Cooperative extension initiatives in marriage and couples education

Cooperative extension has a long‐term history of delivering family life education. Further, the organization has developed numerous research‐based resources and undertaken statewide initiatives in marriage and couples education. Most promising of all is the work of a group of extension specialists to create a practical, research‐based curriculum that may reach communities in the United States through the established network of extension educators and their collaborators. We review various family relationship models and describe how the design of the new couples' curriculum is based on those models.     

河南省4县HIV感染者/艾滋病病人配偶阳转影响因素分析

目的探讨艾滋病单方阳性配偶阳转情况影响因素,为预防艾滋病二代传播措施制定提供科学依据。方法应用回顾性病例对照研究方法,对河南省4县2006—2010年221对人类免疫缺陷病毒（HIV）阳性者及其配偶进行调查,对可能影响阳转的人口学特征、性生活方式、相关知识知晓等因素进行分析。结果单因素分析结果表明,病例组和对照组之间单阳配偶文化程度（χ²=7.298,P=0.026）、性行为频率（χ²=6.075,P=0.048）、先证阳性者CD₄⁺T淋巴细胞（以下简称CD₄）计数（χ²=10.908,P=0.004）、夫妻双方安全套使用情况（χ²=52.474,P=0.000）和艾滋病知识知晓率（χ²=5.503,P=0.019）差异均有统计学意义;多因素非条件logistic回归显示,先证阳性者的CD₄计数≤200时,将艾滋病传染给配偶的危险性是CD₄计数>350者的3.224倍（95%CI=1.266~8.212）,单方阳性夫妻间经常使用安全套和较少使用安全套的HIV阳转危险性分别为每次均用的16.452倍（95%CI=5.837~46.373）和7.643倍（95%CI=2.878~20.296）。结论HIV先证阳性者高CD₄水平和坚持每次使用安全套是HIV夫妻间传播的保护因素。     

南宁市婚育人群地中海贫血空间分布特征分析

目的 探讨广西南宁市育龄夫妇α地中海贫血(简称α地贫)空间分布规律,为南宁市地中海贫血防治提供参考依据.方法 收集2010-2013年南宁市12个县、城区育龄夫妇地中海贫血筛查记录数据,计算南宁市各县、城区各年α地贫检出率及4年平均检出率,采用ArcMap 10.0制作α地贫空间分布图,并进行空间自相关分析.结果 南宁市育龄夫妇α地贫的检出率为18.1%,在空间分布中不存在相关性,但存在高发地区,如良庆区、隆安县、武鸣县.结论 南宁市各县、城区α地贫的检出率较高,针对高发地区应加强筛查力度和产前诊断,以减少α地贫的发生.     

Provider perspectives on service delivery modifications to maintain access to HIV pre‐exposure prophylaxis during the COVID‐19 pandemic: qualitative results from a PrEP implementation project in Kenya

IntroductionHIV pre‐exposure prophylaxis (PrEP) is an essential prevention strategy being scaled up for priority populations in Kenya, including for HIV serodiscordant couples. The COVID‐19 pandemic posed challenges to PrEP rollout. We conducted a qualitative study of PrEP providers to understand how clinics adjusted PrEP delivery during the COVID‐19 pandemic.MethodsSince 2017, the Partners Scale‐Up Project has integrated PrEP into 25 HIV clinics in Central and Western Kenya. We conducted qualitative interviews with 40 purposively sampled clinic personnel. We interviewed personnel once during the first pandemic wave (May–Aug 2020) and again after some decline in COVID‐19 rates (Nov–Jan 2021). We analysed data using inductive memo‐writing and summarized data by themes along the PrEP delivery cascade, guided by the Framework for Reporting Adaptation and Modifications (FRAME).ResultsWe interviewed 27 clinical officers, five nurses, four health records and information officers, and four counsellors from Central (n = 20) and Western (n = 20) Kenya. About half (n = 19) were female, with a median age of 32 (IQR: 29–34) and 2.3 years of experience delivering PrEP (IQR: 2–3). All participants reported clinic changes in PrEP demand creation and service delivery during the pandemic. Modifications occurred during PrEP implementation and sustainment phases, were partly reactive to the pandemic and also facilitated by interim Ministry of Health guidance on PrEP delivery during COVID, and were made by PrEP delivery teams, clients and clinic managers. Commonly reported modifications included dispensing multiple‐month PrEP refills, intensifying phone‐based client engagement and collaborating with other HIV clinics to ensure that clients with prolonged stays in other regions could continue to access PrEP. Some clinics also adopted practices to streamline visits, such as within clinical‐room PrEP dispensing, pre‐packing PrEP and task‐shifting. Most providers liked these changes and hoped they would continue after the pandemic subsides.ConclusionsCOVID‐19 served as a catalyst for PrEP delivery innovations in Kenya. HIV clinics successfully and rapidly adapted their PrEP demand creation, refill and retention strategies to promote PrEP uptake and effective use. These modified implementation strategies highlight opportunities to streamline the delivery of PrEP, as well as other HIV and chronic care services, and strengthen engagement with populations post‐pandemic.     

