Life stories managing chronic illness: Young adults’ lived experiences with type 1 diabetes

This study aimed to characterise diabetes management experiences of South African young adults living with well-controlled type 1 diabetes (n = 8, female = 5, male = 3, age range = 20–25). The young adults told life stories managing their type 1 diabetes. Thematic analysis revealed the young adults to construct personal identities as people living with type 1 diabetes, to mostly utilise emotion-focused management strategies and social support for successful living with type 1 diabetes. Behavioural health strategies appear important for living well with this chronic insulin deficiency condition.     

Type D personality and social relations in adults with diabetes: results from diabetes MILES – The Netherlands

Abstract

Objective: To examine whether individual differences in Type D personality (combination of negative affectivity (NA) and social inhibition (SI)) could explain heterogeneity in perceived social support and relationship adjustment (intimate partner relationship) among people living with diabetes.

Design: In the Diabetes MILES—The Netherlands survey, 621 adults with type 1 or type 2 diabetes (54% female, age: 56?±?14 years) completed measures of Type D personality (DS14), perceived social support and relationship adjustment. We used established DS14 cut-off scores to indicate Type D personality, high NA only, high SI only and reference groups.

Results: Participants from the Type D and NA only groups perceived lower levels of social support (Welch[3,259]?=?37.27, p?<?0.001), and relationship adjustment (Welch[3,191]?=?14.74; p?<?0.01) than those from the SI only and reference groups. Type D was associated with lower social support (lowest quartile; adjusted OR?=?8.73; 95%CI?=?5.05?～?15.09; p?<?0.001) and lower relationship adjustment (lowest quartile; adjusted OR?=?3.70; 95%CI?=?2.10?～?6.53; p?<?0.001). Type D was also associated with increased levels of loneliness.

Conclusion: Participants with Type D and participants with high NA only tend to experience less social support and less relationship adjustment. Type D personality was also associated with more loneliness. Experiencing lower social support and relationship adjustment may complicate coping and self-management in people with diabetes.     

Partners’ representations of diabetes as mediators between patients’ representations and adherence to self-care behaviors,in type 2 diabetes

The purpose of this study was to analyze partners’ representations of diabetes as mediators between patients’ illness representations and adherence to all self-care behaviors, in recently diagnosed type 2 diabetes (T2DM) patients. The sample included 340 patients and their respective partners. The instruments used were: Revised Summary of Diabetes Self-Care Activities (RSDSCA); Medication Adherence Report Scale (MARS); and the Brief Illness Perception Questionnaire (Brief-IPQ). A mediational effect of partners’ representation of diabetes consequences was found between the same patients’ representations and exercise, foot care, and self-monitoring of blood glucose. Partners’ representations of personal and treatment control, were mediators between the same partners’ representations and self-monitoring of blood glucose. No partners’ representations mediated patients’ representation and adherence to medication or diet . This study emphasized partners’ representations on patient’s adherence to exercise, foot care and monitoring of blood glucose, in recent diagnosed T2DM patients. Interventions to promote adherence in T2DM should promote convergence between patients and partners’ diabetes representations. This study provides some evidence for the need to treat T2DM within the dyad to improve adherence, starting after the diagnosis.     

Clinical staff’s attributions about diabetes: Scale-development and staff vs. patient comparisons

Clinical staff’s attributions about diabetes management were measured using newly developed scales. Eighty-five physicians and nurses provided data to investigate the psychometric properties of the scales and to examine the patterns of attributions made. Alpha coefficients for the 7 six-item scales were satisfactory, ranging from .51 to .73. A comparison between attributions for positive and negative outcomes of diabetes management produced examples of self-serving bias. Comparisons were made with data from 286 insulin-dependent diabetes patients. Staff tended to rate patients as having less personal control over positive outcomes (t=2.94;df=338;p<.01) and tended to emphasize chance to a greater extent than did the patients (t=?4.32;df=338;p<.001). There was a tendency for staff to rate negative outcomes as being more foreseeable by the patients than the patients did themselves (t=?3.11;df=346;p<.01). Both patients and staff demonstrated bias towards dispositional attributions. The implications of between and within group differences in attribution patterns are discussed.     

