The effect of depression symptoms and social support on black-white differences in health-related quality of life in early pregnancy: the health status in pregnancy (HIP) study

BACKGROUND

Lower physical and social functioning in pregnancy has been linked to an increased risk of preterm delivery and low birth weight infants, butt few studies have examined racial differences in pregnant women's perception of their functioning. Even fewer studies have elucidated the demographic and clinical factors contributing to racial differences in functioning. Our objective was to determine whether there are racial differences in health-related quality of life (HRQoL) in early pregnancy; and if so, to identify the contributions of socio-demographic characteristics, depression symptoms, social support and clinical factors to these differences.

METHODS

Cross-sectional study of 175 women in early pregnancy attending prenatal clinics in urban setting. In multivariate analysis, we assessed the independent relation of black race (compared to white) to HRQoL scores from the eight domains of the Medical Outcomes (SF-36) SURVEY: Physical Functioning, Role-Physical, Bodily Pain, Vitality, General Health, Social Functioning, Role-Emotional, and Mental Health. We compared socio-demographic and clinical factors and depression symptoms between black and white women and assessed the relative importance of these factors in explaining racial differences in physical and social functioning.

RESULTS

Black women comprised 59% of the sample; white women comprised 41%. Before adjustment, black women had scores that were 14 points lower in Physical Function and Bodily Pain, 8 points lower in General Health, 4 points lower in Vitality and 7 points lower in Social Functioning. After adjustment for depression symptoms, social support and clinical factors, black women still had HRQoL scores that were 4 to 10 points lower than white women, but the differences were no longer statistically significant. Level of social support and payment source accounted for most of the variation in Physical Functioning, Bodily Pain and General Health. Social support accounted for most of the differences in Vitality and Social Functioning.

CONCLUSIONS

Payment source and social support accounted for much of the racial differences in physical and social function scores. Efforts to reduce racial differences might focus on improving social support networks and Socio-economic barriers.

A dismantling study of assertive outreach services: comparing activity and outcomes following replacement with the FACT model

PURPOSE

Financial constraints and some disappointing research evaluations have seen English assertive outreach (AO) teams subject to remodelling, decommissioning and integration into standard care. We tested a specific alternative model of integrating the AO function from two AO teams into six standard community mental health teams (CMHT). The Flexible Assertive Community Treatment model (FACT) was adopted from the Netherlands (Van Veldhuizen, Commun Mental Health J 43(4):421-433, 2007; Bond and Drake, Commun Mental Health J 43(4):435-438, 2007). We aimed to demonstrate non-inferiority in clinical effectiveness and thereby show cost efficiencies associated with FACT.

METHODS

Outcomes were compared in a mirror-image study of the 12 months periods pre- and post-service change with eligible individuals from the AO teams' caseloads (n = 112) acting as their own controls. We also conducted a cost-consequence analysis of the changes. Outcome data regarding admissions, use of crisis and home treatment, frequency of contact and DNA rate were extracted from the electronic patient record.

RESULTS

The results show AO patients (n = 112) transferred to standard CMHTs with FACT had significantly fewer admissions and a halving of bed use (21 fewer admission and 2,394 fewer occupied bed days) whilst being in receipt of a less intensive service (2,979 fewer contacts). This was offset by significantly poorer engagement but not by increased use of crisis and home treatment services.

CONCLUSIONS

Enhancing multi-disciplinary CMHTs with FACT provides a clinically effective alternative to AO teams. FACT offers a cost-effective model compared to AO.

Chronic pain management strategies used by low-income overweight Latinos

OBJECTIVE

The objective of this study is to examine the strategies used to manage chronic pain from the perspective of the individual in group interviews.

METHODS

Sixteen low-income overweight Latino adults participated in two group interviews facilitated by a trained moderator who inquired about the type of chronic pain suffered by participants, followed by more specific questions about pain management. Interviews were audio-recorded, transcribed verbatim (Spanish), back-translated into English, and analyzed using thematic analysis.

