The Hospital Anxiety and Depression Scale: a pilot study to examine its latent structure and the link between psychological state and symptom severity in transient ischaemic attack patients

Transient ischaemic attack (TIA) is often associated with anxiety and depression, which may precipitate secondary stroke and interfere with treatment. The Hospital Anxiety and Depression Scale (HADS) is widely used to assess these states and to inform the management of any associated psychological problems, but there is considerable debate about what it actually measures. The HADS scores from a range of different clinical groups have been reviewed in order to assess its psychometric properties, but so far, no research has examined either its latent structure when used with TIA patients, or the association between symptom severity and the test’s validity. The aims of this study, therefore, were to investigate: (a) the underlying structure of the HADS when used with TIA patients; and (b) the impact of symptom severity on the validity of the HADS. The HADS and a functional capacity measure were administered by post to a sample of 542 confirmed TIA patients. Exploratory factor analysis was conducted on the HADS scores to establish its underlying structure for this clinical group, and then, sub-sample correlations were undertaken between the anxiety/depression scores for different levels of functional capacity. Two factors emerged, with 13 of the 14 HADS items loading significantly on both, suggesting there is a common affective state underlying the standard anxiety and depression scales. Further data-exploration indicated that convergence between these affective states increased as functional capacity deteriorated. The results suggest firstly that the HADS measures general subjective distress when used with TIA patients, and secondly that the higher reported symptom severity in this clinical group may be associated with reduced affective differentiation. As the ability to retain clear affective discrimination is associated with health and well-being, this could provide a focus for post-TIA rehabilitation.     

Job characteristics,well-being and risky behaviour amongst pharmacists

Healthcare practitioners’ fitness to practise has often been linked to their personal and demographic characteristics. It is possible that situational factors, such as the work environment and physical or psychological well-being, also have an influence on an individual’s fitness to practise. However, it is unclear how these factors might be linked to behaviours that risk compromising fitness to practise. The aim of this study was to examine the association between job characteristics, well-being and behaviour reflecting risky practice amongst a sample of registered pharmacists in a region of the United Kingdom. Data were obtained from a cross-sectional self-report survey of 517 pharmacists. These data were subjected to principal component analysis and path analysis, with job characteristics (demand, autonomy and feedback) and well-being (distress and perceived competence) as the predictors and behaviour as the outcome variable. Two aspects of behaviour were found: Overloading (taking on more work than one can comfortably manage) and risk taking (working at or beyond boundaries of safe practice). Separate path models including either job characteristics or well-being as independent variables provided a good fit to the data-set. Of the job characteristics, demand had the strongest association with behaviour, while the association between well-being and risky behaviour differed according to the aspect of behaviour being assessed. The findings suggest that, in general terms, situational factors should be considered alongside personal factors when assessing, judging or remediating fitness to practise. They also suggest the presence of different facets to the relationship between job characteristics, well-being and risky behaviour amongst pharmacists.     

Happiness and life satisfaction in Rwanda

This study investigated predictors of happiness and life satisfaction in Rwanda. Data from the World Values Survey and gathered from 3 030 Rwandese (age ranging 16 to 90 years, mean age = 34.2, SD = 12.7; females = 50.5%) were pooled for the analysis. For the comparison, international World Values Survey data were utilised. A fixed effects multilevel regression model was used to predict happiness and life satisfaction from gender, health, socio-economic, and some subjective measures. Males had greater self-rated happiness and life satisfaction scores than females. State of health and sense of freedom of choice predicted both happiness and life satisfaction. Valuing of friends, weekly religious attendance, and national pride positively predicted happiness, whereas household’s financial satisfaction, full-time employment, high-income group, being a student, and sense of trust predicted life satisfaction. This study suggests that health status, household’s financial satisfaction and emancipative values could maximise subjective well-being in Rwanda.     

