Older people with hearing impairment: A literature review of the spouse's perspective

Spouses of older people with hearing impairment frequently urge their hearing impaired partners to seek help for their hearing difficulties. Only a minority of individuals with hearing impairment are self-motivated, with the majority of clients, especially older clients, presenting at audiology clinics under the persuasion or influence of their spouse or significant other. This highlights the important role that spouses play in initiating aural rehabilitation and indicates that spouses of older people with hearing impairment may become so frustrated with their partners' hearing loss that they are often the primary reason why the hearing impaired person presents for audiological services. To date, however, the number of studies addressing the effect of hearing loss on significant others is limited. Those studies that have investigated the effect of hearing impairment on families are commonly focused on the person with the impairment and most commonly, the significant other has merely been used as a proxy to describe the perceived problems of his or her spouse. Further, there has been no systematic indepth investigation of the needs of spouses of older people with hearing impairment, including the effect of retirement and the increase in time spent together, with the majority of studies focusing primarily on younger spouses of workers affected by noise-induced hearing loss. The cumulative effect of experiencing many years of hearing difficulties with a partner may also influence the extent to which older spouses are affected by hearing impairment. The primary purpose of this article is therefore to critically review the existing literature on the effects of hearing impairment on spouses. It will also provide a rationale for the importance of this topic as a clinical issue and suggest some future directions for research in this area.

Predictive genetic test decisions for Huntington's disease: context, appraisal and new moral imperatives

Predictive testing is one of the new genetic technologies which, in conjunction with developing fields such as pharmacogenomics, promises many benefits for preventive and population health. Understanding how individuals appraise and make genetic test decisions is increasingly relevant as the technology expands. Lay understandings of genetic risk and test decision-making, located within holistic life frameworks including family or kin relationships, may vary considerably from clinical representations of these phenomena. The predictive test for Huntington's disease (HD), whilst specific to a single-gene, serious, mature-onset but currently untreatable disorder, is regarded as a model in this context. This paper reports upon a qualitative Australian study which investigated predictive test decision-making by individuals at risk for HD, the contexts of their decisions and the appraisals which underpinned them. In-depth interviews were conducted in Australia with 16 individuals at 50% risk for HD, with variation across testing decisions, gender, age and selected characteristics. Findings suggested predictive testing was regarded as a significant life decision with important implications for self and others, while the right not to know genetic status was staunchly and unanimously defended. Multiple contexts of reference were identified within which test decisions were located, including intra- and inter-personal frameworks, family history and experience of HID, and temporality. Participants used two main criteria in appraising test options: perceived value of, or need for the test information, for self and/or significant others, and degree to which such information could be tolerated and managed, short and long-term, by self and/or others. Selected moral and ethical considerations involved in decision-making are examined, as well as the clinical and socio-political contexts in which predictive testing is located. The paper argues that psychosocial vulnerabilities generated by the availability of testing technologies and exacerbated by policy imperatives towards individual responsibility and self-governance should be addressed at broader societal levels. (C) 2003 Elsevier Science Ltd. All rights reserved.

Adjusting to change through song: Themes in songs written by clients with traumatic brain injury

The study aimed to identify themes in songs written by clients with traumatic brain injury (TBI). Lyrics (1834) from 82 songs written by 11 female and 21 male clients aged between 5 and 60 years were categorised into 8 main themes and 24 subcategories. Incidence of subcategories and themes were calculated. Self-reflections and messages were the most frequent themes portrayed within songs. Memories and reflections about significant others were also frequently communicated. It was noticeable that clients felt safer to communicate thoughts and feelings about the past and present but were less inclined to confront the future.

Measuring outcomes of a communication program for older people with hearing impairment using the International Outcome Inventory

The main objective of this study was to describe the outcomes of a communication education program for older people with hearing impairment using the International Outcome Inventory - Alternative Interventions (IOI-AI) and the version for significant others (IOI-AI-SO). Ninety-six people aged 58 to 94 years participated in an interactive group education program for two hours per week for five weeks. The IOI-AI was administered at one to two weeks after the last educational session and 29 significant others also completed the IOI-Al-SO at this time. Overall, positive results were obtained using both questionnaires, and satisfaction with the program was particularly high. Findings also compared favourably to reports of outcomes for other audiological interventions (i.e., another communication training program and hearing aid fitting). Principal components analysis of the IOI-AI revealed a somewhat different factor structure than the original IOI-HA. The two versions of the 101 applied in this study are recommended as simple and effective measures of the outcomes of alternative interventions.

