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Girls' experiences in physical education: competition, evaluation, & degradation.

School nurses are often asked to participate in the health component of many physical education (PE) programs in schools. With this opportunity comes an ability to invite a model of physical education that enables physical, mental, and relational health. A pilot study was initiated to explore why girls' enrollment in physical education was dwindling once the compulsory credits were achieved. What emerged was the reality that for many girls, physical education was a source of constant shaming regarding their athletic ability and eventually themselves. Forced competition, degrading evaluation, and sexuality- and size-related harassment by both peers and teachers led the participants in this study to opt out of any further physical education classes. Within school-based physical education exists an opportunity to promote the health of adolescent women. School nurses, in partnership with physical education teachers and girls, can construct a model of physical education that is neither based on competition nor athletic ability, but rather on building a positive self-esteem and a positive relationship with one's body. This model would be rooted in participation, fun, and female friendship.

Adolescent↗

Interrater agreement on the Coping Inventory for Stressful Situations (CISS).

The Coping Inventory for Stressful Situations (CISS) is a 48-item self-report inventory designed to measure three basic coping styles: Task Oriented, Emotion Oriented, and Avoidance Oriented coping. The psychometric properties of this inventory are promising, but CISS scores have not yet been shown to reflect behavioral variation in response to stress. This study was designed as a first step toward this end by examining the relationship between self- and peer-report on the CISS. One hundred and sixty-three pairs of friends completed the CISS, a peer form of the CISS, and a friendship questionnaire. Positive but modest correlations were found for each construct. Higher correlations were obtained when comparing scores across forms completed by the same informant, indicating that examinees believe their friends cope as they do themselves. Actual friend similarity was apparent only on Avoidance Oriented coping. Neither depth of relationship nor item observability moderated peer-self agreement.

Adaptation, Psychological↗

Understanding quality-of-life issues in Chinese women with breast cancer: a qualitative investigation.

Little is known about the cultural beliefs and quality of life (QOL) of US-born and foreign-born Chinese women with breast cancer. We conducted individual semistructured qualitative interviews to explore the meaning of QOL, identify beliefs about cancer, and make comparison between US-born and foreign-born survivors. Women in this study identified the stigma of breast cancer that exists in the Asian community. They also described interpersonal support as central to a good QOL. However, when describing QOL, foreign-born Chinese women referred to wealth more frequently, while US-born Chinese women indicated friendship more frequently. The study findings support the need for culturally appropriate interventions that take into consideration the cancer-related beliefs and QOL of breast cancer survivors in the Chinese community.

Asian People↗

A comparison of relational attitude and personality disorders in the explanation of child molestation.

This study examined parental sensitivity, relational attitude (i.e., trust, friendship, adult romantic attachment), and personality disorders in the aetiology of sexual offences among a group of 84 child molesters and a matched normal control group (n = 80). The child molesters were selected from either a community-based, educational training program (n = 51), or a Belgium prison (n = 33). Analyses using structural equation modeling found that both relational attitude and personality disorders differentiated between the child molesters and the comparison group. Implications for the aetiology and treatment of child molesting is discussed.

Adult↗

Community-based coalitions' capacity for sustainable action: the role of relationships.

Given both the importance and difficulty of promoting community-based public health coalitions, their capacity for sustainable action merits systematic examination. The current study addresses this need, focusing specifically on the relational dimension of capacity, that is, how relationships both among members and with external actors affect coalition-level activity. The context is a multimethod comparative case study of two rural cancer control coalitions. The authors began by using quantitative and qualitative data to characterize relational capacity in each coalition and then assessed the association between coalition-level relational capacity and level of subsequent interventions. The more active coalition had a more inclusive relational structure than did its less active counterpart but also placed less emphasis on personal friendships. The authors conclude that coalitions' relational structures are measurable and that this dimension of capacity may affect sustainable capacity for health promotion.

Appalachian Region↗

Sex in the New World: an empowerment model for HIV prevention in Latina immigrant women.

