Multiple illness perceptions in older adults: Effects on physical functioning and medication adherence

Objective: Previous research on illness perceptions has focused on single illnesses, but most adults over 65 suffer from multiple illnesses (multimorbidity). This study tests three competing operationalisations of multiple illness perceptions in predicting physical functioning and adherence: (1) main effects and interactions model; (2) peak model with effects of the most prominent illness perception; and (3) combined model with averaged illness perceptions over multiple illnesses.

Design: Longitudinal study in N?=?215 individuals (65–86?years) with multimorbidity at two measurement points over six months. Participants filled in two Brief Illness Perception Questionnaires (B-IPQ) on their two most severe illnesses.

Main outcome measures: Physical functioning, medication adherence.

Results: Factor analyses suggest that the B-IPQ contains three dimensions; consequences, control and timeline. Multiple regression models fit the data best for (1) and (3). Timeline (β?=??.18) and control (β?=?.21) predict adherence in (1); consequences (β?=?.16) and control (β?=?.20) in (3). Physical functioning was significantly predicted by interacting control beliefs in (1; β?=?.13), by peak consequences in (2; β?=??.14) and by consequences (β?=??.15) in (3).

Conclusions: Individuals with multimorbidity hold both distinct and combined perceptions about their illnesses. To understand individual responses to multimorbidity, perceptions about all illnesses and multimorbidity as entity should be examined.     

Noreen Herzfeld Technology and Religion: Remaining Human in a Co-created World

ABSTRACT

Astrotheology, not simply a theology of space sciences, is necessary because astrobiology effects a conceptual shift in how we ask the question “Why do we exist?” Here I suggest characterizing that shift in terms of the intra-action of living systems and habitable environments, which has serious implications for approaches to doctrinal theology. I consider this in terms of the imago Dei and what implications a transdisciplinary approach to astrotheology might in turn have for reframing SETI and METI endeavors as a quest for an Extraterrestrial imago Dei (SETiD or METiD).     

Christian Initiation,Apprenticeship in Prayer

Abstract

I confess to you, Lord, that I still do not know what time is. Yet I confess too that I do know that I am saying this in time, that I have been talking about time for a long time, and that this long time would not be a long time if it were not for the fact that time has been passing all the while. How can I know this, when I do not know what time is? Is it that I do know what time is, but do not know how to put what I know into words? I am in a sorry state, for I do not even know what I do not know!     

A qualitative analysis of the role of emotions in different patterns of long-term weight loss

Objective: To explore participant perspectives of the impact emotions have on weight loss.

Design: A qualitative design gathered data through semi-structured interviews with participants in a weight management programme. The interview addresses the following research questions: (1) how do individuals working to lose weight perceive the impact emotions have on their long-term success, and (2) what strategies do more or less successful participants use to regulate their emotions? Researchers conducted and transcribed the interviews then completed content analysis to create and organise themes.

Results: Two broad themes emerged through the interviews with 21 participants: emotional impact and emotional regulation. Further subthemes captured emotions blocking action toward goals, strategies for regulating emotions (e.g. exercise, food) and the need for new strategies to regulate emotions. Themes were also split in to three groups based on weight outcomes: regainer, moderate success (3–6% loss) and large success (>7% loss). More successful participants, compared to regainers, shared being aware of the impact of their emotions and made efforts to develop healthy regulation strategies.

Conclusions: Emotional awareness and regulation play an important role in participant’s weight management experience. Taking time to build emotional awareness and strategies to manage emotions is important to participants in weight management.     