Exploring care relations in later life: disentangling notions of care and choice

The experience of later life varies widely and is often framed in terms of the active lifestyles of the Third Age and the frailty and abjection of the Fourth Age. This thesis sought to understand how the concepts of care and choice are enacted, experienced and interrelated in the context of both informal and formal care in later life and how older people themselves, their families and significant others understand and experience these concepts. The discourse of personalisation that dominates care services has led to an emphasis on individual choice, control and independence so that those in need of care are faced with what has been described as the ‘logic of choice’, a focus on individual responsibility rather than care. Adopting a Feminist Foucauldian theoretical approach and drawing on Tronto’s (1993) ethic of care, this thesis explores the experiences of older people and their informal carers through dialogical narrative analysis. The stories begin with the recognition by individuals that there is a need for care and how this need is met through negotiations with families and significant others. As needs increase the physical and logistical limits of informal care by individuals are reached, often leading to a need to ‘choose’ formal care. Rather than impacting solely on the care recipient, formal care is shown as being an experience that is shared with informal carers. Indeed, the participants depict how informal care continues alongside formal care and how the boundaries between them become blurred. I argue that a binary division between actively making choices and being a passive recipient are not appropriate to understandings of care. By disentangling the notions of care and choice this thesis explores the extent to which these concepts are relevant to the experience of older people in specific care situations.

Predicting posttraumatic stress reactions in children prior to traumatic exposure

The present study examined the relations among previously identified risk and protective variables associated with traumatic exposure and evaluated a model of resilience to traumatic events among Latino youth prior to traumatic exposure using structural equation modeling. Model tests were pursued in the context of Full Information Maximum Likelihood (FIML) methods as implemented in Mplus. The model evaluated the role of the following variables: (a) intervening life events; (b) child characteristics; (c) social support from significant others; and (d) children's coping. Data were collected from 181 Latino youth (M age = 9.22, SD = 1.38; 49.0% female) participants. Data analyses revealed that children's perceived available social support and use of coping strategies predicted low state anxiety following exposure to cues of disaster. Life events and preexisting depression symptoms did not significantly predict social support and coping, whereas preexisting anxiety was a significant predictor of perceived social support. This study represents an important initial step towards establishing and empirically evaluating a resilience model. Implications for preparedness interventions and a framework for the etiology of resilient reactions to disaster exposure are discussed.

Against all odds: Success stories of Latino students who survived the educational pipeline

The purpose of this interview study was to explore the experiences of Latino students, from their perspectives, as they journeyed through the educational pipeline, particularly the part focusing on the transfer experience from a 2-year college to a 4-year institution. This was accomplished by conducting in-depth interviews with 17 self-identified Latino men and women. All of the participants had attended Florida International University for at least 1 semester and had transferred from Miami Dade College. The participants varied in age, generational status, and cultural identity.^ The participants were asked to reflect on the external and internal influences that lead them to the 4-year institution. Tinto's (1993) model of student departure theory provided the theoretical framework for data collection and analysis. Based on the coding of the interviews, numerous themes emerged, including the role of the family, the impact of early education, the experiences of being Latino in Miami, the decisions to choose a college, the experience at the 2-year institution, the experience with the transfer process, and the obstacles and strategies the participants used for overcoming obstacles. These themes were furthered developed to determine which influences were most important for a successful journey through the educational pipeline. ^ The study found that viewing the pipeline via the students' perspectives juxtaposed with Tinto's (1993) model of student departure gave greater insight into the experiences of a population of students who have been underrepresented in higher education. The findings of this case study indicate that the transfer process for Latinos attending a Hispanic Serving Institution such as Florida International University, situated in a majority-minority city, is complex, with participants having to rely on peers and significant others for pertinent information and support. Several factors, including the importance of positive support networks and increased confidence nurtured by the 2-year institution, influenced the students' transfer to a 4-year institution. For professionals in the field, the findings of this study may lead to a broader understanding of the experiences of Latino students in the pipeline and, more importantly, assist college administrators and faculty in successfully guiding a population through a 4-year institution who first came via a 2-year institution. ^

Using modeling as a co-design approach in the planning process of new care environments

