Examining dimensions of vulnerability among children in Uganda

Insufficient data on the nature and extent of children's vulnerability in Uganda has challenged government and donors in priority setting, resource allocation and developing effective approaches to improve well-being. We conducted a population-based survey among a nationally representative sample of 2551 households, covering a total of 7946 children. We engaged national stakeholders in a priority-setting exercise to develop a scoring system to assess dimensions of children's vulnerability. The exercise identified individual and household characteristics to assess vulnerability--many of which had not been measured previously--to which numerical weights representing vulnerability level were assigned. Highly weighted characteristics included maternal death, disability, child labour and pregnancy before age 17. Psychosocial elements included living apart from siblings, having nobody to talk to and never visiting a living parent. According to this approach, an estimated 51.1% of children in Uganda (weighted for national population distribution) are considered critically or moderately vulnerable. It is to these children, equivalent to a national total of 8.7 million, that support services should be prioritised. However, survey data suggest that the most critically vulnerable children are under-represented in several types of support services. This pioneering, participatory methodology provides a rudimentary, but valuable, first step towards quantifying the vulnerability of children in Uganda and assessing their resource needs. It has been used by the Government of Uganda to determine subcategories of vulnerability for resource allocation. A major advantage is that it uses local contextual knowledge of child vulnerability rather than generic criteria applied in international surveys. Further analytical work is required to validate the methodology, link it to child well-being outcomes and devise a practical tool for service providers to refine programme targeting. The approach may be useful to national, regional or local service providers seeking an overview of their client base to monitor and improve programme-targeting efforts.     

Meaningful involvement of people living with HIV/AIDS in Uganda through linkages between network groups and health facilities: an evaluation study

While community-based groups are able to provide vital support to people living with HIV/AIDS (PLHIV), their organizational and technical capacities are limited, and they frequently operate in isolation from PLHIV groups. We evaluated a three-year project implemented by the International HIV/AIDS Alliance in Uganda to increase the involvement of PLHIV in the HIV/AIDS response and to improve access to and utilization of prevention, treatment, care, and support services for households affected by HIV/AIDS. Information sources included project monitoring data, interviews with 113 key informants, and 17 focus group discussions in 11 districts. The evaluation found that PLHIV groups reached large numbers of people with education and awareness activities and made a growing number of referrals to health facilities and community-based services. The project trained individuals living openly with HIV as service providers in the community and at designated health facilities. Their presence helped to reduce the stigma that previously deterred PLHIV from seeking care and encouraged individuals to disclose their HIV status to spouses and family members. The project has put into practice the widely endorsed principles of greater and meaningful involvement of PLHIV in a systematic manner and on a large scale. A wide audience--ranging from grassroots PLHIV networks and AIDS service organizations to national-level non-governmental organizations, government agencies, and international organizations--can benefit from the lessons learned.     

Examining the association between emotion regulation difficulties and probable posttraumatic stress disorder within a sample of African Americans

This study examined the associations between emotion dysregulation and probable posttraumatic stress disorder (PTSD) among 180 African American undergraduates enrolled in a historically black college in the southern United States. Trauma-exposed participants with probable PTSD reported significantly higher levels of overall emotion dysregulation and the specific dimensions of lack of emotional acceptance, difficulties engaging in goal-directed behavior when upset, difficulties controlling impulsive behaviors when distressed, and limited access to effective emotion regulation strategies than participants without Criterion A traumatic exposure and those with Criterion A traumatic exposure but no PTSD (controlling for age and negative affect). Furthermore, results indicated that participants with Criterion A traumatic exposure but no PTSD were significantly less likely to report difficulties controlling impulsive behaviors when distressed and limited access to effective emotion regulation strategies than participants without Criterion A traumatic exposure (controlling for age and negative affect). These findings extend extant research on the role of emotion dysregulation in PTSD, thus providing support for the relevance of emotion dysregulation to PTSD among African American adults in particular.     

Inattention,working memory,and academic achievement in adolescents referred for attention deficit/hyperactivity disorder (ADHD)

This study investigated the role of inattention and working memory in predicting academic achievement in 145 adolescents aged 13 to 18 referred for attention deficit/hyperactivity disorder (ADHD). Path analysis was used to examine whether auditory-verbal and visual-spatial working memory would mediate the relationships between classroom inattention symptoms and achievement outcomes. Results provide support for the mediational model. Behavioral inattention significantly predicted both auditory-verbal and visual-spatial working memory performance. Auditory-verbal working memory was strongly associated with adolescents' achievement in reading and mathematics, while visual-spatial working memory was only associated with achievement in mathematics. The path from inattention symptoms to reading was partially mediated by the working memory variables, but the path from inattention to mathematics was not mediated by working memory. The proposed model demonstrated a good fit to the data and explained a substantial amount of variance in the adolescents' achievement outcomes. These findings imply that working memory is a risk factor for academic failure for adolescents with attentional problems.     

The Levels Hypothesis and the Study of Stimulus Value of Projective Test Items

Summary

Anagrams and semantic differential (S-D) test responses of Ss for whom words were “loaded” on a free association test were compared with those of Ss for whom the words were neutral. No differences in rate of word building or mean productivity of the two groups on the anagrams test were found. Mean S-D scale values similarly failed to differentiate between the two groups. However, when numbers of neutral (0) and extreme (+3 and ?3) responses were compared, “loaded” Ss were found on the whole to rate words more neutrally or more positively. The conclusion was that the stimulus value of the words in the associative condition could not be directly determined from responses in other conditions. The strategy of studying stimulus value of projective test items by using those items as stimuli on tests eliciting different levels of response was, therefore, questioned. Several other related experimental strategies which may mix response levels were also discussed and more appropriate techniques were suggested.     

