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PubMedDate not supplied

Spousal similarities in fruit and vegetable consumption.

PURPOSE: To explore similar patterns of fruit and vegetable consumption between health center employees and their spouses. DESIGN: Cross-sectional mailed survey assessing frequency of fruit and vegetable consumption, as well as demographics and knowledge, attitudes, access, and social support related to fruit and vegetable consumption. SETTING: Six Massachusetts health centers. SUBJECTS: Two hundred eleven health center employee/spouse pairs (422 individuals). MEASURES: The kappa statistic measured agreement in fruit and vegetable consumption between employees and spouses. The Spearman rho coefficient measured correlations for individual responses. Multiple Linear Regression Models examined variables that explained fruit and vegetable consumption level differences. RESULTS: Response rate was 59%. Mean fruit and vegetable daily intake was 4.68 and 4.30 servings for employees and spouses, respectively. Over 75% of employee and spouse estimates measuring fruit and vegetable consumption-related information, on average, were within one survey response category of each other. Knowledge, attitudes, and access indices were significantly correlated with fruit and vegetable consumption for both employees and spouses. The social support index was significantly correlated with fruit and vegetable consumption only for the spouses. Differences in knowledge, attitudes, and access indices between employees and spouses helped to explain different fruit and vegetable consumption levels. Nonresponse, selection, recall, and seasonal reporting biases may limit the findings' generalizability. CONCLUSIONS: The effectiveness of worksite nutrition interventions may be improved by involving family/household members.

Adult↗
PubMedDate not supplied

Managing the reemergence of anguish: pregnancy after a loss due to anomalies.

OBJECTIVE: To explore and describe parents' experiences and feelings when faced with a pregnancy subsequent to a pregnancy in which they had to choose whether or not to terminate following the diagnosis of a fetal abnormality. DESIGN AND METHOD: Exploratory/descriptive study, using the grounded theory method. SETTING: Participants were recruited through physicians in northeastern Florida and throughout the United States via an Internet support network. PARTICIPANTS: Participants included a registered nurse, a physician, and 22 parents (13 women and 9 partners) who were interviewed during a subsequent pregnancy. RESULTS: Mental anguish resulted after a loss due to fetal anomalies. Such parents felt a loss of innocence and a sense of devastation and experienced changes in spousal relationships, fear of hope, isolation, and stigma. This anguish reemerged during a subsequent pregnancy. The parents managed by developing emotional armor, limiting disclosure of the previous and present pregnancy, delaying attachment to the baby, and forming a strong attachment to health care professionals and other people with similar experiences. CONCLUSIONS: Understanding how parents manage the reemergence of mental anguish during a subsequent pregnancy permits health care professionals to assist these parents. Facilitating parents' efforts to develop emotional armor, limit disclosure, delay attachment to the baby, and attach to health care professionals and support groups can mitigate social and psychologic discomfort for these parents.

Abortion, Therapeutic↗
PubMed1998

The importance of family functioning to caregiver adaptation in mothers of child cancer patients: testing a social ecological model.

This study was designed to investigate associations between family relationships, personal-psychological caregiver adaptation (ie, depressive symptomatology, sense of burden), and ability to function within the health care system (perceived doctor-parent relationship) in mothers of child cancer patients. Data were collected through a survey of a sample of 29 mothers whose children were diagnosed with some form of childhood cancer, mainly leukemia. Family functioning was positively related to both caregiver adaptation and doctor-parent relationship. Mothers who reported decreased maternal depression and burden were significantly more likely to report respectively improved spousal relationships and improved spousal communication. Mothers reporting more positive doctor-parent relationships also described themselves as having improved relationships with spouse and child, and improved spousal communication. Maternal well-being and doctor-parent relationship were not directly related. By suggesting that both intrapsychic and instrumental maternal adaptation are influenced by positive relationships in the family, this study provides support for the social ecological model of stress. The possibility that family factors exert a direct influence on both caregiver intrapsychic well-being and instrumental skills argues for the importance of their being carefully considered in any models evaluating caregiver adaptation.