Health anxiety and hypochondriasis in the light of DSM-5

Background: In the DSM-5, the diagnosis of hypochondriasis was replaced by two new diagnositic entities: somatic symptom disorder (SSD) and illness anxiety disorder (IAD). Both diagnoses share high health anxiety as a common criterion, but additonal somatic symptoms are only required for SSD but not IAD. Design: Our aim was to provide empirical evidence for the validity of these new diagnoses using data from a case–control study of highly health-anxious (n = 96), depressed (n = 52), and healthy (n = 52) individuals. Results: The individuals originally diagnosed as DSM-IV hypochondriasis predominantly met criteria for SSD (74%) and rarely for IAD (26%). Individuals with SSD were more impaired, had more often comorbid panic and generalized anxiety disorders, and had more medical consultations as those with IAD. Yet, no significant differences were found between SSD and IAD with regard to levels of health anxiety, other hypochondriacial characteristics, illness behavior, somatic symptom attributions, and physical concerns, whereas both groups differed significantly from clinical and healthy controls in all of these variables. Conclusion: These results do not support the proposed splitting of health anxiety/hypochondriasis into two diagnoses. Further validation studies with larger samples and additional control groups are warranted to prove the validity of the new diagnoses.     

Double trouble: restrained eaters do not eat less and feel worse

Objective: While high levels of dietary restraint do not appear to reflect actual caloric restraint, it has been found to be a risk factor for a wide array of maladaptive eating patterns. These findings raise the question what, if not caloric restriction, dietary restraint entails. We propose that the very finding that restrained eaters do not eat less than they intend to do can provide an answer. Based on this disparity between the intention to restrain oneself and actual behaviour, we therefore hypothesised that high levels of restraint are associated with eating-related guilt.

Method: Three studies (N?=?148) using unobtrusive measures of food intake; different restraint scales; and different measures of guilt tested whether restraint is related to eating-related guilt.

Results: Results indicated that restraint was not associated with food intake, but instead was associated with increased levels of guilt after eating. Guilt was explicitly related to food intake. Moreover, the observed guilt could not be attributed to a general increase in negative affect.

Conclusion: The results of these studies suggest that restraint is not an indicator of actual restricted food intake, but rather a reflection concerns about food and eating manifested in eating-related guilt.     

God and Prepunishment

Abstract

The belief that some misfortunes are punishments sent from God has been affirmed by many different cultures and religions throughout human history. The belief has proved a pervasive one, and is still endorsed today by many adherents of the great western religions of the Judaeo-Christian tradition. Invariably, what is believed is that a present misfortune is divine punishment for a past sin. But could a present misfortune in fact be divine punishment for a future sin? That is, could God prepunish people for their future transgressions? The aim of this paper will be to show that there are solid philosophical grounds for supposing that he could and would do so.     

Kane,Luck, and the significance of free will

Abstract

This paper raises a pair of objections to the novel libertarian position advanced in Robert Kane's recent book, The Significance of Free Will.The first objection's target is a central element in Kane's intriguing response to what he calls the “Intelligibility” and “Existence” questions about free will. It is argued that this response is undermined by considerations of luck.The second objection is directed at a portion of Kane's answer to what he calls “The Significance Question” about free will: “Why do we, or should we, want to possess a free will that is incompatible with determinism? Is it a kind of freedom ‘worth wanting’... and, if so, why?” A desire for “objective worth” has a featured role in his answer. However, a compatibilist can have that desire.     

Worlds in Motion: Temporality and Historicality

ABSTRACT

Worlds are always in motion; what kind of movement is at stake? In this essay, I will argue that Heidegger moves beyond Hegel by making the concept of world central to phenomenology. But how do worlds move? As history, Heidegger says; yet his initial attempt to interpret history, in the final sections of Being and Time, is at certain moments hampered by his attempt to ground the historicality of shared world in the temporality of individual Dasein. Derrida then moves beyond Heidegger by addressing paradoxes in our understanding of time and history. This allows Derrida to introduce the ethical dimension of world from the start as we are called to acknowledge that the Other brings their own world and awaits our response. Worlds are both singular and shared; and in any case, they move (and move us).     

What do targeting positive views on ageing add to a physical activity intervention in older adults? Results from a randomised controlled trial

Objective: Physical activity is a key factor for healthy ageing, yet many older people lead a sedentary lifestyle. Traditional physical activity interventions do not consider the specific needs and views of older adults. As views on ageing are known to be related to health behaviours, the current study evaluates the effectiveness of prompting positive views on ageing within a physical activity intervention.

