Prevalence and correlates of sexual morbidity in long-term breast cancer survivors

Objective: Breast cancer survivors report adverse sexual effects (sexual morbidity) such as disrupted sexual function, sexual distress and body dissatisfaction. However, most studies have failed to evaluate the persistence of these effects in long-term survivors. The present study comprehensively assessed the prevalence and predictors of sexual/body image problems among survivors three or more years post diagnosis.

Design/outcome measures: Eighty-three breast cancer survivors completed surveys a median of seven years post diagnosis. Survey items probed demographic, diagnostic and clinical information, in addition to sexual activity, sexual function (Female Sexual Function Index [FSFI]), body image, and distress regarding body changes and sexual problems (Female Sexual Distress Scale-revised; FSDS-R).

Results: Seventy-seven percent of all participants and 60% of sexually active participants qualified for sexual dysfunction based on the FSFI. Between 37 and 51% met criteria for female sexual dysfunction, based on two FSDS-R clinical cut-offs. Body satisfaction was worse than normative values, while body change stress was mid-range. Notable sexual morbidity predictors included mastectomy, which was associated with worse sexual/body change distress, and post-treatment weight gain, which predicted greater body dissatisfaction/body change stress.

Conclusions: Breast cancer survivors report substantial sexual morbidity years after treatment, especially after mastectomy or post-treatment weight gain. Breast cancer patients and their providers should be aware of these potential sexual effects.     

Identifying the ‘if’ for ‘if-then’ plans: Combining implementation intentions with cue-monitoring targeting unhealthy snacking behaviour

Implementation intentions aimed at changing unwanted habits require the identification of personally relevant cues triggering the habitual response in order to be effective. To facilitate successful implementation intention formation, in the present study, planning was combined with cue-monitoring, a novel way to gain insight into triggers for unhealthy snacking. It was tested whether keeping a cue-monitoring diary and tailoring implementation intentions accordingly improves plan effectiveness. A 2 Monitoring (cue-monitoring, control)?×?2 Planning (implementation intention, goal intention) between subjects design was adopted. Participants (N = 161) monitored their unhealthy snacking behaviour for a week using either a cue-monitoring or a control diary. Participants then formulated a goal intention or an implementation intention tailored to their personal cue. Snacking frequency and caloric intake from unhealthy snacks were examined using a seven-day snack diary. The results did not indicate an interaction but yielded a main effect of Monitoring. Cue-monitoring either or not combined with implementation intentions reduced unhealthy snacking behaviour compared with control. Findings emphasise the effectiveness of cue-monitoring, suggesting that on the short term, cue-monitoring suffices to decrease unhealthy snacking, without additional benefit from planning. Future research should examine whether supplementing cue-monitoring with implementation intentions is required to establish long-term behaviour change maintenance.     

Planning bridges the intention–behaviour gap: Age makes a difference and strategy use explains why

Objective: This study examines age-differential association patterns between intentions, planning and physical activity in young and middle-aged individuals. The effectiveness of planning to bridge the intention–behaviour gap is assumed to increase with advancing age. We explore the use of behaviour change strategies that include selection, optimisation and compensation (SOC) as underlying mechanisms for age differences. Methods: In N = 265 employees of a national railway company (aged 19–64 years), intentions, planning, SOC strategy use and physical activity were assessed at baseline (Time 1) and again 1 month later (Time 2). Hypotheses were tested in two different path models. Results: Age moderates the extent to which planning mediates the intention–behaviour relation due to an increasing strength of the planning–behaviour link. As a possible psychological mechanism for these age differences, we identified SOC strategy use as a mediator of the age by planning interaction effect on physical activity. Conclusion: These findings suggest differential mechanisms in behaviour regulation in young and middle-aged individuals.     

