Psychological and behavioural effects of bone density screening for osteoporosis

Abstract

To examine the psychological effects of bone density measurement, 298 women were assessed two weeks before the bone density scan, immediately before the scan, after the results, a week later and three months later. For the group as a whole, ratings of anxiety and perceived vulnerability were lower at the three month follow-up than at the initial assessment. Women who received a low bone mineral density (BMD) result were more anxious and reported more osteoporosis-preventive behaviours at the three month follow-up than women who received a high BMD result; these differences had not been apparent at the initial assessment Women with low BMD results had higher ratings of perceived vulnerability after the scan, although for some of these ratings there were group differences before the scan. Women with a low BMD result showed a decrease in ratings of the seriousness of a below-average result, which may reflect minimization of the health threat     

Social cognitions measured in 4 to 6 year olds are predictive of objectively measured physical activity

Objective: This study tested whether social cognitions from the reasoned action approach (RAA) can be reliably measured in a sample of primary school children (aged 4–6 years) and whether these RAA measures are predictive of physical activity.

Design: Longitudinal observational study with repeated measures over six months.

Measures: RAA variables were measured using a novel choice paradigm between physically active and sedentary pastimes. Relative reinforcing value, covariates (sex, age, deprivation and BMI) and physical activity by accelerometry (primary outcome) were also measured.

Results: RAA cognitions could be measured with acceptable retest reliability and discriminant validity and social norms regarding parents and teachers (but not friends) were correlated with physical activity and change in physical activity when relative reinforcing value and other covariates were controlled for.

Conclusions: RAA cognitions can be reliably measured in primary school children aged 4–6 and RRA measures appear useful in understanding children’s activity choices and may potentially inform future interventions.     

Socio-economic health inequalities: Their origins and implications

Abstract

Evidence attests to substantial variations in health contingent on socioeconomic position. It is argued that these effects cannot be dismissed as artefact nor can they be explained, in the main, by either social selection or an unequal distribution of accepted behavioural risk factors among different social groups. The most likely explanation would seem to be social causation. However, it is continuing social and material inequality that appears most implicated; accounts which locate the effects in childhood social and material causes are far less compelling. The persistence of socioeconomic health differentials into the materially better-off social strata and the possible determining role of relative as well as absolute living standards suggest that psychological, in addition to material, variables are likely to be involved. Isolating the key psychological variables and identifying the nature of their influences will not be easy tasks, although social relations, psychological stress, uplifts, and control have emerged as possible candidates. However, psychological mediators of this sort most probably constitute surface rather than basic causes. Socio-economic inequality, it is contended, remains the basic cause, and, as such, the proper target for intervention. Psychological interventions are unlikely to yield much in the way of dividends in this context and indeed could inadvertently contribute to victim blaming.     

Psychosocial factors associated with hiv testing amongst scottish gay men

This article describes the relationship between HIV testing and a range of psychosocial, sexual and socio-demographic variables. Trained research staff distributed a self-report questionnaire in the gay bars of Glasgow and Edinburgh, in May 2000. Questionnaires were completed by 803 men (a response rate of 78%). We present the results of both bivariate and multivariate analyses identifying key variables associated with never having had an HIV test. Thus we outline some psychosocial barriers to HIV testing. Multivariate analysis indicated that the most important factor associated with never having tested was fear of a positive result; this was particularly true for those men who reported higher levels of risky sexual conduct. We discuss the relevance of these findings in terms of presenting a psychosocial agenda which demands that stigma and the social exclusion of HIV positive people should be addressed before gay men are encouraged to seek HIV testing.     

Understanding the impact of HIV diagnosis amongst gay men in Scotland: An interpretative phenomenological analysis

Objectives: Although a wide literature details the psychological impact of human immunodeficiency virus (HIV) diagnosis, it predates the introduction of effective treatment for HIV (i.e. anti-retroviral therapies, ARTs). This article explores the psychological impact of HIV diagnosis in post-ART accounts. This is important, given the recent policy developments which focus upon increasing HIV testing and thus diagnoses.

Design: This study presents a qualitative exploration of the experiential accounts of HIV-positive gay men living in Scotland. A total of 14 HIV-positive gay men took part in open-ended interviews.

Methods: Interpretative phenomenological analysis was employed to identify recurrent themes across the interviews.