Design: Randomised controlled trial with three groups aged 65+: Intervention for physical activity with ‘views-on-ageing’-component (n?=?101; IGVoA), and without ‘views-on-ageing’-component (n?=?30; IG), and active control intervention for volunteering (n?=?103; CG).

Main outcome measures: Attitudes towards older adults and physical activity were assessed five weeks before intervention, two weeks, six weeks and 8.5?months after the intervention.

Results: Compared to the IG and CG, positive attitudes towards older adults increased in the IGVoA after the intervention. For IGVoA, the indirect intervention effect on change in activity via change in attitudes towards older adults was reliable.

Conclusion: A ‘views-on-ageing’-component within a physical activity intervention affects change in physical activity via change in views on ageing. Views on ageing are a promising intervention technique to be incorporated into future physical activity interventions for older adults.     

The transgender parent: Experiences and constructions of pregnancy and parenthood for transgender men in Australia

Background: Transgender (trans) men are commonly born with the reproductive anatomy that allows them to become pregnant and give birth and many wish to do so. However, little is known about Australian trans men's experiences of desiring parenthood and gestational pregnancy.

Aims: The present study aims to address this gap in the literature through addressing the following research questions: how do Australian trans men construct and experience their desire for parenthood? And, how do Australian trans men construct and experience gestational pregnancy?

Methods: This study aimed to explore these experiences, through a mixed-methods research design using online survey data and one-on-one interviews, with 25 trans men, aged 25–46 years old, who had experienced a gestational pregnancy. Data were analyzed using thematic analysis.

Results: For our participants, parenthood was initially described as alienating and complex, however transitioning enabled participants to negotiate and construct their own parenting identity. Pregnancy was positioned as a problematic but “functional sacrifice,” however formal assisted fertility experiences were rife with exclusion. At the same time dysphoria associated with withdrawing from testosterone and the growing fecund body were significantly troubling. Changes to the chest were of particular concern for participants. Exclusion, isolation, and loneliness were the predominant features of trans men's experiences of gestational pregnancies. Healthcare systems are not generally supportive of trans bodies and identities and trans men encounter significant issues when interacting with healthcare providers. As such, the results reinforce the importance of inclusive and specialized health services to support trans men through pregnancy.     

A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children

ABSTRACT

Background: It has been widely suggested that over 80% of transgender children will come to identify as cisgender (i.e., desist) as they mature, with the assumption that for this 80%, the trans identity was a temporary “phase.” This statistic is used as the scientific rationale for discouraging social transition for pre-pubertal children. This article is a critical commentary on the limitations of this research and a caution against using these studies to develop care recommendations for gender-nonconforming children.

Methods: A critical review methodology is employed to systematically interpret four frequently-cited studies that sought to document identity outcomes for gender-nonconforming children (often referred to as “desistance” research).

Results: Methodological, theoretical, ethical, and interpretive concerns regarding four “desistance” studies are presented. The authors clarify the historical and clinical contexts within which these studies were conducted to deconstruct assumptions in interpretations of the results. The discussion makes distinctions between the specific evidence provided by these studies versus the assumptions that have shaped recommendations for care. The affirmative model is presented as a way to move away from the question of, “How should children's gender identities develop over time?” toward a more useful question: “How should children best be supported as their gender identity develops?”

Conclusion: The tethering of childhood gender diversity to the framework of “desistance” or “persistence” has stifled advancements in our understanding of children's gender in all its complexity. These follow-up studies fall short in helping us understand what children need. As work begins on the 8th version of the Standards of Care by the World Professional Association for Transgender Health, we call for a more inclusive conceptual framework that takes children's voices seriously. Listening to children's experiences will enable a more comprehensive understanding of the needs of gender-nonconforming children and provide guidance to scientific and lay communities.     