Adolescents’ reasons for tanning and appearance motives: A preliminary study

We examined adolescents’ reasons for tanning and how these relate to appearance evaluation and orientation. Two hundred and sixty-four Canadian adolescents (age range 15–19 years) in grades 10, 11, and 12 completed a survey that included scales measuring their reasons for tanning, appearance evaluation, and appearance orientation. It was found that girls and boys differed on four of nine subscales measuring reasons for tanning. Girls believed more strongly than boys that tanning improved their general appearance and that friends influenced their decision to tan. Girls also expressed less concern than boys that tanning caused immediate skin damage or premature aging. The pattern of correlations between the reasons for tanning and appearance orientation was similar for girls and boys. For both, appearance reasons for tanning and sociocultural influences on tanning were positively associated with appearance orientation. Suggestions for future research with adolescents and a proposal for a guiding model are provided.     

Are exercise social-cognitive factors and behaviours different for adults with diabetes? A randomized community sample

Exercise plays a key role in the prevention and delay of the onset of Type 2 diabetes and in the management of this disorder. To determine if there are differences in key social-cognitive determinants of exercise and self-reported physical activity levels between adults with diabetes and those without the condition, a random selected sample of adults was surveyed. A telephone interview assessed physical activity behaviour and key social-cognitive constructs from major health behaviour change theories/models. The mean energy expenditure was not significantly different between the diabetes (n?=?46) and the non-diabetes (n?=?1556) groups. The diabetes group reported significantly lower scores for self-efficacy and perceived behavioural control, but higher for fear of, and vulnerability to, general health and cardiovascular disease threat. The data suggest that it may not be necessary to promote health threat messages, as threat is already high for this diabetes population and studies have shown that excess threat does not promote recommended exercise and health behaviours. Instead, the low levels of self-efficacy and perceived behavioural control among those with diabetes emphasize the importance of designing specific strategies (e.g., skills, incremental success) to increase their self-confidence in undertaking physical activity.     

Foot care, ‘spousal’ support and type 2 diabetes: an exploratory qualitative study

Objectives: People with type 2 diabetes (T2DM) should check their feet and protect them against harm, but few do. Living with a spouse contributes to good foot care behaviour. This study explores awareness, perceived susceptibility of, and concern about, foot problems, and reported foot care behaviour, and ways in which a spouse may or may not contribute to foot care in T2DM.

Methods: 1:1 interviews were conducted with 6 individuals with T2DM. Half had a spouse half did not. There was one person at low, medium and high risk in each sample. Each spouse participated in a separate interview, and the dyads were interviewed together. Interviews were analysed using Applied Thematic Analysis.

Results: All participants knew that diabetes was associated with foot problems. Not all people with T2DM thought that they were susceptible; spouses perceived greater susceptibility for the patient. This was unrelated to risk level. Most people with T2DM and all spouses engaged in behaviour to identify problems or protect feet, but rarely both. Spouses’ attitude and behaviour did influence the patients’ own behaviour. At times spouse support was perceived positively, and at times negatively.

Conclusion: Engaging spouses in foot care education may improve foot care behaviour.     

Representing diabetes: ‘Brightside’ and ‘chaos’ in autobiography

This paper examines six autobiographical sources written by people with type 1 diabetes. In seeking to improve the understanding of diabetic lifeworlds; some of the autobiographies present heroic stories of ‘overcoming’ diabetes while others present a more ‘chaotic’ narrative. Regardless of their form, all the autobiographies highlight how the everyday problems and concerns associated with diabetes can be hidden and silenced. Therefore, I ask the question of how to use autobiographies as sources of evidence, being aware of the power constructs that may have directed their form. Despite this question, I argue that autobiographies remain crucial sources for exploring the experience of everyday life and much of the silencing in the texts reflects spatial and emotional challenges faced by the authors. I also consider the limitations of representation in the autobiographies calling for an understanding that the experience of diabetes carries with it feelings, emotions and affects that are non-representable and so never entirely knowable. Thus, this paper builds on recent geographical research on emotion and ‘contested’ illnesses, especially those that are not obviously visible or are easily hidden.     

