Diabetes Distress: Understanding the Hidden Struggles of Living with Diabetes and Exploring Intervention Strategies

Diabetes Distress is a rational emotional response to the threat of a life-changing illness. Distinct from depression, it is rooted in the demands of diabetes management and is a product of psychological adjustment. Diabetes distress has been found to be significantly associated with HbA1c and self-care, which demonstrates its clinical use in treatment outcomes. Interpersonal factors such as perceived support and protectiveness of partners significantly contribute to elevated distress, suggesting that these are valued areas of focus for interventions. Pioneering large-scale research, DAWN2, gives voices to the families of those with diabetes and reaffirms the need to consider psychosocial factors in routine diabetes care. Structured diabetes education programmes are the most widely used in helping individuals cope with diabetes, but they fail to consider the psychological or interpersonal aspects of diabetes management. Psycho-educational approaches are found to be effective in reducing diabetes distress while also improving HbA1c. Certain limitations in the current literature are discussed, along with future directions. Of utmost importance is the need for health practitioners, irrespective of background, to demonstrate an understanding of diabetes distress and actively engage in discussion with individuals struggling to cope with diabetes; to normalize this and integrate it into routine diabetes practice.

Christianity as a Vocation: The Rostrevor Benedictines and the Renewal of Faith in Ireland

This chapter explores how the Benedictine monks at Holy Cross Monastery in Rostrevor, Northern Ireland, have re-introduced the idea of vocation into the minds of a range of Christians on the island of Ireland. A picture of this new vision of the church in Ireland is painted through sections devoted to 'living ecumenism' and 'creating safe spaces'. The work of the Rostrevor Benedictines may seem limited because of the small scale of the changes among individuals. But Holy Cross is just one of multiple 'extra-institutional' spaces in Ireland's changing religious landscape. From their strategic positions on the margins, extra-institutional expressions of religion may prompt more significant changes in religious practice than initially seem possible.

Stated preference methods and landscape ecology indicators: an example of transdisciplinarity in landscape economic valuation

This paper addresses the representation of landscape complexity in stated preferences research. It integrates landscape ecology and landscape economics and conducts the landscape analysis in a three-dimensional space to provide ecologically meaningful quantitative landscape indicators that are used as variables for the monetary valuation of landscape in a stated preferences study. Expected heterogeneity in taste intensity across respondents is addressed with a mixed logit model in Willingness to Pay space. Our methodology is applied to value, in monetary terms, the landscape of the Sorrento Peninsula in Italy, an area that has faced increasing pressure from urbanization affecting its traditional horticultural, herbaceous, and arboreal structure, with loss of biodiversity, and an increasing risk of landslides. We find that residents of the Sorrento Peninsula would prefer landscapes characterized by large open views and natural features. Residents also appear to dislike heterogeneous landscapes and the presence of lemon orchards and farmers' stewardship, which are associated with the current failure of protecting the traditional landscape. The outcomes suggest that the use of landscape ecology metrics in a stated preferences model may be an effective way to move forward integrated methodologies to better understand and represent landscape and its complexity.

Living to the range limit: consumer isotopic variation increases with environmental stress

Background: Theoretically, each species’ ecological niche is phylogenetically-determined and expressed spatially as the species’ range. However, environmental stress gradients may directly or indirectly decrease individual performance, such that the precise process delimiting a species range may not be revealed simply by studying abundance patterns. In the intertidal habitat the vertical ranges of marine species may be constrained by their abilities to tolerate thermal and desiccation stress, which may act directly or indirectly, the latter by limiting the availability of preferred trophic resources. Therefore, we expected individuals at greater shore heights to show greater variation in diet alongside lower indices of physiological condition.

Methods: We sampled the grazing gastropod Echinolittorina peruviana from the desert coastline of northern Chile at three shore heights, across eighteen regionally-representative shores. Stable isotope values (δ13C and δ15N) were extracted from E. peruviana and its putative food resources to estimate Bayesian ellipse area, carbon and nitrogen ranges and diet. Individual physiological condition was tracked by muscle % C and % N.