Projective Adaptivism

Abstract

Moderate invariantism is the orthodox semantics for knowledge attributions (i.e., sentences of the form ?S knows/doesn’t know that Φ?). In recent years it has fallen out of favour, in large part because it fails to explain why ordinary speakers have the intuition that some utterances of knowledge attributions are felicitous and others infelicitous (felicity intuitions) in several types of cases. To address this issue moderate invariantists have developed a variety of what I call non-semantic theories (aka error theories) which they claim account for the relevant felicity intuitions independently of moderate invariantist semantics. Some critics have responded by arguing that these non-semantic theories are implausible for one or more of the following reasons: (i) they do not have a basis in empirical data or established theory; (ii) they do not account for all of the relevant felicity intuitions; (iii) they are ad hoc; or (iv) they in fact explain too many felicity intuitions and thus undermine the case for moderate invariantism. I develop a new non-semantic theory––projective adaptivism––that I argue escapes issues (i) to (iv) above.     

Heidegger and the contradiction of Being: a dialetheic interpretation of the late Heidegger

ABSTRACT

It is well known that, from the beginning to the end of his philosophical trajectory, Martin Heidegger tries to develop a fundamental ontology which aims at answering the so-called question of Being: what does Being mean? Unfortunately, in trying to answer this question, Heidegger faces a predicament: given his own premises, speaking about Being leads to a contradiction. Moreover, according to the majority, if not all, of the interpreters who admit the existence of such a predicament, Heidegger tries to avoid the contradiction in question. But is this the only way Heidegger tries to solve the predicament? In this paper, I argue that, in some of his late works and, in particular, in the Contributions to Philosophy, Heidegger also takes into serious consideration the possibility of accepting the contradiction he faces in speaking about Being as true. If this is correct, Heidegger endorses what nowadays analytic philosophers call dialetheism, namely the metaphysical position according to which some (but not all) contradictions are true.     

Combining total laparoscopic hysterectomy and bilateral salpingo-oophorectomy with subcutaneous mastectomy in trans men: The effect on safety outcomes

Abstract

Background: Masculinizing mastectomy is the most requested gender affirming surgery (GAS) in trans men, followed by genital GAS. Mastectomy and total laparoscopic hysterectomy, with or without bilateral salpingo-oophorectomy (TLH?±?BSO), can both be performed in one single operation session. However, data on complication rates of the combined procedure is scarce and no consensus exists on the preferred order of procedures.

Aims: To compare safety outcomes between mastectomy performed in a single procedure with those when performed in a combined procedure and assess whether the order of procedures matters when they are combined.

Methods: A retrospective chart review was performed of trans men who underwent masculinizing mastectomy with or without TLH?±?BSO in a combined session. The effects of the surgical procedure on complication and reoperation rate of the chest were assessed using logistic regression.

Results: In total, 480 trans men were included in the study. Of these, 212 patients underwent the combined procedure. The gynecological procedure was performed first in 152 (71.7%) patients. In the total sample, postoperative hematoma of the chest occurred in 11.3%; 16% in the combined versus 7.5% in the single mastectomy group (p?=?0.001). Reoperations due to hematoma of the chest were performed in 7.5% of all patients; 10.8% in the combined versus 4.9% in the single mastectomy group (p?=?0.017). The order of procedures in the combined group had no significant effect on postoperative hematoma of the chest (p?=?0.856), and reoperations (p?=?0.689).

Conclusion: Combining masculinizing mastectomy with TLH?±?BSO in one session was associated with significantly more hematoma and reoperations compared with separately performing mastectomy. This increased risk of complications after a combined procedure should be considered when deciding on surgical options. The order of procedures in a combined procedure did not have an effect on safety outcomes.     

Do behavioural self-blame and stigma predict positive health changes in survivors of lung or head and neck cancers?

Survivors of lung or head and neck cancers often change tobacco and alcohol consumption after diagnosis, but few studies have examined other positive health changes (PHCs) or their determinants in these groups. The present study aims to: (a) document PHCs in survivors of lung (n?=?107) or head and neck cancers (n?=?99) and (b) examine behavioural self-blame and stigma as determinants of PHCs. We hypothesised that: (a) survivors would make a variety of PHCs; (b) behavioural self-blame for the disease would positively predict making PHCs; and (c) stigma would negatively predict making PHCs.

Methods: Respondents self-administered measures of PHC, behavioural self-blame, and stigma. Hierarchical multiple regression analysis tested the hypotheses.

