The interpersonal and mental health implications of the coherence of coming out narratives for a sample of gay men in committed romantic relationships

The coming out process has been conceptualized as a developmental imperative for those who will eventually accept their same-sex attractions. It is widely accepted that homophobia, heterosexism, and homonegativity are cultural realities that may complicate this developmental process for gay men. The current study views coming out as an extra-developmental life task that is at best a stressful event, and at worst traumatic when coming out results in the rupture of salient relationships with parents, siblings, and/or close friends. To date, the minority stress model (Meyer, 1995; 2003) has been utilized as an organizing framework for how to empirically examine external stressors and mental health disparities for lesbians, gay men, and bisexual individuals in the United States. The current study builds on this literature by focusing on the influence of how gay men make sense of and represent the coming out process in a semi-structured interview, more specifically, by examining the legacy of the coming out process on indicators of wellness. In a two-part process, this study first employs the framework well articulated in the adult attachment literature of coherence of narratives to explore both variation and implications of the coming out experience for a sample of gay men (n = 60) in romantic relationships (n = 30). In particular, this study employed constructs identified in the adult attachment literature, namely Preoccupied and Dismissing current state of mind, to code a Coming Out Interview (COI). In the present study current state of mind refers to the degree of coherent discourse produced about coming out experiences as relayed during the COI. Multilevel analyses tested the extent to which these COI dimensions, as revealed through an analysis of coming out narratives in the COI, were associated with relationship quality, including self-reported satisfaction and observed emotional tone in a standard laboratory interaction task and self-reported symptoms of psychopathology. In addition, multilevel analyses also assessed the Acceptance by primary relationship figures at the time of disclosure, as well as the degree of Outness at the time of the study. Results revealed that participant’s narratives on the COI varied with regard to Preoccupied and Dismissing current state of mind, suggesting that the AAI coding system provides a viable organizing framework for extracting meaning from coming out narratives as related to attachment relevant constructs. Multilevel modeling revealed construct validity of the attachment dimensions assessed via the COI; attachment (i.e., Preoccupied and Dismissing current state of mind) as assessed via the Adult Attachment Interview (AAI) was significantly correlated with the corresponding COI variables. These finding suggest both methodological and conceptual convergence between these two measures. However, with one exception, COI Preoccupied and Dismissing current state of mind did not predict relationship outcomes or self-reported internalizing and externalizing symptoms. However, further analyses revealed that the degree to which one is out to others moderated the relationship between COI Preoccupied and internalizing. Specifically, for those who were less out to others, there was a significant and positive relationship between Preoccupied current state of mind towards coming out and internalizing symptoms. In addition, the degree of perceived acceptance of sexual orientation by salient relationship figures at the time of disclosure emerged as a predictor of mental health. In particular, Acceptance was significantly negatively related to internalizing symptoms. Overall, the results offer preliminary support that gay men’s narratives do reflect variation as assessed by attachment dimensions and highlights the role of Acceptance by salient relationship figures at the time of disclosure. Still, for the most part, current state of mind towards coming out in this study was not associated with relationship quality and self-reported indicators of mental health. This finding may be a function of low statistical power given the modest sample size. However, the relationship between Preoccupied current state of mind and mental health (i.e., internalizing) appears to depend on degree of Outness. In addition, the response of primary relationships figures to coming out may be a relevant factor in shaping mental health outcomes for gay men. Limitations and suggestions for future research and clinical intervention are offered.

Perception of health benefits of dietary fibre among the Portuguese population

Introduction: Dietary iber (DF) has been part of human diet since ever, and its beneits for the human health have been well estab-lished and scientiically conirmed. Among these stand improved gastrointestinal functions, prevent cholesterol, diabetes or CVD. Objectives: To study the level of knowledge of people residing in Portugal about the health effects related to an adequate ingestion of DF. Methods: This is a descriptive cross-sectional study carried out on a non-probabilistic sample of 382 adults residing in Portugal. The questionnaire included a section about the socio-demographic characteristics (age, gender, level of education and living environ- ment) and another about the relation between dietary iber and possible beneicial effects to treat and prevent diseases. The data was treated using the SPSS software (V22). Results: The results allowed concluding that people were dif- ferently informed about the effects of DF in preventing and/or treating different diseases, being constipation the most recog- nized, followed in decreasing order by obesity, bowel cancer, cholesterol, cardiovascular diseases, diabetes and breast can- cer. The results also showed that signiicant differences were encountered between age groups for most of the diseases evalu- ated, but not between genders, levels of education or living en- vironments. Conclusions: Generally, it was concluded that the participants in this study were relatively well informed about the roles of DF in preventing and/or treating various diseases.