Results: There was an increase in isotopic variation at high shore levels, where E. peruviana’s preferred resource, tide-deposited particulate organic matter (POM), appeared to decrease in dietary contribution, and was expected to be less abundant. Both muscle % C and % N of individuals decreased with height on the shore.

Discussion: Individuals at higher stress levels appear to be less discriminating in diet, likely because of abiotic forcing, which decreases both consumer mobility and the availability of a preferred resource. Abiotic stress might be expected to increase trophic variation in other selective dietary generalist species. Where this coincides with a lower physiological condition, this may be a direct factor in setting their range limit.

Waiting for International Political Sociology: A Field Guide to Living In-Between

This paper explores the in-between positionality of International Political Sociology (IPS) and offers a field guide to help scholars, students and thinkers embrace this disposition more energetically. It makes the case for a more balanced transdisciplinarity that attends to the international, the political and the social at the same time and in equal measure. The power of this in-between approach is that it forces thinkers in IPS to constantly look at the horrors of our contemporary world without turning away. Through the ambivalent position of the ‘happy wreck’, the paper explores the need to do something about these horrors (e.g. diagnose, act, intervene) while fully acknowledging that such actions always produce new forms of violence and exclusion. To help thinkers in IPS inhabit this challenging space of inquiry more confidently, the paper makes four suggestions: (i) broadening our emotional responses to the horrors of the world; (ii) resisting resolution through non-cathartic dispositions; (iii) pursuing slow research to contest dominant rhetorics of crisis and emergency; and (iv) re-imagining shared conditions of vulnerability.

Risk indicators associated with root decay in independently living older adults

Objective: To determine the risk indicators associated with root caries experience in a cohort of independently living older adults in Ireland.
Methods: The data reported in the present study were obtained from a prospective longitudinal study conducted on the risk factors associated with root caries incidence in a cohort of independently living older adults (n=334). Each subject underwent an oral examination, performed by a single calibrated examiner, to determine the root caries index and other clinical variables. Questionnaires were used to collect data on oral hygiene habits, diet, smoking and alcohol habits and education level. A regression analysis with the outcome variable of root caries experience (no/yes) was conducted.
Results: A total of 334 older adults with a mean age of 69.1 years were examined. 53.3% had at least one filled or decayed root surface. The median root caries index was 3.13 (IQR 0.00, 13.92). The results from the multivariate regression analysis indicated that individuals with poor plaque control (OR 9.59, 95%CI 3.84-24.00), xerostomia (OR 18.49, 95%CI 2.00-172.80), two or more teeth with coronal decay (OR 4.50, 95% CI 2.02-10.02) and 37 or more exposed root surfaces (OR 5.48, 95% CI 2.49-12.01) were more likely to have been affected by root caries.
Conclusions: The prevalence of root caries was high in this cohort. This study suggests a correlation between root caries and the variables poor plaque control, xerostomia, coronal decay (≥2 teeth affected) and exposed root surfaces (≥37). The significance of these risk indicators and the resulting prediction model should be further evaluated in a prospective study of root caries incidence.
Clinical Significance: Identification of risk indicators for root caries in independently living older adults would facilitate dental practitioners to identify those who would benefit most from interventions aimed at prevention.

Othering, blame and shame when working with people living with HIV

Significant advances in HIV treatment has meant that for the majority of patients with HIV they are able to live a normal lifespan. However, HIV remains a highly stigmatizing disease with the potential to significantly impact on ones social identity and sense of self. This paper draws on data from a qualitative study of interviews with five gay men, to explore the experiences of shame in relation to living with HIV. The paper adopts a psychoanalytic lens to highlight the mechanisms of splitting that may be involved at both a social and individual level, and the experience of shame among the participants. The paper aims to use this research data to supplement our understanding of what may be occurring ‘on the couch’ with patients who are living with HIV.