RESULTS

Participants' pain varied in type, location, and intensity. Participants discussed pain-related changes in activities and social life, and difficulties with health care providers, and as a result, we discovered five major themes: pain-related life alterations, enduring the pain, trying different strategies, emotional suffering, and encounters with health care system/providers.

DISCUSSION

Findings indicated that there are opportunities for providers to improve care for low-income overweight Latinos with chronic pain by listening respectfully to how pain alters their daily lives and assisting them in feasible self-management strategies.

Social participation and dental health status among older Japanese adults: a population-based cross-sectional study

BACKGROUND

Although social participation is a key determinant of health among older adults, few studies have focused on the association between social participation and dental health. This study examined the associations between social participation and dental health status in community-dwelling older Japanese adults.

METHODS AND FINDINGS

In 2010, self-administered postal questionnaires were distributed to all people aged ≥ 65 years in Iwanuma City, Japan (response rate, 59.0%). Data from 3,517 respondents were analyzed. Data on the number of remaining natural teeth, for determining the dental health status, and social participation were obtained using self-administered questionnaires. The number, type, and frequency of social activities were used to assess social participation. Social activities were political organizations or associations, industrial or professional groups, volunteer groups, senior citizens' clubs, religious groups or associations, sports groups, neighborhood community associations, and hobby clubs. Using ordinal logistic regression, we calculated the odds ratios (OR) and 95% confidence intervals (95% CI) for an increase in category of remaining teeth based on the number, type, and frequency of social activities. Sex, age, marital status, current medical history, activity of daily living, educational attainment, and annual equivalent income were used as covariates. Of the respondents, 34.2% reported having ≥ 20 teeth; 27.1%, 10-19 teeth; 26.3%, 1-9 teeth; and 12.4%, edentulousness. Social participation appeared to be related with an increased likelihood of having a greater number of teeth in old age, even after adjusting for covariates (OR = 1.30, 95% CI = 1.10-1.53). Participation in sports groups, neighborhood community associations, or hobby clubs was significantly associated with having more teeth.

CONCLUSIONS

Our results suggest a protective effect of social participation on dental health. In particular, participation in sports groups, neighborhood community associations, or hobby clubs might be a strong predictor for retaining more teeth in later life.

Gendered races: implications for interracial marriage, leadership selection, and athletic participation

Six studies explored the overlap between racial and gender stereotypes, and the consequences of this overlap for interracial dating, leadership selection, and athletic participation. Two initial studies captured the explicit and implicit gender content of racial stereotypes: Compared with the White stereotype, the Asian stereotype was more feminine, whereas the Black stereotype was more masculine. Study 3 found that heterosexual White men had a romantic preference for Asians over Blacks and that heterosexual White women had a romantic preference for Blacks over Asians; preferences for masculinity versus femininity mediated participants' attraction to Blacks relative to Asians. The pattern of romantic preferences observed in Study 3 was replicated in Study 4, an analysis of the data on interracial marriages from the 2000 U.S. Census. Study 5 showed that Blacks were more likely and Asians less likely than Whites to be selected for a masculine leadership position. In Study 6, an analysis of college athletics showed that Blacks were more heavily represented in more masculine sports, relative to Asians. These studies demonstrate that the gender content of racial stereotypes has important real-world consequences.

Perceived and experienced restrictions in participation and autonomy among adult survivors of stroke in Ghana

BACKGROUND

Many stroke survivors do not participate in everyday life activities.

OBJECTIVE

To assess the perceived and experienced restrictions in participation and autonomy among adult stroke survivors in Ghana.

METHOD

The "Impact on Participation and Autonomy Questionnaire" (IPAQ) instrument was administered in a survey of 200 adult stroke survivors to assess perceived restrictions in participation and autonomy, followed by in-depth interviews with a sub-sample on the restrictions they experienced in participation.

RESULTS

Perceived restrictions in participation were most prevalent in the domains of education and training (3.46±0.79), paid or voluntary work (2.68±0.89), helping and supporting other people (2.20±0.82), and mobility (2.12±0.79). There were significant differences in two domains between survivors who received physiotherapy and those who received traditional rehabilitation. Over half of the survivors also perceived they would encounter severe problems in participation in the domains of paid or voluntary work, mobility, and education and training. The sub-sample of stroke survivors (n=7) mostly experienced restrictions in participation and autonomy in going outside the house, working, and in fulfilling family roles.

