Violência por parceiro íntimo entre homens que se relacionam com homens / Intimate partner violence among men who relate with men / Violencia de pareja íntima entre hombres que tienen relaciones con hombres

A violência por parceiro íntimo (VPI) consiste em atos que ameacem causar ou efetivamente causem danos em um parceiro dentro de uma relação afetivo-sexual, independente da configuração ou tempo do relacionamento ou de haver coabitação ou não entre as partes. Nas relações homossexuais, a VPI é invisibilizada de diversas maneiras, mesmo sendo reconhecida como uma grave violação de direitos humanos. O estudo objetivou compreender os significados da VPI para um grupo de homens que se relacionam com homens (HRH). Participaram da pesquisa oito HRH, selecionados através da técnica "bola de neve", utilizada devido à sensibilidade do tema, considerando os estigmas de ser HRH. Os dados foram obtidos através de entrevista semiestruturada e foram analisados pela Análise Temática. Como resultados, foram construídas seis categorias: 1º) O armário; 2º) Homofobia 3º) Racismo, poder e vulnerabilidade a VPI; 4º) Sexualidade; 5º) Infidelidade; 6º) HIV, que discutem a interseccionalidade de diversas formas de opressão na produção de VPI entre HRH. Conclui-se que a VPI vivenciada por esse grupo é influenciada por diversos fatores que envolvem a interseccionalidade de vários marcadores sociais, como os estereótipos de masculinidade em relação a hipersexualização e infidelidade, a homofobia como fator direto do estresse minoritário, o racismo que hierarquiza os corpos e invisibiliza o afeto de homens negros, e o estigma de HIV no imaginário social.(AU)

Intimate partner violence (IPV) consists of acts that threaten to harm or actually harm to a partner within an affective-sexual relationship, regardless of the configuration or duration of the relationship or whether or not there is cohabitation between the parties. In homosexual relationships, IPV is made invisible in several ways, even though it is recognized as a serious violation of human rights. The study aimed to understand the meanings of IPV for a group of men in same sex relationships (MSSR). Eight MSSR participated in the research, selected by snowball sampling, used due to the topic's sensitivity, considering the stigmas involved in being MSSR. Data were constructed via semi-structured interviews and analyzed using Thematic Analysis. As a result, six categories were constructed: 1) The closet persons; 2) Homophobia; 3) Racism, power, and vulnerability to IPV; 4) Sexuality; 5) Infidelity; 6) HIV, which discuss the intersectionality of various forms of oppression in the production of IPV among MSSR. Thus, the IPV experienced by this group is influenced by several factors that involve the intersectionality between different social markers, such as stereotypes of masculinity in relation to hypersexualization and infidelity, homophobia as a direct factor of minority stress, the racism that hierarchizes bodies and makes the affection of Black men and the stigma of HIV invisible in the social imaginary.(AU)

La violencia de pareja (VP) consiste en actos que amenazan con causar o de hecho causan daño a una pareja dentro de una relación afectivo-sexual, independientemente de la configuración o duración de la relación o de si existe o no cohabitación entre las partes. En las relaciones homosexuales, la VP se invisibiliza de varias formas, a pesar de que se reconoce como una grave violación de los derechos humanos. Este estudio tuvo como objetivo comprender los significados de VP para un grupo de hombres que se relacionan con hombres (HRH). Ocho HRH participaron de la investigación, seleccionados mediante la técnica de "bola de nieve", utilizada debido a la sensibilidad del tema, considerando los estigmas de ser HRH. Los datos se construyeron mediante entrevistas semiestructuradas y se sometieron a análisis temático. Como resultado se construyeron seis categorías: 1.ª) El armario; 2.º) Homofobia; 3.º) Racismo, poder y vulnerabilidad a la VP; 4.º) Sexualidad; 5.º) Infidelidad; 6.ª) HIV; que discuten la interseccionalidad de diferentes formas de opresión en la producción de VP entre HRH. Se concluye que la VP vivida por este grupo está influida por varios factores que involucran la interseccionalidad entre distintos marcadores sociales, como los estereotipos de masculinidad en relación con la hipersexualización y la infidelidad, la homofobia como factor directo de estrés minoritario, el racismo que jerarquiza cuerpos e invisibiliza en el imaginario social el afecto de los hombres negros y el estigma del HIV en el imaginario social.(AU)

O florir da violeta: um estudo de caso em avaliação terapêutica / The flowering of violet: a case study in therapeutic assessment / La flor de la violeta: un estudio de caso en evaluación terapéutica

