk to and turn to in times of need (Durkheim 1951; Litwak and Messeri 1989). We propose that, through these processes, 275 276 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR education improves the subjective quality of life, measured as psychological well-being and distress. We extend core economic and sociological perspectives on the meaning of education to individual well-being. We argue that educa- tion’s value extends beyond jobs, earnings, prestige, and power to people’s psychological well-being. According to human capital and status attainment theories, employers need workers who can read, write, do basic math, communicate, negotiate, solve problems, look things up, figure things out, and develop ideas; this human capital is acquired in school, and these skills, knowledge, and abilities help a person get a good job (Blau and Duncan 1967; Becker 1964; Hyman, Wright, and Reed 1975; Sewell and Hauser 1975; Spaeth 1976; Treiman and Terrell 1975). The same skills and abilities shaped by schooling, we argue, improve individual well-being through their effects on objective life conditions and social psychological resources. THE LINKS BETWEEN EDUCATION AND DISTRESS The negative association between education and psychological distress is well documented (Glenn and Weaver 1981; Kessler 1982; Lennon and Rosenfield 1992; Link, Lennon, and Dohrenwend 1993; Mirowsky and Ross 1989, 1995; Pearlin et al. 1981; Ross and Huber 1985; Ross and Mirowsky 1989), but the mechanisms by which education affects well-being are not. Education is rarely the focus of investigation in the sociological study of stress (Pearlin 1989). Instead, it is usually a control variable in research whose focus is on something else. This means that research has not identified the mechanisms by which edu- cation affects psychological well-being. Furthermore, when subjective well-being is measured as satisfaction, researchers find little positive effect of education. This raises the question of whether education’s effect is uni- formly positive. Well-educated persons are not more satisfied with their jobs than the poorly educated (Andrisani 1978; Gordon and Arvey 1975; Glenn and Weaver 1982; Quinn, Staines, and McCullough 1974; Ross and Reskin 1992), and they are not more satisfied with life in general (Pascarella and Terenzini 1991). Some argue that if education does not increase job satisfaction, or satisfaction over- all, maybe it has little real value to the subjec- tive quality of life, since a principal motivation for attaining a high level of formal education in the United States is access to satisfying work (Berg 1971; Quinn and Mandilovitch 1977). We examine the relationship between edu- cation and a variety of indicators of subjective quality of life. We distinguish distress- depression, anxiety, anger, aches and pains, and malaise-from dissatisfaction. Theo- retically, distress results from deprivation, whereas dissatisfaction results from depriva- tion relative to one’s expectations (Mirowsky and Ross 1989). We propose that education improves the subjective quality of life, mea- sured as psychological well-being and distress -measures not confounded by high expecta- tions among the advantaged. If education cor- relates positively with subjective well-being, what explains the association? We focus on two pathways by which education might affect individual well-being: (1) work and economic conditions, which increase personal control and (2) marriage and family conditions, which increase social support. Often educational attainment is used simply as an indicator of socioeconomic status. However, education, income, and work indi- cate different underlying concepts, so we keep the three aspects separate. Schooling indicates the accumulated knowledge, skills, values, and behaviors learned at school, in addition to being a credential that structures employment opportunities. Income and economic hardship indicate economic well-being. Work is pro- ductive activity (paid or not). Further, educa- tion, employment, and economic resources are not on the same causal level. Education is the key to one’s position in the stratification sys- tem; it shapes the likelihood of being em- ployed, the qualities of the job a person can get, and income. Combining variables from different causal levels obscures processes. If education affects psychological well-being, is its effect direct, or is it indirect by way of work or economic resources? Work and Economic Conditions Paid Work. Well-educated people are more likely to be employed and are more likely to be employed full-time (vs. part-time) than are those EDUCATION AND THE SUBJECTIVE QUALITY OF LIFE 277 with little education (U. S. Department of Education 1992). Employment, especially full- time employment, in turn, is associated with higher levels of psychological and physical well-being (Gore and Mangione 1983; Lennon and Rosenfield 1992; Pearlin et al. 1981; Ross and Bird 1994; Verbrugge 1983). Although physical and mental health affect an individual’s likelihood of being employed, the positive asso- ciation between well-being and employment is not simply due to the selection of healthy people into the work force (Kessler, House, and Turner 1987; Ross and Mirowsky 1995). Nonalienated Work. We expect that educa- tion gives people access to nonalienated work