Adaptation, Psychological↗
PubMed1989

The spousal factor in pilot stress.

This paper discusses the various occupational and non-occupational stresses faced by commercial aviators, with particular emphasis on the role of the pilot's spouse in the stress management equation. Using findings from scientific studies, we suggest that the spouse can be a major social support system for the aviator and a significant factor in the pilot's ability to deal effectively with psychosocial stress. We recommend that airlines develop programs that: a) honor (recognize) the spouses for their contribution to safe aircraft operation (by helping the aviator cope with stress more effectively); and b) make both husband and wife more aware of the special needs, concerns, and challenges that each partner faces in an "airline marriage." These programs are not intended to be counseling sessions or intrusions into the personal lives of the participants, but rather, opportunities for aviators and their spouses to become more aware of their dual role and contributions to effective stress management which, in turn, can enhance flight deck performance. One such program, already in use by an international airline, is described and discussed.

Adaptation, Psychological↗
PubMedDate not supplied

Prostate cancer treatment decisions: a focus group exploration.

PURPOSE/OBJECTIVES: To explore the decision-making process as retrospectively described by patients with prostate cancer and their spouses and to test the feasibility of a larger scale prospective examination of decision making in this same population. DESIGN: A qualitative study using focus group methodology. SAMPLE/SETTING: Twelve patients with prostate cancer and six spouses were recruited purposefully from a newly organized prostate cancer support group in an urban North Carolina community. METHODS: Using an interview guide, an experienced facilitator conducted two 90-minute focus groups. Sessions were audiotaped, transcribed verbatim, and analyzed using thematic content analysis techniques. MAIN RESEARCH VARIABLES: Decision making, prostate cancer treatment, spousal participation. FINDINGS: Six themes were derived from the data: (a) Finding Out, (b) Prostate Specific Antigen Talk, (c) (Getting the Story, (d) Who Decides, (e) Treatment Options, and (f) Looking Back. The data corroborated American Cancer Society findings that national cancer resources are not being used effectively by this population and reinforced the need for a multidisciplinary approach to the management of prostate cancer. CONCLUSIONS: Additional prospective studies are needed to explore the decision process from a family perspective. Studies focusing on the unique needs of older patients with prostate cancer and their spouses also are needed. IMPLICATIONS FOR NURSING PRACTICE: Nurses must assess informal information sources and work toward a more comprehensive presentation of treatment options. Misconceptions about surgery and radiotherapy hamper informed decision making. Nurses are in a unique position to educate families regarding prostate cancer treatment options.

Aged↗
PubMed1994

Coping and marital support as correlates of tinnitus disability.

Although there is increasing awareness that depression can add significantly to the disability associated with chronic medical illness, it is not clear whether all of the impact of psychosocial factors upon medical disability are mediated by or moderated by depression. It has not been determined whether treating depression alone is an adequate strategy for addressing psychosocial magnification of medical disability. We analyzed data collected at initiation of a treatment trial from 92 subjects with chronic severe tinnitus to assess the role of coping, and 49 subject-spouse pairs to assess the role of marital interaction in tinnitus-related role dysfunction. Three multiple regression models were developed. After accounting for gender, tinnitus loudness, and depressive severity among the 92 subjects, greater role dysfunction was associated appraisal of tinnitus as salient, and less role dysfunction with coping through avoidance or seeking social support. Marital interaction was assessed from patient and spouse perspectives. In the patient-rated set, less marital cohesion was associated with greater tinnitus-related role dysfunction. In the spouse-rated set, more punishing responses to subject illness behavior were associated with greater tinnitus-related role dysfunction. In each case the disabling effect was greater in the face of high levels of subject depression. This study provides evidence for the oft-stated analogy between chronic tinnitus and chronic pain, and provides justification for a similar multimodal treatment strategy. Reducing depression is an important means to reduce medical disability but should be supplemented by clinical attention to appraisal of the illness, modes of coping with the illness, and spousal response to the illness.