Genetic Counselors’ Experiences with Adolescent Patients in Prenatal Genetic Counseling

Adolescents comprise a portion of women who present to genetic counselors prenatally. In this study, prenatal genetic counselors (N = 128) were surveyed regarding their perceptions of genetic counseling sessions for adolescent (ages 13–19) and adult (ages 20–34) patients. Counselors perceived differences in methods used to communicate risk information for adolescent versus adult populations. Respondents reported that it is more difficult for adolescents to understand prognostic information than adults. They also noted differences between adult and adolescent populations with respect to the people who typically accompany the patient to the session. Respondents stated that adolescents were accompanied by a parent, friend, or sibling, which differed from adults who reportedly were accompanied by a significant other, father of the pregnancy, or by no one. These findings suggest it is important to recognize that adolescent patients are in a unique stage of their development which may influence a prenatal genetic counseling session.     

Patients’ and Parents’ Perceptions of Appearance in Scoliosis Treated with a Brace: A Cross-Sectional Analysis

The perspective of trunk deformity is a matter of special concern for adolescent idiopathic scoliosis (AIS) patients. No research group has ever reported interviewing patients and their parents regarding differences in perception of body appearance in the course of Cheneau brace treatment. We aimed to investigate the level of agreement in the field of concerns and perceptions of spinal appearance in relation to brace- and scoliosis-related data between parents and female patients with AIS, treated with a Cheneau brace, by means of the Spinal Appearance Questionnaire-pl (SAQ-pl). In this cross-sectional study forty-one pairs of parents and female patients with AIS were asked to separately complete the Polish versions of the Spinal Appearance Questionnaire-pl patient form (SAQ-pl patient form) and the SAQ-pl parent form. Age of patients was 13.60 years SD 1.60 (range 10–17). Patients scored 2.70 (SD 0.60) and parents scored 2.70 SD 0.60 in the total score of the SAQ-pl. The study groups do not differ significantly in regards to the SAQ-pl results. The percentage of consistent answers on SAQ-pl items ranges from 34.10 % (item 20) to 78 % (item 8). Height, age and brace-wearing time per day, were significantly related to the differences in the patient-parent General perception of body shape (r _s  = ?0.51, r _s  = ?0.34, r _s  = 0.36, respectively). Parents and female patients with AIS have similar concerns and perceptions of spinal appearance. The discrepancies in General perception of spinal appearance between parents and AIS females decrease with age of patient. Parental emotional support may contribute to minimizing the risk factors of psychological impairment, especially in late adolescents with AIS.     

Patients’ intention to speak up for health care providers’ hand hygiene in inpatient diabetic foot wound treatment: a cross-sectional survey in diabetes outpatient centres in Lower Saxony,Germany*

Hand hygiene in wound care by health care providers (HCPs) is a key principle in treating hospitalized patients with diabetic foot infections. This study aimed to estimate the extent to which patients with type-2-diabetes (T2D) intend to speak up for HCPs’ hand hygiene during inpatient foot treatment, test whether this motivation increases given the hospital would invite patients to speak up, and identify associations with socio-demographics, knowledge of hand hygiene requirements, and diabetes-related factors. A questionnaire-survey was conducted in eight diabetes outpatient centres in Lower Saxony/Germany. Intentions to speak up (without and with institutional encouragement) and knowledge about hand hygiene during foot-care were assessed. Analyses of variance were conducted, partly as repeated measures-models with intention-items as within-subject factor. N = 473 patients participated (response = 77.4%). N = 177 (41%) strongly intended to speak up. Institutional encouragement was associated with an increased rate of strong (54% vs. 41%; p < .001) and higher mean intention (M = 3.9 vs. 3.4 with vs. without encouragement [5-point-scales]; F(1, 434)?=?41.5, p < .001). In patients without diabetic foot syndrome, this effect was limited to those with at least medium school education (F(2, 292)?=?4.4, p = .013) and knowledge on HCPs’ hand hygiene (F(2, 294)?=?3.1, p = .047). In conclusion, a majority of T2D-patients in diabetes outpatient centres intend to speak for HCPs’ hand hygiene in inpatient foot treatment, and are receptive to institutional encouragement. However, this presupposes at least medium education and knowledge about hand hygiene, emphasizing that patient empowerment begins with knowledge.     

