"A renewed sense of purpose": Mothers' and fathers' experience of having a child following a recent stillbirth.

Background Most research has focused on mothers¿ experiences of perinatal loss itself or on the subsequent pregnancy, whereas little attention has been paid to both parents¿ experiences of having a child following late perinatal loss and the experience of parenting this child. The current study therefore explored mothers¿ and fathers' experiences of becoming a parent to a child born after a recent stillbirth, covering the period of the second pregnancy and up to two years after the birth of the next baby.MethodIn depth interviews were conducted with 7 couples (14 participants). Couples were eligible if they previously had a stillbirth (after 24 weeks of gestation) and subsequently had another child (their first live baby) who was now under the age of 2 years. Couples who had more than one child after experiencing a stillbirth and those who were not fluent in English were excluded. Qualitative analysis of the interview data was conducted using Interpretive Phenomenological Analysis.ResultsFive superordinate themes emerged from the data: Living with uncertainty; Coping with uncertainty; Relationship with the next child; The continuing grief process; Identity as a parent. Overall, fathers' experiences were similar to those of mothers', including high levels of anxiety and guilt during the subsequent pregnancy and after the child was born. Coping strategies to address these were identified. Differences between mothers and fathers regarding the grief process during the subsequent pregnancy and after their second child was born were identified. Despite difficulties with bonding during pregnancy and at the time when the baby was born, parents' perceptions of their relationship with their subsequent child were positive.ConclusionsFindings highlight the importance of tailoring support systems not only according to mothers' but also to fathers' needs. Parents¿, and particularly fathers', reported lack of opportunities for grieving as well as the high level of anxiety of both parents about their baby's wellbeing during pregnancy and after birth implies a need for structured support. Difficulties experienced in bonding with the subsequent child during pregnancy and once the child is born need to be normalised.

Identifying the unmet health needs of patients with congenital hypogonadotropic hypogonadism using a web-based needs assessment: implications for online interventions and peer-to-peer support.

BACKGROUND: Patients with rare diseases such as congenital hypogonadotropic hypogonadism (CHH) are dispersed, often challenged to find specialized care and face other health disparities. The internet has the potential to reach a wide audience of rare disease patients and can help connect patients and specialists. Therefore, this study aimed to: (i) determine if web-based platforms could be effectively used to conduct an online needs assessment of dispersed CHH patients; (ii) identify the unmet health and informational needs of CHH patients and (iii) assess patient acceptability regarding patient-centered, web-based interventions to bridge shortfalls in care. METHODS: A sequential mixed-methods design was used: first, an online survey was conducted to evaluate health promoting behavior and identify unmet health and informational needs of CHH men. Subsequently, patient focus groups were held to explore specific patient-identified targets for care and to examine the acceptability of possible online interventions. Descriptive statistics and thematic qualitative analyses were used. RESULTS: 105 male participants completed the online survey (mean age 37 ± 11, range 19-66 years) representing a spectrum of patients across a broad socioeconomic range and all but one subject had adequate healthcare literacy. The survey revealed periods of non-adherence to treatment (34/93, 37%) and gaps in healthcare (36/87, 41%) exceeding one year. Patient focus groups identified lasting psychological effects related to feelings of isolation, shame and body-image concerns. Survey respondents were active internet users, nearly all had sought CHH information online (101/105, 96%), and they rated the internet, healthcare providers, and online community as equally important CHH information sources. Focus group participants were overwhelmingly positive regarding online interventions/support with links to reach expert healthcare providers and for peer-to-peer support. CONCLUSION: The web-based needs assessment was an effective way to reach dispersed CHH patients. These individuals often have long gaps in care and struggle with the psychosocial sequelae of CHH. They are highly motivated internet users seeking information and tapping into online communities and are receptive to novel web-based interventions addressing their unmet needs.

A Temporal Analysis of Emotions in Girls' Secondary School Physical Education Games and Fitness Classes

Female enthusiasm towards engaging in physical education (PE) significantly decreases with age as it provides females with positive and negative emotional experiences. This study examined emotions within four grade nine female PE soccer and fitness classes (N = 67). Emotional patterns were studied over time and across two units of instruction and in relation to student grades. A mixed-method approach was utilized assessing the state emotions of shame, enjoyment, anxiety, and social physique anxiety (SPA). Results revealed unsatisfactory internal consistency for shame and thus it was removed. Statistical analysis revealed no significant changes in emotions over time, whereas qualitative analysis found that state emotions were inconsistent. Statistical analysis indicated that students in the fitness classes reported significantly higher levels of anxiety and SPA on the final class (p < .01). Qualitative analysis signaled different origins and themes of students‟ emotions. No predictive relationship between emotion and students‟ grade was found.