Current research shows a relationship between healthcare architecture and patient-related Outcomes. The planning and designing of new healthcare environments is a complex process; the needs of the various end-users of the environment must be considered, including the patients, the patients’ significant others, and the staff. The aim of this study was to explore the experiences of healthcare professionals participating in group modelling utilizing system dynamics in the pre-design phase of new healthcare environments. We engaged healthcare professionals in a series of workshops using system dynamics to discuss the planning of healthcare environments in the beginning of a construction, and then interviewed them about their experience. An explorative and qualitative design was used to describe participants’ experiences of participating in the group modelling projects. Participants (n=20) were recruited from a larger intervention study using group modeling and system dynamics in planning and designing projects. The interviews were analysed by qualitative content analysis. Two themes were formed, representing the experiences in the group modeling process: ‘Partaking in the G-M created knowledge and empowerment’and ‘Partaking in the G-M was different from what was expected and required time and skills’. The method can support participants in design teams to focus more on their healthcare organization, their care activities and their aims rather than focusing on detailed layout solutions. This clarification is important when decisions about the design are discussed and prepared and will most likely lead to greater readiness for future building process.

Searching for Masculine Capital: Experiences Leading to High Drive for Muscularity in Men

Studies on the drive for muscularity (DFM) have primarily been quantitative, focused on identifying correlates. Currently little is known about men’s experiences leading them to desire high levels of muscle and engage in behaviours to increase their masculine capital. Our purpose was to explore the stories of men with high DFM revealing the socio-cultural and personal factors leading to DFM and their search for masculine capital. In-depth life-history interviews and multiple in-the-field conversations were undertaken with twenty men (Mean age=28.45, SD=6.96, years) scoring ≥ 3 on the Drive for Muscularity Scale (Mean=4.30, SD=0.70). Men’s stories focused on a set of dysfunctional childhood and adolescent socio-cultural interactions, including forms of symbolic violence, between them and significant others. In these interactions men were exposed to dominant social narratives of masculinity, and through comparisons and reinforcement they identified discrepancies between themselves and these narratives. In late adolescence and early adulthood men came to believe that they lacked masculine capital. Men struggled to increase their masculine capital through engagement with other traditional masculine activities (e.g., sport) and driven by activating events, they compensated through DFM desires and behaviours. This study advances knowledge by revealing the socio-cultural and personal processes participants believed led to their high DFM. Findings disclose that men’s search for masculine capital may have led them to develop and maintain high levels of DFM.

Parental influences and mothers’ experiences on infant and young child feeding practices

The objective of this thesis was to better understand how parental factors influence feeding practices, how mothers experience feeding and what factors mothers perceive influencing feeding in different contexts. This study is largely based on STEPS Study (Steps to Healthy Development of Children), which is a longitudinal cohort of 1797 families. In addition, qualitative data was collected among mothers in Finland and Solomon Islands. The results of this study show that different parental determinants associate with infant and young child feeding behavior and practices. Mothers with high cognitive restraint of eating introduced complementary foods earlier and neophobic mothers’ breastfed exclusively for a shorter time than mothers who ranked lower in these behaviors. Fathers’ poor diet quality associated with shorter total breastfeeding duration. Mothers’ postnatal depressive symptoms associated with shorter duration of exclusive breastfeeding, earlier introduction of complementary foods and lower compliance of feeding recommendations. The higher amount of marital distress associated with longer duration of exclusive breastfeeding and better compliance with feeding recommendations. Mothers, who participated in qualitative interviews, described how complex interplay of individual perceptions, significant others and socio-cultural environment influenced feeding practices and behavior. This study showed that several parental factors influence infant and young child feeding practices as well as compliance with the feeding recommendations. Maternal experiences and perceptions on child feeding relate to the context where mother-infant pair lives in. These results highlight the importance of targeting feeding support and, if needed, specific interventions to mothers and families who are in risk of poor feeding practices.