In 1996, nearly 60% of U.S. AIDS cases among Latinas were attributed to unprotected sex with men. Economic disadvantage, language barriers, and strong cultural gender norms regarding sex exacerbate the risk for HIV infection among Latina immigrant women. Through a collaboration among scientists and providers, this study was designed to evaluate the impact of a multifaceted empowerment program for Latina immigrant women on HIV risk behaviors. Women (N = 74) were followed for the first 6 months of their participation and attended up to nine distinct types of activities (e.g., information meetings, friendship circles, and workshops). Although the program was not developed to specifically target HIV risk behaviors, women showed significant increases in sexual communication comfort, were less likely to maintain traditional sexual gender norms, and reported changes in decision-making power. Targeting broader sociocultural issues may increase the necessary skills for Latina women to prevent HIV infection from their sexual partners. Successful collaborations between scientists and providers are critical in developing effective, community-relevant interventions.

Adult↗

The interaction between young people with atypical gender identity organization and their peers.

This exploratory study involved the qualitative analysis of the responses of eight children with atypical gender identity organization to open-ended questions about their experiences of secondary school. The aim was to develop an understanding of these young people's interaction with their peers. It became apparent that all but one of the participants had been bullied. In this context, participants reported difficulties in developing friendships, although each participant received support from at least one of their peers. Given the hostile school environment participants did not necessarily talk to these individuals about their experiences in relation to their gender identity. The clinical implications for working with young people on a developing gender identity, and the impact on their mental health, are considered.

Adolescent↗

Self-concept, self-esteem and body weight in adolescent females: a three-year longitudinal study.

Eighty girls aged 12.8 (0.6) years, completed self-concept, depression and anxiety scales over three years and had their height and weight measured. All nine self-concept domains were lower in the Highest BMI group, compared to the Lower BMI group and this trend was stable over three years. Highest BMI girls were substantially lower than population norms on all nine scales. Over three years, the Physical Appearance and Close Friendship scores of Highest BMI girls decreased compared to Lower BMI girls. This pattern was similar for all of the other self-concept domains. Several aspects of early adolescent girls' self-image may be adversely influenced by a heavy weight status.

Adolescent↗

Living with ASD: how do children and their parents assess their difficulties with social interaction and understanding?

Social interaction and understanding in autistic spectrum disorder (ASD) are key areas of concern to practitioners and researchers alike. However, there is a relative lack of information about the skills and competencies of children and young people with ASD who access ordinary community facilities including mainstream education. In particular, contributions by parents and their children have been under-utilized. Using two structured questionnaires, 19 children with ASD reported difficulties with social skills including social engagement and temper management and also reported difficulties with social competence, affecting both friendships and peer relationships. Parents rated the children's social skill and competence as significantly worse than did the children themselves, but there was considerable agreement about the areas that were problematic. Using an informal measure to highlight their children's difficulties, parents raised issues relating to conversation skills, social emotional reciprocity and peer relationships. The implications for assessment and intervention are discussed.

Adolescent↗

Children's asthma experience and the importance of place.

Asthma is increasing dramatically among poor, inner-city children. Fourteen children with, and twelve without, asthma were interviewed and observed to examine how children with asthma understand their illness and how the asthma experience shapes their sense of place. Quantitative data showed no difference in objective preferences for particular places, but qualitative analysis showed important differences. We identified eight place-related themes, and on seven there were clear differences between children with and without asthma--offering freedom, being aesthetically pleasing, being comfortable, nature of social contact, being isolating, being familiar and being safe. Children experienced asthma as an interruption in daily life that influences time spent outside, being active and being with friends. Children with asthma are more sensitive to places that are 'dirty' or contain asthma triggers, are less likely to explore new or people-free places and emphasize family interactions, while children without asthma emphasize friendships and are sensitive to neighborhood violence.

Asthma↗

Abandonment fears of persons with Alzheimer's disease attending adult day care.

By using participant observation and staff interviews, we examined the phenomenon of abandonment fears in persons with Alzheimer's disease who were frequent attendees of an adult day care center. Two women, who most frequently expressed fears of abandonment, were the primary participants of the study. Their fears stemmed from two sources: contextual confusion, centered on their inability to grasp the concept of attending an adult day care center, and imagined barriers between them and their caregivers. One of the women tended to "recruit" the other woman into her world of insecurity, and hence their friendship actually may have had a detrimental effect on each other's days at the center. Staff members discussed the issue with reluctance and indicated that methods to attempt to change the behavior would be futile.