Émotions et identité : le rôle des émotions dans la formation de l'identité narrative

Cette thèse met en place un modèle permettant d'éclairer les relations entre certaines émotions et la conception que l'individu a de lui-même. En accord avec plusieurs auteurs contemporains, il est ici défendu que la conception que nous avons de nous-mêmes prend la forme d'une identité narrative, c'est-à-dire d'un récit à l'intérieur duquel nous tentons de structurer une image cohérente de nous-mêmes. Dans cette perspective, il est proposé qu'un certain groupe d'émotions, comme la honte, la fierté et la culpabilité, occupe une place cruciale dans la formation et le maintien de cette image de soi. Ces émotions, que nous pouvons qualifier d'auto-évaluatives, conditionnent l'évaluation que nous avons de nous-mêmes et participent ainsi à l'élaboration de la représentation de soi. De plus, cette identité narrative, à travers un certain aspect normatif et motivant, vient à son tour influencer la manifestation et l'interprétation de ces mêmes émotions. Ainsi, la relation entre les émotions auto-évaluatives et l'identité narrative serait une relation complexe d'influences réciproques. L’analyse proposée devrait permettre de clarifier de nombreux aspects de l’économie mentale de l’individu et plus particulièrement de sa motivation morale.

Climate Change and "historical responsibilities"

The historical responsibility of countries listed in the Annex I of the Convention on Climate Change has been used extensively as a justification for the lack of action of countries not included in Annex I to reduce their greenhouse gas emissions. We analyzed the contribution of non-Annex I countries to the CO2 emissions in the period 1850 - 2006 to assess their relative contribution to total CO2 emissions. In the period 1980 - 2006 non-Annex I countries represented 44% of the total but this contribution increased in the period 1990 - 2006 to 48%. If we extrapolate present trends to 2020 they will represent 56% in the period 1990 - 2020. The "historical responsibility" of Annex I countries is therefore decreasing. If we take 1990 as the starting year in which the Climate Convention recognized clearly that greenhouse gases are interfering dangerously with the climate system, it becomes very difficult to attribute "blame" and "guilt" to Annex I for their historical contributions. It becomes also quite clear the need of non-Annex I countries to engage with Annex I countries in the effort to reduce emissions. The Copenhagen Accord has no mention of "historical responsibilities".

The relationship between eating behavior and psychological distress among overweight and obese people: is there a role for mindfulness?

This research based on 3 indipendent studies, sought to explore the nature of the relationship between overweight/obesity, eating behaviors and psychological distress; the construct of Mindful eating trough the validation of the Italian adaptation of the Mindful Eating Questionnaire (MEQ); the role of mindfulnessand mindful eating as respectively potential mediator and moderator between overeating behavior (binge eating and emotional overeating) and negative outcomes (psychological distress, body dissatisfaction). All the samples were divided in normal weight, overweight and obese according to BMI categories. STUDY1: In a sample of 691 subjects (69.6% female, mean aged 39.26 years) was found that BMI was not associated with psychological distress, whereas binge eating increases the psychopathological level. BMI and male gender represent negative predictors of psychological distress, but certain types of overeating (i.e., NES/grazing, overeating during or out of meals, and guilt/restraint) result as positive predictors.. STUDY 2 : A sample of 1067 subjects (61.4% female, mean aged 34 years) was analized. The Italian MEQ resulted in a 26-item 4-factor model measuring Disinhibition, Awareness, Distraction, and Emotional response. Internal consistency and test-retest reliability were acceptable MEQ correlated positively with mindfulness (FMI) and it was associated with sociodemographic variables, BMI, meditation. type of exercise and diet. STUDY 3, based on a sample of 502 subjects (68.8% female, mean aged 39.42 years) showed that MEQ and FMI negatively correlated with BES, EOQ, SCL-90-R, and BIAQ. Obese people showed lower level of mindful eating and higher levels of binge eating, emotional overeating, and body dissatisfaction, compared to the other groups Mindfulness resulted to partially mediates the relationship between a) binge eating and psychological distress, b) emotional overeating and psychological distress, c) binge eating and mental well-being, d) emotional overeating and menal well-being. Mindful eating was a moderator only in the relationship between emotional overeating and body dissatisfaction.