Locus de controle e a efetividade empresarial em microempresários do estado do Rio Grande do Norte

Entrepreneurs are individuals who can transform economic and social realities by promoting development, so it became important tools in generating externalities in regions where they operate. In Brazil, 59.9% of new ventures do not reach the fourth year of life, the mortality rate of new ventures is high. The causes of mortality are numerous, and within the behavioral aspects, one is the locus of control. This study determines the degree of association between internal locus of control and achieving business success of entrepreneurs in Rio Grande do Norte who participated in the workshop EMPRETEC. The approach that studies the behavior entrepreneurs agreed that there are psychological characteristics associated with a set of values, attitudes and needs that determine the behavior and induce the entrepreneur to achieve success. Among these features is the locus of control, a skill that individuals must identify in their actions, or lack of them, the causes of their successes and failures. The locus is external when the individual attributes to factors outside themselves as causes of their results, and is built in when you can identify the actions that led to success. We surveyed 223 entrepreneurs statewide who answered the questionnaire for assessing the scale of locus of control, selfassessment questionnaire of entrepreneurial characteristics of EMPRETEC and a questionnaire assessing the business success. 71.9% were identified as having success. Among the behavioral characteristics strongest in the group of entrepreneurs are setting goals and commitment. Was found for locus of control mean value of 7.35, confidence interval between 7.05 and 7.66. Showing that the locus of control group is predominantly internal. We also found a correlation between the locus and commitment, between setting goals and commitment; calculated risks and information search; search of information and commitment, and between commitment and independence and self confidence. Dependence was not identified among the set of features and business success, determining the absence of an ideal profile. However, logistic regression significant association was found indicating that the smaller the individual's locus of control increased the likelihood of it achieving business success

Une étude sur les déterminants biologiques, psychologiques et du travail de l'épuisement professionnel