that involves a variety of tasks, nonroutine work, and the chance for continued learning and development, which decreases distress. In nonalienated work, workers control the labor process; they have the chance to use their skills in the design and implementation of the work. Nonroutine work gives people the free- dom to use thought and independent judgment in doing different things in different ways rather than doing the same thing in the same way in a process designed and controlled by others. Skilled work gives people the chance to learn new things and develop as a person through work. Together, creative, nonroutine, independent work that gives a person control over the labor process, and work that is intrin- sic to a person’s development not external to it, are the essence of nonalienated labor. Kohn and colleagues find that control over the work process, rather than ownership of the means of production or control over the labor of others, is most important to psychological functioning (Kohn 1976; Kohn and Schooler 1982; Kohn et al. 1990). We expect that the work done by well- educated people is less alienated than that done by the poorly educated, and that this work decreases distress. However, the evi- dence as to whether work characteristics explain some of the effect of education on psy- chological well-being is mixed. Lennon (1994) finds that the effect of education on depression is explained when work condi- tions-autonomy, time pressure, responsibili- ty, interruptions, physical effort, and routine- are added. Link and colleagues (1993) find that education’s impact on psychological well- being works largely through giving individu- als access to jobs involving direction, control, and planning. However, others find that the effect of education on distress remains unchanged with adjustment for job control and other occupational characteristics (Kessler 1982; Lennon and Rosenfield 1992). Economic Resources. Low levels of educa- tion increase economic hardship. Individuals with low levels of education have lower incomes than those with high levels of educa- tion (Sewell and Hauser 1975), in part because they are less likely to be employed, and if employed, more likely to hold low-level jobs. Low levels of education further deprive people of the problem-solving resources needed to cope with the stresses of economic hardship. Ross and Huber (1985) find a synergistic effect on economic hardship of low education and low income, each making the effect of the other worse. Hardship increases psychological distress; the chronic strain of struggling to pay the bills and to feed and clothe the children takes its toll, often in feelings of depression and malaise (Pearlin et al. 1981; Ross and Huber 1985). Marriage and Family Composition Marital Status. Evidence that education is positively associated with marriage is some- what mixed and indirect. The well educated are less likely to divorce, probably due to the fact that they marry later and do so under more favorable economic conditions (Glick 1984; Houseknecht and Spanier 1980). Education is negatively associated with widowhood, too, since men and women choose partners with similar levels of education (Kalmijn 1991; Qian and Preston 1993), and well-educated people live longer than those with lower levels of education (Rogot, Sorlie, and Johnson 1992). Although education is negatively asso- ciated with marital dissolution, either through divorce or widowhood, it is also negatively associated with marrying in the first place, especially for some groups. Education decreases the probability of ever marrying among Whites, while highly educated Blacks are more likely to marry than Blacks with lower levels of education (Bennett, Bloom, and Craig 1989). Women with high levels of education are more likely to postpone mar- riage, not to remarry after divorce, and never marry in the first place than are women with lower levels of education; and women who fail to marry in young adulthood attain a higher 278 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR level of education than those who do marry (McLanahan and Casper 1994). All told, how- ever, well-educated women and men are more likely to be currently married than those with- out high school degrees (Qian and Preston 1993). Overall, married people and those who live with partners are healthier and happier than those who are single, divorced, or widowed (Waite 1995). Married people have higher lev- els of physical and psychological well-being than do unmarried people (Gove, Hughes, and Style 1983; Ross, Mirowsky, and Goldsteen 1990; Ross 1995). If marriage has any nega- tive effects on well-being, it may be due to child care responsibilities, which fall dispro- portionately on women. People with children at home do not have higher levels of psycho- logical well-being than nonparents (Gore and Mangione 1983; Kessler and McRae 1982; McLanahan and Adams 1987). In many instances, parents-especially mothers-are more psychologically distressed than non- parents (Gove and Geerken 1977; Pearlin 1975). Most of the stress of children in the home is due to economic strains, excessive child care responsibilities, and difficulties arranging child care while parents are at work (Ross and Huber 1985; Ross and Mirowsky 1988). Since children often accompany mar- riage, the effect of