Factors that influence infertile couples’ selection of reproductive medicine centers---A cross-sectional questionnaire study

ObjectiveThe number of infertile women undergoing in vitro fertilization (IVF) cycles has increased annually. Due to this competitive environment, we designed a questionnaire and aimed to investigate factors affecting the choice of reproductive medicine center among infertile couples.Materials and methodsThis was a retrospective cross-sectional study that analyzed questionnaires provided by the reproductive medicine center of the Kaohsiung Veterans General Hospital from January 2018 to June 2018. In the questionnaire, there are six categories (environment and equipment, service quality, patient safety, medical quality, information acquisition channel and other) and 36 items. The identified factors were scored and then weighted using principal component analysis.ResultsMost of the 100 identified infertile women were aged 31–35 years, were married 1–3 years, and had a university education level. In the weight analysis, “Clean outpatient clinic and medical equipment” had the greatest weight in the dimension of environment and equipment. The item with the greatest weight in the dimension of service quality was “Waiting time for registration, charging, and receiving medicine”. In the dimension of patient safety, “Privacy is highly respected by medical personnel” had the highest weight. The item with the greatest weight in the dimension of medical quality was “Success rate of reproductive medicine center”. The three items with the highest weights in the dimension of information acquisition channel were “Newspapers and magazines”, “TV media”, and “Facebook page and website of our hospital”. In the other dimensions, the two with the greatest weights were “Reputation of the hospital” and “Reputation of physicians”.ConclusionIn the infertile couples' view, optimal reproductive medicine centers should have a high success rate and great reputation on the internet and in mass media. Additionally, a short waiting time and high levels of privacy and confidentiality are also imperative.     

The influence of relational mutuality on dyadic coping among couples facing breast cancer

Abstract

Objective: The study examined how a couple’s capacity for mutuality as conceptualized by the Relational-Cultural Theory plays a role in their managing the stresses accompanying breast cancer.

Methods: Eighty-six women treated for a primary, non-metastatic breast cancer and their partners completed measures of quality of life, relational mutuality, and dyadic coping. Demographic and clinical factors were self-reported. The relationship between mutuality and dyadic coping was evaluated using the Actor-Partner Interdependence Model (APIM).

Results: Relational mutuality was positively associated with both the patients’ and the caregivers’ scores on common and positive dyadic coping. Similarly, relational mutuality was associated with both patients’ and caregivers’ reduced scores on avoidance of dyadic coping.

Conclusions: Relational mutuality emerges as a significant factor in our understanding about dyadic coping in the context of cancer and this study highlights the role it plays in dyadic coping behaviors.

Implications: The promotion of relational mutuality in couples coping with cancer-related stress should be a major focus in couple-based interventions.     

Ajustement psychologique des couples confrontés à un cancer du sein : perceptions des comportements de soutien du conjoint

This cross-sectional study for couples explores the relationship between the perceptions within the couple of the spouse's supportive behaviors and the psychological adjustment of both partners during treatment for breast cancer. Forty-eight women operated on for a non-metastatic breast cancer and their spouses completed questionnaires assessing psychological adjustment (STAI, BDI-SF), and the spouse's support behaviors during discussions about the disease (PSE). Support behaviors are positively valued by both partners, especially non-verbal comfort and concrete actions. Support by minimization is associated with fewer depressive symptoms in patients and spouses. For spouses, the positive perception of support by concrete action is associated with a lower depression score. Moreover, high adjustment difficulties for spouses are linked to greater perception differences between partners on emotional support and minimization. These results highlight the importance of non-verbal comfort and minimization for the perception of social support within the couple, and the usefulness of support by concrete actions proposed by spouses. Advices for professionals are available.     

A Typology of Work‐Family Arrangements Among Dual‐Earner Couples in Norway

A symmetrical family model of two workers or caregivers is a political goal in many western European countries. We explore how common this family type is in Norway, a country with high gender‐equality ambitions, by using a multinomial latent class model to develop a typology of dual‐earner couples with children based on the partners' allocations of paid and unpaid work. Using data on 2,617 respondents from the Norwegian Generations and Gender Survey, we estimate 4 classes, of which 2 are characterized by a fairly equal sharing between the partners and 2 have more traditional arrangements. Equal sharing is practiced by 4 out of 10 couples and is most likely when the partners are well educated and work regular hours and the father is in public‐sector employment. A traditional practice is likely when the partners have less education, the mother has health problems, the father has private‐sector employment, and the partners work irregular hours.     

A Problem-Solving Strategy and Self-Esteem in Recovering Chemically Dependent Women

The primary purpose of the study was to determine the effectiveness of a problem-solving strategy intervention in raising the self-esteem of recovering women. An A-B-A single subject design was employed in the investigation. Self-esteem was measured by: pre-intervention and post-intervention administrations of the Tennessee Self-Concept Scale, the percentage of positive self-statements recorded in journal entries, and self-ratings of decision-making ability. Of the four subjects who participated in the study, three experienced an increase in self-esteem.     

Promoting Resilience Following Traumatic Brain Injury: Application of an Interdisciplinary,Evidence‐Based Model for Intervention

With an increasing instance of traumatic brain injury and little advancement over recent decades in the rehabilitation of brain injury survivors and their family members, focus has shifted toward the establishment of effective whole‐family resilience promotion interventions. Using the Brain Injury Family Intervention as a model, clinicians constructed two curriculum‐based interventions grounded in resilience theory and drawing from the interdisciplinary approaches of neuropsychology and marriage and family therapy: (a) the Resilience and Adjustment Intervention, for individual survivors of traumatic brain jury, and (b) the Therapeutic Couples Intervention, designed to increase relational satisfaction in couples following a traumatic brain injury. The present study outlines the need for the integration of resilience tenets into rehabilitation techniques, summarizes the empirical justification for the use of an interdisciplinary approach, and offers an overview with implementation specifics regarding these two newly designed interventions.