Expectations of reducing fat intake: The role of perceived need within the theory of planned behaviour

Abstract

Dietary fat intake has been implicated in the causation of major diseases including coronary heart disease and cancer. Hence, current recommendatioris to improve health emphasise the reduction of fat intake (COMA, 1991). The present study investigated the effect of perceived need to reduce fat intake and past behaviour on peoples' expectations of reducing fat intake, using the framework of the Theory of Planned Behaviour (TPB) (Ajzen, 1985; 1991). The effects of estimated fat intake and body weight on perceived need to reduce were also investigated. One hundred and fifty-two adults completed a four-day weighed dietary record and completed a questionnaire based on the TPB. Perceived need to reduce fat intake, cognitive and affective components of attitude and past behaviour wm found to be significant predictors of expectation of reducing fat intake. Perceived body weight and estimated fat intake were significant predictors of perceived need to reduce fat intake. The implications of these findings for health promotion policy are discussed.     

Reducing the Linear Perception of Nonlinearity: Use of a Physical Representation

Research shows that while judging accumulations of quantities over time (e.g., money in a bank account or CO₂ in Earth's atmosphere), people assume that the shape of the accumulation is similar to the shape of the inflow (i.e., people rely on a correlation heuristic). Relying on the correlation heuristic is particularly worrisome for Earth's climate, as judging the CO₂ accumulation according to its emissions (inflow) would underestimate the actual (nonlinear) increase. This misperception undermines the seriousness of climate problem and results in wait‐and‐see behavior. We report two experiments where the effectiveness of a physical representation is compared with graphical and text representations in reducing people's underestimation of nonlinear accumulation in different contexts and problems. A physical representation presents an accumulation using a picture that works as a metaphor. In the first experiment, participants drew the shape of an accumulation over time relying on physical or graphical representations in one of two contexts: carbon dioxide and marbles. Although the participants underestimated the accumulation in both contexts, underestimations were reduced in the physical representation compared with the graphical representation. In the second experiment, we extended the evaluation of physical representations against both text and graphical representations in two different climate problems (with linearly increasing or decreasing inflow). Again, underestimations of the accumulation were reduced in the physical representation compared with the other two representations, regardless of the nature of the problem. We discuss implications of using the physical representation for improving people's estimates of nonlinear CO₂ accumulation. Copyright © 2011 John Wiley & Sons, Ltd.     

Change and Stability in Attitudes Toward Violence During ISAF Service

A Swedish contingent to the International Security Assistance Force (ISAF; N = approx. 320) was studied before and after deployment to Afghanistan to assess if the mission and experiences on it affected attitudes toward violence. Attitudes toward war violence and penal violence were assessed across t = 1 and t = 2, as were the effects of combat exposure on change and stability in attitudes. It was hypothesized that the attitudes would remain stable across the deployment due to their importance to the soldierly identity, but that experiences of combat exposure would cause an increase in the propensity toward change. Results demonstrate that attitudes did not change between the pre- and postdeployment stages. Unexpectedly, increasing levels of combat exposure did not predict higher rates of change, but rather increased stability in attitudes toward violence. The results demonstrate that in terms of the willingness to use force, peacekeeping deployments do not have detrimental effects on soldiers.     

EXAMINING A MODEL OF EVOLUTIONARY EDUCATIONAL SYSTEMIC CHANGE WITHIN EXISTING SOCIETAL SYSTEMS

Within today's emerging global society, educational systemic change is a dynamic, complex process that must seek to engage active participation of all stakeholders. This article examines alternative models of this process, providing different perspectives of the recursive and comprehensive nature of change when viewed from the vantage points of those stakeholders within the process. An envisioned school or educational system that addresses preparation of a citizenry dedicated to democratic principles and issues of social justice must consciously examine the relationships, that form and reform interconnecting and unifying diverse subsystems within the school's constructed meaning and purpose.     

SUSTAINABILITY SEEN THROUGH AN INTEGRAL LENS

The call to create a sustainable society includes many ideas that are consonant with Integral Science, including its conception of humans as part of nature, emphasis on healthy communities as fundamental building blocks, and emphasis on collaborative social organization. Integral Science expands the sustainability discussion by adding an ecological view of growth, and fractal structures to explain resilient structure. It describes the new society as a collaborative learning society that adapts appropriately to accurate signals. It also shows that the new society is already emerging.