marriage on well-being may not be uniformly positive. However, the well educated may get the benefits of mar- riage, without the stress associated with chil- dren, since well-educated women have fewer children than poorly educated women. Women with high levels of education are more likely to remain childless, to postpone having chil- dren, and to have fewer children than are those with lower levels of education (Bloom and Trussel 1984; Rindfuss, Morgan, and Swice- good 1984; Veevers 1979). Since men and women tend to choose partners with similar levels of education (Kalmijn 1991; Qian and Preston 1993), well-educated men have fewer children, too. Social-Psychological Resources Sense of Control. Belief in personal control is a learned, generalized expectation that out- comes are contingent on one’s own choices and actions (Mirowsky and Ross 1989; Rotter 1966). The sense of powerlessness, the oppo- site, is the belief that one’s actions do not affect outcomes. It is the main form of subjec- tive alienation (Seeman 1959, 1983). Education correlates positively with the sense of control, and the sense of personal control mediates a large part of the negative associa- tion between education and distress (Mirow- sky and Ross 1989; Ross and Mirowsky 1989). The well educated have higher person- al control than the poorly educated, even adjusting for employment, job autonomy, earnings, minority status, age, marital status, sex, and household work (Bird and Ross 1993; Ross and Mirowsky 1992). People with high levels of personal control have low levels of psychological distress (Aneshensel 1992; Gecas 1989; Mirowsky and Ross 1986; Pearlin et al. 1981; Wheaton 1980, 1983), and perceived control over both good and bad outcomes correlates negatively with depression (Krause and Stryker 1984; Mirowsky and Ross 1990). High personal con- trol helps people cope actively and flexibly, to avoid problems and to prepare for those that cannot be avoided (Mirowsky and Ross 1989; Turner and Noh 1983; Wheaton 1983). In con- trast, the sense of powerlessness is demoraliz- ing in itself and interferes with active problem- solving. Social Support. Social support is the com- mitment, caring, advice, and aid provided in personal relationships, the sense of being cared for and loved, esteemed and valued as a person, and part of a network of communica- tion and obligation (Kaplan, Robbins, and Martin 1983). Little research has examined the social determinants of support. Education may provide social support by giving people access to multiple roles with independent social net- works which boost the potential for supportive relationships (Walker, Wasserman, and Wellman 1993). Education may also help peo- ple maintain supportive relationships with oth- ers directly by way of increased flexibility in dealing with problems, the ability to negotiate and compromise, and to see more than one side of an issue; and indirectly by reducing stressors of unemployment, poverty, and eco- nomic hardship which strain interpersonal relationships (Atkinson, Liem, and Liem 1986; Gore 1978). Ross and Mirowsky (1989) find that the well educated have higher levels of support than the poorly educated, but few other studies have examined the association between education and social support. EDUCATION AND THE SUBJECTIVE QUALITY OF LIFE 279 Low levels of social support, especially emotional support, are associated with psycho- logical distress, including depression and anx- iety, and poor health (Gerstel, Riessman, and Rosenfield 1985; House, Landis, and Um- berson 1988; Kessler and McLeod 1985). Social support reduces distress directly and it interacts with stressful life events and situa- tions, buffering their negative effect (Wheaton 1983). Summary of Proposed Mechanisms by Which Education Affects Distress We propose that education gives people access to nonalienated paid work and eco- nomic resources that increase the sense of personal control, and that education gives peo- ple access to stable social relationships, espe- cially marriage, that increase social support. Through these processes, we hypothesize, education affects subjective quality of life. SAMPLES We use two representative national samples. With these we will replicate regression analy- ses in order to strengthen confidence in our results, distinguish robust findings from sample-specific ones, and comprehensively measure distress and dissatisfaction in two years. The first is the Aging, Status, and the Sense of Control (ASOC) survey. It is a 1995 telephone survey of a national probability sample of U. S. households. Respondents were selected using a prescreened random-digit dialing method that increases the rate of con- tacting eligible numbers (or decreases the rate of contacting business and nonworking num- bers) and decreases standard errors compared to the standard Mitofsky-Waksberg method while producing a sample with the same demographic profile (Lund and Wright 1994; Waksberg 1978). The ASOC survey has two subsamples, designed to produce an 80 percent oversample of persons age 60 and older. The survey was limited to English-speaking adults. The main sample draws from all households; the oversample draws only from households with one or more seniors. In the main sample, the adult (18 or older) with the most recent birthday was selected as respondent.

