Is physical activity a part of who I am? A review and meta-analysis of identity,schema and physical activity

Two parallel literatures on the physical activity (PA) identity and schema constructs have the potential to supplement traditional social cognitive approaches used for PA promotion. The purpose of this paper was to review schema/identity research and appraise its relationship with PA via meta-analysis followed by thematic analyses of its correlates, as well as its proposed mechanisms on PA. Eligible studies were from English, peer-reviewed published articles that examined identity and/or schema in the context of PA. Searches were completed in June 2015 in five databases. Sixty-two independent data-sets (32 available for meta-analysis), primarily of modest quality, were identified. Results of the random effects meta-analysis showed that the point-estimate between identity/schema and behaviour was r?=?.44 (CI?=?.39?.48), and invariant to selected study characteristics. Thematic review showed that identity/schema was associated with commitment, ability, affective judgments, identified/integrated regulation and social comparison and predicted intention, self-regulatory efficacy, and self-regulation strategy use. It had reliable evidence as a moderator of the intention–behavior relationship, was associated with increases in the speed of processing of relevant information and created negative affect under hypothetical identity–behavior discrepant situations. While this initial research is promising, more rigorous research designs, including interventions to increase identity/schema, are warranted.     

Predictors of medical students’ ethical decision-making: A pilot study using the Theory of Interpersonal Behavior

ObjectiveTo understand medical students’ (MS) ethical decision-making using the Theory of Interpersonal Behavior (TIB).MethodsWe conducted two rounds of focus groups to develop a TIB-based questionnaire by eliciting students’ perspectives on an ethical dilemma they will encounter in a standardized patient (SP) station, in which an SP “surgeon” asked them to intubate a sedated patient whom the student knew had requested no student involvement. We administrated questionnaires to 241 third-year MS following this SP station, asking for their decisions in the SP station and if a surgeon made the same request in their clerkship. Confirmatory factor analysis (CFA) was used to test whether observed data fit the proposed TIB-based model.ResultsThe CFA provided an acceptable fit to the a priori proposed model. Fifty-five percent of students indicated they would intubate in an actual situation versus 18% in the SP station (p < 0.05). Using logistic regression, TIB domains affect and facilitating factors reported significant association with students’ decisions in both the SP and hypothesized actual situations.ConclusionsThe TIB appears to be an effective theoretical framework for explaining students’ ethical decision-making.Practice implicationsThe TIB may guide design and assessment of educational programs for professional formation.     

Pregnant women’s cortisol is elevated with anxiety and depression — but only when comorbid

Elevated cortisol during pregnancy is associated with adverse birth outcomes and may alter fetal development and subsequent adult health. Numerous studies link elevated cortisol to depression and anxiety, but only a few have examined these relationships during pregnancy and in response to laboratory stressors. No studies have investigated the impact of comorbid anxiety and depression on cortisol during pregnancy. Salivary cortisol samples were collected twice before and once after a set of computer-based tasks (Stroop color-word matching task and either mental arithmetic or a controlled breathing task) from 180 pregnant women at approximately 36 weeks gestation. Based on psychiatric diagnoses, four groups of women were compared: 121 control, 16 depression, 34 anxiety, and 9 comorbid. Women also completed symptom and stress self-report scales. There was a significant main effect for maternal diagnosis on cortisol levels. Post hoc comparisons showed that comorbid subjects had higher salivary cortisol levels than controls, but subjects with only one diagnosis did not. Similar to cortisol, the comorbid subjects also had higher ratings on pregnancy-specific distress. Comorbidity during pregnancy, versus depression or an anxiety disorder alone, is uniquely associated with elevated cortisol and a negative evaluation of pregnancy. The potential impact of this combined psychiatric diagnosis on fetal development and future adult health needs further investigation.     