Cette thèse de doctorat s’intéresse à mieux comprendre, d’une part, ce qui influence la sécrétion de cortisol salivaire, et d’autre part, ce qui influence l’épuisement professionnel. Plusieurs objectifs en découlent. D’abord, elle vise à mieux cerner la contribution des conditions de l’organisation du travail (utilisation des compétences, autorité décisionnelle, demandes psychologiques, demandes physiques, horaire de travail irrégulier, nombre d’heures travaillées, soutien social des collègues, soutien social des superviseurs, insécurité d’emploi) sur la sécrétion de cortisol salivaire, ainsi que le rôle modérateur de certains traits de personnalité (extraversion, agréabilité, névrosisme, conscience, ouverture d’esprit, estime de soi, centre de contrôle) sur la relation entre les conditions de l’organisation du travail et la sécrétion de cortisol salivaire. Par ailleurs, cette thèse vise à établir la contribution des conditions de l’organisation du travail sur l’épuisement professionnel, ainsi que le rôle modérateur des traits de personnalité sur la relation entre les conditions de l’organisation du travail et l’épuisement professionnel. Finalement, cette thèse vise à vérifier si la sécrétion de cortisol salivaire joue un rôle médiateur sur la relation entre les conditions de l’organisation du travail et l’épuisement professionnel, ainsi qu’à identifier les effets de médiation modérés par les traits de personnalité sur la relation entre les conditions de l’organisation du travail et la sécrétion de cortisol salivaire. Ces objectifs sont inspirés de nombreuses limites observées dans la littérature, principalement l’intégration de déterminants à la fois biologiques, psychologiques et du travail dans la compréhension de l’épuisement professionnel. La thèse propose un modèle conceptuel qui tente de savoir comment ces différents stresseurs entraînent une dérégulation de la sécrétion de cortisol dans la salive des travailleurs. Ensuite, ce modèle conceptuel vise à voir si cette dérégulation s’associe à l’épuisement professionnel. Finalement, ce modèle conceptuel cherche à expliquer comment la personnalité peut influencer la manière dont ces variables sont reliées entre elles, c’est-à-dire de voir si la personnalité joue un rôle modérateur. Ce modèle découle de quatre théories particulières, notamment la perspective biologique de Selye (1936). Les travaux de Selye s’orientent sur l’étude de la réaction physiologique d’un organisme soumis à un stresseur. Dans ces circonstances, l’organisme est en perpétuel effort de maintien de son équilibre (homéostasie) et ne tolère que très peu de modifications à cet équilibre. En cas de modifications excessives, une réponse de stress est activée afin d’assurer l’adaptation en maintenant l’équilibre de base de l’organisme. Ensuite, le modèle conceptuel s’appuie sur le modèle de Lazarus et Folkman (1984) qui postule que la réponse de stress dépend plutôt de l’évaluation que font les individus de la situation stressante, et également sur le modèle de Pearlin (1999) qui postule que les individus exposés aux mêmes stresseurs ne sont pas nécessairement affectés de la même manière. Finalement, le modèle conceptuel de cette thèse s’appuie sur le modèle de Marchand (2004) qui postule que les réactions dépendent du décodage que font les acteurs des contraintes et ressources qui les affectent. Diverses hypothèses émergent de cette conceptualisation théorique. La première est que les conditions de l’organisation du travail contribuent directement aux variations de la sécrétion de cortisol salivaire. La deuxième est que les conditions de l’organisation du travail contribuent directement à l’épuisement professionnel. La troisième est que la sécrétion de cortisol salivaire médiatise la relation entre les conditions de l’organisation du travail et l’épuisement professionnel. La quatrième est que la relation entre les conditions de l’organisation du travail et la sécrétion de cortisol salivaire est modérée par les traits de personnalité. La cinquième est que la relation entre les conditions de l’organisation du travail, la sécrétion de cortisol salivaire et l’épuisement professionnel est modérée par les traits de personnalité. Des modèles de régression multiniveaux et des analyses de cheminement de causalité ont été effectués sur un échantillon de travailleurs canadiens provenant de l’étude SALVEO. Les résultats obtenus sont présentés sous forme de trois articles, soumis pour publication, lesquels constituent les chapitres 4 à 6 de cette thèse. Dans l’ensemble, le modèle intégrateur biopsychosocial proposé dans le cadre de cette thèse de doctorat permet de mieux saisir la complexité de l’épuisement professionnel qui trouve une explication biologique, organisationnelle et individuelle. Ce constat permet d’offrir une compréhension élargie et multiniveaux et assure l’avancement des connaissances sur une problématique préoccupante pour les organisations, la société ainsi que pour les travailleurs. Effectivement, la prise en compte des traits de personnalité et de la sécrétion du cortisol salivaire dans l’étude de l’épuisement professionnel assure une analyse intégrée et plus objective. Cette thèse conclue sur les implications de ces résultats pour la recherche, et sur les retombées qui en découlent pour les milieux de travail.

Therapeutic commitment for general nurses in dealing with mental health problems of People Living with HIV/AIDS in Blantyre, Malawi

Introduction Therapeutic commitment of general nurses influences their provision of mental health care to clients. It is the general nurses’ predisposition for working therapeutically with clients who have mental health problems (MHPs). In Malawi, general nurses are the majority of health care professionals who care for people living with HIV/AIDS (PLWHA) and they are expected to deal with the mental health problems of these patients. The provision of mental health care to PLWHA is vital because apart from the physical illnesses associated with the virus, these people are also affected by mental health problems. However, most general nurses, feel neither confident nor competent when dealing with the mental health problems of their clients in Malawi. This may negatively influence their therapeutic commitment in dealing with mental health problems of PLWHA. However, therapeutic commitment of general nurses in providing mental health care to PLWHA in Malawi remains unknown. Materials and Methods The study used a quantitative descriptive survey design. a convenient sample comprising of 136 general nurses was used and data was collected using Mental Health Problems Perception Questionnaire. Permission to use the tool in this study was granted by Prof. Lauder. Ethical approval to conduct the study was granted by Ethics Committees at University of KwaZulu Natal and University of Malawi. Data were analysed using Statistical Package for Social Sciences version 15.0. Results The study findings revealed that there is a linear relationship between general nurses’ levels of knowledge and skills and their therapeutic commitment (r=.40, n=136, p<.05) to provide mental health care of PLWHA. Conclusion This study suggests general nurses’ levels of therapeutic commitment in dealing with MHPs of PLWHA vary and their levels of knowledge and skill to deal with MHPs influence their willingness to provide mental health care to PLWHA.