Irrational Beliefs and Psychological Distress: A Meta-Analysis

Background: Since the cognitive revolution of the early 1950s, cognitions have been discussed as central components in the understanding and treatment of mental illnesses. Even though there is an extensive literature on the association between therapy-related cognitions such as irrational beliefs and psychological distress over the past 60 years, there is little meta-analytical knowledge about the nature of this association. Methods: The relationship between irrational beliefs and distress was examined based on a systematic review that included 100 independent samples, gathered in 83 primary studies, using a random-effect model. The overall effects as well as potential moderators were examined: (a) distress measure, (b) irrational belief measure, (c) irrational belief type, (d) method of assessment of distress, (e) nature of irrational beliefs, (f) time lag between irrational beliefs and distress assessment, (g) nature of stressful events, (h) sample characteristics (i.e. age, gender, income, and educational, marital, occupational and clinical status), (i) developer/validator status of the author(s), and (k) publication year and country. Results: Overall, irrational beliefs were positively associated with various types of distress, such as general distress, anxiety, depression, anger, and guilt (omnibus: r = 0.38). The following variables were significant moderators of the relationship between the intensity of irrational beliefs and the level of distress: irrational belief measure and type, stressful event, age, educational and clinical status, and developer/validator status of the author. Conclusions: Irrational beliefs and distress are moderately connected to each other; this relationship remains significant even after controlling for several potential covariates.

Jury decision making and the Story Model: How do deliberation style and evidence order influence the story that juries create?

This study investigated the utility of the Story Model for decision making at the jury level by examining the influence of evidence order and deliberation style on story consistency and guilt. Participants were shown a video-taped trial stimulus and then provided case perceptions including a guilt judgment and a narrative about what occurred during the incident. Participants then deliberated for approximately thirty minutes using either an evidence-driven or verdict-driven deliberation style before again providing case perceptions, including a guilt determination, a narrative about what happened during the incident, and an evidence recognition test. Multi-level regression analyses revealed that evidence order, deliberation style and sample interacted to influence both story consistency measures and guilt. Among students, participants in the verdict-driven deliberation condition formed more consistent pro-prosecution stories when the prosecution presented their case in story-order, while participants in the evidence-driven deliberation condition formed more consistent pro-prosecution stories when the defense's case was presented in story-order. Findings were the opposite among community members, with participants in the verdict-driven deliberation condition forming more consistent pro-prosecution stories when the defense's case was presented in story-order, and participants in the evidence-driven deliberation condition forming more consistent pro-prosecution stories when the prosecution's case was presented in story-order. Additionally several story consistency measures influenced guilt decisions. Thus there is some support for the hypothesis that story consistency mediates the influence of evidence order and deliberation style on guilt decisions.

Experiences of Internalized and Enacted Stigma among Women with Obstetric Fistula in Tanzania

Background: Obstetric fistula is the development of a necrosis between the bladder and the vagina and/or the bladder and the rectum as a result of prolonged obstructed labor, resulting in urinary or fecal incontinence. In Tanzania surgical repair for obstetric fistula is provided freely by the government but it is estimated that there are over 25,000 women living with an untreated fistula. These women experience high degrees of psycho-social stresses exacerbated by the stigma surrounding their condition. There is a dire need to explore stigma within this population in order to better understand its impact, as stigma affects both treatment seeking behavior as well as long term recovery of those who access surgical repair.

Study Aims: This study aims to understand the experiences of stigma among women with obstetric fistulas by examining both internalized and enacted stigma, and by identifying pertinent correlates of internalized stigma.

Methods: This mixed-methods study utilized both quantitative and qualitative data collected in two related studies at a single hospital in Moshi, Tanzania. All study participants were women receiving surgical repair for an obstetric fistula. In the quantitative portion, cross-sectional survey data were collected from 52 patients. The primary outcome was fistula-related stigma, measured using an adaptation of the HASI-P stigma scale, which included constructs of both internalized and enacted stigma. In the qualitative portion, 45 patients participated in a semi-structured in-depth interview, which explored topics such as stressors caused by the fistula, coping mechanisms, and available support. The transcripts were analyzed using analytic memos and an iterative process of thematic coding using the framework of content analysis.