A Avaliação Terapêutica (AT) é um processo avaliativo e interventivo proposto para ser semiestruturado e colaborativo com o objetivo de promover mudanças positivas no cliente, que é convidado a ter uma participação ativa durante o processo. Na AT, os resultados dos testes psicológicos padronizados ganham destaque como facilitadores do processo de autoconhecimento do cliente. Desse modo, usualmente, integram-se os achados de testes psicológicos de autorrelato com os métodos projetivos para gerar informações que possam ampliar a visão que o cliente tem de si. Neste artigo, buscou-se compreender o potencial de uso dos testes psicológicos e da relação colaborativa a partir de um caso atendido na perspectiva da AT. A participante, Violeta (nome fictício), foi atendida em 10 sessões com duração entre 60 e 115 minutos. Foram utilizados os testes psicológicos Escala de Bem-Estar Psicológico (Ebep), Escala de Vulnerabilidade e Estresse no Trabalho (Event), Bateria Fatorial de Personalidade (BFP), Método de Rorschach e Inventários de Habilidades Sociais 2 (IHS-2). Observou-se que, durante o processo, Violeta ampliou sua autopercepção, o que possibilitou mudanças no modo de agir em seus relacionamentos amorosos e na reflexão sobre como sua postura era vista por si e por seus colegas de trabalho. Acredita-se que a AT cumpriu com o objetivo de estabelecer uma experiência terapêutica que possibilitasse mudanças positivas para a cliente. Este estudo de caso contribuiu para ampliar a compreensão sobre a importância e o uso dos testes psicológicos neste modelo de avaliação psicológica.(AU)

The Therapeutic Assessment (TA) is an evaluative and interventional process proposed to be semi-structured and collaborative with the objective of promoting positive changes in the client, who is invited to have an active participation during the process. At the TA, the results of standardized psychological tests are highlighted as facilitators of the client's self-knowledge process. In this way, the findings of psychological self-report tests are usually integrated with projective methods to generate information that can broaden the client's view of themselves. In this article, understanding the potential use of psychological tests and of the collaborative relationship from a case treated from the TA perspective was sought. The participant, Violet (fictitious name), was assisted in 10 sessions lasting between 60 and 115 minutes. The psychological tests Psychological Well-Being Scale (EBEP), Vulnerability and Stress at Work Scale (EVENT), Personality Factorial Battery (BFP), Rorschach Method and Social Skills Inventories 2 (IHS-2) were used. It was observed that, during the process, Violet increased her self-perception, which allowed changes in her way of acting in her love life and in her reflection on how her posture was seen by herself and herco-workers. It is believed that TA fulfilled the objective of establishing a therapeutic experience that would enable positive changes for the client. This case study contributed to broaden the understanding about the importance and use of psychological testing in this psychological assessment model.(AU)

La Evaluación Terapéutica (ET) es un proceso de evaluación e intervención que se propone ser semiestructurado y colaborativo, con el objetivo de lograr cambios positivos en el cliente, quien es invitado a tener participación activa durante el proceso. En la ET se destacan los resultados de las pruebas psicológicas estandarizadas como facilitadoras del proceso de autoconocimiento del cliente. Los hallazgos de las pruebas psicológicas de autoinforme suelen integrarse con métodos proyectivos para generar información que pueda ampliar la visión que el cliente tiene de sí mismo. En este artículo se buscó comprender el uso potencial de las pruebas psicológicas y de la relación colaborativa a partir de un estudio de caso tratado desde la perspectiva de la ET. Atendieron a la participante Violeta (nombre ficticio), en 10 sesiones que duraron entre 60 y 115 minutos. Se utilizaron las pruebas psicológicas Escala de Bienestar Psicológico (EBEP), Escala de Vulnerabilidad y Estrés en el Trabajo (EVENT), Batería de Factorial de la Personalidad (BFP), Método de Rorschach e Inventario de Habilidades Sociales 2 (IHS-dos). Se observó que, durante el proceso, Violeta amplió su autopercepción, lo que permitió cambios en la forma de actuar en sus relaciones amorosas y en el reflejo de como ella y sus compañeros de trabajo veían su postura. Así, se cree que ET ha cumplido el objetivo de establecer una experiencia terapéutica que permitió cambios positivos a la cliente. Este estudio contribuyó a ampliar la comprensión sobre la importancia y el uso de las pruebas psicológicas en este modelo de evaluación psicológica.(AU)

Vagalumes e biografemas: poéticas e políticas públicas no desligamento institucional por maioridade / Fireflies and biographems: poetics and public policies regarding institutional removal due to adulthood / Luciérnagas y biografemas: poéticas y políticas públicas en desconexión institucional debido a la edad adulta

Este artigo versa sobre o processo de desligamento institucional por maioridade de jovens que residem em serviços de acolhimento. Aposta-se em uma política do sensível para visibilizar os encontros e desencontros que acontecem entre as e os jovens e as políticas públicas brasileiras. Para tanto, realizaram-se encontros com jovens que já haviam passado pelo processo de desligamento e com jovens que logo completariam 18 anos e teriam de sair das instituições de acolhimento. Para tornar visíveis essas existências, investiu-se na escrita de biografemas, inspirados na obra de Roland Barthes. Os conceitos de necropolítica e vidas precárias foram fundamentais para compreender as omissões do Estado no momento do desligamento. Verificou-se que o Estado pode maximizar a precariedade de algumas vidas, especialmente daquelas marcadas por características de raça, gênero e classe culturalmente marginalizados. Contudo, é também o encontro com as políticas públicas que garante melhores condições de vida para alguns, facilitando o acesso à universidade e ao mercado de trabalho. A pesquisa aponta que, diante do abandono, as e os jovens se fazem vagalumes, produzindo luminosidades em meio à escuridão e reivindicando o direito à vida.(AU)