Experiencing emotion: children’s perceptions,reflections and self-regulation

Twenty-two children aged 4–11 attended sessions of Somatic Movement Education (incorporating developmental play and movement patterns). They were given the opportunity to express their emotions through movement, and to develop their understanding and processing of emotion through pair work, group work, journaling, mark-making and reflections as part of a phenomenological research project. The children showed that they were able to identify and express their emotions through movement and creative methods. In some cases they were also able to move towards self-regulating their emotions, and articulate their experiences of this clearly.     

Living with huntington’s disease: illness perceptions,coping mechanisms,and spouses’ quality of life

Chronic illness not only affects the life of those suffering from Huntington’s disease but also threatens the quality of life (QOL) of their spouses. In this study, we focus on Huntington’s disease (HD). The impact of HDonthe QOL of spouses has been hardly studied from a behavioral medicine or health psychology perspective. We hypothesize that spouses’ illness perceptions and coping mechanisms will contribute significantly to the prediction of their QOL. Illness perceptions, coping mechanisms, and the QOL of 90 spouses ofpatients with HD were assessed by meansof the Illness Perception Questionnaire, the COPE, and the Medical Outcome Study 36-item Short Form Health Survey, respectively. After controlling for demographic and illness-related variables, coping mechanisms explained a significant amount of variance of spouses’ role functioning. Given our results, more empirical and longitudinal research is justified on coping mechanisms and illness perceptions of spouses living with Huntington’s disease.     

Does timing and sequencing of transitions to adulthood make a difference? stress, smoking, and physical activity among young australian women

The major changes of the transition to adulthood are argued to be stressful, and health-related behaviors such as smoking and physical activity may be adopted, consolidated, or abandoned at this time. On the other hand, research has suggested that the normative transitions of emerging adulthood, although involving considerable change, may be associated with low stress because they are perceived as both positive and normal at this life stage. This article examines relations between the timing and sequencing of life transitions and stress and health-related behaviors, focusing on the transition to young adulthood among Australian women. A total of 853 women aged 22 to 27 provided information about the timing and sequencing of 6 life transitions: moving out of home, stopping full-time education, starting full-time work, having the first live-in relationship, marriage, and motherhood—and stress, smoking, and physical activity. Most had moved out of home, stopped full-time education, and started full-time work, but only 14% had undertaken all 6 transitions. Overall, 70% of participants had made transitions “in order.” Overall, the findings suggest that the relations between timing and sequencing of transitions, and indicators of health, are moderate for smoking, but small for stress and for physical activity. These effects remained after controlling for socioeconomic status of the participants’families of origin. Matching current social norms for the timing and sequencing of life changes may be of less importance for women’s well-being than is commonly believed. Although the significant relations between early or “out of order” transitions and smoking are of concern, the smaller relations with stress and with sedentariness suggest that such transitions may have limited negative consequences, and support the view that individuals are active in choosing the life path that is appropriate for them and their circumstances.     

Selected biologic markers of inflammation and activity of Crohn’s disease

Abstract

The study aimed to compare the accuracy of selected biologic markers in assessing the disease activity in patients with Crohn’s disease (CD). The analysis included serum IL-2, IL-6, IL-17, TNF-α, IFN-γ, hsCRP, peripheral CD4?+?CD25?+?FOXP3?+?regulatory T cells, as well as fecal calprotectin and lactoferrin. A group of 55 adults with CD was enrolled to the study. Disease activity was assessed using Crohn’s Disease Endoscopic Index of Severity (CDEIS), which currently represents the gold standard for the evaluation of endoscopic activity. For clinical activity scoring, the Crohn’s Disease Activity Index (CDAI) was used. Concentrations of investigated markers were estimated by means of flow cytometry and enzyme-linked immunosorbent assays, and the results were correlated with both indices. The study demonstrated that both fecal markers, i.e. calprotectin (r?=?0.827, p?<?0.001) and lactoferrin (r?=?0.704, p?<?0.001), correlate closely with CDEIS score, and might be used to evaluate the severity of CD in clinical setting. The correlation of those markers with CDAI was also significant, with r?=?0.742 for calprotectin (p?<?0.001) and r?=?0.675 for lactoferrin (p?<?0.05). As for the other investigated markers, only hsCRP (r?=?0.672, p?<?0.001) and IL-17 (r?=?0.296, p?<?0.005) correlated closely with CDEIS. The correlation of the markers with CDAI was also significant, though weaker, with r?=?0.518 for hsCRP (p?<?0.001) and r?=?0.296 for IL-17 (p?<?0.05). The study showed that IL-17, despite its vague role in the pathogenesis of CD, might be a useful marker, comparable with hsCRP, in assessing the activity of the disease.     