NUTRITION AND HEALTH STATUS OF HIV-INFECTED ADULTS ON ARVS AT AMREF CLINIC KIBERA URBAN SLUM, KENYA

The health of people living with HIV and AIDS (PLWHA) is nutritionally challenged in many nations of the world. The scourge has reduced socio-economic progress globally and more so in sub-Saharan Africa (SSA) where its impact has been compounded by poverty and food insecurity. Good nutrition with proper drug use improves the quality of life for those infected but it is not known how PLWHA exposed to chronic malnutrition and food shortages from developing nations adjust their nutrition with use of Anti-Retro-viral Drugs (ARVs). This study assessed nutritional status, dietary practices, and dietary management of common illnesses that hinder daily food intake by the patients and use of ARVs with food recommendations provided by the health care givers. A descriptive case study design was used to sample 120 HIV-infected patients using systematic sampling procedure. These patients sought health care from an urban slum, Kibera AMREF clinic. Data were collected by anthropometric measurements, bio-chemical analysis, semi-structured questionnaire and secondary data. The Statistical Package for Social Sciences (SPSS) and the Nutri-Survey software packages were used to analyze data. Dietary intakes of micro-nutrients were inadequate for >70% of the patients when compared to the Recommended Daily Requirements. When Body Mass Indices (BMI) were used, only 6.7% of the respondents were underweight (BMI<18.5kg/m2) and 9.2% were overweight (BMI> 25kg/m2), serum albumin test results (mean 3.34±0.06g/dl) showed 60.8% of the respondents were protein deficient and this was confirmed by low dietary protein intakes. The BMI was not related to dietary nutrient intakes, serum albumin and CD4 cell counts (p>0.05). It appeared that there was no significant difference in BMI readings at different categories of CD4 cell count (p>0.05) suggesting that the level of immunity did not affect weight gain with ARV as observed in many studies from developed countries. Malnutrition was, therefore, evident among the 60.8% of the cases as identified by serum albumin tests and food intake was not adequate (68%) for the patients as they ate once a day due to lack of food. National food and nutrition policy should incorporate food security boosting guidelines for the poor people infected with HIV and using ARVs.

Towards a Workflow Management Approach for Health Monitoring of Bridges

Part 14: Interoperability and Integration

Oral health quality of the workers of a telemarketing company and their satisfaction with the treatments provided by the corporative dental insurance plan

Aim: To evaluate the oral health quality of the workers of a telemarketing company and their satisfaction with the dental treatments provided by the corporative dental insurance plan. Methods: Data collection was by an online intranet questionnaire on dental service providers from Uberlândia/MG and Campinas/SP. It was addressed to 6000 associates, with objective and subjective questions, comprising the level of the telemarketing operators’ oral health, dental needs, satisfaction with dental care providers and the importance of having the laboral dental services provided by the company. Results: After analysis of the results, we observed that: 57.52% of the workers required improvement in their oral health and 56.03% mentioned prevention as the largest need, 66.70% use the dental providers’ services, but only 31.34% were satisfied with them. Conclusions: The results underscore that the workers have an intermediate level of dental needs, with prevention as top importance. Additionally, establishment of a basic attention program inside the company would increase the satisfaction and adhesion indexes of providers and the workers’ oral health.