Results: Our analysis focuses upon the participants’ struggles in adjusting to their HIV status. Diagnosis was a deeply shocking and unexpected experience. Stigma and fear of prejudice dominated their accounts. HIV was understood, variously, as a shameful, fatal and life-changing condition. Overall, within these accounts there was little sense of HIV normalisation.

Conclusions: In Scotland, where HIV prevalence is low, and where no accessible HIV-positive sub-culture exists, there is on-going psychological distress and morbidity amongst gay men testing HIV positive. As HIV-related policy increasingly focuses on increasing rates of antibody testing, there is a need to reduce the psychosocial costs associated with HIV-positive diagnoses.     

Affective and health-related outcome expectancies for physical activity in older adults

This study tests the effects of affective and health-related outcome expectancies on physical exercise, assuming stronger direct and indirect (via intention) effects from affective outcome expectancy to physical exercise than from health-related outcome expectancy to exercise. Physical exercise and social cognitive variables were assessed at baseline, and 6- and 12-month follow-up in 335 older adults (60–95 years of age). Applying structural equation modelling, there was a direct effect from affective, but not from health-related outcome expectancy on intentions and behaviour. Also, the indirect effect from self-efficacy on physical exercise via affective outcome expectancy was significant, whereas the mediation via health-related outcome expectancy was not. These findings emphasise the relative importance of affective versus health-related outcome expectancies in predicting intentions and physical exercise in older adults and highlight the importance to separate these facets at a conceptual level to enhance both theory development and health promotion.     

Transpersonal Psychology: Defining the Past,Divining the Future

Retrospective analysis of definitions published over some 35 years suggests the major subject areas of the field can be summed up in three themes: beyond-ego psychology, integrative/holistic psychology, and psychology of transformation. Theme frequency analysis reveals that early emphasis on alternative states of consciousness has moderated into a broader approach to human transcendence, wholeness, and transformation. This expanded definition of transpersonal psychology suggests the field has much in common with integral psychology. As a comprehensive, historically based content summary, this tripartite definition contributes a small but vital piece to the foundation of a transpersonal vision that is spreading across the globe. While transpersonal psychology still needs to embody the inclusiveness and diversity that it represents, its vision is one of great relevance to the contemporary human condition.     

Word Memory Test Performance in Children

One-hundred and thirty-five children between the ages of 7 and 18 years were evaluated clinically. Their diagnoses included Fetal Alcohol Syndrome (FAS) or Effects, Schizophrenia, Bipolar Mood Disorder, various neurological diseases, Attention Deficit Hyperactivity Disorder (ADHD), Conduct Disorder, Oppositional-Defiant Disorder and learning disabilities. As part of a comprehensive neuropsychological assessment, the children were given the Word Memory Test (WMT; Green, Allen, & Astner, 1996; Green & Astner, 1995), containing various subtests which measure, respectively, effort and verbal memory. Although age and verbal intelligence are known to affect scores on most ability tests, they were not found to be significant determinants of WMT effort scores. Younger children did not score any lower on the effort subtests than older children. The children scored as well as a group of parents seeking custody of their children and they scored higher than adult patients with mild head injuries. The computerized WMT requires some basic reading skills and some children with lower than a grade 3 reading level scored at a relatively low level on the effort subtests. The current data suggest that most children with at least a grade 3 reading level can pass the WMT using the adult criteria. It is concluded that the WMT is potentially useful in the evaluation of effort during pediatric neuropsychological evaluations. Further research is needed to replicate these findings and to develop child norms for the memory subtests.     

Science and practice: The struggle to bridge the gap

Abstract

Ida Sue Baron, Eileen Fennell, and Kytja Voeller (1995). Pediatric Neuropsychology in the Medical Setting. New York: Oxford University Press. ISBN 0-19-506345-7. 427 pp. US $57.50     

Structural studies of ultrathin zirconia dielectrics

We present detailed structural and chemical studies on ultrathin zirconia films grown by ultraviolet oxidation and natural (no ultraviolet light) oxidation of Zr precursor metal layers on SiO2-passivated Si(100) wafers. Quantitative electron-energy-loss spectroscopy (EELS) was used to obtain the chemical composition and electronic structure on an atomic scale. The EELS OK near-edge fine structure was used as a fingerprint to study the stoichiometry and composition variation in the dielectric stacks. X-ray absorption spectroscopy studies were performed in order to aid interpretation of the EELS results. The electronic structure data are correlated with the electrical performance of the films.