Health behaviour change theory meets falls prevention: Feasibility of a habit-based balance and strength exercise intervention for older adults

ObjectivesHabit formation is a proposed mechanism for behaviour maintenance. Very few falls prevention studies have adopted this as an intervention framework and outcome. Therefore, we tested feasibility of a theory-based behaviour change intervention that encouraged women to embed balance and strength exercises into daily life routines (e.g., eating, self-care routines).DesignThe EASY LiFE study was a mixed-methods, 4-month feasibility intervention that included seven group-based sessions and two telephone calls.Main outcome measuresWe obtained performance-based (i.e., Short-Physical-Performance-Battery) and psychological self-report measures (i.e., intention, self-efficacy, planning, action control, habit strength, quality of life) from 13 women at baseline (T1) and 4-month follow-up (T2). We applied the Framework-Method to post-intervention, semi-structured interviews to evaluate program content and delivery.ResultsIn total, 10 of 13 women completed the program (M_age = 66.23, SD = 3.98) and showed changes in their level of action control [mean difference_T1−T2 = 1.7, 95% CI (−2.2 to −0.8)], action planning [mean difference_T1−T2 = 0.8, 95% CI (−1.1 to −0.2)], automaticity [mean difference_T1−T2 = 2.5, 95% CI (−3.7 to −1.2)], and exercise identity [mean difference_T1−T2 = 2.0, 95% CI (−3.2 to −0.8)]. Based on the Theoretical Domains Framework we identified knowledge, behavioural regulation, and social factors as important themes. For program delivery, dominant themes were engagement, session facilitators and group format.ConclusionThe theory-based framework showed feasibility for promoting lifestyle integrated balance and strength exercise habits. Using activity and object-based cues may be particularly effective in generating action and automaticity.     

Communicating power and resistance: exploring interactions between aboriginal youth and non-aboriginal staff members in a residential child welfare facility

Aboriginal youth are highly overrepresented within the child welfare system. High-risk youth are often placed in out-of-community residential placements. Such residential placements have been described by some as a continuation of colonial practices. Using communication theory as a conceptual model, we propose a qualitative analysis of micro-interactions that take place between Aboriginal youth and non-Aboriginal workers during the management of high-risk behaviors within a residential program. Three broad categories of interaction emerge from the data: complementary, symmetrical/complementary (where youth show a form of submission despite resistance), and symmetrical (characterized by a power struggle). Despite the diversity of interactions along this symmetrical to complementary continuum, interventions always start and finish in the same fashion. Moreover, the nature of interactions depended mostly on how quickly youth accepted the consequences of their behaviors. We also extracted five categories related to culture, race or context that are perceived as influencing the interactions that take place between staff and youth. The analysis of micro-interactions within clinical, organizational, social and historical contexts points to mechanisms by which asymmetrical power relations may be replicated on a day-to-day basis despite the best intentions of residential workers.     

The War Between Faith and Fact

Is there a war going on between science and religion or not? The Center for Theology and the Natural Sciences and many other bridge-building advocates deny that a war must be fought between genuine science and authentic faith. Yet, a new book, Faith vs. Fact, by Jerry Coyne, launches a new attack against those with faith in God. This essay asks whether such an attack comes from genuine science or from scientism—a materialist ideology that claims rational science as its ally.     

Aboriginal Health Care and Bioethics: A Reflection on the Teaching of the Seven Grandfathers

Contemporary bioethics recognizes the importance of the culture in shaping ethical issues, yet in practice, a process for ethical analysis and decision making is rarely adjusted to the culture and ethnicity of involved parties. This is of a particular concern in a health care system that is caring for a growing Aboriginal population. We raise the possibility of constructing a bioethics grounded in traditional Aboriginal knowledge. As an example of an element of traditional knowledge that contains strong ethical guidance, we present the story of the Gifts of the Seven Grandfathers. We note a resemblance of this Ojibway teaching to virtue ethics in European traditions, but we suggest that there are also important differences in how these two traditions are currently presented. We hope that further engagement with a variety of indigenous moral teachings and traditions could improve health care involving Aboriginal patients and communities, and enrich the discipline of bioethics.     

The “Jewish Knight” of Slobodka honor culture and the image of the body in an Ultra-Orthodox Jewish context

Scholarship on Ultra-Orthodox Jewish thought has traditionally assumed that the views of these communities derive from a struggle against the Jewish Enlightenment and Zionism, as well as against any values they identify as “modern.” This article challenges that assumption. Beginning with an examination of Ultra-Orthodox sources that present an image of the religious leader as the “ideal Jew,” the author then focuses on sources concerning the founder of the Slobodka Yeshiva in Lithuania. This rabbi intended his students to internalize “modern” norms found in the European honor culture of his time, while translating them into the language of Jewish Ultra-Orthodoxy. The author chooses to present his argument by tracing the image of the body in the Slobodka method, since it is precisely through the nexus of the body that Ultra-Orthodox Judaism was segregated from general European society and culture.