The sense-of-coherence and the capability of performing daily occupations in persons with chronic pain

OBJECTIVES: It may be helpful for occupational therapists who promote enabling occupations among persons with chronic pain, to understand the relationship between the persons feelings of meaningfulness, comprehensibility and manageability in life and their capability to perform daily occupations. AIM: The aim of this study was to describe and investigate how these concepts of person and occupational performance of 27 daily occupations in terms of "effort", "inconvenience", "avoidance", "give up", "frequency" and "satisfaction" were related to each other. DESIGN: A prospective correlative study was conducted. METHOD: A consecutive series of eighty-four patients with chronic pain completed a structured interview and responded to the self-assessment instruments Sense-of-Coherence Scale (SOC-13) and Capability of Performing Daily Occupations (CPDO). RESULTS: Weak but significant correlation (p < 0.05) were found between the SOC-13 sub-scale "manageability" and the specific occupations "physical exercise / training" (r = - 0.24), "climb stairs" (r = - 0.27) "social activity" (r= - 0.25) and "wash the laundry" (r = - 0.30), as well as between the SOC-13 sub-scale "meaningfulness" and the CPDO occupations "grocery shopping" (r = -0.22), "performing meals" (r = - 0.24), and "wash the laundry" (r = - 0.31) and the CPDO question "frequency of performing occupations" r = -0.22). The participants' mean value (mean = 58) of SOC-13 was below the other populations represented in a literature review. The mean values for CPDO (3.4-4.3) (optimal score is zero) showed that the participants perceived themselves having activity limitations concerning performance of daily occupations, and the performance area of work productive activities were experienced as more disabling. The degree to which the participants perceived themselves having a strong sense of coherence or being disabled by pain varied greatly both for the results of SOC-13 ( range 32-90 points) and CPDO (range 1.1-7.8 points). CONCLUSION: The expected significant relationship between a person's sense of coherence and the performance of daily occupations was partly verified with weak significant correlations. In clinical practice the assessment instruments are suggested to be of value in rehabilitation clinics for occupational therapists who work with people with chronic pain.     

Winding Stairs: A sampling tool to compute sensitivity indices

Sensitivity analysis aims to ascertain how each model input factor influences the variation in the model output. In performing global sensitivity analysis, we often encounter the problem of selecting the required number of runs in order to estimate the first order and/or the total indices accurately at a reasonable computational cost. The Winding Stairs sampling scheme (Jansen M.J.W., Rossing W.A.H., and Daamen R.A. 1994. In: Gasman J. and van Straten G. (Eds.), Predictability and Nonlinear Modelling in Natural Sciences and Economics. pp. 334–343.) is designed to provide an economic way to compute these indices. The main advantage of it is the multiple use of model evaluations, hence reducing the total number of model evaluations by more than half. The scheme is used in three simulation studies to compare its performance with the classic Sobol' LP. Results suggest that the Jansen Winding Stairs method provides better estimates of the Total Sensitivity Indices at small sample sizes.     

Social work, siblings, and SIDS: conceptual and case-based guidance for family system intervention

Sudden Infant Death Syndrome (SIDS) is a tragic loss event within the family, impacting adults as well as children. This article uses three case illustrations to discuss the role of a SIDS event on the family system with a special focus on the emergent challenges for surviving siblings of various ages. Practice application examples are woven throughout the review to illustrate the age-specific grief responses which may occur following a SIDS event. The article also presents a theoretically supported intervention matrix that integrates models of bereavement support and family system responses, taking into account children's varying developmental needs and tasks based on sibling age.     

The moderating effects of culture on peer deviance and alcohol use among high-risk African-American Adolescents