This article discusses the process of institutional removal of young people that reside in foster care institutions for reaching adulthood. It relies on a politics of the sensitive to make visible the encounters and mismatches that take place between young people and Brazilian public policies. To do so, meetings were held with young people who had already experienced the removal process and with young people who would soon turn 18 and would have to leave the host institutions. To make these existences visible, this study invested in the writing of biographems, inspired by the works of Roland Barthes. The concepts of necropolitics and precarious lives were fundamental to understand the omissions of the State at the time of removal. It was also found that the State can maximize the precariousness of some lives, especially those marked by culturally marginalized race, gender, and class characteristics. However, it is also the encounter with public policies that ensures better living conditions for some, facilitating access to the university and the labor market. This research points out that, in the face of abandonment, young people become fireflies, producing luminosity amid the darkness and claiming the right to life.(AU)

Este artículo aborda el proceso de desconexión institucional justificado por la edad adulta de los jóvenes que residen en los servicios de acogida. Utilizamos una política sensible para hacer visibles las reuniones y los desajustes que tienen lugar entre los jóvenes y las políticas públicas brasileñas. Con este fin, se celebraron reuniones con los jóvenes que ya habían pasado por el proceso de desconexión institucional y también con los jóvenes que pronto cumplirían los 18 años y tendrían que abandonar las instituciones de acogida. Para hacer visibles estas existencias, se redactaron biografemas, inspirados en el trabajo de Roland Barthes. Los conceptos de necropolítica y vida precaria fueron fundamentales para comprender las omisiones del Estado en el momento de la desconexión. Se encontró que el Estado puede maximizar la precariedad de algunas vidas, principalmente de aquellas marcadas por características de raza, género y clase culturalmente marginadas. Sin embargo, el encuentro con las políticas también puede garantizar mejores condiciones de vida para algunos, facilitándoles el acceso a la universidad y al mercado laboral. Esta investigación señala que, ante el abandono, los jóvenes se convierten en luciérnagas, produciendo luminosidad en medio de la oscuridad y reclamando el derecho a la vida.(AU)

Domestic violence against women in the brazilian media: study of social representations / Violencia doméstica contra las mujeres en los medios de comunicación brasileños: estudio de representaciones sociales / Violência doméstica contra as mulheres na mídia brasileira: estudo de representações sociais

This study examined the content published by the newspaper Folha de São Paulo regarding domestic violence before and after Law 11340/06, commonly known as Maria da Penha Law, came into force. A retrospective and comparative documentary research analyzed 3408 news reports published between 1994 and 2018. Divided into two corpora, '12 years before' and '12 years after' the Law, the material was analyzed using the IRaMuTeQ software and Descending Hierarchical Classification. The first corpus included news reports on cases involving celebrities and little about ordinary people. It also covered the feminist struggle to reduce domestic violence, focusing on specialized police stations and shelters. The second corpus included reports on the achievements generated by the Law and its challenges, pointing out the need to regard the law as more than a punitive instrument, addressing its preventive and care spheres. Problematizing how the media discloses such law is paramount, since the content divulged affects the construction of social representations.(AU)

Este artículo tuvo por objetivo identificar el contenido de la violencia doméstica transmitido en el periódico Folha de S. Paulo antes y después de la Ley 11.340/2006 (Ley Maria da Penha). La investigación fue de carácter documental retrospectivo y comparativa, realizada a partir de 3.408 noticias difundidas entre 1994 y 2018. El material se dividió en dos corpus: 12 años antes y 12 años después de la Ley, y se analizó con el software IRaMuTeQ. En el primer corpus, los medios informaron casos de celebridades y poco sobre la gente común. También abordaron la lucha feminista para reducir la violencia doméstica. Como no existe una legislación específica, la atención se centró en estaciones de policía especializadas y refugios. En el segundo corpus, se observaron los logros generados por la Ley y sus desafíos. Se identificó la necesidad de mirar la Ley desde un punto de vista no solo punitivo, sino también abordando las esferas preventivas y de asistencia. Se enfatiza la importancia de problematizar la difusión de la Ley en los medios, ya que los contenidos generalizados afectan la construcción de las representaciones sociales.(AU)

Este artigo pretende identificar o conteúdo sobre violência doméstica difundido no jornal Folha de S. Paulo antes e depois da Lei 11340/06 (Maria da Penha). A pesquisa foi documental, retrospectiva e comparativa; com 3408 reportagens entre 1994 e 2018. O material foi dividido em dois corpora: 12 anos antes e 12 anos depois da lei, e analisado com software IRaMuTeQ. No primeiro corpus, a mídia divulgava casos de celebridades e pouco acerca de pessoas do cotidiano. Também trouxe a luta feminista para diminuir a violência doméstica. Em virtude da então inexistência de uma legislação específica, os destaques eram as delegacias especializadas e as casas abrigo. No segundo corpus, observou-se as conquistas geradas pela lei e seus desafios. Identificou-se a necessidade de olhar para a lei por um viés não apenas punitivista, abordando as esferas preventivas e assistenciais. Destaca-se a importância de problematizar a difusão da lei na mídia, visto que os conteúdos perpassados afetam a construção de representações sociais.(AU)

The Impact of Dependency Burden on Urban Household Health Expenditure and Its Regional Heterogeneity in China: Based on Quantile Regression Method.

