Methods for Assessing Quality of Life and Well-Being in Frail Older People

The appropriateness, reliability and convergence of differing methods and associated instruments for the assessment of quality of life and well-being in frail older people was examined in 60 ( S 65 years of age) nursing home residents. The feasibility of measuring quality of life and well-being via a variety of instruments was explored through observation (an adaptation of Dementia Care Mapping), structured interview (Schedule for the Evaluation of Individual Quality of Life - Direct Weighting), and proxy questionnaire (Pleasant Events Schedule - Alzheimer Disease; Apparent Emotion Rating Scale). The observational assessment and Pleasant Events Schedule demonstrated good reliability. Significant associations were found between well-being as assessed by observation, and active social interaction and engagement in recreation as assessed by observation, quality of life as assessed by structured interview, and enjoyment of activities as assessed by proxy questionnaire. These findings indicate the importance of social activity in later life, and the potential of different approaches for the appropriate assessment of key aspects of quality of life in frail older people.     

Body-related pride in young adults: An exploration of the triggers,contexts, outcomes and attributions

This study explored body-related emotional experiences of pride in young adult males (n = 138) and females (n = 165). Data were collected using a relived emotion task and analyzed using inductive content analysis. Thirty-nine codes were identified and grouped into six categories (triggers, contexts, cognitive attributions, and affective, cognitive, and behavioral outcomes) for each of two themes (hubristic and authentic pride). Hubristic pride triggers included evaluating appearance/fitness as superior. Cognitions centered on feelings of superiority. Behaviors included strategies to show off. Triggers for authentic pride were personal improvements/maintenance in appearance and meeting or exceeding goals. Feeling accomplished was a cognitive outcome, and physical activity was a behavioral strategy. Contexts for the experience of both facets of pride primarily involved sports settings, swimming/beach, and clothes shopping. These findings provide theoretical support for models of pride as it applies to body image, and advances conceptual understanding of positive body image.     

Are age-related changes in cognitive function driven by age-related changes in sensory processing?

Although there has been keen interest in the association among measures of sensory function and cognitive function for many years, in general, measures of sensory function have been confined to one or two senses and measures of threshold sensitivity (acuity). In this study, rigorous psychophysical measures of threshold sensitivity, temporal gap detection, temporal order identification, and temporal masking have been obtained, in hearing, vision, and touch. In addition, all subjects completed 15 subtests of the Wechsler Adult Intelligence Scale, 3rd edition (WAIS–III). Data were obtained from 245 adults (18–87 years old) for the WAIS–III and for 40 measures of threshold sensitivity and temporal processing. The focus in this report is on individual differences in performance for the entire data set. Principal-components (PC) factor analysis reduced the 40 psychophysical measures to eight correlated factors, which were reduced further to a single global sensory processing factor. Similarly, PC factor analysis of the 15 WAIS–III scores resulted in three correlated factors that were further reduced to a single global cognitive function factor. Age, global sensory processing, and global cognitive function were all moderately and significantly correlated with one another. However, paired partial correlations, controlling for the third of these three measures, revealed that the moderate correlation between age and global cognitive function went to zero when global sensory processing was controlled for; the other two partial correlations remained intact. Structural models confirmed this result. These analyses suggest that the long-standing observation of age-related changes in cognitive function may be mediated by age-related changes in global sensory processing.     

Intersections Between Nativity, Ethnic Density, and Neighborhood SES: Using an Ethnic Enclave Framework to Explore Variation in Puerto Ricans’ Physical Health

Although past research has demonstrated a “health disadvantage” for Puerto Rican adults, very little is known about correlates of health among this group. Given Puerto Ricans’ unique experiences of migration and settlement, an ethnic enclave framework that integrates nativity, ethnic density, and neighborhood SES may offer insight into factors influencing Puerto Ricans’ health. This study uses a sample of 449 adult mainland- and island-born Puerto Ricans living in New York City and Chicago. The data, collected as a part of the MIDUS Survey of Minority Groups, are stratified by neighborhood ethnic density and neighborhood SES, allowing for the examination of the individual and joint influences of neighborhood characteristics on physical health. Results revealed that ethnic density and neighborhood SES were not independently or interactively related to physical health for mainland-born Puerto Ricans. However, the interaction between ethnic density and neighborhood SES was related to self-reported health, functional limitations, and health symptoms for island-born Puerto Ricans. Island-born Puerto Ricans living in ethnically dense, low SES neighborhoods reported worse health than island-born Puerto Ricans living in other types of neighborhoods. This may be a result of isolation from resources both within and outside the neighborhood.     