CONCLUSION

If these perceptions and experiences are not addressed during rehabilitation, they could further inhibit the full participation and social integration of stroke survivors.

Picture me playing-a portrait of participation and enjoyment of leisure activities in adolescents with cerebral palsy

In recent years attention has been paid to the participation levels of children and youth with Cerebral Palsy (CP), particularly the extent to which they have the opportunity to be involved in and enjoy leisure activities. The objective of this study is to describe the level of participation and enjoyment in leisure activities among adolescents with CP and to identify potential differences in participation patterns related to sociodemographic attributes. A cross-sectional design was used. Participants were 175 adolescents 12-20 years old (M=15.3; ±2.2), GMFCS I=55/II=43/III=13/IV=18/V=39 who completed the Children's Assessment of Participation and Enjoyment (CAPE). The types of activities participants engaged in most frequently were social and recreational activities, whereas self-improvement and skill-based activities were least frequent. Social activities were the activities they enjoyed most. In general, participation decreases, as youth grow older. Girls engaged in more self-improvement activities than boys. Adolescents who study in special segregated schools experienced a lower diversity and intensity of engagement in all leisure activity domains. Adolescents who were not ambulatory and those presenting with more severe manual ability limitations participated less in all activity types except skill-based activities. Adolescents with CP place a high value on the ability to engage in activities of their own choosing and on interacting with friends. Engagement in a variety of leisure activities is important for a healthy development. Understanding the leisure patterns and preferences of this population, in addition to the contextual factors, may help in the elaboration of interventions and programs to promote a healthy development for this population.

Social contact patterns and leprosy disease: a case-control study in Bangladesh

Socioeconomic and culturally defined social contact patterns are expected to be an important determinant in the continuing transmission of Mycobacterium leprae in leprosy-endemic areas. In a case-control study in two districts in Bangladesh, we assessed the association between social contact patterns and the risk of acquiring clinical leprosy. Social contacts of 90 recently diagnosed patients were compared to those of 199 controls. Leprosy was associated with a more intensive social contact pattern in the home [odds ratio (OR) 1·09, 95% confidence interval (CI) 1·00-1·19, P = 0·043] and in the nearby neighbourhood (OR 1·07, 95% CI 1·03-1·11, P = 0·001). Although it is known that M. leprae spreads most easily within households of infected persons, in endemic areas social contacts within the neighbourhood, village or urban ward, also appear to be important for transmission. We advise that disease control measures in leprosy-endemic areas should not be limited to households, but include high-risk groups in the nearby neighbourhood of patients.

Evaluation of Project P.A.T.H.S. by the program implementers: findings based on the extension phase

A total of 236 schools participated in the Project P.A.T.H.S. in the 2010/2011 school year. After completion of the Tier 1 Program, subjective outcome evaluation data were collected from 3275 program implementers. Based on the consolidated findings based on schools as units, results showed that participants had positive perceptions of the program, implementers, and benefits of the program. More than four-fifths of the implementers regarded the program as helpful to the program participants. Multiple regression analysis revealed that perceived qualities of the program and the program implementers predicted perceived effectiveness of the program. Grade differences were not significant. The present study provides additional support for the effectiveness of the Tier 1 Program of the Project P.A.T.H.S. in Hong Kong.

Implementation quality of the Tier 1 Program of the Project P.A.T.H.S. in Hong Kong: findings from the extension phase

To evaluate the implementation quality of the Tier 1 Program of the Project P.A.T.H.S. (Secondary 1 to Secondary 3), a study based on classroom observations of 597 units in 207 schools was conducted under the Co-Walker Scheme. Results demonstrated that the implementation quality of the program was high in general, with a mean program adherence of 80.8%. The 13 aspects of program delivery under observation were significantly intercorrelated. Multiple regression analyses indicated that: (i) overall implementation quality was significantly predicted by classroom control, interactive delivery method, use of positive and supportive feedback, opportunity for reflection, degree of achievement of the objectives, time management, and lesson preparation; (ii) success of implementation was significantly predicted by student participation and involvement, opportunity for reflection, degree of achievement of the objectives, and time management.