Results: More than 65% of respondents reported making PHCs, the most common being changes in diet (25%), exercise (23%) and tobacco consumption (16.5%). Behavioural self-blame significantly predicted PHCs but stigma did not. However, both behavioural self-blame and stigma significantly predicted changes in tobacco consumption.

Conclusions: Many survivors of lung or head and neck cancers engage in PHCs, but those who do not attribute the disease to their behaviour are less likely to do so. Attention to this problem and additional counselling may help people to adopt PHCs.     

VARIATIONS IN THE CONTEMPLATION OF THE REPULSIVENESS OF FOOD, ĀHĀREPATIKŪLASAÑÑĀ: CANONICAL,THERAVĀDA,SARVĀSTIVĀDA AND MAHĀYĀNA FORMS

ABSTRACT

This article explores the changing treatment of a meditation practice, the contemplation of the repulsiveness of food, āhārepa?ikūlasaññā, from its presence in lists of saññā in canonical texts to its detailed explanation in post-canonical texts of the first millennium CE. We observe two main developments: the limitation in the benefits attributed to the practice within commentarial-period Theravada, and two entirely divergent branches in the way the practice is treated. In the Visuddhimagga of Theravada Buddhism, we see a somewhat practical approach that identifies the unpleasant aspects of the monk’s experience of seeking, eating, digesting and excreting food, and takes them as the focus of a 10-stage meditation practice. In the Sarvāstivāda texts, we see a conceptual aversion created by the association of specific food items with other items treated as impure within meditation practice. This articles explores all these divergences, drawing conclusions about what this says in terms of the understanding of food in these two branches.     

Response to Commentators on Existential Flourishing

ABSTRACT

In this piece I respond to questions and criticisms raised by commentators on my recent book, Existential Flourishing: A Phenomenology of the Virtues (Cambridge University Press, 2019). I argue for an irreducible normative plurality governing our struggle to lead good human lives, and address questions about how to decide what to do in the face of such plurality.     

Eating styles in the morbidly obese: Restraint eating,but not emotional and external eating,predicts dietary behaviour

Objectives : The research explored (1) the relationships between self-reported eating style (restraint, emotional and external eating) and dietary intake and (2) emotional eater status as a moderator of food intake when emotional, in a morbidly obese population.

Design : A sample of 57 obese participants (BMI: M?=?51.84, SD?=?8.66) completed a five-day food diary together with a reflective diary, which assessed eating style and positive and negative affect daily.

Main outcome measures : A dietician-scored food pyramid analysis of intake.

Results : Restraint eating was the only predictor (negative) of overall food intake and the variable most strongly associated with the consumption of top-shelf foods. Emotional and external eating were unrelated to food intake. Emotional eater status did not moderate food intake in response to positive and negative mood states.

Conclusion : The findings indicated largely analogous relationships between eating style and dietary intake in this obese sample compared with previous results from healthy populations. The lack of predictive validity for emotional eating scales (when emotional) raises questions over people’s ability to adequately assess their eating style and consequently, the overall validity of emotional eater scales.     

Spatial location and emotion modulate voice perception

ABSTRACT

How do we perceive voices coming from different spatial locations, and how is this affected by emotion? The current study probed the interplay between space and emotion during voice perception. Thirty participants listened to nonverbal vocalizations coming from different locations around the head (left vs. right; front vs. back), and differing in valence (neutral, positive [amusement] or negative [anger]). They were instructed to identify the location of the vocalizations (Experiment 1) and to evaluate their emotional qualities (Experiment 2). Emotion-space interactions were observed, but only in Experiment 1: emotional vocalizations were better localised than neutral ones when they were presented from the back and the right side. In Experiment 2, emotion recognition accuracy was increased for positive vs. negative and neutral vocalizations, and perceived arousal was increased for emotional vs. neutral vocalizations, but this was independent of spatial location. These findings indicate that emotional salience affects how we perceive the spatial location of voices. They additionally suggest that the interaction between spatial (“where”) and emotional (“what”) properties of the voice differs as a function of task.