Results: Expressions of internalized stigma were common in the sample, with a median score of 2.1 on a scale of 0 – 3. Internalized was significantly correlated with negative religious coping, social participation, impact of incontinence and enacted stigma. Qualitative analysis was consistent and demonstrated widespread themes of shame and embarrassment. Experiences of enacted stigma were not as common (median score of 0), although some items, like those pertaining to mockery and blame, were endorsed by up to 25% of the study sample. Themes of anticipated stigma (isolation and non-disclosure due to the possibility of stigmatization) were also evident in the qualitative sample and may explain the low enacted stigma scores observed.

Conclusion: In this sample of women receiving surgical repair for an obstetric fistula, stigma was evident, with internalized stigma resulting in psychological impacts for patients. Experiences of both anticipated and enacted stigma were also observed. There is a need to explore interventions that would decrease stigma while also increasing support for these women, as stigma may be a barrier towards accessing surgical repair and reintegration following surgery.

Keywords: Tanzania, obstetric fistula, stigma, maternal health

Exploring the needs, concerns and knowledge of women diagnosed with gestational diabetes: A qualitative study

Objective
To explore the concerns, needs and knowledge of women diagnosed with Gestational Diabetes Mellitus (GDM).
Design
A qualitative study of women with GDM or a history of GDM.
Methods
Nineteen women who were both pregnant and recently diagnosed with GDM or post- natal with a recent history of GDM were recruited from outpatient diabetes care clinics. This qualitative study utilised focus groups. Participants were asked a series of open-ended questions to explore 1) current knowledge of GDM; 2) anxiety when diagnosed with GDM, and whether this changed overtime; 3) understanding and managing GDM and 4) the future impact of GDM. The data were analysed using a conventional content analysis approach.
Findings
Women experience a steep learning curve when initially diagnosed and eventually become skilled at managing their disease effectively. The use of insulin is associated with fear and guilt. Diet advice was sometimes complex and not culturally appropriate. Women appear not to be fully aware of the short or long-term consequences of a diagnosis of GDM.
Conclusions
Midwives and other Health Care Professionals need to be cognisant of the impact of a diagnosis of GDM and give individual and culturally appropriate advice (especially with regards to diet). High quality, evidence based information resources need to be made available to this group of women. Future health risks and lifestyle changes need to be discussed at diagnosis to ensure women have the opportunity to improve their health.

Adolescent boys’ health : managing emotions, masculinities and subjective social status

