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The extent to which culture moderates the effects of need for approval from others on a person's handling of interpersonal conflict was investigated. Students from 24 nations rated how they handled a recent interpersonal conflict, using measures derived from face-negotiation theory. Samples varied in the extent to which they were perceived as characterised by the cultural logics of dignity, honour, or face. It was hypothesised that the emphasis on harmony within face cultures would reduce the relevance of need for approval from others to face-negotiation concerns. Respondents rated their need for approval from others and how much they sought to preserve their own face and the face of the other party during the conflict. Need for approval was associated with concerns for both self-face and other-face. However, as predicted, the association between need for approval from others and concern for self-face was weaker where face logic was prevalent. Favourable conflict outcome was positively related to other-face and negatively related to self-face and to need for approval from others, but there were no significant interactions related to prevailing cultural logics. The results illustrate how particular face-threatening factors can moderate the distinctive face-concerns earlier found to characterise individualistic and collectivistic cultural groups.
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Comparación Transcultural , Relaciones Interpersonales , Humanos , Conflicto Psicológico , Negociación , IndividualidadRESUMEN
Background Post-COVID-19 condition encompasses symptoms following COVID-19 infection that linger at least 4 weeks after the end of active infection. Symptoms are wide ranging, but breathlessness is common. Purpose To determine if the previously described lung abnormalities seen on hyperpolarized (HP) pulmonary xenon 129 (129Xe) MRI scans in participants with post-COVID-19 condition who were hospitalized are also present in participants with post-COVID-19 condition who were not hospitalized. Materials and Methods In this prospective study, nonhospitalized participants with post-COVID-19 condition (NHLC) and posthospitalized participants with post-COVID-19 condition (PHC) were enrolled from June 2020 to August 2021. Participants underwent chest CT, HP 129Xe MRI, pulmonary function testing, and the 1-minute sit-to-stand test and completed breathlessness questionnaires. Control subjects underwent HP 129Xe MRI only. CT scans were analyzed for post-COVID-19 interstitial lung disease severity using a previously published scoring system and full-scale airway network (FAN) modeling. Analysis used group and pairwise comparisons between participants and control subjects and correlations between participant clinical and imaging data. Results A total of 11 NHLC participants (four men, seven women; mean age, 44 years ± 11 [SD]; 95% CI: 37, 50) and 12 PHC participants (10 men, two women; mean age, 58 years ±10; 95% CI: 52, 64) were included, with a significant difference in age between groups (P = .05). Mean time from infection was 287 days ± 79 (95% CI: 240, 334) and 143 days ± 72 (95% CI: 105, 190) in NHLC and PHC participants, respectively. NHLC and PHC participants had normal or near normal CT scans (mean, 0.3/25 ± 0.6 [95% CI: 0, 0.63] and 7/25 ± 5 [95% CI: 4, 10], respectively). Gas transfer (Dlco) was different between NHLC and PHC participants (mean Dlco, 76% ± 8 [95% CI: 73, 83] vs 86% ± 8 [95% CI: 80, 91], respectively; P = .04), but there was no evidence of other differences in lung function. Mean red blood cell-to-tissue plasma ratio was different between volunteers (mean, 0.45 ± 0.07; 95% CI: 0.43, 0.47]) and PHC participants (mean, 0.31 ± 0.10; 95% CI: 0.24, 0.37; P = .02) and between volunteers and NHLC participants (mean, 0.37 ± 0.10; 95% CI: 0.31, 0.44; P = .03) but not between NHLC and PHC participants (P = .26). FAN results did not correlate with Dlco) or HP 129Xe MRI results. Conclusion Nonhospitalized participants with post-COVID-19 condition (NHLC) and posthospitalized participants with post-COVID-19 condition (PHC) showed hyperpolarized pulmonary xenon 129 MRI and red blood cell-to-tissue plasma abnormalities, with NHLC participants demonstrating lower gas transfer than PHC participants despite having normal CT findings. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Parraga and Matheson in this issue.