Aged↗

A systematic approach to analyse health-related quality of life in multiple sclerosis: the GEDMA study.

OBJECTIVE: To describe a holistic and comprehensive approach to the assessment of sufferer's perceptions of health-related quality of life (HRQoL) in a cohort of multiple sclerosis (MS) patients. METHODS: The GEDMA (Grupo de Enfermedades Desmielinizantes de Madrid, in Spanish) study is an ongoing longitudinal survey using quantitative and qualitative methodologies. The baseline cohort consisted of a large sample of MS patients recruited from 13 hospitals in Madrid, Spain. Using a standardized protocol we collected data concerning the sociodemographic and health status characteristics of patients, as well as implementing a modified Spanish version of the Functional Assessment of Multiple Sclerosis quality of life instrument Primary caregivers were interviewed using a specific protocol combined with the Zarit Burden Interview. RESULTS: The index cohort comprised 371 MS patients (68.7% female) of mean age 38.9+/-0.9 years. Age, sex and clinical form distribution were similar to other MS population-based surveys. There were 258 (69.5%) relapsing-remitting (RR) MS patients and 113 (30.5%) progressive MS patients. More than one-third of the married patients with progressive MS and almost a quarter of the RRMS patients separated or divorced following a diagnosis of MS; 71.3% of the progressive MS patients as well as 65.8% of the RRMS patients were unemployed as a consequence of the disease. Qualitative analysis showed that friendship and family relationships and occupational status were the most significant dimensions influenced by MS. On the other hand, the speech analysis of primary caregivers showed that emotional burden was related to patients' physical disability. Furthermore, primary caregivers described the influence of MS on their own occupational status, their nonacceptance of the disease, a perception of a lack of support by other members of the family as well as a 'selfish and intransigent' attitude of the patients themselves. CONCLUSIONS: The analysis of the GEDMA cohort provides valuable information that helps clarify the impact of MS on patients' HRQoL.

Adult↗

Academic difficulty among male Egyptian university students. II. Associations with demographic and psychological factors.

We compared 178 students with academic problems with 77 academically successful students. Academic difficulty showed highly significant associations with low socio-economic status, over-crowded housing, paternal behaviour problems and a poor relationship between the parents; also significant associations with family history of psychiatric disorder and living away from home. Academic achievement at school was no guide to university performance. Failed students had fewer friendships, especially with women, and more limited recreational activities. They also scored significantly lower on tests of verbal and non-verbal IQ, and worse on the Bender Gestalt and trail-making tests. EPQ results suggested that university students, particularly those with academic difficulties, are more neurotic and introverted than the general Egyptian population.

Educational Measurement↗

Adult personality functioning assessment (APFA). An investigator-based standardised interview.

The development of an investigator-based standardised interview to assess patterns of specific and general social dysfunction is described. It covers six domains of functioning: work; love relationships; friendships; non-intimate social contacts; negotiations; and everyday coping. Inter-rater reliability was tested by three investigators rating 21 audiotaped interviews, and was shown to be high, with an intraclass correlation of 0.87 for the total score. The pattern of associations between specific and general social dysfunction was examined through determination of sensitivities and specificities and through LISREL modelling. The findings varied across social domains but it was concluded that the total APFA score provided a reasonable measure of general social dysfunction.

Adaptation, Psychological↗

Creativity and psychopathology. A study of 291 world-famous men.