Quality of life and adverse effects of olanzapine versus risperidone therapy in patients with schizophrenia

This cross-sectional study aimed to compare the effects of treatment with an atypical antipsychotic drug (olanzapine or risperidone) on quality of life (QoL) and to document adverse effects in 115 patients diagnosed with schizophrenia who attended the ambulatory service of Hospital Dr. João Machado, Natal, Rio Grande do Norte, Brazil. Socioeconomic, sociodemographic, and clinical variables were compared. The QoL Scale validated for Brazil (QLS-BR) was used to evaluate QoL, and adverse effects were assessed using the Udvalg for Kliniske Undersøgelser Side Effect Rating Scale. Data were analyzed using the χ(2) test and Student's t test, with a significance level of 5 %. Patients in both drug groups showed severe impairment in the occupational domain of the QLS-BR. Global QLS-BR scores indicated impairment among risperidone users and severe impairment among olanzapine users. The most significant side effects were associated with risperidone, including asthenia/lassitude/fatigue, somnolence/sedation, paresthesia, change in visual accommodation, increased salivation, diarrhea, orthostatic posture, palpitations/tachycardia, erythema, photosensitivity, weight loss, galactorrhea, decreased sexual desire, erectile/orgasmic dysfunction, vaginal dryness, headache, and physical dependence. QoL was impaired in patients using olanzapine and in those using risperidone. Risperidone use was associated with psychic, neurological, and autonomous adverse effects and other side effects.

Evaluation of the Project P.A.T.H.S. (extension phase) based on the perspective of the program participants

Subjective outcome evaluation data were collected from 236 schools (n=87,943 students) after students had participated in the Tier 1 Program in the second year of the Extension Phase of the Project P.A.T.H.S. in Hong Kong. Using schools as the units of analysis, results showed that the program and implementers were perceived in a positive manner and approximately four-fifths of the participants regarded the program as helpful to them. There were some significant grade differences in the subjective outcome evaluation findings with small effect size. Multiple regression analyses showed that whereas perceived qualities of the program positively predicted perceived effectiveness of the program, perceived qualities of implementers negatively predicted program effectiveness. The present study suggests that irrespective of cohorts at different times, junior secondary school students perceived the program to be beneficial to them. The theoretical and practical implications of the present findings are discussed.

Helping adolescents with greater psychosocial needs: the extension phase of the Project P.A.T.H.S. in Hong Kong

Subjective outcome evaluation data were collected from 24,198 students of 236 schools after completion of the Tier 2 Program in the second year of the Extension Phase of the Project P.A.T.H.S. in Hong Kong. Using schools as units of analysis, results showed that the program, implementers, and effectiveness were perceived in a positive manner. Although subjective outcome evaluation findings differed across participant types, grades, and program types did not show significant differences on the outcome measures. Consistent with previous reports, perceived effectiveness of the program was significantly predicted by student perceptions about the program and program instructor. These findings provide support for the claim that the Tier 2 Program is effective in promoting positive development among adolescents with greater psychosocial needs in the extension phase of the Project P.A.T.H.S. in Hong Kong.

[IT tools as a vector of care]

A laptop with an Internet connection forms an extremely important communication tool for the patient. It satisfies one of the primary needs of the human being by supporting one of the cornerstones of the psyche: the social structure. The use of this tool is seen by patients and their families as offering a real benefit in terms of sharing and peace of mind.

Advances in civic engagement research: issues of civic measures and civic context

Civic engagement has gained prominence over the past two decades as an important topic in developmental science. Much has been learned about what civic engagement means, how it is measured, and how young people develop civic engagement. In this chapter, we discuss emerging areas of research for civic engagement and core questions that we believe need to be explored. In particular, we focus on a broader conceptualization of civic engagement beyond behavioral measures, consider the relevance of cultural and political contexts on the development of civic engagement among under-served populations, and discuss the implications of advancing the civic engagement field on the civic participation of youth in the United States and throughout the world.

