Marital role strain,illness intrusiveness,and their impact on marital and individual adjustment in end-stage renal disease

Abstract

A marital role theory approach was used to investigate individual psychosocial well-being and marital adjustment in 89 end-stage renal disease (ESRD) patients and their spouses. Four different patient groups were selected according to a continuum of clinical milestones in the treatment of ESRD, including pre-dialysis (n=17), incenter dialysis (n=18), home dialysis (n=19), and posttransplant patients (n=17). A nephrology clinic control group (n=18) was also included. Standardized instruments were employed to investigate marital role strain (Marital Role Questionnaire, KDS-15), marital adjustment (Locke-Wallace Marital Adjustment Test), subjective well-being (Affect Balance Scale, Rosenberg Self-Esteem Inventory), and psychopathology (Symptom Checklist 90-R). Hierarchical multiple regression analyses provided strong and consistent support for the major hypotheses relating elevated marital role strain to compromised marital adjustment and individual well-being. Further analyses demonstrated that increased perceived intrusiveness of ESRD was significantly related to greater marital role strain, poorer marital adjustment, and decreased individual well-being. This is consistent with the idea that perceived intrusiveness may be an important mediator of marital role strain and of coping with chronic illness. “Objective” intrusiveness, defined in terms of patient group, was not significantly related to marital or individual well-being. These findings support a dyadic approach to the psychosocial study of chronic illness.     

What are the positive consequences of illness?

Abstract

Fifty five people, either currently sick or having recovered from their illness, were recruited if they reported positive consequences of illness. They were questioned about their experiences of illness, 41 by semi-structured interview and 14 by open-ended questionnaire and responses were classified into 17 categories. The categories were similar but slightly more extensive than previous accounts of positive consequences reported in the literature. The content of the interviews and questionnaires was used to construct a 66 item questionnaire about positive consequences of illness which was then completed by 97 patients. A principal components analysis indicated a large first factor accounting for 27% of the variance. Endorsement of items varied between 87% and zero for chronic lung disease patients attending pulmonary rehabilitation. However, all patients endorsed at least one item and the median number of items endorsed was 31. Positive consequences of illness are highly varied and more common than often realised, and this has implications for the concept and measurement of quality of life.     

Predicting short and long-term exercise intentions and behaviour in patients with coronary artery disease: A test of protection motivation theory

The purpose of this study was to examine the utility of protection motivation theory (PMT) in the prediction of exercise intentions and behaviour in the year following hospitalisation for coronary artery disease (CAD). Patients with documented CAD (n?=?787), recruited at hospital discharge, completed questionnaires measuring PMT's threat (i.e. perceived severity and vulnerability) and coping (i.e. self-efficacy, response efficacy) appraisal constructs at baseline, 2 and 6 months, and exercise behaviour at baseline, 6 and 12 months post-hospitalisation. Structural equation modelling showed that the PMT model of exercise at 6 months had a good fit with the empirical data. Self-efficacy, response efficacy, and perceived severity predicted exercise intentions, which, in turn predicted exercise behaviour. Overall, the PMT variables accounted for a moderate amount of variance in exercise intentions (23%) and behaviour (20%). In contrast, the PMT model was not reliable for predicting exercise behaviour at 12 months post-hospitalisation. The data provided support for PMT applied to short-term, but not long-term, exercise behaviour among patients with CAD. Health education should concentrate on providing positive coping messages to enhance patients’ confidence regarding exercise and their belief that exercise provides health benefits, as well as realistic information about disease severity.     

Risk drinking and contraception effectiveness among college women

Risk drinking, especially binge drinking, and unprotected sex may co-occur in college women and increase the risks of STI exposure and pregnancy, but the relationships among these behaviors are incompletely understood. A survey was administered to 2012 women of ages 18–24 enrolled in a public urban university. One-quarter of the college women (23%) drank eight or more drinks per week on average, and 63% binged in the past 90 days, with 64% meeting criteria for risk drinking. Nearly all sexually active women used some form of contraception (94%), but 18% used their method ineffectively and were potentially at risk for pregnancy. Forty-four percent were potentially at risk for STIs due to ineffective or absent condom usage. Ineffective contraception odds were increased by the use of barrier methods of contraception, reliance on a partner's decision to use contraception, and risk drinking, but were decreased by the use of barrier with hormonal contraception, being White, and later age to initiate contraception. In contrast, ineffective condom use was increased by reliance on a partner's decision to use condoms, the use of condoms for STI prevention only, and by risk drinking. Thirteen percent of university women were risk drinkers and using ineffective contraception, and 31% were risk drinkers and failing to use condoms consistently. Risk drinking is related to ineffective contraception and condom use. Colleges should promote effective contraception and condom use for STI prevention and consider coordinating their programs to reduce drinking with programs for reproductive health. Emphasizing the use of condoms for both pregnancy prevention and STI prevention may maximize women's interest in using them.     