Background: The aging population has led to a growing health expenditure burden. According to the National Bureau of Statistics of China, the old-age dependency ratio rose from 10.7% in 2003 to 17.8% in 2019, and health expenditure increased from 658.410 billion yuan in 2003 to 5812.191 billion yuan in 2019 in China. Methods: This paper utilizes the quantile regression method to discuss the influencing factors of health expenditure in urban China based on the China Household Finance Survey (CHFS), especially dependency burden. Moreover, its regional heterogeneity is also compared. Results: The old-age dependency ratio, age, family size, self-rated health status, and income significantly impact the health expenditure of urban families in the quantile regression of the national sample. Dependency burden and other variables on urban household health expenditure have great regional heterogeneity. The relationship between urban health expenditure and residential areas in western China is more stable than that in eastern and central China. Discussion: Government should improve the healthcare system suitable for the older adult population as soon as possible. The government of western China should pay more attention to the introduction of professional medical talents and the configuration of precision medical equipment to improve the health system in western China.

Care to the dependent older person: motivations of caregivers in Brazil and Portugal / O cuidado ao idoso dependente: motivações de cuidadores do Brasil e Portugal / Cuidando a los dependientes mayores: motivaciones de cuidadores en Brasil y Portugal

In an attempt to fulfill care needs to the elderly, the family usually assumes this function. In order to understand the social representations of informal caregivers of Brazilian and Portuguese elderly people about the motivations for care, a qualitative, exploratory-descriptive research was carried out, based on the Social Representations Theory, in which 21 informal Brazilian caregivers and 11 informal Portuguese caregivers of elderly dependents were interviewed. Thematic Content Analysis and QSR NVivo® software were used in the treatment of the data, and the results showed care as the main motivation: family relationships, in which marriage, parenting, and the affections resulting from these relationships led to the function; the negative representation of Portuguese caregivers on the home, as a place of abandonment and action contrary to the cultural norm; and the representation of the elderly as frail and dependent, who, like children, constantly need care and attention.

Na tentativa de suprir as necessidades de cuidado destinado ao idoso, a família comumente é a instituição que assume tal função. Com o objetivo de compreender as representações sociais dos cuidadores informais de idosos brasileiros e portugueses acerca das motivações para o cuidado, realizou-se uma pesquisa qualitativa, exploratória e descritiva, fundamentada na Teoria das Representações Sociais, em que foram entrevistados 21 cuidadores informais brasileiros e 11 cuidadores informais portugueses de idosos dependentes. Utilizaram-se a análise de conteúdo temática e o software QSR NVivo® no tratamento dos dados, e os resultados evidenciaram como principais motivações o cuidado: as relações familiares, em que o matrimônio, a parentalidade e os afetos decorrentes dessas relações conduziram a função; a representação negativa dos cuidadores portugueses sobre o lar como local de abandono e ação contrária à norma cultural; e a representação da pessoa idosa como frágil e dependente, que, assim como as crianças, precisa constantemente de cuidados e atenção.

En un intento por atender las necesidades de cuidado de las personas mayores, la familia suele ser la institución que asume esta función. Para comprender las representaciones sociales de los cuidadores informales de ancianos brasileños y portugueses sobre las motivaciones del cuidado, se realizó una investigación cualitativa, exploratoria-descriptiva, basada en la Teoría de las Representaciones Sociales, en la que 21 cuidadores informales brasileños y 11 informales portugueses Se entrevistó a los cuidadores de ancianos dependientes. En el tratamiento de los datos se utilizó el software de Análisis de Contenido Temático y QSR NVivo® y los resultados se mostraron como las principales motivaciones: las relaciones familiares, en las que el matrimonio, la paternidad y los afectos resultantes de estas relaciones condujeron a la función; la representación negativa de los cuidadores portugueses en el hogar, como lugar de abandono y acción contraria a la norma cultural; y la representación de los ancianos como frágiles y dependientes, quienes, como los niños, necesitan cuidados y atenciones constantes.