African-American adolescents have lower rates of alcohol consumption than White youth. However, African-American youth suffer disproportionately more adverse social, mental, and physical health outcomes related to alcohol use. Affiliating with negative peers is a risk factor for alcohol initiation and consumption. Cultural variables have shown moderating effects against other risk factors for African-American youth and therefore were the focus of this study. Specifically, we tested whether three culturally-relevant variables, Africentric beliefs, religiosity, and ethnic identity were promotive or protective for alcohol initiation and use within the context of negative peer affiliations. The sample consisted of 114 at-risk African-American adolescents whose ages ranged from 13 to 20. Participants were administered a questionnaire with measures of alcohol initiation and use, peer risk behaviors, ethnic identity, Africentric beliefs, religiosity, and demographic items. Peer risk behaviors accounted for significant percentages of the variance in age of alcohol initiation, lifetime use, and current and heavy alcohol use after adjusting for age and gender. Cultural variables showed both promotive and protective effects. Africentric beliefs were promotive of delayed alcohol initiation, whereas both Africentrism and religiosity moderated peer risk behaviors effect on alcohol initiation. Africentric beliefs were also inversely related to lifetime alcohol use revealing a promotive effect. Moreover, there were significant protective effects of ethnic identity and religiosity on heavy alcohol consumption. One implication of these findings is that prevention programs that infuse cultural values and practices such as Africentrism, ethnic identity, and religiosity may delay alcohol initiation and reduce use especially for youth with high risk peers.     

Mindful relating: exploring mindfulness and emotion repertoires in intimate relationships

This study tested the theory that mindfulness contributes to greater intimate relationship satisfaction by fostering more relationally skillful emotion repertoires. A sample of married couples was administered measures of mindful awareness, emotion skills, and marital quality. We hypothesized that mindfulness would be associated with both marital quality and partners' emotion skills and that the association between mindfulness and marital quality would be mediated by emotion repertoire skill. Findings suggested that emotion skills and mindfulness are both related to marital adjustment, and that skilled emotion repertoires, specifically those associated with identifying and communicating emotions, as well as the regulation of anger expression, fully mediate the association between mindfulness and marital quality. Theoretical implications are discussed.     

Self-expansion as a mediator of relationship improvements in a mindfulness intervention

In a recent randomized controlled trial, couples participating in a mindfulness-based relationship enhancement program demonstrated significant improvements in relationship satisfaction and relationship distress (Carson, Carson, Gil, & Baucom, 2004). Here we report on a multiple mediation analysis of these couples' improvements. Potential mediators included measures of couples' engagement in exciting self-expanding activities, couples' ability to accept one another's difficult characteristics, and individual partners' ability to relax. Results indicate that to a large extent, the mindfulness-related relationship improvements can be attributed to partners' sense that they were participating in exciting self-expanding activities together during the course of the intervention. The implications of these findings for future mindfulness research are discussed.     

Normative beliefs as risk factors for involvement in unhealthy weight control behavior

OBJECTIVE: The authors' aim in this study was to determine, after adjustment for the effects of body mass index and sociodemographic measures, whether sex-specific weight control norms would have significant independent relationships with the weight control behavior of college women and men. PARTICIPANTS: The authors used an anonymous questionnaire to assess a sample of 470 college students, aged 18 to 26 years, attending either a 2- year community college or a 4-year public university. METHODS: To calculate body mass index, the authors objectively measured the height and weight of each participant. They conducted separate discriminant function analyses for women and men. RESULTS: The discriminant function analyses clearly indicated that weight control norms of same-sex, close friends were the best discriminators of involvement in weight control. CONCLUSIONS: The findings indicate that perceived peer norms may be important but overlooked risk factors for engaging in unhealthy weight control practices. The authors discuss the implications of these findings in the context of student health promotion.     

A Diagnostic for Association in Bivariate Survival Models

We propose exploratory, easily implemented methods for diagnosing the appropriateness of an underlying copula model for bivariate failure time data, allowing censoring in either or both failure times. It is found that the proposed approach effectively distinguishes gamma from positive stable copula models when the sample is moderately large or the association is strong. Data from the Womens Health and Aging Study (WHAS, Guralnik et al., The Womenss Health and Aging Study: Health and Social Characterisitics of Older Women with Disability. National Institute on Aging: Bethesda, Mayland, 1995) are analyzed to demonstrate the proposed diagnostic methodology. The positive stable model gives a better overall fit to these data than the gamma frailty model, but it tends to underestimate association at the later time points. The finding is consistent with recent theory differentiating catastrophic from progressive disability onset in older adults. The proposed methods supply an interpretable quantity for copula diagnosis. We hope that they will usefully inform practitioners as to the reasonableness of their modeling choices.