“Short-Form” Content Scales for the MMPI

Using an abbreviated version of content scales derived by a rational-theoretical approach to the MMPI item pool rather than the traditional criterion group approach, this report demonstrates both satisfactory long- short-form correlations and promising internal consistency for these short-form scales. Comparing women discharged from a psychiatric hospital (N = 40) and non-psychiatric controls (N = 41), these content scales differentiate the two groups both at the beginning of an aftercare intervention study and approximately 20 months later. Mood scales are somewhat less stable over time, especially among patients. While not correlated with age or verbal intelligence, several scales are correlated with measures of social status.     

Combined hysterectomy and mastectomy surgery for transgender patients in an integrated health care setting

Background: Hysterectomy and mastectomy surgery for gender affirmation have traditionally been performed as separate surgeries. Our institution offers these surgeries as a single combined procedure, typically with same-day discharge. Decreasing the number of times patients need to have surgery may reduce barriers to care by limiting surgical and hospital stay events. Our primary objective was to describe the perioperative experience of transgender patients who underwent combined hysterectomy and mastectomy surgery.

Methods: This retrospective case series assessed patients who underwent combined hysterectomy and mastectomy surgery between 2013 and 2015 in an integrated health care setting in the United States. Chart reviews were performed for outcomes of interest, which included operative and postoperative complications.

Results: We identified 25 patients who underwent a combined hysterectomy and mastectomy for the indication of gender transition. Preoperative patient characteristics included a median age of 31, with a median BMI of 25. Ninety-two percent of the patients were on testosterone therapy at the time of surgery. A total of 76% and 24% of patients had laparoscopic and vaginal hysterectomies, respectively. Intraoperatively, the average blood loss was 104 mL, and there were no complications. Eighty percent of patients were discharged on the same day. Postoperatively, 92% of patients experienced no major complications. One patient received a uterine artery embolization and blood transfusion for postoperative intraabdominal bleeding, and one patient presented 9 weeks after surgery with partial vaginal cuff dehiscence requiring a cuff revision. There were no re-admissions within six months of surgery. There were no major mastectomy-related complications.

Conclusions: Combined surgeries are feasible and reduce the number of surgical events and hospital stays. There were no complications that could be attributed to undergoing two procedures as a single incident.     

Rhesus macaques (Macaca mulatta) as living fossils of hominoid personality and subjective well-being

Personality dimensions capturing individual differences in behavior, cognition, and affect have been described in several species, including humans, chimpanzees, and orangutans. However, comparisons between species are limited by the use of different questionnaires. We asked raters to assess free-ranging rhesus macaques at two time points on personality and subjective well-being questionnaires used earlier to rate chimpanzees and orangutans. Principal-components analysis yielded domains we labeled Confidence, Friendliness, Dominance, Anxiety, Openness, and Activity. The presence of Openness in rhesus macaques suggests it is an ancestral characteristic. The absence of Conscientiousness suggests it is a derived characteristic in African apes. Higher Confidence and Friendliness, and lower Anxiety were prospectively related to subjective well-being, indicating that the connection between personality and subjective well-being in humans, chimpanzees, and orangutans is ancestral in catarrhine primates. As demonstrated here, each additional species studied adds another fold to the rich, historical story of primate personality evolution.     

A comparison of procedural variations in teaching behavior chains: manual guidance, trainer completion, and no completion of untrained steps

We compared variations for teaching a sequence of responses through forward chaining. Seven children who had been diagnosed with autism participated in a comparison of teacher completion (TC) of steps beyond the training step and manually guiding the student (SC) to complete steps beyond the training step. A no-completion (NC) condition, in which the steps beyond the training step were not completed, was added to the comparison with 4 of the participants. Results showed that learning occurred with all procedures, although 5 participants acquired the chains most efficiently in the SC condition and the other 2 learned most efficiently in the TC condition. Of the participants for whom an NC condition was included, the tasks were acquired with the shortest average session length and total training time. Despite the potential benefits of TC and SC procedures, NC is a viable option and may be preferable for some students.     

Unconscious phantasy as a structural principle and organizer of mental life: The evolution of a concept from Freud to Klein and some of her successors

Starting with Freud's discovery of unconscious phantasy as a means of accessing his patients’ internal world, the author discusses the evolution of the concept in the work of Melanie Klein and some of her successors. Whereas Freud sees phantasy as a wish fulfilling imagination, dominated by primary process functioning and kept apart from reality testing, Klein understands phantasies as a structural function and organizer of mental life. From their very beginnings they involve object relations and gradually evolve from primitive body‐near experiences to images and symbolic representations. With her concept of projective identification in particular, Klein anticipates the communicative function of unconscious phantasies. They are at the basis of processes of symbolization, but may also be put into the service of complex defensive operations. The author traces the further evolution of the concept from the contributions of S. Isaacs, the theories of thinking proposed by W.R. Bion and R. Money‐Kyrle, Hanna Segal's ideas on symbolization and reparation all the way to the latest approaches by R. Britton, J. Steiner and others, including the understanding of transference and counter‐transference as a ‘total situation’. Points of contact with Freud are to be found particularly in connection with his concept of ‘primal phantasies’. In the author's view, the idea of the transmission and communicative potential of unconscious phantasies enabled these authors to overcome the solipsistic origins of drive theory in favour of a notion in which unconscious phantasies both set down the coordinates of the inner world and form and reflect the matrix of inter‐subjective relations.