Dependencia emocional y violencia en mujeres atendidas en la Fundación Nosotras con Equidad, de Riobamba / Emotional dependence and violence in women treated at the FundaciónNosotras con Equidad, of Riobamba

RESUMEN Introducción: la violencia es un fenómeno psicosocial, considerado un problema de salud pública que genera graves consecuencias en las mujeres. La dependencia emocional podría ser un factor esencial para que una mujer tolere situaciones de violencia. Objetivo: determinar la relación entre la dependencia emocional y la violencia en mujeres atendidas en la Fundación Nosotras con Equidad, de Riobamba, Ecuador. Materiales y métodos: se realizó un estudio observacional, prospectivo, transversal, analítico, bivariado y de nivel relacional, en una población de 300 mujeres de 18 a 65 años de la Fundación Nosotras con Equidad, de Riobamba, durante el primer semestre de 2020. Para el procesamiento de datos de dependencia emocional y violencia se utilizó el programa IBM SPSS Statistics 25.0; para el análisis estadístico-descriptivo gráficos de barras agrupadas, y para el análisis bivariado el coeficiente de correlación tau-b de Kendall. Resultados: se evidenció que 237 mujeres presentaron dependencia emocional moderada (79,0 %) y que 279 indicaron haber sufrido violencia de pareja severa (93,0%). La correlación entre la dependencia emocional y la violencia psicológica es media positiva (0.473). Conclusiones: en las mujeres víctimas de violencia se hallaron altos niveles de dependencia emocional y se evidenció una correlación media positiva entre la violencia psicológica y la dependencia emocional. En la variable de dependencia emocional se observaron como indicadores relevantes el miedo a la soledad, a ser abandonada, lo que representa una forma de rechazo a su autoestima, manteniéndose sumergida en una relación violenta (AU).

ABSTRACT Introduction: violence is a psychosocial phenomenon, considered a public health problem that generates serious consequences for women. Emotional dependence could be an important factor for a woman to tolerate situations of violence. Objective: to determine the relationship between emotional dependence and violence in women attended at the FundaciónNosotras con Equidad, of Riobamba, Ecuador. Materials and methods: an observational, prospective, cross-sectional, analytical, bivariate and relational study was conducted in a population of 300 women aged 18 to 65 years from the FundaciónNosotras con Equidad, of Riobamba, during the first semester of 2020. The IBM SPSS Statistics 25.0 program was used for processing emotional dependence and violence data; for statistical-descriptive analysis, grouped bar graphs, and for bivariate analysis, the correlation coefficient tau-b of Kendall. Results: it was shown that 237 women had moderate emotional dependence (79.0%) and 279 reported that they had suffered severe partner violence (93.0%). The correlation between emotional dependence and psychological violence is average positive (0.473). Conclusions: high levels of emotional dependence were found in women victims of violence and an average positive correlation between psychological violence and emotional dependence was evident. In the variable of emotional dependence, the fear of loneliness, of being abandoned, was observed as relevant indicators, which represents a form of rejection of their self-esteem, remaining immersed in a violent relationship (AU).

Risk Profiles for Care Dependency: Cross-Sectional Findings of a Population-Based Cohort Study in Germany.

Background: Rising life expectancy in Western societies is accompanied by a rising incidence of care dependency (CD) among older people. Objective: The aim of the study was to examine which health-related and social determinants were associated with CD. Method: We used cross-sectional data from the first follow-up (N = 1,699) of a prospective, population-based cohort study of older participants (≥70 years). CD was assessed if participants required substantial assistance in at least two activities of daily living for 90+ minutes daily. Multivariate logistic regressions were applied. Results: Participants' mean age was 82 years; 18.9% were care-dependent. CD was significantly associated with older age, urinary incontinence, stroke, falls, cancer, diabetes, education level, having no partner, limited mobility, and limited physical activity. Discussion: Our research highlights the importance of promoting mobility, even in care-dependent people. Further research should investigate the role of partnership in terms of the prevention and delay of CD.

Conditional Direction Dependence Analysis: Evaluating the Causal Direction of Effects in Linear Models with Interaction Terms.

Direction dependence analysis (DDA) makes use of higher than second moment information of variables (x and y) to detect potential confounding and to probe the causal direction of linear variable relations (i.e., whether x → y or y → x better approximates the underlying causal mechanism). The "true" predictor is assumed to be a continuous nonnormal exogenous variable. Existing methods compatible with DDA, however, are of limited use when the relation of a focal predictor and an outcome is affected by a moderator. This study presents a conditional direction dependence analysis (CDDA) framework which enables researchers to evaluate the causal direction of conditional regression effects. Monte-Carlo simulations were used to evaluate two different moderation scenarios: Study 1 evaluates the performance of CDDA tests when a moderator affects the strength of the causal effect x → y. Study 2 evaluates cases in which the causal direction itself (x → y vs y → x) depends on moderator values. Study 3 evaluates the robustness of DDA tests in the presence of functional model misspecifications. Results suggest that significance tests compatible with CDDA are suitable in both moderation scenarios, i.e., CDDA allows one to discern regions of a moderator in which the causal direction is uniquely identifiable. An empirical example is provided to illustrate the approach.

Self-criticism and dependency predict affective variability in borderline personality disorder: An ecological momentary assessment study.