Accuracy of self-reported weight and height in women from Bogotá, Colombia

Aim: To identify correlates of bias in self-reported anthropometry among reproductive-aged Colombian women and to correct overweight/obesity and obesity prevalence based on self-reported data using two calibration techniques.

Subjects and methods: Self-reported and objectively measured anthropometry were obtained from 597 women aged 21–55 years from Bogotá, Colombia. This study identified correlates of reporting bias (self-reported minus measured anthropometry) by examining its distribution across categories of sociodemographic characteristics, objectively measured anthropometry and body shape perception using linear regression. Next, weight status misclassification was assessed using self-reported anthropometry. Finally, multivariable linear regression and ROC curves were used to calibrate weight status misclassification from self-reported data; these techniques were applied in half of the study population and validated in the remaining half.

Results: Women under-estimated weight by 2.0?±?5.0?kg and over-estimated height by 0.6?±?4.0?cm. Correlates of bias included objectively measured anthropometry and marital status. Self-reported BMI yielded spuriously low prevalences of overweight/obesity and obesity. The ROC approach effectively corrected overweight/obesity prevalence, while the regression method provided a more accurate estimate of obesity prevalence.

Conclusions: Bias in self-reported anthropometry varied with respect to objectively measured anthropometry and sociodemographic characteristics. BMI from self-reported anthropometry under-estimates overweight/obesity and obesity prevalence; calibration methods can effectively correct reporting bias.     

Public health communication and education to promote more physical activity and less sedentary behaviour: Development and formative evaluation of the ‘physical activity triangle’

ObjectiveCommunication and education about health behaviours to the general population is essential in public health promotion. This paper describes the process and outcome of developing a new health education model (infographic) for physical activity (PA) and sedentary behaviour used in Flanders (Belgium).MethodsThe Flanders Institute for Healthy Living, expertise centre for public health, coordinated a process, including the evaluation of its previous education model among citizens; reviewing existing models from other countries; expert panel meetings (n = 3); and a formative evaluation (34 focus groups) among citizen with various profiles.ResultsThe previous model was difficult to understand and not motivating. Foreign models (n = 18) were mostly expert-based (72 %), but not evaluated among citizens. Based on expert meetings, the new model includes a daily and weekly variety of activities at different volumes and intensities, sitting (interruptions), and physical and mental health benefits of PA. Based on the focus groups, no quantitative PA recommendations were integrated, and specific symbols, colours, and heart icons were crucial to illustrate different PA behaviours, volumes and intensities.Practice ImplicationsInvolving several key stakeholders, especially sedentary/inactive and vulnerable citizens, is suggested when developing a health model. Citizens preferred non-quantitative PA messages and quantitative messages around sitting interruptions.     

Patient perceptions of a decision support tool to assist with young women’s contraceptive choice

ObjectiveContraceptive decision support tools (DSTs) have been suggested as a way to provide patient-centered contraceptive care, but little is known about the role they play in women’s decision-making. The aim of this study is to understand patients’ perceptions of the value of a contraceptive DST.MethodsWe conducted 21 semi-structured interviews with unmarried women aged 18–29 from an integrated health care system who viewed the DST. Thematic analysis was conducted to identify common themes in the participants’ experience.ResultsFour themes were identified: Informative; Narrowing down options; Tool vs. doctor; and Preparation for a clinical visit. In general, participants felt the tool was valuable because it provided them relevant information and facilitated their decision-making process by narrowing down contraceptive options. Participants felt the tool could prepare them for a visit with their health care provider by helping them identify questions for their provider, but also saw distinctions between the DST and what their provider could offer.ConclusionContraceptive DSTs are valuable to their users when they include information on contraceptive attributes women deem important and allow for user-driven tailoring.Practice implicationsContraceptive DSTs may address patient informational needs and can serve as a complement to provider counseling.     