Adaptation, Psychological↗
PubMed1996

Behavioral components of marital satisfaction: an individualized assessment approach.

This study examined the extent to which spousal behaviors, obtained through a daily checklist of marital activities individualized along an importance dimension, related to global and daily marital satisfaction. Eighty-two marital couples completed daily checklists of spousal behaviors for 7 days using either an individualized or a standardized assessment method. The results demonstrated that the individualized measures of daily behavioral events were significantly related to global and daily measures of marital satisfaction and discriminated distressed from nondistressed spouses. Although the individualized method did not correlate with marital satisfaction to a significantly greater degree than the standardized method, the individualized assessment approach provides a valid, viable, and cost-effective alternative for assessing daily spousal events that relate to marital satisfaction.

Adult↗
PubMed1997

Nutrition management in a pregnant comatose patient.

Major intracranial injury or disease during pregnancy resulting in a comatose state presents unique and complex management challenges. Our patient is a 34-year-old woman who suffered a closed-head injury associated with spousal abuse at 22 weeks' gestation. This injury resulted in a large right frontoparietal hematoma that was subsequently evacuated via a right frontotemporal craniotomy 5 days after the injury. She remained in a vegetative state postoperatively. Aggressive nutrition support was provided with enteral feedings through a nasoduodenal feeding tube. Mild oligohydramnios was detected at 30 weeks' gestation and was subsequently determined to be due to preterm premature rupture of membranes. She was managed until 33 weeks' gestation, when signs of chorioamnionitis were noted. She then underwent a primary cesarean delivery and was delivered of an appropriate-for-gestational-age 2150-g viable male infant. The patient had progressive improvement in her mental status with occupational and physical therapy and was discharged on the 29th postpartum day. This case presents the nutrition and medical challenges of maintaining adequate maternal and fetal health in a pregnant comatose patient.

Adult↗
PubMed2000

Conjugal multiple sclerosis: population-based prevalence and recurrence risks in offspring. Canadian Collaborative Study Group.

From a population-based sample of 15,504 patients attending Canadian multiple sclerosis (MS) clinics, we have determined the frequency of conjugal MS and have estimated the recurrence risk in offspring of such matings. Twenty-three MS cases were found among 13,550 spouses of study probands for a crude conjugal rate of 0.17% (95% CI of 0.10%-0.24%). Despite ascertainment bias that expectedly inflates this number, this is a frequency intermediate between the point prevalence (0.1%) and lifetime risk (0.2%) for the general population and close to an order of magnitude less than reported for half siblings reared apart (1.06%) from the same population. Six of the 49 offspring of conjugal pairs also had MS, and age conversion gives a rate similar to the concordance rate for Canadian monozygotic twins. However, this correction may not be appropriate in this special case. Despite an ascertainment bias in favor of recognizing affected spouses and a large population sample, the common environment in adulthood shared by spousal pairs could not be shown to increase the risk of conjugal MS. Although the high recurrence rate in offspring is similarly subject to an upward bias, the low risk for MS spouses and the high risk for offspring support other data indicating that familial risk is genetically determined. Furthermore, these results imply that susceptibility alleles are shared by unrelated individuals with the disease.

Adult↗
PubMed2006

The relationship between threat appraisal and social constraints in cancer survivors and their spouses.

: Social constraints stem from unsupportive social environments and are associated with reluctance to discuss stressor-related thoughts and feelings. Support deterioration and erosion models provide a framework for explaining how a cancer patient's threat appraisal contributes to a spouse's inadvertent constraint on the patient's emotional expression. Also, based on social comparison theory and the convoy model, a discrepancy in threat appraisal between patient and spouse may create social constraints. Contrary to social cognitive processing theories, we hypothesized that threat appraisals may be an antecedent of social constraints, rather than a consequence. Cancer patients (n=75) and their spouses (n=75) completed questionnaires assessing cancer-related threat appraisals and perceived spousal social constraints at two time points. Cross-lagged panel design results suggested that patient appraisal precedes and predicts patients' perception of social constraints. However, patient and spouse appraisals did not significantly interact in predicting spousal constraints. Limitations and implications are discussed.