Transforming potential program implementers in professional development: the Project P.A.T.H.S. in Hong Kong

High quality pre-implementation professional training is the cornerstone for successful implementation of positive youth development programs. A qualitative evaluation study was conducted to understand the experiences of the potential program implementers of the Project P.A.T.H.S. in Hong Kong. The findings showed that participants highly valued the learning experiences acquired from the training program, particularly in the areas of knowledge acquisition and personal growth. Participants who benefited from these dimensions developed attitudes and skills that are desirable for the implementation of the Project P.A.T.H.S. Implications about the conditions that are conducive to the P.A.T.H.S. training program in promoting knowledge, skills acquisition, retention, application, and generalization are discussed.

[Disability certification as a tool for gaining access to human rights and social participation]

Given that one of the main reasons prioritising public policy agendas is related to implementing action responding to the increase in the prevalence of disability and the violation people of such people's rights, governments in many parts of the world have advanced disability certification as a tool for claiming rights, seeking to comply with the principles of dignity, liberty, equality and non-discrimination regarding this population. Certification of disability In Colombia is novel and has been introduced to meet the provisions of national and international standards regarding handicapped people's rights. A first approach has thus been made through developing a disability certification manual aimed at healthcare institutions and professionals forming interdisciplinary teams; it was developed by assessing disabled people voluntarily undergoing certification and thus becoming a tool for claiming rights, facilitating access to services and benefits in terms of equity and social inclusion.

Organisational engagement: an examination of members' engagement in the Irish Dental Association

STATEMENT OF THE PROBLEM

Many members in the IDA are not actively involved in the association. Therefore, despite representation being a key function of the IDA, members are not equally represented in the association.

PURPOSE OF THE STUDY

This study aimed to examine IDA members' views, with a view to identifying changes that might enhance the members' active engagement.

MATERIALS AND METHODS

A self-report questionnaire was developed following an analysis of interviews and a focus group with IDA members. The IDA distributed the questionnaire to its members by email.

RESULTS

Survey participants (N=240) consisted of 128 male IDA members, 79 female IDA members, and 33 participants who did not report their gender. Analysis yielded differences in terms of perceptions of the IDA due to gender, practice type, loyalty and satisfaction. Key inhibitors of engagement identified include: communication barriers; family commitments; feeling as though time spent involved is unproductive; and, the perception of an old boys' club. Key facilitators of engagement identified include: representation; continuing professional development (CPD); social interaction; and, support.

CONCLUSIONS

While differences in terms of perceptions of the IDA were observed in the analysis of gender and practice type, the most profound differences were observed between loyal and less loyal participants, and between satisfied and dissatisfied participants. Loyal and satisfied participants were generally more positive about all aspects of the IDA than less loyal and dissatisfied participants. The IDA should target inhibitors of engagement as identified by less loyal and dissatisfied members. It may be useful to firstly address communication barriers in the IDA in an attempt to increase membership engagement.

Social inclusion and people with intellectual disability and challenging behaviour: a systematic review

BACKGROUND

Social inclusion is central to disability policies internationally. The high risk of social exclusion for people with intellectual disability is compounded for those with challenging behaviour.

METHOD

A systematic literature review examined how social inclusion of people with intellectual disability and challenging behaviour has been researched and operationalised in the empirical literature, and aimed to determine what evidence exists about the extent of social inclusion by people with intellectual disability and challenging behaviour.

RESULTS

A thematic analysis of the 14 papers identified that social inclusion has been poorly defined and measured, and that the little research that has occurred in respect of people with challenging behaviour has demonstrated their potential to be socially included.

CONCLUSIONS

Clearer conceptualisation of inclusion, and greater understanding of practices that support social inclusion and system level mechanisms, which ensure goals around inclusion gain prominence in funding and support plans, may address the neglect of this critical quality-of-life domain for people with challenging behaviour.

Comparing participation in activities among children with disabilities

INTRODUCTION

Compared to typically developing peers, children with disabilities due to neurodevelopmental disorders and disabilities (NDD/D) and to chronic medical conditions (CMC) have reduced participation in activities. The extent to which these two groups of children have different levels of participation is unknown and was examined in this study.