Countering Perfectionism in Research on Clinical Practice. III: Implications for Randomized Designs of the Presence of Uncontrolled Interactions and Spontaneous Changes

In a crossover study, we took pre-test, post-first-treatment, and post-second-treatment measures of self-expressiveness (assertiveness) and of acute emotional distress while we successively trained different groups of students in assertiveness and group therapy exercises. Our (unfulfilled) expectations were straightforward: We thought that assertiveness training would produce specific improvement in self-expression measures with little impact on overall distress and that group therapy would produce specific improvement in general distress with little impact on assertiveness. Both treatments improved assertiveness and decreased distress. The fact that our treatments had impure effects enhanced the likelihood of Type II statistical errors and compromised the effectiveness of our design. In addition, quite surprisingly, assertiveness training selectively improved the mental health of women students, and group therapy selectively improved the assertiveness of men students more than the alternative treatment did. This interaction between gender and randomly administered experimental treatment procedures raises serious, generally important questions about the logic of statistically controlled experimentation that relies on randomization to eliminate the effects of uncontrolled, but relevant, variables.     

Eating Behavior Among Thais and Americans

A cross-cultural analysis of eating patterns was conducted to examine the possible relationship between eating style and obesity. Thai and American students were surveyed about such bad eating habits as eating between meals, eating too quickly, eating when not hungry, and eating in response to external food cues. Contrary to the learning model of obesity, which postulates a causal relationship between eating style and body size, American subjects reported significantly better eating habits than did their much thinner Thai counterparts. A within-culture comparison of the American subjects showed a less significant but similar trend, with obese subjects claiming to have better eating patterns than both thin and underweight subjects.     

Effects of Stimulus Color,Pattern, and Practice on Sex Differences in Mental Rotations Task Performance

Redundant color information improved performance for both sexes on the Shepard Mental Rotations Task (MRT; Shepard & Metzler, 1971). Absolute score gains for women were larger than those for men; therefore, relative improvement was greater. Substantial practice effects, also favoring women, were apparent in both studies. Study 1 showed that redundant color improved performance by 0.25 SD. Study 2 demonstrated that redundant black-and-white pattern information did not have any effect; a second visuospatial channel, redundant color, was a critical factor in improving scores of men and women on difficult mental rotations tasks.     

Trajectories and predictors of developmental skills in healthy twins up to 24 months of age

Background

Low birth weight and low 5-min Apgar scores have been associated with developmental delay, while older maternal age is a protective factor. Little is known about trajectories and predictors of developmental skills in infant twins, who are generally born with lower birth weights, lower Apgar scores and to older mothers.

Methods

Developmental skills were assessed at 3, 6, 9, 12, 18 and 24 months using the Ages and Stages Questionnaires in 152 twins from the Birmingham Registry for Twin and Heritability Studies. Multilevel spline and linear regression models (adjusted for gestational age, gender, maternal age) were used to estimate developmental trajectories and the associations between birth weight, maternal age and Apgar scores on developmental skills.

Results

Twins performed worse than singletons on communication, gross motor, fine motor, problem solving and personal-social skills (p < 0.001). Twins caught up around 6 months (score within −1 standard deviation of norm), except on gross motor skills, which did not catch up until after the age of 12 months. A one-year increase in maternal age was significantly associated with decreases in gross motor and personal–social z-scores of up to −0.09, whereas one unit increases in Apgar score increased z-scores up to 0.90 (p < 0.01).

Conclusions

Healthy twins should be considered at a higher risk for developmental delay. Whether these results are comparable to preterm singletons, or whether there are twin-specific issues involved, should be further investigated in a study that uses a matched singleton control group.     

Speaking of feelings affects,language, and psychoanalysis

For a surprising number of analysands, many with above‐average intelligence and facility with language, words do not adequately capture or convey emotion or symbolize experience. This often subtle difficulty can have a powerful impact on the ability to verbally communicate emotions, process affect, and utilize traditional psychoanalytic interventions. Analysands with these problems therefore often have difficulty using analysis to explore and understand their own experience, yet the reasons for such difficulties are often not recognized by either analyst or analysand. In this article, I suggest that the concept of alexithymia can provide a valuable tool for understanding this gap between affects and language and, in its broadest interpretation, can aid therapists in their pursuit of meaningful approaches to the analytic process. Using the concept as a starting point, I describe and illustrate an approach in which paying attention to apparently insignificant aspects of an analysand's experience gradually helps analysands identify and explore personal symbols and meanings in their lives.