Affective variability is a defining feature of borderline personality disorder (BPD). We hypothesize that patients with BPD who score higher on self-criticism and/or dependency-patients with a relative emphasis on self-definition and interpersonal relatedness, respectively-are characterized by more affective variability in positive and negative emotions. To examine this hypothesis, a sample of 32 patients with BPD reported their momentary feelings of anger, depression, anxiety, cheerfulness, and relaxation in an experience sampling study with 10 random signals scheduled per day for 8 days. Using heterogeneous linear mixed models, results indicate that patients with BPD who score higher on self-criticism show more within-person variance (WPV) in anger, depression, anxiety, cheerfulness, and feeling relaxed, whereas patients who score higher on dependency show more WPV in anger but less WPV in anxiety and feeling relaxed. Consequently, individual differences in affective variability in BPD are, after adjustment for the confounding between the mean and WPV of affect, related to personality vulnerabilities like self-criticism and dependency. These results add evidence to two-polarities models of personality and the existing view that there is substantial heterogeneity in BPD. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Assessment of family functioning in families with a child diagnosed with type 1 diabetes: Validation and clinical relevance of the general functioning subscale of the McMaster family assessment device.

BACKGROUND: Type 1 diabetes (T1D) can have a negative effect on family functioning, which is associated with deterioration in metabolic control. Therefore, a valid tool for assessing family functioning is clinically relevant. We assessed the quality and validity of the Danish general functioning (GF) subscale of the family assessment device (FAD). Additionally, we investigated GF scores among adolescents with T1D and their parents and the relationship between family functioning and background variables, including metabolic control. METHODS: All Danish families with a child diagnosed with T1D (N = 1997) were invited to participate in a web-based survey. In total, 616 adolescents (aged 12-17 years) and 1035 parents (of children aged 2-17 years) responded. The quality and validity of measurements made using the GF subscale were assessed using the Rasch model and graphical log-linear Rasch models (GLLRMs). Differences among GF responses were also assessed using GLLRMs. The relationships between GF scores and background variables were examined by multivariate analyses. RESULTS: A dichotomized version of the GF subscale provided essentially valid measures of family functioning. Furthermore, the GF subscale measured family functioning most accurately in families with worse family functioning than in our population. To accurately characterize family functioning, it is important to take both parent's and adolescent's perceptions into account. Family functioning was associated with glycated hemoglobin (HbA1c) levels, and discrepancies in family functioning were associated with higher HbA1c levels. CONCLUSIONS: A dichotomized GF subscale is useful for assessment of family functioning. Parent's and adolescent's scores should be kept separate. Family functioning is associated with HbA1c levels.

Who knows best? A Q methodology study to explore perspectives of professional stakeholders and community participants on health in low-income communities.

BACKGROUND: Health inequalities in the UK have proved to be stubborn, and health gaps between best and worst-off are widening. While there is growing understanding of how the main causes of poor health are perceived among different stakeholders, similar insight is lacking regarding what solutions should be prioritised. Furthermore, we do not know the relationship between perceived causes and solutions to health inequalities, whether there is agreement between professional stakeholders and people living in low-income communities or agreement within these groups. METHODS: Q methodology was used to identify and describe the shared perspectives ('subjectivities') that exist on i) why health is worse in low-income communities ('Causes') and ii) the ways that health could be improved in these same communities ('Solutions'). Purposively selected individuals (n = 53) from low-income communities (n = 25) and professional stakeholder groups (n = 28) ranked ordered sets of statements - 34 'Causes' and 39 'Solutions' - onto quasi-normal shaped grids according to their point of view. Factor analysis was used to identify shared points of view. 'Causes' and 'Solutions' were analysed independently, before examining correlations between perspectives on causes and perspectives on solutions. RESULTS: Analysis produced three factor solutions for both the 'Causes' and 'Solutions'. Broadly summarised these accounts for 'Causes' are: i) 'Unfair Society', ii) 'Dependent, workless and lazy', iii) 'Intergenerational hardships' and for 'Solutions': i) 'Empower communities', ii) 'Paternalism', iii) 'Redistribution'. No professionals defined (i.e. had a significant association with one factor only) the 'Causes' factor 'Dependent, workless and lazy' and the 'Solutions' factor 'Paternalism'. No community participants defined the 'Solutions' factor 'Redistribution'. The direction of correlations between the two sets of factor solutions - 'Causes' and 'Solutions' - appear to be intuitive, given the accounts identified. CONCLUSIONS: Despite the plurality of views there was broad agreement across accounts about issues relating to money. This is important as it points a way forward for tackling health inequalities, highlighting areas for policy and future research to focus on.

Psychometric properties of the Zarit Caregiver Burden Interview administered to caregivers to patients with Duchenne muscular dystrophy: a Rasch analysis.

