Discrimination in clinical settings and its relationship to depression and anger in women living with HIV

Objectives: To describe the frequency of feared discrimination in various social situations and of perceived discrimination in clinical settings, as well as to study the relationship between discrimination and depression and anger in women living with human immunodeiciency virus (HIV). Material and methods: The scale of Feared and Perceived Discrimination for Women with HIV (DTP-40-MV), the Beck Depression Inventory (BDI-2), and the Anger Expression scale of State-Trait-anger expression inventory (STaXi-2-aX/eX) were applied to a random sample of 200 women living with HIV. Results: These women feared being discriminated against, perceived discrimination upon the review of medical records, but perceived little discrimination in clinical care. a model with good adjustment to the data showed that the fear of being discriminated against creates a disposition toward perception of discrimination in the clinical settings (latent variable with 2 indicators: review of the medical records and clinical care) and increases cognitive/affective depressive symptoms; higher anger control decreases the anger manifestation; greater discrimination perceived in the clinical settings decreases anger control, which facilitates the expression of anger and slows cognitive/affective depressive symptoms; and these latter symptoms sensitize the perception of discrimination before the clinical records. Conclusion: Feared discrimination is a clinically relevant aspect due to its frequency and effect on depressive symptoms and perception of discrimination before the review of medical records.

Romantic relationships and adjustment in early adulthood: The role of cross-sex experience in the context of social norms and support

Attachment and interpersonal theory suggest a sequential pattern of relationships beginning in the earliest stage of development and progressing to social and eventually romantic relationships. Theoretically, cross-sex experiences have an important role in the progression of interpersonal relationships. Despite the prevalence of these theories about the nature of romantic relationship development, the linkage of cross-sex experience (CSE) to romantic relationships has not been established. Indeed, it is an intuitive assumption, especially within Western society and these theories do not consider socio-cultural factors that may influence CSE and relationship satisfaction. This study addresses the varying contextual factors that may contribute to relationship satisfaction and adjustment, aside from CSE, and is divided into two parts. Study 1, addresses CSE, relationship satisfaction, and adjustment in a unique population, ultra-Orthodox Jews. Among this population, social or romantic CSE is limited and sexes are effectively segregated. Study 2, expanded the study to a larger sample of U.S. college students, to assess the linkage of CSE to romantic relationship satisfaction in a more typical Western population. It included social norm and support variables to address the contextual nature of relationship development and satisfaction. Results demonstrated clear differences in the relation between CSE and relationship satisfaction in the two samples. In the first sample CSE was unrelated to relationship satisfaction; nevertheless, relationship satisfaction was associated with adjustment as it is for more typical populations with greater CSE. These results suggested the importance of specifying how social norms and social support relate to CSE, relationship satisfaction and adjustment. The results from the second sample were consistent with the theoretical framework upon which the social/romantic literature is based. CSE was directly connected to relationship satisfaction. As anticipated, CSE, relationship satisfaction, and adjustment also varied as a function of social norms and support. These findings further validate the influence of socio-cultural factors on relationship satisfaction and adjustment. This study contributes to the romantic relationship literature and broadens our understanding of the complex nature of interpersonal and romantic relationships.^