BACKGROUND: This investigation sought to determine the prevalences of various psychopathologies in outstandingly creative individuals, and to test a hypothesis that the high prevalence of mental abnormalities reported in prominent living creative persons would not be found in those who had achieved and retained world status. METHOD: The family background, physical health, personality, psychosexuality and mental health of 291 famous men in science, thought, politics, and art were investigated. The membership of the six series of scientists and inventors, thinkers and scholars, statesmen and national leaders, painters and sculptors, composers, and of novelists and playwrights was determined by the availability of sufficiently adequate biographies. Extracted data were transformed into diagnoses in accordance with DSM-III-R criteria, when appropriate. RESULTS: All excelled not only by virtue of their abilities and originality, but also of their drive, perseverance, industry, and meticulousness. With a few exceptions, these men were emotionally warm, with a gift for friendship and sociability. Most had unusual personality characteristics and, in addition, minor 'neurotic' abnormalities were probably more common than in the general population. Severe personality deviations were unduly frequent only in the case of visual artists and writers. Functional psychoses were probably less frequent than psychiatric epidemiology would suggest, and they were entirely restricted to the affective varieties. Among other functional disorders, only depressive conditions, alcoholism, and, less reliably, psychosexual problems were more prevalent than expected in some professional categories, but strikingly so in writers. CONCLUSIONS: Similar findings have been reported for living artists and writers, and this suggests that certain pathological personality characteristics, as well as tendencies towards depression and alcoholism, are causally linked to some kinds of valuable creativity.

Creativity↗

Public education for community care. A new approach.

BACKGROUND: The findings from a controlled study of the effect of a public education campaign on community attitudes to mentally ill people are presented. METHOD: A census of neighbours' attitudes toward mental illness was conducted in two areas before the opening of supported houses for the mentally ill. In one area an educational campaign was conducted. The attitude survey was then repeated in both areas and patients' social contact with neighbours was recorded. RESULTS: Respondents exposed to the didactic component of the campaign showed only a small increase in knowledge about mental illness but there was a lessening of fearful and rejecting attitudes in the experimental area and not in the control area. Neighbours in the experimental area were more likely to make social contact with both staff and patients. It was social contact which was directly associated with improved attitudes rather than education per se. Patients in the experimental area made contact and even friendships with neighbours whereas those in the control area did not. CONCLUSIONS: The public education campaign did not lead to significant change in neighbours' knowledge of mental illness. However, their attitudes improved and patients' social integration was enhanced.

Activities of Daily Living↗

Adolescent-onset psychosis: prevalence, needs and service provision.

BACKGROUND: Little is known of the epidemiology and care needs of people with adolescent-onset psychosis. AIMS: To examine prevalence and the cross-sectional disability, needs and service provision for adolescent-onset psychosis in areas of central Scotland with a total population of 1.75 million. METHOD: We identified and contacted 103 young people using an opt-out research design. Fifty-three participants and their carers and keyworkers were interviewed using a modified version of the Cardinal Needs Schedule. RESULTS: The 3-year prevalence was 5.9 per 100,000 general population. Twenty-one (20%) adolescents were not in contact with mental health services; 80% of first admissions were to adult acute psychiatric wards. Those interviewed had high levels of morbidity: 29 (55%) had serious to pervasive impairment of functioning; there were relatively high levels of side-effects, negative symptoms, anxiety, occupational, friendship and family difficulties. Care provision was better for'clinical'than for'social'domains; 20% had five or more unmet needs; 17% had at least one intractable problem. CONCLUSIONS: This low-prevalence disorder requires an assertive multi-agency approach in the context of a national planning framework.

Adolescent↗

Male adolescent rites of passage: positive visions of multiple developmental pathways.

Unlike the separation-based, stereotyped views of boys' developmental movement into adulthood, this paper will argue that there are more modern and relational models, as well as multiple pathways, for young males to journey through such rites of passage. Indeed, it will be suggested and supported by both qualitative and quantitative data that the more classic models depend on a "boy code" of traumatic separation from mother and the feminine, a process that is not only negative rather than positive in its developmental trajectory, but also likely to create a premature traumatic separation, leaving boys at risk for emotional maladjustment, everyday sadness, increased incidence of depression and the potential for violence toward the self, suicide, as well as violence toward others. More-positive visions and versions of male rites of passage will be posited and described. The definition of emotional "resilience" during this significant period will be re-addressed as one of "healthy vulnerability," sustained through connection to loving adults, rather than a classic belief in stoicism and release from relational ties. Attachment theory will be brought to bear and the desperate yearnings of adolescent males not only for connection to adult mentors, but also for non-romanticized friendships with adolescent females, will be discussed. Finally, the understanding and substitution of these new, more positive, developmental pathways will be linked to the prevention of violence.

Adolescent↗