PURPOSE: To explore the psychometric properties of the full 22-item English (UK and US) version of the Zarit Caregiver Burden Interview administered to caregivers to patients with Duchenne muscular dystrophy. MATERIALS AND METHODS: Caregivers to patients with Duchenne muscular dystrophy from the United Kingdom and the United States, recruited through the TREAT-NMD network, completed the Zarit Caregiver Burden Interview online. The psychometric properties of the Zarit Caregiver Burden Interview were examined using Rasch analysis. RESULTS: A total of 475 caregivers completed the Zarit Caregiver Burden Interview. Model misfit was identified for 9 of 22 items (mean item fit residual 0.061, SD: 2.736) and 13 of 22 items displayed disordered thresholds. The overall item-trait interaction chi-square value was 499 (198 degrees of freedom, p < 0.001). The mean person fit residual was estimated at -0.213 (SD: 1.235). The Person Separation Index and Cronbach's α were estimated at 0.902 and 0.914, respectively. Item dependency was low and we found no significant differential item functioning by country or sex. CONCLUSION: Our Rasch analysis shows that the Zarit Caregiver Burden Interview fails to fully operationalize a quantitative conceptualization of caregiver burden among caregivers to patients with Duchenne muscular dystrophy from the United Kingdom and the United States. Further research is needed to understand the psychometric properties of the Zarit Caregiver Burden Interview in other populations and settings. Implications for Rehabilitation Duchenne muscular dystrophy is a terminal disease characterized by progressive muscle degeneration resulting in substantial disability and a significant burden on family caregivers. The Zarit Caregiver Burden Interview is one of the most widely applied measures of caregiver burden. Our Rasch analysis suggests that the Zarit Caregiver Burden Interview is not fit for purpose to measure burden in UK and US caregivers to patients with Duchenne muscular dystrophy. Clinicians and decision-makers should interpret Zarit Caregiver Burden Interview data from these populations with caution.

Intergenerational Ambivalence and Dyadic Strain: Understanding Stress in Family Care Partners of Older Adults.

OBJECTIVES: The present study used Pearlin, Mullan, Semple & Skaff's (1990) caregiving stress process model as a framework to examine the comparative influence of two stressors: (a) intergenerational ambivalence as a unified construct and (b) dyadic strain, which is one isolated component of intergenerational ambivalence. METHODS: Participants were 120 women providing healthcare and medication assistance to an earlier generation family member with physical and/or cognitive impairments. RESULTS: Hierarchical regression confirmed that intergenerational ambivalence explained perceived stress in family care partners, beyond the variance accounted for by other commonly reported stressors such as length of caregiving experience, memory/cognitive and functional impairments of the care recipient, caregiver overload, family conflict and financial strain. Further analyses revealed that examining dyadic strain apart from intergenerational ambivalence may more accurately explain the influence of ambivalence scores on care partners' perceived stress. CONCLUSIONS AND CLINICAL IMPLICATIONS: The comparative influence of dyadic strain versus ambivalence suggests that stress-reducing interventions may benefit from a focus on reducing care partners' experiences of negative strain in the dyadic relationship rather than managing ambivalence.

Validation of the JEN frailty index in the National Long-Term Care Survey community population: identifying functionally impaired older adults from claims data.

BACKGROUND: Use of a claims-based index to identify persons with physical function impairment and at risk for long-term institutionalization would facilitate population health and comparative effectiveness research. The JEN Frailty Index [JFI] is comprised of diagnosis domains representing impairments and multimorbid clusters with high long-term institutionalization [LTI] risk. We test the index's discrimination of activities-of-daily-living [ADL] dependency and 1-year LTI and mortality in a nationally representative sample of over 12,000 Medicare beneficiaries, and compare long-term community survival stratified by ADL and JFI. METHODS: 2004 U.S. National Long-Term Care Survey data were linked to Medicare, Minimum Data Set, Veterans Health Administration files and vital statistics. ADL dependencies, JFI score, age and sex were measured at baseline survey. ADL and JFI groups were cross-tabulated generating likelihood ratios and classification statistics. Logistic regression compared discrimination (areas under receiver operating characteristic curves), multivariable calibration and accuracy of the JFI and, separately, ADLs, in predicting 1-year outcomes. Hall-Wellner bands facilitated contrasts of JFI- and ADL-stratified 5-year community survival. RESULTS: Likelihood ratios rose evenly across JFI risk categories. Areas under the curves of functional dependency at ≥3 and ≥ 2 for JFI, age and sex models were 0.807 [95% c.i.: 0.795, 0.819] and 0.812 [0.801, 0.822], respectively. The area under the LTI curve for JFI and age (0.781 [0.747, 0.815]) discriminated less well than the ADL-based model (0.829 [0.799, 0.860]). Community survival separated by JFI strata was comparable to ADL strata. CONCLUSIONS: The JEN Frailty Index with demographic covariates is a valid claims-based measure of concurrent activities-of-daily-living impairments and future long-term institutionalization risk in older populations lacking functional information.

The Sustainable Development Agenda Needs to Include Long-term Care.

