Quality of life is a process not an outcome

Quality improvement mechanisms increasingly use outcome measures to evaluate health care providers. This move toward outcome measures is a radical departure from the traditional focus on process measures. More radical still is the proposal to shift from relatively simple and proximal measures of outcome, such as mortality, to complex outcomes, such as quality of life. While the practical, scientific, and ethical issues associated with the use of outcomes such as mortality and morbidity to compare health care providers have been well rehearsed, the specific concerns associated with the use of quality of life measures in quality of care research have received little attention. As with much research on quality of life there is a tendency to assume that the disadvantages are outweighed by the general virtue of ??listening?? to patients. In this paper we disagree with this assumption and argue that quality of life is a process, not an outcome.     

Reciprocal relations between recovery and work engagement: the moderating role of job stressors

In this paper, we examined the within-person relations between morning recovery level (i.e., feeling refreshed and replenished) and work engagement throughout the day, and between work engagement throughout the day and the subsequent recovery level at the end of the workday. We hypothesized that job stressors (situational constraints, job demands) moderate these relations. A diary study over 1 workweek with 2 measurement occasions per day (N = 111 persons) provided support for most of the hypotheses: Morning recovery level predicted work engagement, and work engagement predicted subsequent recovery level at the end of the workday after controlling for morning recovery level. As predicted, situational constraints attenuated these relations, but job demands did not. The results suggest that recovery translates into employee work engagement, and work engagement, in turn, prevents a loss in recovery level throughout the day, particularly when situational constraints are low. Situational constraints seem to interrupt the reciprocal processes between recovery level and work engagement.     

The Effects of Parental Depressive Symptoms,Appraisals, and Physical Punishment on Later Child Externalizing Behavior

Examined a cognitive-behavioral pathway by which depressive symptoms in mothers and fathers increase risk for later child externalizing problem behavior via parents’ appraisals of child behavior and physical discipline. Participants were 245 children (118 girls) at risk for school-age conduct problems, and their parents and teachers. Children were approximately 3 years old at Time 1 (T1) and 5 ½ years old at Time 2 (T2). At T1, mothers and fathers reported their depressive symptoms, perceptions of their child’s reciprocal affection and responsiveness, frequency of physical punishment, and child externalizing problems. Mothers, fathers, and teachers provided ratings of externalizing behavior at T2. Structural equation modeling revealed that parents’ negative attributions mediated positive relations between their depressive symptoms and frequency of physical punishment for both fathers and mothers. More frequent physical punishment, in turn, predicted increased child externalizing behavior at T2. In future research, transactional mechanisms underlying effects of clinical depression on child conduct problems should be explored at multiple stages of development. For parents showing depressive symptoms, restructuring distorted perceptions about their children’s behavior may be an important component of intervention programs.     

Peer Rejection and Friendships in Children with Attention-Deficit/Hyperactivity Disorder: Contributions to Long-Term Outcomes

Even after evidence-based treatment, Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with poor long-term outcomes. These outcomes may be partly explained by difficulties in peer functioning, which are common among children with ADHD and which do not respond optimally to standard ADHD treatments. We examined whether peer rejection and lack of dyadic friendships experienced by children with ADHD after treatment contribute to long-term emotional and behavioral problems and global impairment, and whether having a reciprocal friend buffers the negative effects of peer rejection. Children with Combined type ADHD (N?=?300) enrolled in the Multimodal Treatment Study of Children with ADHD (MTA) were followed for 8 years. Peer rejection and dyadic friendships were measured with sociometric assessments after the active treatment period (14 or 24 months after baseline; M ages 9.7 and 10.5 years, respectively). Outcomes included delinquency, depression, anxiety, substance use, and general impairment at 6 and 8 years after baseline (Mean ages 14.9 and 16.8 years, respectively). With inclusion of key covariates, including demographics, symptoms of ADHD, ODD, and CD, and level of the outcome variable at 24 months, peer rejection predicted cigarette smoking, delinquency, anxiety, and global impairment at 6 years and global impairment at 8 years after baseline. Having a reciprocal friend was not, however, uniquely predictive of any outcomes and did not reduce the negative effects of peer rejection. Evaluating and addressing peer rejection in treatment planning may be necessary to improve long-term outcomes in children with ADHD.     