METHODS

The 2006 Participation and Activity Limitation Survey children dataset collected by Statistics Canada was analyzed. Children with disabilities due to NDD/D and CMC were identified following review and classification of all ICD-10 codes in the dataset by two pediatricians. Dependent variables were parent-reported child participation in supervised and unsupervised physical activities within and outside of school, educational activities, and social/recreational activities. Logistic regression analyses, with relevant covariates (child and familial characteristics), were used to analyze the data.

RESULTS

Children with NDD/D were significantly more likely to take part in supervised and unsupervised physical activity at school than children with CMC (p<0.001). A similar trend was observed for participation in school outings, although the effect was not significant at p<0.01. Finally, a trend in the opposite direction was observed for educational activities, as children with NDD/D were less likely to take part in these activities than children with CMC.

DISCUSSION

Finding decreased participation among children with CMC compared with NDD/D was not predicted a priori but has potential implications for their mental and physical health.

CONCLUSIONS

Gaining a better understanding of the barriers to participation in physical activity may contribute to improving the overall health status of children with CMC.

Participation in mass gatherings can benefit well-being: longitudinal and control data from a North Indian Hindu pilgrimage event

How does participation in a long-duration mass gathering (such as a pilgrimage event) impact well-being? There are good reasons to believe such collective events pose risks to health. There are risks associated with communicable diseases. Moreover, the physical conditions at such events (noise, crowding, harsh conditions) are often detrimental to well-being. Yet, at the same time, social psychological research suggests participation in group-related activities can impact well-being positively, and we therefore investigated if participating in a long-duration mass gathering can actually bring such benefits. In our research we studied one of the world's largest collective events - a demanding month-long Hindu religious festival in North India. Participants (comprising 416 pilgrims who attended the gathering for the whole month of its duration, and 127 controls who did not) completed measures of self-assessed well-being and symptoms of ill-health at two time points. The first was a month before the gathering commenced, the second was a month after it finished. We found that those participating in this collective event reported a longitudinal increase in well-being relative to those who did not participate. Our data therefore imply we should reconceptualise how mass gatherings impact individuals. Although such gatherings can entail significant health risks, the benefits for well-being also need recognition. Indeed, an exclusive focus on risk is misleading and limits our understanding of why such events may be so attractive. More importantly, as our research is longitudinal and includes a control group, our work adds robust evidence to the social psychological literature concerning the relationship between participation in social group activities and well-being.

Social participation, social environment and death ideations in later life

OBJECTIVE

Few studies on elders' suicide and depression have integrated social and community factors in their explicative models. Most of the studied variables used are focused on individual and based on psychopathological models. The purpose of this study is to investigate the impact of socio-environmental factors on death ideations, using data from the European SHARE cohort.

METHOD

Social support components and death ideations have been studied, together with known individual risk factors, within a sample of 11,425 European participants in the SHARE study, aged over 64. The item evaluating death ideations was extracted from the EURO-D12 questionnaire.

RESULTS

The high prevalence of death ideations (6.9% for men and 13.0% for women) confirmed that elders' death ideations, as it is known to be linked to suicidal behaviors, is a major public health issue. Bivariate analyses revealed a strong association between community participation and death ideations. This association was no longer significant while adjusting for depressive symptomatology. The logistic model identified that factors significantly associated with death ideations, when adjusted for the other factors were: having multiple depressive symptoms (OR = 1.64 per symptom) being aged, especially over 84 (OR = 1.58), being retired for fewer than five years (OR = 1.46), being widowed (OR = 1.35) and having a long-term illness (OR = 1.28).

CONCLUSIONS

Although social and community participation is associated to death ideations, this link becomes non-significant in a regression model taking into account other factors. It is important to notice that depressive symptoms, which are obviously closely related to death ideations, take the greatest part in the association among all associated factors. Our results suggest that, consistently with the literature, while addressing death ideation or suicide prevention, professionals have to consider first the secondary prevention of depressive symptomatology. Strategies targeting social isolation and community participation should be considered as part of primary prevention policies.