Adultos com experiências precoces de vitimação e resiliência

A literatura tem vindo a comprovar que determinados indivíduos conseguem integrar-se ou ajustar-se de forma positiva e normativa nas sociedades em que vivem, apesar das vivências altamente adversas ocorridas, ainda numa idade precoce, poderem potenciar um percurso significativamente diferente. O presente estudo, de índole qualitativo, tem como objetivo geral analisar e caracterizar o percurso de vida de adultos, que precocemente vivenciaram formas de vitimação em contexto familiar, procurando identificar os fatores que contribuíram para o seu ajustamento psicossocial. Para tal, recorreu-se a uma entrevista semiestruturada, elaborada para o efeito, e a qual foi administrada a 10 participantes com idades entre 19 e 41 anos (M=26.1; DP=8), selecionados a partir de informantes privilegiados e que os identificaram como sendo resilientes. O conteúdo das entrevistas foi analisado através da grounded analysis. Os resultados revelam que os participantes no decorrer do processo de vitimação desenvolveram características comportamentais semelhantes (e.g., isolamento, baixa autoestima, revolta, agressividade), identificando a retirada do meio familiar como elemento promotor da mudança ocorrida no seu percurso e autoconceito. De igual modo, identificaram a existência de sonhos, de objetivos de vida e a presença de pessoas significativas (e.g., irmãos, parceiros, amigos) como sendo determinantes na construção do seu percurso resiliente. A retirada do contexto familiar foi identificada pelos participantes como uma medida de intervenção relevante na proteção da criança e subsequente ajustamento psicossocial. Os resultados do presente estudo permitem evidenciar a importância dos fatores protetivos no ajustamento psicossocial, algo que deve ser considerado na intervenção psicoterapêutica com crianças em risco.

Autenticidade, reconhecimento e dádiva - Para uma renovação dos direitos humanos

Esta investigação pretende articular a Teoria do Reconhecimento de Axel Honneth com a Ética da Autenticidade de Charles Taylor e complementar este diálogo com a Teoria da Dádiva, que tem vindo a ser desenvolvida por vários autores franceses e latino-americanos. A autenticidade foi, ao longo da história ocidental, considerada como sendo uma busca individual do eu, baseada numa racionalidade desvinculada, que não considerava os horizontes de sentido ou as relações com os outros significantes. Através da teoria de Taylor, essa perspetiva mudou: a autenticidade agora é descrita como um ideal moral dialógico, fundamentada no reconhecimento. Neste percurso do reconhecimento procuramos aprofundar não só a ideia de luta, mas também a relação de mutualidade da dádiva fundamentada no reconhecimento simbólico. Nesse sentido, o individualismo, neutralismo e a distinção entre esfera pública e privada, usados como critérios hermenêuticos para os Direitos Humanos, são substituídos pela autenticidade, reconhecimento e dádiva, num aprofundamento político-normativo de forma a contribuir para uma sociedade mais inclusiva e para a renovação ética dos Direitos Humanos; ABSTRACT: This research aims to articulate Axel Honneth’s Theory of Recognition with Charles Taylor’s Ethics of Authenticity, supplementing and weaving them with the Theory of Gift, which has been developed by several French and Latin-American authors. Authenticity has been considered, throughout western history, to be an individual search of the self, based on a detached rationality that did not take into consideration the horizons of meaning/sense or relations with the significant others. Along with Taylor’s theory, such perspective has changed: authenticity is now described as a dialogic moral ideal, grounded on recognition. In this route towards recognition we seek to deepen not only the idea of struggle, but also the mutual relation of gift grounded on symbolic recognition. In that sense, individualism, neutrality and distinction between public and private spheres, used as hermeneutic criteria for Human Rights, are replaced by authenticity, recognition and gifting, in a political-normative depth, in order to contribute to a more inclusive society and to an ethical renewal of Human Rights.

Imagem corporal e auto-estima em rapazes pré-adolescentes

Dissertação de Mestrado apresentada ao Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica.

Comportamentos agressivos entre pares e padrões de vinculação : Um estudo com jovens adolescentes

Embora de natureza radicalmente distinta, bullying e vinculação são fenómenos de natureza relacional. Se o bullying é descrito como um abuso sistemático de poder, que ocorre intencional e repetidamente entre pares, a vinculação refere-se ao estabelecimento de laços afectivos fortes com determinadas pessoas significativas, especialmente em momentos percepcionados como perigosos. A investigação, apesar do reduzido número de estudos, mostra uma relação entre estes conceitos. A agressão instrumental interpares parece estar relacionada com vinculações inseguras. O objectivo deste estudo é compreender a relação entre o bullying e os padrões de vinculação. Foi realizado em três escolas da zona de Évora, com os alunos do 7° ano (237 alunos). Utilizaram-se dois questionários de auto-relato: o QEVE - Questionário de Exclusão Social e Violência Escolar e o IVIA - Inventário sobre Vinculação para a Infância e a Adolescência. Os resultados deste estudo corroboram os estudos anteriores, relativamente aos comportamentos agressivos entre pares. Mostram que existem correlações estatisticamente significativas entre as dimensões da vitimação e da agressão e, ainda, verificou-se que a vinculação segura parece funcionar como um factor protector para a vitimação e a agressividade e a vinculação ansiosa parece relacionar-se com a vitimação. ABSTRACT: Although radically different, bullying and attachment are relational in nature phenomena. lf the bullying is described as a systematic abuse of power, which is intentionally and repeatedly between peers, attachment refers to the establishment of strong emotional ties with certain significant others, especially at times perceived as dangerous. The research, despite the small number of studies show a relationship between these concepts. Instrumental peer aggression seems to be associated with insecure attachments. The aim of this study is to understand the relationship between bullying and patterns of binding. lt was conducted in three schools in the district of Évora with the students of 7th Grade (237 students). We used two questionnaires self-report: the QEVE - Questionnaire of Social Exclusion and Violence in School and IVIA - lnventory on Attachment for Children and Adolescents. These results corroborate previous studies, for aggressive behavior among peers. Show that there are statistically significant correlations between the dimensions of victimization and aggression and also found that a secure attachment appears to be a protective factor for victimization and aggression and anxious attachment seems to relate to the victimization.