Facilitation in Wason’s selection task: Content and instructions

Two experiments investigated the influence of rule content and instructions on subjects’ ability to reason about conditional rules. Experiment 1 had subjects determine whether two rules were “true or false” or whether two rules were being “violated.” Subjects had direct experience with one rule and indirect experience with the other. Performance was superior with direct experiential rules and with violation instructions. Experiment 2 was conducted to determine whether violation instructions could facilitate correct selections with content for which subjects had no experience. Subjects were presented with a familiar and unfamiliar rule. The results were consistent with those of Experiment 1. The possibility of a cognitive trade-off between rule familiarity and instructions is discussed.     

Blending Arendtian Exemplarity with Weberian Ideal-Typic Analysis: Arendt’s ‘Socrates’ as a Vehicle for Social Critique

Arendt uses the exemplary validity of Socrates to think and value the possibilities of joint philosophical and political orientations in our present juncture. In this way Arendt’s ‘Socrates’ is not a mythic, historic, or dramatic individual, but offers an example of the best of the human condition. Unfortunately, because Arendt held the social conditioning and constraining of Socrates’ possibilities at arm’s length, his status as an exemplar is problematic and he ends up referring to a historical rather than contemporary possibilities. While Arendt had resources in her notion of the ‘world’ to better ground her simultaneously analytic and normative construction of ‘Socrates’, the lack of a social grounding makes ‘Socrates’ a significantly unmoored and shifting signifier. After showing the vacillations of ‘Socrates’ in Arendt, I supplement her normatively laden account with a Weberian grounding. With this firmer social grounding, ‘Socrates’ can refer to the possibilities of joint philosophical and political orientations in ancient Athens and thereby highlight how our world makes a contemporary version unlikely or impossible. Yet, this Weberian grounding comes at a cost. The normative dimension essential in Arendt’s ‘Socrates’ is lost due to Weberian value-neutrality. ‘Socrates’ can name a contemporary unlikelihood or impossibility, but if the enveloping social order does not value what it renders impossible, Weberian ideal-types on their own are incapable of offering normative resources for critique. I conclude by blending a Weberian social mooring with Arendt’s value-laden framework for social analysis and thereby recuperate the missing normative dimension. In short, by accepting the relational, necessarily plural, and dynamic root of human action we can, much like Arendt’s intended use of ‘Socrates’, value orientations that best express these norms, and criticize contemporary conditions that constrain their realization.     

Cognitive and motor deficits in older adults with HIV infection: Comparison with normal ageing and Parkinson’s disease

Despite the life-extending success of antiretroviral pharmacotherapy in HIV infection (HIV), the prevalence of mild cognitive impairment in HIV remains high. Near-normal life expectancy invokes an emerging role for age–infection interaction and a potential synergy between immunosenescence and HIV-related health factors, increasing risk of cognitive and motor impairment associated with degradation in corticostriatal circuits. These neural systems are also compromised in Parkinson’s disease (PD), which could help model the cognitive deficit pattern in HIV. This cross-sectional study examined three groups, age 45–79 years: 42 HIV, 41 PD, and 37 control (CTRL) participants, tested at Stanford University Medical School and SRI International. Neuropsychological tests assessed executive function (EF), information processing speed (IPS), episodic memory (MEM), visuospatial processing (VSP), and upper motor (MOT) speed and dexterity. The HIV and PD deficit profiles were similar for EF, MEM, and VSP. Although only the PD group was impaired on MOT compared with CTRL, MOT scores were related to cognitive scores in HIV but not PD. Performance was not related to depressive symptoms, socioeconomic status, or CD4⁺ T-cell counts. The overlap of HIV-PD cognitive deficits implicates frontostriatal disruption in both conditions. The motor-cognitive score relation in HIV provides further support for the hypothesis that these processes share similar underlying mechanisms in HIV infection possibly expressed with or exacerbated by ageing.     