Association between vigor and exhaustion during the workweek: a person-centered approach to daily assessments

The purpose of this quantitative diary study was to investigate daily vigor and exhaustion using a person-centered approach. The study also investigated whether and how experiences of vigor and exhaustion relate to a state of being recovered. A total of 256 Finnish employees filled in a diary questionnaire during five consecutive workdays. Vigor and exhaustion showed strong negative interdependence within and between days. However, by applying a person-centered analysis, we were able to differentiate three groups with meaningful variation in vigor and exhaustion. The groups were labeled as Constantly vigorous (n = 179), Concurrently vigorous and exhausted (n = 30) and Constantly exhausted (n = 43). The vigor-exhaustion groups were also characterized by their recovery experiences: The Constantly vigorous employees recovered well from work strain during the workweek whereas the Constantly exhausted group recovered poorly. Overall, while the results indicate that, typically, vigor and exhaustion are exclusive experiences, it is also possible for them to be experienced simultaneously from day to day at the moderate levels. Thus, positive and negative experiences may co-occur.     

Psychological Capital Among University Students: Relationships with Study Engagement and Intrinsic Motivation

This paper reports two studies: Study 1 aimed to evaluate respective modified versions of existing scales of psychological capital (PsyCap) and study engagement (SE), and to test the reciprocal relationship between PsyCap and SE; Study 2 aimed to test intrinsic motivation as a mediator between PsyCap and SE. A two-wave cross-lagged design was adopted in Study 1 with a matched sample of 103 students, with 4 months apart. With confirmatory factor analyses, the results supported the construct validity of a higher-order model of PsyCap (PsyCap overall) and of study engagement comprising dedication, absorption and vigor. Further, the reciprocal relationship between PsyCap and SE was demonstrated. Results of Study 2 among 100 university students showed that intrinsic motivation measured at time 2 was a significant mediator between time 1 PsyCap and time 2 SE.     

Low Prospects and High Risk: Structural Determinants of Health Associated with Sexual Risk Among Young African American Women Residing in Resource-Poor Communities in the South

African American women at increased risk of HIV/sexually transmitted infection (STI) may engage in risky sex as a coping mechanism for depressed economic conditions. This study examines the association between high-risk sexual behavior and structural determinants of sexual health among a sample of young African American women. 237 young African American women (16–19 years old) from economically disadvantaged neighborhoods in North Carolina were enrolled into a randomized trial testing the efficacy of an adapted HIV/STI prevention intervention. Logistic regression analyses predicted the likelihood that young women reporting lack of food at home, homelessness and low future prospects would also report sexual risk behaviors. Young women reporting a lack of food at home (22 %), homelessness (27 %), and low perceived education/employment prospects (19 %) had between 2.2 and 4.7 times the odds as those not reporting these risk factors of reporting multiple sex partners, risky sex partners including older men and partners involved in gangs, substance use prior to sex, and exchange sex. Self-reported structural determinants of sexual health were associated with myriad sexual risk behaviors. Diminished economic conditions among these young women may lead to sexual risk due to hopelessness, the need for survival or other factors.     

Imposters,Tricksters, and Trustworthiness as an Epistemic Virtue

This paper argues that trustworthiness is an epistemic virtue that promotes objectivity. I show that untrustworthy imposture can be an arrogant act of privilege that silences marginalized voices. But, as epistemologists of ignorance have shown, sometimes trickery and the betrayal of epistemic norms are important resistance strategies. This raises the question: when is betrayal of trust epistemically virtuous? After establishing that trust is central to objectivity, I argue for the following answer: a betrayal is epistemically vicious when it strengthens or promotes oppressive, exclusive networks of trust, and a betrayal is epistemically virtuous when it expands trust networks to involve the oppressed. These criteria correctly account for both the epistemic vice of a recent case of Internet imposture and the epistemic virtue of resistant tricksters.     

Positive Experiences at Work and Daily Recovery: Effects on Couple’s Well-Being

The present diary study investigates, at the within-person level, how job satisfaction mediates the relationship between self-rated job performance and recovery experiences (i.e., psychological detachment from work and relaxation) during off-job time. Furthermore, we explore the effects of these two recovery experiences on couple´s well-being. Data were collected from 145 dual-earner couples (N = 290 participants; N = 1450 occasions) with a daily diary design (five consecutive working days). Multilevel analyses showed that daily job performance positively predicted psychological detachment and relaxation, and that daily job satisfaction partially mediated this relationship. In addition, we found that psychological detachment and relaxation have positive effects on own and partner´s indicators of well-being (i.e., relationship satisfaction and positive emotions). The benefits of recovery go beyond the individual and affect their partner´s level of well-being.