Exclusive enteral nutrition and induction of remission of active Crohn’s disease in children

Exclusive enteral nutrition is an effective therapy for the management of active Crohn’s disease, especially in children and adolescents. This therapeutic approach involves the use of a liquid nutritional product with the exclusion of normal diet for a period of many weeks. Although recent studies have helped to delineate some aspects of how exclusive enteral nutrition should be used, there remain many gaps in our understanding. In addition, several recent reports have provided intriguing insights into the mechanisms of this nutritional approach.     

The effect of widowhood on husbands’ and wives’ physical activity: the cardiovascular health study

This prospective study examined the effect of widowhood on physical activity by comparing widowed elders to health status-, age-, and sex-matched married controls. Participants included 396 married controls and 396 widows/widowers age 64–91 (M age = 72.7 years) who experienced the death of their spouse while participating in the Cardiovascular Health Study. Compared to married controls, widowed men, but not women, were more likely to increase their physical activity following the death of their spouse. However, this increased level of activity was not sustained and declines as time since spousal death passes. Moreover, during the year before spousal death, soon-to-be widowed men, but not women, increase their physical activity. Our results suggest that widowed men experience significant changes in physical activity and that the transition to widowhood contribute to these changes.     

Patients’ perceptions of palliative care: adaptation of the Quality from the Patient’s Perspective instrument for use in palliative care,and description of patients’ perceptions of care received

Background

Globally, the number of people who die with dementia is increasing. The importance of a palliative approach in the care of people with dementia is recognised and there are national polices to enhance current care. In the UK implementation of these polices is promoted by the National Institute for Health and Care Excellence (NICE) Dementia Quality Standards (QS). Since publication of the QS new care interventions have been developed.

Aim

To explore critically the current international research evidence on effect available to inform NICE Dementia QS relevant to end of life (EOL) care.

Design

We used systematic review methods to seek the research evidence for three statements within the Dementia QS. These are those that recommend: (1) a case management approach, (2) discussing and consideration of making a statement about future care (SFC) and (3) a palliative care assessment (PCA). We included evaluative studies of relevant interventions that used a comparative design, such as trials and cohort studies, and measured EOL care outcomes for persons dying with moderate to severe dementia. Our primary outcome of interest was whether the intervention led to a measurable impact on wellbeing for the person with dementia and their family. We assessed included studies for quality using a scale by Higginson and colleagues (2002) for assessment of quality of studies in palliative care, and two authors undertook key review processes. Data sources included Cinahl, Embase, and PsychINFO from 2001 to August 2014. Our search strategy included free text and medical subject headings relevant to population and recommended care.

Results

We found seven studies evaluating a care intervention; four assessed SFC, three PCA. None assessed case management. Studies were of weak design; all used retrospective data and relied on others for precise record keeping and for accurate recall of events. There was limited overlap in outcome measurements. Overall reported benefits were mixed.

Conclusions

Quality statements relevant to EOL care are useful to advance practice however they have a limited evidence base. High quality empirical work is needed to establish that the recommendations in these statements are best practice.