The health of adolescent boys is complex and surprisingly little is known about how adolescent boys perceive, conceptualise and experience their health. Thus, the overall aim of this thesis was to explore adolescent boys’ perceptions and experiences of health, emotions, masculinity and subjective social status (SSS). This thesis consists of a qualitative, a quantitative and a mixed methods study. The qualitative study aimed to explore how adolescent boys understand the concept of health and what they find important for its achievement. Furthermore, the adolescent boys’ views of masculinity, emotion management and their potential effects on wellbeing were explored. For this purpose, individual interviews were conducted with 33 adolescent boys aged 16-17 years. The quantitative study aimed to investigate the associations between pride, shame and health in adolescence. Data were collected through a cross-sectional postal survey with 705 adolescents. The purpose of the mixed methods study was to investigate associations between SSS in school, socioeconomic status (SES) and self-rated health (SRH), and to explore the concept of SSS in school. Cross-sectional data were combined with interview data in which the meaning of SSS was further explored. Individual interviews with 35 adolescents aged 17-18 years were conducted. In the qualitative study, data were analysed using Grounded Theory. In the quantitative study, statistical analyses (e.g., chi-square test and uni- and multivariable logistic regression analyses) were performed. In the mixed method study, a combination of statistical analyses and thematic network analysis was applied. The results showed that there was a complexity in how the adolescent boys viewed, experienced, dealt with and valued health. On a conceptual level, they perceived health as holistic but when dealing with difficult emotions, they were prone to separate the body from the mind. Thus, the adolescent boys experienced a difference between health as a concept and health as an experience (paper I). Concerning emotional orientation in masculinity, two main categories of masculine conceptions were identified: a gender-normative masculinity and a non-gender-normative masculinity (paper II). Gender-normative masculinity comprised two seemingly opposite emotional masculinity orientations, one towards toughness and the other towards sensitivity, both of which were highly influenced by contextual and situational group norms and demands, despite that their expressions are in contrast to each other. Non-gender-normative masculinity included an orientation towards sincerity, emphasising the personal values of the boys. Emotions were expressed more independently of peer group norms. The findings suggest that different masculinities and the expression of emotions are intricately intertwined and that managing emotions is vital for wellbeing. The present findings also showed that both shame and pride were significantly associated with SRH, and furthermore, that there seems to be a protective effect of experiencing pride for health (paper III). The results also demonstrated that SSS is strongly related to SRH, and high SRH is related to high SSS, and further that the positioning was done in a gendered space (paper IV). Results from all studies suggest that the emotional and relational aspects, as well as perceived SSS, were strongly related to SRH. Positive emotions, trustful relationships and having a sense of belonging were important factors for health and pride was an important emotion protecting health. Physical health, on the other hand, had a more subordinated value, but the body was experienced as an important tool to achieve health. Even though health was mainly perceived in a holistic manner by the boys, there were boys who were prone to dichotomise the health experience into a mind-body dualism when having to deal with difficult emotions. In conclusion, this thesis demonstrates that young, masculine health is largely experienced through emotions and relationships between individuals and their contexts affected by gendered practices. Health is to feel and function well in mind and body and to have trusting relationships. The results support theories on health as a social construction of interconnected processes. Having confidence in self-esteem, access to trustful relationships and the courage to resist traditional masculine norms while still reinforcing and maintaining social status are all conducive to good health. Researchers as well as professionals need to consider the complexity of adolescent boys’ health in which norms, values, relationships and gender form its social determinants. Those working with young boys should encourage them to integrate physical, social and emotional aspects of health into an interconnected and holistic experience.

A «corrupção e a fraude» no espaço comunicacional português e europeu: contributo para uma visão interdisciplinar constitucional criminológica e jurídico-penal

As formas de definir «corrupção e fraude» são infinitas, pelo que a aplicação do Direito penal constitucional pode ficar prejudicada. A comunicação e o comentário público e política são por vezes feitos em termos profundamente equivocados. Recentemente, em Portugal, destacados políticos e comentadores chegaram a apelar à «criminalização do enriquecimento ilícito», nem que fosse com o sacrifício da própria Constituição ou do Estado de Direito. É a democracia que passa a estar em perigo. Ao mesmo tempo que se defende com fanatismo quase teológico o sistema económico capitalista, procura-se consagrar na lei a sua destruição. Ou seja, há uma certa demagogia política que quer ter tudo ao mesmo tempo como se isso fosse possível. Perante isto, resta ao cidadão comum agir se for necessário sob as possibilidades das causas de justificação e fazendo uso do direito constitucional de resistência. ABSTRACT Ways to define «corruption and fraud» are endless, so the application of constitutional criminal law may be impaired. The communication and public comment and politics are sometimes done in terms profoundly mistaken. Recently, in Portugal, prominent politicians and commentators have come to call the «criminalization of illicit enrichment» (embezzlement) even if it was at the sacrifice of the Constitution or the rule of law. It is democracy that happens to be in danger. At the same time it defends itself with almost theological fanaticism the capitalist economic system, seeking to enshrine in law its destruction. That is, there is a certain political demagoguery that wants to have everything at the same time as if that were possible. Given this, it remains to ordinary act if necessary under the scope of defenses and making use of the constitutional right of resistance.

Keep calm enfrenta a vergonha : contributos para um programa de competências sócio-emocionais

Trabalho apresentado em XIII Congreso Internacional Galego-Portugués de Psicopedagoxía, Área 1 Aprendizaje, memoria y motivación. Universidad da Coruña, 2 de Setembro de 2015.

Keep calm enfrenta a vergonha : contributos para um programa de competências sócio-emocionais

Trabalho apresentado em XIII Congreso Internacional Galego-Portugués de Psicopedagoxía, Área 1 Aprendizaje, memoria y motivación. Universidad da Coruña, 2 de Setembro de 2015.

Contributo para a compreensão das causas de exclusão de ilicitude e da culpa no crime de acesso ilegítimo

Dissertação de mestrado em Direito e Informática