Partner relationship in couples living with atrial fibrillation

The aim of this thesis was to describe and explore how the partner relationship of patient–partner dyads isaffected following cardiac disease and, in particular, atrial fibrillation (AF) in one of the spouses. The thesis is based on four individual studies with different designs: descriptive (I), explorative (II, IV), and cross-sectional (III). Applied methods comprised a systematic review (I) and qualitative (II, IV) and quantitative methods (III). Participants in the studies were couples in which one of the spouses was afflicted with AF. Coherent with a systemic perspective, the research focused on the dyad as the unit of analysis. To identify and describe the current research position and knowledge base, the data for the systematic review were analyzed using an integrative approach. To explore couples’ main concern, interview data (n=12 couples) in study II were analyzed using classical grounded theory. Associations between patients and partners (n=91 couples) where analyzed through the Actor–Partner Interdependence Model using structural equation modelling (III). To explore couples’ illness beliefs, interview data (n=9 couples) in study IV were analyzed using Gadamerian hermeneutics. Study I revealed five themes of how the partner relationship is affected following cardiac disease: overprotection, communication deficiency, sexual concerns, changes in domestic roles, and adjustment to illness. Study II showed that couples living with AF experienced uncertainty as the common main concern, rooted in causation of AF and apprehension about AF episodes. The theory of Managing Uncertainty revealed the strategies of explicit sharing (mutual collaboration and finding resemblance) and implicit sharing (keeping distance and tacit understanding). Patients and spouses showed significant differences in terms of self-reported physical and mental health where patients rated themselves lower than spouses did (III). Several actor effects were identified, suggesting that emotional distress affects and is associated with perceived health. Patient partner effects and spouse partner effects were observed for vitality, indicating that higher levels of symptoms of depression in patients and spouses were associated with lower vitality in their partners. In study IV, couples’ core and secondary illness beliefs were revealed. From the core illness belief that “the heart is a representation of life,” two secondary illness beliefs were derived: AF is a threat to life, and AF can and must be explained. From the core illness belief that “change is an integral part of life,” two secondary illness beliefs were derived: AF is a disruption in our lives, and AF will not interfere with our lives. Finally, from the core illness belief that “adaptation is fundamental in life,” two secondary illness beliefs were derived: AF entails adjustment in daily life, and AF entails confidence in and adherence to professional care. In conclusion, the thesis result suggests that illness, in terms of cardiac disease and AF, affected and influenced the couple on aspects such as making sense of AF, responding to AF, and mutually incorporating and dealing with AF in their daily lives. In the light of this, the thesis results suggest that clinicians working with persons with AF and their partners should employ a systemic view with consideration of couple’s reciprocity and interdependence, but also have knowledge regarding AF, in terms of pathophysiology, the nature of AF (i.e., cause, consequences, and trajectory), and treatments. A possible approach to achieve this is a clinical utilization of an FSN based framework, such as the FamHC. Even if a formalized FSN framework is not utilized, partners should not be neglected but, rather, be considered a resource and be a part of clinical caring activities. This could be met by inviting partners to take part in rounds, treatment decisions, discharge calls or follow-up visits or other clinical caring activities. Likewise, interventional studies should include the couple as a unit of analysis as well as the target of interventions.

Modelling the relationship between biomechanics and performance of young sprinting swimmers

The aim of this study was to compute a swimming performance confirmatory model based on biomechanical parameters. The sample included 100 young swimmers (overall: 12.3 ± 0.74 years; 49 boys: 12.5 ± 0.76 years; 51 girls: 12.2 ± 0.71 years; both genders in Tanner stages 1–2 by self-report) participating on a regular basis in regional and national-level events. The 100 m freestyle event was chosen as the performance indicator. Anthropometric (arm span), strength (throwing velocity), power output (power to overcome drag), kinematic (swimming velocity) and efficiency (propelling efficiency) parameters were measured and included in the model. The path-flow analysis procedure was used to design and compute the model. The anthropometric parameter (arm span) was excluded in the final model, increasing its goodness-of-fit. The final model included the throw velocity, power output, swimming velocity and propelling efficiency. All links were significant between the parameters included, but the throw velocity–power output. The final model was explained by 69% presenting a reasonable adjustment (model’s goodness-of-fit; x2/df = 3.89). This model shows that strength and power output parameters do play a mediator and meaningful role in the young swimmers’ performance.

Exposure to pesticides, ill health and averting behaviour : costs and determining the relationship

Farmers' exposure to pesticides is high in developing countries. As a result many farmers suffer from ill-health, both short and long term. Deaths are not uncommon. This paper addresses this issue. Field survey data from Sri Lanka are used to estimate farmers' expenditure on defensive behavior (DE) and to determine factors that influence DE. The avertive behavior approach is used to estimate costs. Tobit regression analysis is used to determine factors that influence DE. Field survey data show that farmers' expenditures on DE are low. This is inversely related to high incidence of ill health among farmers using pesticides.