The Basics of Getting Started in Homeschooling

When youre new to homeschooling, the logistics can seem overwhelming, but it doesnt have to be a stressful time. These homeschooling basics will help you have your homeschool up and running as stress-free as possible. 1. Make the Decision to Homeschool Making the decision to homeschool can be  difficult and is not one to be made lightly. As you are  deciding if homeschooling is right for you, consider factors such as: The time commitmentThe pros and cons of homeschooling based on your family’s needsYour spouse and child’s opinions about homeschooling There are many factors that go into deciding to homeschool and many are unique to your family’s specific needs. Talk to other homeschooling families in person or online. Consider attending a homeschool support group meeting or find out if the groups in your area offer  events for new homeschooling families. Some groups will pair families with an experienced mentor or host QA nights. 2. Understand  Homeschool Laws It is important to know and follow the homeschool laws and requirements of your state or region. Although homeschooling is legal in all 50  states, some  are more heavily regulated than others, particularly if your child is  a certain age (6 or 7 to 16 or 17  in most states) or has already been enrolled in public school. Make sure that you understand what is required of you to withdraw your child from school (if applicable) and  begin homeschooling. If your child has not been in school, make sure you know the age by which you must notify your state that you will be educating at home. 3.  Start  Strong Once you make the decision to homeschool, you’ll want to do all that you can to ensure that you start on a positive note.  If your student is transitioning from public school to homeschool, there are steps you can  take to smooth the transition. For example, you’ll want to allow time for everyone to make the adjustment. You don’t have to make every decision right away. You may find yourself in the position of wondering what to do if your child doesn’t want to homeschool. Sometimes that is simply part of the adjustment period. Other times, there are root causes that you will need to address. Be willing to learn from the mistakes of veteran homeschooling parents and to listen to your own instincts regarding your children. 4. Choose a Support Group Meeting together with other homeschoolers can be helpful, but finding a support group can sometimes be difficult. It often takes patience to find the right match for your family. Support groups can be a great source of encouragement. The leaders and members can often help with choosing curriculum, understanding whats required for record-keeping, understanding state homeschool laws, and providing opportunities and activities for your students. You can begin by searching for homeschool support groups by state or asking other homeschool families you may know. You may also find great support in online support groups. 5. Select  Curriculum Selecting your homeschool curriculum can be overwhelming. There is a dizzying array of options and it’s easy  to overspend and still not find the right curriculum for your student. You may not even need curriculum right away and can utilize free printables and your local library while you decide. Consider used curriculum or creating your own in order to save money on homeschool curriculum. 6. Learn the Basics  of Record Keeping It is very important to keep good records of your childs homeschool years. Your records can be as simple as a daily journal or as elaborate as a purchased computer program or notebook system. Your state may require that you write a homeschool progress report, keep a record of grades, or turn in a portfolio. Even if your state doesn’t require such reporting, many parents enjoy keeping portfolios, progress reports, or work samples as keepsakes of their children’s homeschooling years. 7. Learn the Basics of Scheduling Homeschoolers generally have a great deal of freedom and flexibility when it comes to  scheduling, but it sometimes takes a while to find  what works best for your family. Learning how to create a homeschool schedule doesnt have to be difficult when you break it down into manageable steps. It can be  helpful to ask other homeschooling families what a typical homeschool day looks like for them. A few tips to  consider: When your kids work best: Are they early birds or  night owls?Your spouse’s work scheduleOutside classes and commitments 8. Understand Homeschool Methods There are many methods  for homeschooling your children. Finding the right style for your family may take some trial and error. It’s  not uncommon to try a few different methods throughout your homeschooling years or to mix and match. You may find that some aspects of unschooling may work for your family or there may be some bits of the Charlotte Mason method or some unit study techniques you’d like to employ. The most important thing to remember is to be open to what works for your family rather than feeling that you have to make a lifetime commitment to a particular homeschooling method. 9. Attend a Homeschool Convention Homeschool conventions are much more than book sales. Most, particularly larger conventions, have vendor workshops and special speakers in addition to the vendor hall. The speakers can be a great source of inspiration and guidance. Homeschool conventions also provide a chance to talk to vendors who can answer your questions and help you determine which curriculum is right for your student. 10. Know What to Do If You Begin Homeschool  Mid-year Is it possible to begin homeschooling midyear? Yes! Just remember to check your state’s homeschool laws so that you know how to properly withdraw your children from school and begin homeschooling. Don’t feel that you have to jump into a homeschool curriculum right away. Utilize your library and online resources while you figure out the best homeschool curriculum choices for your student. Homeschooling is a big decision, but it doesnt have to be difficult or overwhelming to get started.