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COVID-19 , Isótopos de Xenón , Masculino , Humanos , Femenino , Adulto , Persona de Mediana Edad , COVID-19/diagnóstico por imagen , Estudios Prospectivos , Imagen por Resonancia Magnética/métodos , Pulmón/diagnóstico por imagen , Disnea , Síndrome Post Agudo de COVID-19RESUMEN
BACKGROUND: Preparatory, written plans for mass casualty incidents are designed to help hospitals deliver an effective response. However, addressing the frequently observed mismatch between planning and delivery of effective responses to mass casualty incidents is a key challenge. We aimed to use simulation-based iterative learning to bridge this gap. METHODS: We used Normalisation Process Theory as the framework for iterative learning from mass casualty incident simulations. Five small-scale 'focused response' simulations generated learning points that were fed into two large-scale whole-hospital response simulations. Debrief notes were used to improve the written plans iteratively. Anonymised individual online staff surveys tracked learning. The primary outcome was system safety and latent errors identified from group debriefs. The secondary outcomes were the proportion of completed surveys, confirmation of reporting location, and respective roles for mass casualty incidents. RESULTS: Seven simulation exercises involving more than 700 staff and multidisciplinary responses were completed with debriefs. Usual emergency care was not affected by simulations. Each simulation identified latent errors and system safety issues, including overly complex processes, utilisation of space, and the need for clarifying roles. After the second whole hospital simulation, participants were more likely to return completed surveys (odds ratio=2.7; 95% confidence interval [CI], 1.7-4.3). Repeated exercises resulted in respondents being more likely to know where to report (odds ratio=4.3; 95% CI, 2.5-7.3) and their respective roles (odds ratio=3.7; 95% CI, 2.2-6.1) after a simulated mass casualty incident was declared. CONCLUSION: Simulation exercises are a useful tool to improve mass casualty incident plans iteratively and continuously through hospital-wide engagement of staff.
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Atención a la Salud/organización & administración , Planificación en Desastres/métodos , Incidentes con Víctimas en Masa , Personal de Hospital/educación , Evaluación Educacional , Hospitales , Humanos , Aprendizaje , Entrenamiento SimuladoRESUMEN
OBJECTIVE: People's psychological tendencies are attuned to their sociocultural context and culture-specific ways of being, feeling, and thinking are believed to assist individuals in successfully navigating their environment. Supporting this idea, a stronger "fit" with one's cultural environment has often been linked to positive psychological outcomes. The current research expands the cultural, conceptual, and methodological space of cultural fit research by exploring the link between well-being and honor, a central driver of social behavior in the Mediterranean region. METHOD: Drawing on a multi-national sample from eight countries circum-Mediterranean (N = 2257), we examined the relationship between cultural fit in honor and well-being at the distal level (fit with one's perceived society) using response surface analysis (RSA) and at the proximal level (fit with one's university gender group) using profile analysis. RESULTS: We found positive links between fit and well-being in both distal (for some, but not all, honor facets) and proximal fit analyses (across all honor facets). Furthermore, most fit effects in the RSA were complemented with positive level effects of the predictors, with higher average honor levels predicting higher well-being. CONCLUSIONS: Our findings highlight the interplay between individual and environmental factors in honor as well as the important role honor plays in well-being in the Mediterranean region.
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BACKGROUND: Loss of hand function following high level spinal cord injury (SCI) is perceived as a high priority area for rehabilitation. Following discharge, it is often impractical for the specialist care centre to provide ongoing therapy for people living with chronic SCI at home, which can lead to further deterioration of hand function and a direct impact on an individual's capability to perform essential activities of daily living (ADL). OBJECTIVE: This pilot study investigated the therapeutic effect of a self-administered home-based hand rehabilitation programme for people with cervical SCI using the soft extra muscle (SEM) Glove by Bioservo Technologies AB. METHODS: Fifteen participants with chronic cervical motor incomplete (AIS C and D) SCI were recruited and provided with the glove device to use at home to complete a set task and perform their usual ADL for a minimum of 4 h a day for 12 weeks. Assessment was made at Week 0 (Initial), 6, 12 and 18 (6-week follow-up). The primary outcome measure was the Toronto Rehabilitation Institute hand function test (TRI-HFT), with secondary outcome measures including pinch dynamometry and the modified Ashworth scale. RESULTS: The TRI-HFT demonstrated improvement in hand function at Week 6 of the therapy including improvement in object manipulation (58.3 ±3.2 to 66.9 ±1.8, p ≈ 0.01), and palmar grasp assessed as the length of the wooden bar that can be held using a pronated palmar grip (29.1 ±6.0 cm to 45.8 ±6.8 cm, p <0.01). A significant improvement in pinch strength, with reduced thumb muscle hypertonia was also detected. Improvements in function were present during the Week 12 assessment and also during the follow-up. CONCLUSIONS: Self-administered rehabilitation using the SEM Glove is effective for improving and retaining gross and fine hand motor function for people living with chronic spinal cord injury at home. Retention of improved hand function suggests that an intensive activity-based rehabilitation programme in specific individuals is sufficient to improve long-term neuromuscular activity. Future studies should characterise the neuromuscular mechanism of action and the minimal rehabilitation programme necessary with the assistive device to improve ADL tasks following chronic cervical SCI. TRIAL REGISTRATION NUMBER: Trial registration: ISRCTN, ISRCTN98677526, Registered 01/June/2017 - Retrospectively registered, http://www.isrctn.com/ISRCTN98677526.