Emphasizing appearance versus health outcomes in exercise: The influence of the instructor and participants’ reasons for exercise

The objectifying nature of exercise environments may prevent women from reaping psychological benefits of exercise. The present experiment manipulated self-objectification through an exercise class taught by an instructor who emphasized exercise as either a means of acquiring appearance or health outcomes. The purpose of this study was to test for interactions between the class emphasis and participants’ reasons for exercise (i.e., appearance, health) predicting participants’ state self-objectification, state social physique anxiety, exercise class enjoyment, and future intentions of returning to a similar exercise class. Results, obtained via pre- and post-exercise questionnaires, revealed a significant interaction between class emphasis and health reasons for exercise predicting state self-objectification. Participants with lower health reasons for exercise reported greater state self-objectification in the appearance-focused class compared to those with higher health reasons for exercise. Adopting stronger health reasons for exercise may buffer exercise participants from the more objectifying aspects of the group exercise environment.     

I Think We’re Alone Now: Solitary Social Behaviors in Adolescents with Autism Spectrum Disorder

Research into emotional responsiveness in Autism Spectrum Disorder (ASD) has yielded mixed findings. Some studies report uniform, flat and emotionless expressions in ASD; others describe highly variable expressions that are as or even more intense than those of typically developing (TD) individuals. Variability in findings is likely due to differences in study design: some studies have examined posed (i.e., not spontaneous expressions) and others have examined spontaneous expressions in social contexts, during which individuals with ASD—by nature of the disorder—are likely to behave differently than their TD peers. To determine whether (and how) spontaneous facial expressions and other emotional responses are different from TD individuals, we video-recorded the spontaneous responses of children and adolescents with and without ASD (between the ages of 10 and 17 years) as they watched emotionally evocative videos in a non-social context. Researchers coded facial expressions for intensity, and noted the presence of laughter and other responsive vocalizations. Adolescents with ASD displayed more intense, frequent and varied spontaneous facial expressions than their TD peers. They also produced significantly more emotional vocalizations, including laughter. Individuals with ASD may display their emotions more frequently and more intensely than TD individuals when they are unencumbered by social pressure. Differences in the interpretation of the social setting and/or understanding of emotional display rules may also contribute to differences in emotional behaviors between groups.     

Men’s Interpersonal (mis)Perception: Fitting in with Gender Norms Following Social Rejection

Interpersonal perception (IP) is useful for meeting affiliation needs, but what if IP skills are derogated by those one wishes to affiliate with? We tested the effects of affiliation motivation on IP in predominately Caucasian men. Participants were mainly U.S. undergraduates from the intermountain west. We expected that following rejection, IP performance would vary depending on the skill’s gender appropriateness. Study 1 (N?=?69) found men who recounted an in-group rejection performed better on a masculine-framed IP test. Study 2 (N?=?102) extended findings to empathic accuracy, demonstrating that rejection influenced IP as a function of the gender norms of an in-group member. The role of affiliation motivation and gender norms in the development and maintenance of men’s nonverbal skills is discussed.     

Impaired Interpretation of Others’ Behavior is Associated with Difficulties in Recognizing Pragmatic Language in Patients with Schizophrenia

Much attention has been paid to the pragmatic language function in schizophrenia. This study of Japanese patients with schizophrenia examined the relationship between impaired interpretation of the behaviors of other people in social contexts and the ability to recognize metaphor and irony. We assessed 34 patients with schizophrenia and 34 normal subjects using first- and second-order theory of mind tasks, the Metaphor and Sarcasm Scenario Test, and the Dewey Story Test (which tests the ability to judge others’ social behaviors). We compared the performance between the groups and analyzed correlations between the tasks. All tasks revealed significant deficits in the patients compared with the controls. In the patient group, metaphor comprehension was correlated with the ability to judge normal behaviors, and irony comprehension was correlated with the ability to judge abnormal behaviors, suggesting that deficits of social cognition in schizophrenia include these two types of factors associated with pragmatic language.