Satisfação no trabalho e perceções sobre o clima organizacional dos enfermeiros do Centro de Saúde de Oleiros

A satisfação profissional tem sido nas últimas décadas encarada como condição importante, se não mesmo essencial para lograr e melhorar o funcionamento de empresas e demais organizações. Este relatório de estágio tem como objetivo conhecer as principais razões que condicionam a satisfação profissional dos enfermeiros que atuam nos Cuidados de Saúde Primários, nomeadamente no Centro de Saúde de Oleiros e pela necessidade em conhecer as relações existentes entre a satisfação no trabalho desses enfermeiros, o clima organizacional, o locus de controlo e algumas variáveis sócio-demográficas. O estágio decorreu entre fevereiro e junho de 2011, baseou –se num estudo exploratório, recorrendo-se a observação direta e aplicação de um questionário constituído por quatro partes distintas: questionário sócio-demográfico e profissional; Escala sobre a Satisfação Geral no Trabalho; Escala de Locus de Controlo de Levenson e a Work Environment Scale. A população – alvo é constituída por 9 enfermeiros que exercem funções no Centro de Saúde de Oleiros e salientando-se como principais conclusões que o conforto físico é o menos valorizado como importante para o clima organizacional, sendo o envolvimento e a coesão entre os colegas o mais valorizado. O relacionamento como dimensão do clima organizacional interfere no nível de satisfação geral no trabalho. O estudo demonstrou que das expectativas avaliadas através de uma escala de locus de controlo, sendo que os indivíduos cujos acontecimentos determinantes são percebidos como escapando ao controlo individual e dependentes de fatores tais como a ação de outras pessoas ou instituições poderosas, tendem a ter menor satisfação.

Development and Verification of Control and Protection Strategies in Hybrid AC/DC Power Systems for Smart Grid Applications

Modern power networks incorporate communications and information technology infrastructure into the electrical power system to create a smart grid in terms of control and operation. The smart grid enables real-time communication and control between consumers and utility companies allowing suppliers to optimize energy usage based on price preference and system technical issues. The smart grid design aims to provide overall power system monitoring, create protection and control strategies to maintain system performance, stability and security. This dissertation contributed to the development of a unique and novel smart grid test-bed laboratory with integrated monitoring, protection and control systems. This test-bed was used as a platform to test the smart grid operational ideas developed here. The implementation of this system in the real-time software creates an environment for studying, implementing and verifying novel control and protection schemes developed in this dissertation. Phasor measurement techniques were developed using the available Data Acquisition (DAQ) devices in order to monitor all points in the power system in real time. This provides a practical view of system parameter changes, system abnormal conditions and its stability and security information system. These developments provide valuable measurements for technical power system operators in the energy control centers. Phasor Measurement technology is an excellent solution for improving system planning, operation and energy trading in addition to enabling advanced applications in Wide Area Monitoring, Protection and Control (WAMPAC). Moreover, a virtual protection system was developed and implemented in the smart grid laboratory with integrated functionality for wide area applications. Experiments and procedures were developed in the system in order to detect the system abnormal conditions and apply proper remedies to heal the system. A design for DC microgrid was developed to integrate it to the AC system with appropriate control capability. This system represents realistic hybrid AC/DC microgrids connectivity to the AC side to study the use of such architecture in system operation to help remedy system abnormal conditions. In addition, this dissertation explored the challenges and feasibility of the implementation of real-time system analysis features in order to monitor the system security and stability measures. These indices are measured experimentally during the operation of the developed hybrid AC/DC microgrids. Furthermore, a real-time optimal power flow system was implemented to optimally manage the power sharing between AC generators and DC side resources. A study relating to real-time energy management algorithm in hybrid microgrids was performed to evaluate the effects of using energy storage resources and their use in mitigating heavy load impacts on system stability and operational security.

Importance of Ecological Factors and Colony Handling for Optimizing Health Status of Apiaries in Mediterranean Ecosystems

We analyzed six apiaries in several natural environments with a Mediterranean ecosystem in Madrid, central Spain, in order to understand how landscape and management characteristics may influence apiary health and bee production in the long term. We focused on five criteria (habitat quality, landscape heterogeneity, climate, management and health), as well as 30 subcriteria, and we used the analytic hierarchy process (AHP) to rank them according to relevance. Habitat quality proved to have the highest relevance, followed by beehive management. Within habitat quality, the following subcriteria proved to be most relevant: orographic diversity, elevation range and important plant species located 1.5 km from the apiary. The most important subcriteria under beehive management were honey production, movement of the apiary to a location with a higher altitude and wax renewal. Temperature was the most important subcriterion under climate, while pathogen and Varroa loads were the most significant under health. Two of the six apiaries showed the best values in the AHP analysis and showed annual honey production of 70 and 28 kg/colony. This high productivity was due primarily to high elevation range and high orographic diversity, which favored high habitat quality. In addition, one of these apiaries showed the best value for beehive management, while the other showed the best value for health, reflected in the low pathogen load and low average number of viruses. These results highlight the importance of environmental factors and good sanitary practices to maximize apiary health and honey productivity.