     

A systematic review of women’s satisfaction and regret following risk-reducing mastectomy

ObjectiveA systematic review of quantitative and qualitative studies, to describe patient satisfaction and regret associated with risk-reducing mastectomies (RRM), and the patient-reported factors associated with these among women at high risk of developing breast cancer.MethodsStudies were identified using Medline, CINAHL, Embase and PsycInfo databases (1995–2016). Data were extracted and crosschecked for accuracy. Article quality was assessed using standardised criteria.ResultsOf the 1657 unique articles identified, 30 studies met the inclusion criteria (n = 23 quantitative studies, n = 3 qualitative studies, n = 4 mixed-method studies). Studies included were cross-sectional (n = 23) or retrospective (n = 7). General satisfaction with RRM, decision satisfaction and aesthetic satisfaction were generally high, although some women expressed regret around their decision and dissatisfaction with their appearance. Factors associated with both patient satisfaction and regret included: post-operative complications, body image changes, psychological distress and perceived inadequacy of information.ConclusionWhile satisfaction with RRM was generally high, some women had regrets and expressed dissatisfaction. Future research is needed to further explore RRM, and to investigate current satisfaction trends given the ongoing improvements to surgical and clinical practice.Practice implicationsOffering pre-operative preparation, decisional support and continuous psychological input may help to facilitate satisfaction with this complex procedure.     

Factors influencing women’s perceptions of shared decision making during labor and delivery: Results from a large-scale cohort study of first childbirth

Objective

To examine correlates of shared decision making during labor and delivery.

Recovery from postpartum psychosis: a systematic review and metasynthesis of women’s and families’ experiences

Postpartum psychosis is a serious disorder that can result in adverse consequences for the mother and baby. It is important that we understand the experiences of women, to develop effective interventions during this critical period. The aim of this systematic review was to conduct a metasynthesis of qualitative research exploring women’s experiences of postpartum psychosis and factors involved in recovery from the perspective of women and family members. A comprehensive literature search of five databases was conducted and the findings were appraised and synthesised, following a thematic synthesis approach. Fifteen studies, capturing the views of 103 women and 42 family members, met the inclusion criteria. Four main themes incorporating 13 subthemes were identified following synthesis: (1) Experiencing the unspeakable, (2) Loss and disruption, (3) Realigning old self and new self and the integrative theme of (4) Social context. The findings offer new insight into the unique experience of postpartum psychosis and demonstrate that recovery does not follow a linear path. To improve clinical outcomes, a more integrative and individualised approach is needed which incorporates long-term psychological and psychosocial support, and considers the needs of the family. Further areas for staff training, service development and future research are highlighted.

     

A graph-based recovery and decomposition of Swanson’s hypothesis using semantic predications

ObjectivesThis paper presents a methodology for recovering and decomposing Swanson’s Raynaud Syndrome–Fish Oil hypothesis semi-automatically. The methodology leverages the semantics of assertions extracted from biomedical literature (called semantic predications) along with structured background knowledge and graph-based algorithms to semi-automatically capture the informative associations originally discovered manually by Swanson. Demonstrating that Swanson’s manually intensive techniques can be undertaken semi-automatically, paves the way for fully automatic semantics-based hypothesis generation from scientific literature.MethodsSemantic predications obtained from biomedical literature allow the construction of labeled directed graphs which contain various associations among concepts from the literature. By aggregating such associations into informative subgraphs, some of the relevant details originally articulated by Swanson have been uncovered. However, by leveraging background knowledge to bridge important knowledge gaps in the literature, a methodology for semi-automatically capturing the detailed associations originally explicated in natural language by Swanson, has been developed.ResultsOur methodology not only recovered the three associations commonly recognized as Swanson’s hypothesis, but also decomposed them into an additional 16 detailed associations, formulated as chains of semantic predications. Altogether, 14 out of the 19 associations that can be attributed to Swanson were retrieved using our approach. To the best of our knowledge, such an in-depth recovery and decomposition of Swanson’s hypothesis has never been attempted.ConclusionIn this work therefore, we presented a methodology to semi-automatically recover and decompose Swanson’s RS-DFO hypothesis using semantic representations and graph algorithms. Our methodology provides new insights into potential prerequisites for semantics-driven Literature-Based Discovery (LBD). Based on our observations, three critical aspects of LBD include: (1) the need for more expressive representations beyond Swanson’s ABC model; (2) an ability to accurately extract semantic information from text; and (3) the semantic integration of scientific literature and structured background knowledge.