Adult↗
PubMed1999

Spousal concordance for cancer incidence: A cohort study.

BACKGROUND: Because married couples share at least their home environment, spousal aggregation of cancer might provide clues to unsuspected etiologic factors. The authors sought to measure the concordance of cancer occurrence in married couples and explore factors that might explain greater-than-expected concordance. METHODS: The authors identified 25,670 cancer-free married couples in northern California who were followed for up to 31 years for the development of cancer. In Cox proportional hazards analysis, the development of cancer in a spouse was treated as a time-dependent, independent variable, and spouse-with/spouse-without risk ratios were determined, controlling for age and gender. For selected concordant espoused pairs, additional explanatory information was sought in their medical records. RESULTS: There was no excess concordance for all cancers combined; the spouse-with/spouse-without risk ratio was 0.97 (95% confidence interval, 0.90-1.05). Statistically significant husband-wife associations were found only for cancer of the tongue and stomach and for non-Hodgkin lymphoma. Except for cancer of the penis/endometrium and testis/vulva, based on one couple with each combination, gender specific cancers did not aggregate within married couples. Established and suspected risk factors, not necessarily related to the marriage, were found for some individuals who had concordance with their spouses. CONCLUSIONS: Little spousal concordance for cancer occurrence was found. The study of spousal aggregation does not appear useful in identifying unsuspected environmental causes of cancer in heterogeneous populations in urban areas of affluent Western countries. A cohort study would have to be much larger than this one to detect weak spousal concordance reliably.

Adult↗
PubMed2006

Characteristics and views of family carers of older people with heart failure.

AIMS: to explore the characteristics and views of the family carers of older people with heart failure. METHOD: 213 family carers of heart failure patients >60 years were recruited from UK general practitioner (GP) practices. Carer strain, quality of life (QOL) and service satisfaction questionnaires were completed every 3 months for 2 years, as well as 16 interviews with patients and carers, and 9 focus groups with health care professionals. RESULTS: 76% of carers were female, 70% were >60 years and 73% were spousal carers. Predictors of carer strain were symptoms of depression, age and patient NYHA. Predictors of lower QOL were: spousal carer; 2+ health conditions and symptoms of depression. Qualitative findings related to the change in circumstances, impact of responsibilities and health conditions of the family carers. CONCLUSION: carers were mainly older women, often experiencing multiple health conditions. Addressing the practical and emotional support required presents a challenge for specialist palliative care in responding to calls for increased involvement in heart failure. A shared care model with liaison between specialist heart failure nurses, cardiologists, primary care teams and hospice services is advocated.

Activities of Daily Living↗
PubMed1992

Women in clerical jobs: spousal role satisfaction, stress, and coping.

Little is known about the qualitative components of women's multiple roles or about women's perceptions and subjective feelings about their occupational and domestic roles, although all of these factors modulate health outcomes. The research upon which this manuscript is based was designed to respond to the need for understanding the daily experiences of women in clerical jobs. The data about spousal role satisfactions, stress and coping strategies, as perceived and articulated by them, indicates there are almost an equal number of satisfying and stressful aspects of the spousal relationship. Examples of the satisfying aspects are companionship, reciprocity, and interaction; while stressful aspects are inequality of tasks, disagreements and domination. Women in this study cope by using strategies that are more solitary in nature. They identify very little power to negotiate support and tangible assistance.

Adaptation, Psychological↗
PubMed2001

A comparison of marital interaction patterns between couples in which the husband does or does not have Alzheimer's disease.