The relationship between self-reported oral symptoms and life-events

Abstract

This paper investigates whether eight specific life-events were related to self-reported chronic (persistent trouble over the last 12 months) and acute (trouble in the last 14 days) oral symptoms in a sample of 3861 civil servants aged 35-44 years. The results of a logistic regression analysis taking age, social class and gender into account showed that a range of life-events—marital or family problems other than divorce, death of a relative, personal serious illness, serious illness of a close relative, major financial difficulty and mugging and robbery—were significantly associated with either acute or chronic oral symptoms. Further analysis showed that marital or family problems other than divorce was found to be the most important life event studied. The results support the argument that marital dissatisfaction leads to poorer physical and psychological health.     

Work strain and the post-discharge adjustment of patients following a heart attack

Abstract

The role of work characteristics in determining return to work after an acute coronary event was examined. One hundred and forty nine patients were enrolled. One year post-discharge, 74 had returned to work. Work characteristics (decision latitude, and opportunity for social interaction at work), together with age, depression, and medical prognosis, correctly classified work status in 78% of cases. At 12 months post-discharge, patients who had not returned to work recorded significantly poorer levels of adjustment compared to those who had returned to work. A better quality of life is associated with a lower level of depression pre-hospitalization, ownership of a larger home, being male, and having a more positive work environment. The findings suggest that the pre-illness work environment of the patient is a factor influencing return to work, which needs to be considered in rehabilitation programmes.     

A survey of smoking status and cancer risk perceptions among participants attending a hospital-based head and neck screening program

Abstract

Screening for head and neck cancer is underutilized. Given that lack of knowledge of the risk factors may partially account for screening underutilization. we surveyed subjective risk and knowledge of risk factors for head and neck cancer among 124 individuals who attended a free. hospital-based head and neck cancer screening. Few participants were current smokers. Most attendees perceived their risk as similar to others of their age and sex. Personal health habits comprised almost all of the risk-decreasing factors, yet less than half of the risk-increasing factors. generated. Personal habits were less frequently endorsed than factors such as pollution and heredity. Those who mentioned a risk behavior, or a family cancer history, reported higher subjective risk. Those who mentioned a personal health habit reported lower subjective risk. Results highlight needed efforts to increase screening among high-risk individuals through targeted education messages.     

Controlled trial of a minimal-intervention exercise program for middle-aged working women

Abstract

Despite potential for major benefits, middle-aged women have low levels of aerobic exercise. A 12-week minimal-intervention exercise program was evaluated with female university employees aged 40 to 61. Following pre-testing, participants were randomly assigned to exercise or wait-list control. Testing was repeated at 12, 24 and 48 weeks. Exercisers improved significantly in aerobic fitness at 12 and 24 weeks, both groups decreased resting arterial pnssurc and body composition measures, and improved in exercise knowledge. Effects, however, were not well maintained at 48 weeks. These results are comparable to those obtained fmm intensive interventions and, while modest, suggest that a threshold has been reached for the modification of physiological control systems which are important for reducing cardiovascular disease risk. Middle-aged women face major social and practical baniers to regular exercise, and the minimal-intervention approach allows for a combination of flexibility and structure which seems appropriate for this group.     

Bringing up condom use and using condoms with new sexual partners: Intentional or habitual?

Abstract

A prospective study of 94 Dutch adults who have casual sexual partners examined whether two important aspects of safe sex, namely bringing up condom use (BCU) and actual condom use (ACU) are intentional or habitual. For each of these aspects, a model based on the Theory of Planned Behaviour (TPB: Ajzen, 1991) was pitted against a similar model that was extended with a path from past to later BCU and ACU, respectively. The results suggest that bringing up the issue of condom use was equally predicted by intentions and past BCU. However, among people with casual partners, using condoms - and more importantly not using condoms - was especially predicted by past ACU, suggesting a strong habitual component. These results are discussed in terms of their implications for safe sex education and the use of theories in safe sex promotion campaigns.     

A Review of Eating Disorders in Athletes

SUMMARY

The current review aims to evaluate the literature on eating disorders and athletes with the purpose of making recommendations for sport psychologists and other relevant personnel on how to proceed in identifying, managing, and preventing eating disorders in school settings. Whereas the intention of this review is to make recommendations for secondary educational settings, research on other populations such as collegiate and young adult athletes was also reviewed where helpful or where information on adolescent athletes was not available. Recommendations for prevention and intervention include ongoing education of athletes and coaches regarding nutrition, body composition, and performance, using appropriate screening to detect eating disorders, and use of a sport management team to aid in athlete recovery.