Towards a positive cross-cultural lexicography: Enriching our emotional landscape through 216 ‘untranslatable’ words pertaining to well-being

Although much attention has been paid to culture-specific psychopathologies, there have been no comparable attempts to chart positive mental states that may be particular to certain cultures. This paper outlines the beginnings of a positive cross-cultural lexicography of ‘untranslatable’ words pertaining to wellbeing, culled from across the world’s languages. A quasi-systematic search uncovered 216 such terms. Using grounded theory, these words were organised into three categories: feelings (comprising positive and complex feelings); relationships (comprising intimacy and pro-sociality); and character (comprising personal resources and spirituality). The paper has two main aims. First, it aims to provide a window onto cultural differences in constructions of wellbeing, thereby enriching our understanding of wellbeing. Second, a more ambitious aim is that this lexicon may help expand the emotional vocabulary of English speakers (and indeed speakers of all languages), and consequently enrich their experiences of wellbeing. The paper concludes by setting out a research agenda to pursue these aims further.

Mindful Living in Older Age: a Pilot Study of a Brief, Community-Based, Positive Aging Intervention

Although mindfulness-based interventions have been successfully used with older adults, there have been few interventions that, (a) are created specifically for older adults, (b) are delivered in the community, and (c) aim to promote ‘successful aging’ (rather than just treating dysfunction/disorder). To this end, the current study piloted a brief ‘positive aging’ intervention, comprising two 150 minute sessions, with six female older adults living in the community. Data were gathered through focus groups that were interwoven throughout the intervention. Using thematic analysis, four main themes were identified: (a) aging as a mixed blessing; (b) understanding mindfulness; (c) the challenges of mindfulness; and (d) the benefits of mindfulness. Overall, the intervention was successful in introducing participants to mindfulness and potentially forming the basis of a longer term practice. However, the study also highlighted important points on the challenges of practising mindfulness, in relation to which the paper makes recommendations pertaining to the teaching of mindfulness with older adults.

Profiles of ageing in the South of Portugal: education and cognitive functioning in elderly persons living in institutionalized and community contexts

The region of the Algarve shows huge differences between the coastline where population in the urban areas grows, and the inland rural areas, in some cases very isolated, which frequently have high ageing indexes. This general scenario, with an elderly population with very different economic and social conditions, frames the ongoing PhD research designed as a cross-sectional study of an intentional sample of elderly persons. The basic theoretical framework departs from the perspective of developmental psychology of life-span and the model of selection, optimisation and compensation for optimal ageing (Baltes & Baltes, 1990; Freund & Baltes, 2002). The present study is a first step in the analysis of empirical data collected in the PhD sample (N=156; age range 65 to 97 years; M = 80.4 years; SD = 7.2 years). Its purpose is to assess the cognitive functioning of participants, screening for cognitive impairment and examine the relations between the cognitive status of the subjects and a number of selected variables including educational level, age, physical activity and living contexts of the subjects. We accessed the cognitive status of the participants with the Portuguese version of Mini Mental State Examination (MMSE) finding a 10.3% prevalence of positive cases with cognitive impairment. The results also show significant relationships between the cognitive status accessed by the MMSE and educational level, professional qualification, age, living arrangement and activity level of the participants. The relationship verified between educational level and cognitive status of the participants was the largest correlation found in the study with the variability in educational level accounting for 44.8% of the variability in MMSE score. This results points in the same direction of several lines of research that corroborate the strong intercorrelation between education and cognitive functioning in old age.

Exploring the linguistic landscape: the case of the ‘Golden Triangle’ in the Algarve, Portugal

Studies of the linguistic landscape (LL) are concerned with language in its written form, in the public sphere; language that is visible to all through texts such as billboards and other public signs. The LL is such a taken-for-granted part of our everyday experience that its importance as a form of social practice is often overlooked. Taking a mixed methods approach to the case of the linguistic landscape of the ‘Golden Triangle’, an area of tourist resorts which is gradually becoming a residential area in the Algarve, Portugal, I suggest that the discursive construction of a place is partly achieved through the highly visible texts of the LL which may also impact upon the discursive construction of the collective identities of those who inhabit the place.