UNLABELLED: Objectives. Our main purpose was to examine similarities and differences in patterns of interpersonal interaction between Alzheimer's disease (AD) caregiving and noncaregiving couples (n = 54). Methods. Twenty-seven wives caring for moderately impaired husbands with probable AD and 27 noncaregiving wives from comparable sociodemographic backgrounds were videotaped in their homes during both mealtime and a future event planning task. In addition, they completed self-report questionnaires to assess depression, stress, relationship mutuality, and perceived hope. Results. Compared with their counterparts, caregiving wives reported higher levels of depression and stress, but similar shared values and closeness. For the three factors developed from the Marital Interaction Coding System (MICS, version IV; Supportive Facilitative, and Rapport Building), a complex pattern of results was found in which disease status, type of task, and gender interacted significantly. Noncaregiving couples were more interactive overall and expressed more support to each other. Caregiving wives were found to be most facilitative during the planning task, whereas AD husbands were highest on interactions that built rapport (e.g., smiling) during that same task. Caregiving wives actually increased their facilitative behavior from the mealtime to planning task, probably reflecting the increased demand characteristics of the latter. DISCUSSION: This study is one of a small body of literature to describe the negative impact of AD on spousal communication as observed and coded in two videotaped interaction situations in the home. Suggestions are made for future research, including the inclusion of longitudinal designs and non-Caucasian couples.

Adaptation, Psychological↗
PubMed2005

Who foregoes survivor protection in employer-sponsored pension annuities?

PURPOSE: Retirees in traditional pension plans must generally choose between single life annuities, which provide regular payments until death, and joint and survivor annuities, which pay less each month but continue to make payments to the spouse after the death of the retired worker. This article examines the payout decision and measures the share of married retirees with pension annuities who forego survivor protection. DESIGN AND METHODS: The analysis consists of a probit model of the pension payout decision, based on data from the 1992-2000 waves of the Health and Retirement Study. RESULTS: More than one quarter (28%) of married men and two thirds of married women receiving employer-sponsored retirement annuities declined survivor protection. Men with small pensions and limited household wealth, men in better health than their spouses, and men whose spouses have pension coverage from their own employers are more likely than other men to reject survivor protection. IMPLICATIONS: Most workers appear to make payout decisions by rationally balancing the costs and benefits of each type of annuity, suggesting that existing measures to encourage joint and survivor annuities are adequate. However, the growth in 401(k) plans, which are generally not covered by existing laws protecting spousal pension rights, may leave widows vulnerable.

Female↗
PubMed2005

Gay marriage, same-sex parenting, and America's children.

Same-sex marriage, barely on the political radar a decade ago, is a reality in America. How will it affect the well-being of children? Some observers worry that legalizing same-sex marriage would send the message that same-sex parenting and opposite-sex parenting are interchangeable, when in fact they may lead to different outcomes for children. To evaluate that concern, William Meezan and Jonathan Rauch review the growing body of research on how same-sex parenting affects children. After considering the methodological problems inherent in studying small, hard-to-locate populations--problems that have bedeviled this literature-the authors find that the children who have been studied are doing about as well as children normally do. What the research does not yet show is whether the children studied are typical of the general population of children raised by gay and lesbian couples. A second important question is how same-sex marriage might affect children who are already being raised by same-sex couples. Meezan and Rauch observe that marriage confers on children three types of benefits that seem likely to carry over to children in same-sex families. First, marriage may increase children's material well-being through such benefits as family leave from work and spousal health insurance eligibility. It may also help ensure financial continuity, should a spouse die or be disabled. Second, same-sex marriage may benefit children by increasing the durability and stability of their parents' relationship. Finally, marriage may bring increased social acceptance of and support for same-sex families, although those benefits might not materialize in communities that meet same-sex marriage with rejection or hostility. The authors note that the best way to ascertain the costs and benefits of the effects of same-sex marriage on children is to compare it with the alternatives. Massachusetts is marrying same-sex couples, Vermont and Connecticut are offering civil unions, and several states offer partner-benefit programs. Studying the effect of these various forms of unions on children could inform the debate over gay marriage to the benefit of all sides of the argument.

Adult↗