The rapid ageing of populations around the world and the associated shift in the burden of disease from infectious to chronic conditions are creating complex challenges for national governments. Addressing the needs of these older populations in a sustainable and equitable way, will be a fundamental pillar of socioeconomic development in the 21st Century. The World Health Organization (WHO) Global strategy and action plan on ageing and health, which was adopted by all the Organization's 194 Member states in 2016, provides a clear framework for global action. One critical priority is to establish sustainable and equitable long-term care systems in every country. WHO defines long-term care as "the activities undertaken by others to ensure that people with, or at risk of, a significant ongoing loss of intrinsic capacity can maintain a level of functional ability consistent with their basic rights, fundamental freedoms and human dignity". These activities include both social care and health care, as well as contributions from other sectors, such as education or transport. And these activities need to be effectively coordinated if they are to efficiently, equitably and sustainably meet the needs of older people. This requires the stewardship of governments to ensure that: care is accessible and affordable; the rights of older people to lives of meaning and dignity are upheld regardless of their physical or mental capacity; services are oriented around the individual's specific needs; caregivers are supported; the workforce (both paid and unpaid) are treated fairly; and older people's intrinsic capacity is maintained for as long as possible. WHO has proposed three inter-related strategies to establish and sustain long-term care systems. System infrastructure needs to be developed and continually improved. The capacity of the workforce needs to be strengthened and families and communities must be supported. And the care and support provided needs to be more person-centred and integrated, underpinned by minimum standards and accreditation for care providers. This paper outlines some of the critical issues confronting governments in countries at all levels of development if this ambitious vision is to be achieved.

Utility of the Dependence Scale in dementia: validity, meaningfulness, and health economic considerations.

BACKGROUND: The concept of dependence has been proposed as a unified representation of disease severity to quantify and stage disease progression in a manner more informative to patients, caregivers, and healthcare providers. METHODS: This paper provides a review of the Dependence Scale (DS) as a quantitative measure of Alzheimer's disease severity, its properties as an outcome measure, a metric of disease progression, and a correlate of medical costs. RESULTS: The literature supports the notion that the DS is related to, but distinct from, key severity measures, including cognition, function, and behavior, and captures the full spectrum of patient needs. It also presents as a useful measure for assessing disease progression. CONCLUSIONS: Results underscore the importance of the DS as a unique endpoint in Alzheimer's disease clinical trials, providing important information about the impact of therapeutic interventions. The DS also is a useful measure for economic evaluation of novel interventions aimed at delaying progression.

Actitudes hacia la labor profesional del psicólogo en Bogotá: un estudio descriptivo comparativo según el tiempo en terapia / Attitudes toward the psychologist professional work in Bogotá: a descriptive comparative study according to therapy time

Resumen La presente investigación tuvo como objetivo determinar la actitud hacia la labor profesional del psicólogo en una muestra bogotana, según los tiempos de permanencia en terapia psicológica. Para ello se llevó a cabo un estudio de tipo descriptivo con método de comparación de grupos. Se aplicó la escala de "actitudes" frente a la labor profesional del psicólogo a una muestra de 540 personas de nacionalidad colombiana, residentes en Bogotá. Se encontró una actitud neutra hacia la labor profesional del psicólogo, destacando una mejor actitud por parte de las mujeres en comparación con los hombres, asimismo, una actitud más favorable en los participantes que han asistido mayor tiempo a terapia psicológica, actitud que empeora tras los 6 meses.

Abstract The objective of this investigation was to determine the attitude toward the psychologist professional work in a Bogotá sample, according to the psychological therapy's time. It has been made a descriptive study with a group comparative method, and the ¼Attitude toward the Psychologist Professional Work" was used in a scale to a Bogotá sample of 540 people. A neutral attitude was founded, toward the psychologist professional work, highlihting a better attitude of women in comparation with men's attitude. Nevertheless the most favorable attitude of the sample was from people who received psychological therapy for more time, attitude that gets worse after 6 months.

Evaluation of an interaction-skills training for reducing the burden of family caregivers of patients with severe mental illness: a pre-posttest design.

BACKGROUND: Family members who care for patients with severe mental illness experience emotional distress and report a higher incidence of mental illness than those in the general population. They report feeling inadequately prepared to provide the necessary practical and emotional support for these patients. The MAT training, an Interaction-Skills Training program (IST) for caregivers, was developed to meet those needs. This study used a single-arm pretest-posttest design to examine the impact of the training on caregivers' sense of competence (self-efficacy) and burden. METHODS: One hundred family caregivers recruited from three mental health institutions participated in the training. Burden was assessed using the Involvement Evaluation Questionnaire, and self-efficacy using the Self-Efficacy Questionnaire. Analysis of variance with repeated measures was used to investigate whether participation in the training changed the level of family caregivers' burden and self-efficacy. Pearson's correlation was used to examine the relationships between self-efficacy and burden. RESULTS: Our results indicate that, after the training, self-efficacy increased significantly over time (p < 0.001) and that burden decreased significantly (p < 0.001). However, the results could not demonstrate the expected association between an increase of self-efficacy and decrease of burden. Caregivers expressed high appreciation for the training. CONCLUSIONS: After following the IST program, family caregivers of patients with severe mental illness experienced a greater sense of competence and a significant decrease in burden. The training was greatly appreciated and satisfied caregivers' need to acquire the skills required in complex caregiving situations. TRIAL REGISTRATION: This study was retrospectively registered (14/01/2018) in the ISRCTN registry with study ID ISRCTN44495131 .