Health profile of centenarians in Portugal: a census-based approach

Background: The number of centenarians is rapidly increasing in Europe. In Portugal, it has almost tripled over the last 10 years and constitutes one of the fastest-growing segments of the population. This paper aims to describe the health and sociodemographic characteristics of Portuguese centenarians as given in the 2011 census and to identify sex differences. Methods: All persons living in Portugal mainland and Madeira and Azores islands aged 100 years old at the time of the 2011 census (N = 1,526) were considered. Measures include sociodemographic characteristics and perceived difficulties in six functional domains of basic actions (seeing, hearing, walking, cognition, self-care, and communication) as assessed by the Portuguese census official questionnaires. Results: Most centenarians are women (82.1 %), widowed (82 %), never attended school (51 %), and live in private households (71 %). The majority show major constraints in seeing (67.4 %), hearing (72.3 %), and particularly in their mobility (83.7 % cannot/have great difficulties in walking/climbing stairs and 80.7 % in bathing/dressing). In general, a better outcome was found for reported memory/concentration and understanding, with 39.1 % and 42.5 % presenting no or mild difficulty, respectively. Top-level functioning (no/mild difficulties in all dimensions concurrently) was observed in a minority of cases (5.96 %). Women outnumber men by a ratio of 4.6, and statistically significant differences were found between men and women for all health-related variables, with women presenting a higher percentage of difficulties. Conclusion: Portuguese centenarians experience great difficulties in sensory domains and basic daily living activities, and to a lesser extent in cognition and communication. The obtained profile, though self-reported, is important in considering the potential of social and family participation of this population regardless of their functional and sensory limitations. Based on the observed differences between men and women, gender-specific and gender-sensitive interventions are recommended in order to acknowledge women’s worse overall condition.

Nurses knowledge of health effects of dietary fibre

Introduction: Nurses accompany patients throughout their health care to prevent and treat disease, so their knowledge about diet and dietary fibre is key to successful diet therapy, which is an essential part of a patient's non-pharmacological treatment. It is known from the literature that a high proportion of nurses have limited knowledge about diet therapy and about sources of soluble fibre and other foods that can prevent or treat certain diseases. Given the position of nurses as key providers of dietary guidance, and given the health benefits of dietary fibre, we wanted to assess the level of fibre-related knowledge among nurses in Croatia. Material and Methods: Cross-sectional study based on data collected between October 2014 and March 2015 using a survey developed by the CI&DETS Polytechnic Institute in Viseu, Portugal. The survey contains questions about demographic characteristics as well as about knowledge of sources of dietary fibre, recommended daily intake and effects of fibre intake on particular diseases. The study included a total of 369 nurses from two health institutions and one nursing school from Croatia older than 18 years. Differences in knowledge were assessed for significance using the non-parametric Mann-Whitney U test. Possible associations among variables were explored using Spearman's rank correlation. For all statistical analyses, the threshold of significance was defined as P<0.05. Results: The level of knowledge among nurses in Croatia about dietary fibre varied from «undecided» to «partial knowledge». The median for level of knowledge ranged from 3 to 4 with low variability ranging from 0.11 to 0.33. Average levels of knowledge in percentages varied from 57.6% to 82.1%. Nurses with higher education levels showed significantly higher knowledge levels about the influence of dietary fiber intake on the risk of certain diseases (p = 0.007), constipation (p = 0.016), bowel cancer (p = 0.005) and breast cancer (p = 0.039). Conclusion: The level of nurses’ knowledge about dietary fiber is suboptimal. This indicates the need to strengthen nurse education in the areas of diet and diet therapy. Increase the level of knowledge of nurses about nutrition can positively influence the quality of care.

The Epidemiology and Health Economics of Ankle Injuries

Thesis (Ph.D, Community Health & Epidemiology) -- Queen's University, 2016-10-03 22:59:05.858