Listening in to others : in between noise and silence

Since the launch of the ‘Clean Delhi, Green Delhi’ campaign in 2003, slums have become a significant social and political issue in India’s capital city. Through this campaign, the state, in collaboration with Delhi’s middle class through the ‘Bhagidari system’ (literally translated as ‘participatory system’), aims to transform Delhi into a ‘world-class city’ that offers a sanitised, aesthetically appealing urban experience to its citizens and Western visitors. In 2007, Delhi won the bid to host the 2010 Commonwealth Games; since then, this agenda has acquired an urgent, almost violent, impetus to transform Delhi into an environmentally friendly, aesthetically appealing and ‘truly international city’. Slums and slum-dwellers, with their ‘filth, dirt, and noise’, have no place in this imagined city. The violence inflicted upon slum-dwellers, including the denial of their judicial rights, is justified on these accounts. In addition, the juridical discourse since 2000 has ‘re-problematised slums as ‘nuisance’. The rising antagonism of the middle-classes against the poor, supported by the state’s ambition to have a ‘world-class city’, has allowed a new rhetoric to situate the slums in the city. These representations articulate slums as homogenised spaces of experience and identity. The ‘illegal’ status of slum-dwellers, as encroachers upon public space, is stretched to involve ‘social, cultural, and moral’ decadence and depravity. This thesis is an ethnographic exploration of everyday life in a prominent slum settlement in Delhi. It sensually examines the social, cultural and political materiality of slums, and the relationship of slums with the middle class. In doing so, it highlights the politics of sensorial ordering of slums as ‘filthy, dirty, and noisy’ by the middle classes to calcify their position as ‘others’ in order to further segregate, exclude and discriminate the slums. The ethnographic experience in the slums, however, highlights a complex sensorial ordering and politics of its own. Not only are the interactions between diverse communities in slums highly restricted and sensually ordained, but the middle class is identified as a sensual ‘other’, and its sensual practices prohibited. This is significant in two ways. First, it highlights the multiplicity of social, cultural experience and engagement in the slums, thereby challenging its homogenised representation. Second, the ethnographic exploration allowed me to frame a distinct sense of self amongst the slums, which is denied in mainstream discourses, and allowed me to identify the slums’ own ’others’, middle class being one of them. This thesis highlights sound – its production, performances and articulations – as an act with social, cultural, and political implications and manifestations. ‘Noise’ can be understood as a political construct to identify ‘others’ – and both slum-dwellers and the middle classes identify different sonic practices as noise to situate the ‘other’ sonically. It is within this context that this thesis frames the position of Listener and Hearer, which corresponds to their social-political positions. These positions can be, and are, resisted and circumvented through sonic practices. For instance, amplification tactics in the Karimnagar slums, which are understood as ‘uncultured, callous activities to just create more noise’ by the slums’ middle-class neighbours, also serve definite purposes in shaping and navigating the space through the slums’ soundscapes, asserting a presence that is otherwise denied. Such tactics allow the residents to define their sonic territories and scope of sonic performances; they are significant in terms of exerting one’s position, territory and identity, and they are very important in subverting hierarchies. The residents of the Karimnagar slums have to negotiate many social, cultural, moral and political prejudices in their everyday lives. Their identity is constantly under scrutiny and threat. However, the sonic cultures and practices in the Karimnagar slums allow their residents to exert a definite sonic presence – which the middle class has to hear. The articulation of noise and silence is an act manifesting, referencing and resisting social, cultural, and political power and hierarchies.