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Dispositivo Exoesqueleto , Traumatismos de la Médula Espinal/rehabilitación , Actividades Cotidianas , Adulto , Femenino , Mano/fisiopatología , Fuerza de la Mano/fisiología , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Desempeño Psicomotor , Dispositivos de AutoayudaRESUMEN
In honour cultures, such as Turkey, reputation management is emphasised, whereas in dignity cultures such as northern US, self-respect and personal achievements are central. Turkey is also a collectivistic culture, where relationship harmony is as important as reputation management. When Turkish people's reputation is threatened, they may experience an internal conflict between these two motives and display helplessness. The purpose of the present study was to examine how people from Turkey (an honour culture; n = 52) and northern US (a dignity culture; n = 48) would perceive and respond to reputation threats as opposed to self-respect threats. As predicted, Turkish participants anticipated stronger anger, shame, and helplessness in response to reputation threats than self-respect threats, whereas differences were smaller or non-existent in northern US. Moreover, shame was a mediator between appraisal and helplessness for reputation threats in Turkey (shame positively predicted helplessness); anger was a mediator between appraisal and helplessness for self-respect threats in northern US (anger negatively predicted helplessness). These results are novel in their inclusion of helplessness and appraisal theory of emotions when examining responses to threats in honour and dignity cultures.
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Comparación Transcultural , Emociones/fisiología , Abuso Físico/psicología , Adolescente , Femenino , Indicadores de Salud , Desamparo Adquirido , Humanos , MasculinoRESUMEN
RATIONALE: Highly prevalent and severe sleep-disordered breathing caused by acute cervical spinal cord injury (quadriplegia) is associated with neurocognitive dysfunction and sleepiness and is likely to impair rehabilitation. OBJECTIVE: To determine whether 3 months of autotitrating CPAP would improve neurocognitive function, sleepiness, quality of life, anxiety and depression more than usual care in acute quadriplegia. METHODS AND MEASUREMENTS: Multinational, randomised controlled trial (11 centres) from July 2009 to October 2015. The primary outcome was neurocognitive (attention and information processing as measure with the Paced Auditory Serial Addition Task). Daytime sleepiness (Karolinska Sleepiness Scale) was a priori identified as the most important secondary outcome. MAIN RESULTS: 1810 incident cases were screened. 332 underwent full, portable polysomnography, 273 of whom had an apnoea hypopnoea index greater than 10. 160 tolerated at least 4 hours of CPAP during a 3-day run-in and were randomised. 149 participants (134 men, age 46±34 years, 81±57 days postinjury) completed the trial. CPAP use averaged 2.9±2.3 hours per night with 21% fully 'adherent' (at least 4 hours use on 5 days per week). Intention-to-treat analyses revealed no significant differences between groups in the Paced Auditory Serial Addition Task (mean improvement of 2.28, 95% CI -7.09 to 11.6; p=0.63). Controlling for premorbid intelligence, age and obstructive sleep apnoea severity (group effect -1.15, 95% CI -10 to 7.7) did not alter this finding. Sleepiness was significantly improved by CPAP on intention-to-treat analysis (mean difference -1.26, 95% CI -2.2 to -0.32; p=0.01). CONCLUSION: CPAP did not improve Paced Auditory Serial Addition Task scores but significantly reduced sleepiness after acute quadriplegia. TRIAL REGISTRATION NUMBER: ACTRN12605000799651.
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Presión de las Vías Aéreas Positiva Contínua , Cuadriplejía/complicaciones , Síndromes de la Apnea del Sueño/terapia , Traumatismos de la Médula Espinal/complicaciones , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuadriplejía/psicología , Calidad de Vida , Síndromes de la Apnea del Sueño/diagnóstico , Síndromes de la Apnea del Sueño/etiología , Traumatismos de la Médula Espinal/psicología , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Obstructive sleep apnoea (OSA) is highly prevalent in people with spinal cord injury (SCI). Polysomnography (PSG) is the gold-standard diagnostic test for OSA, however PSG is expensive and frequently inaccessible, especially in SCI. A two-stage model, incorporating a questionnaire followed by oximetry, has been found to accurately detect moderate to severe OSA (MS-OSA) in a non-disabled primary care population. This study investigated the accuracy of the two-stage model in chronic tetraplegia using both the original model and a modified version for tetraplegia. METHODS: An existing data set of 78 people with tetraplegia was used to modify the original two-stage model. Multivariable analysis identified significant risk factors for inclusion in a new tetraplegia-specific questionnaire. Receiver operating characteristic (ROC) curve analyses of the questionnaires and oximetry established thresholds for diagnosing MS-OSA. The accuracy of both models in diagnosing MS-OSA was prospectively evaluated in 100 participants with chronic tetraplegia across four international SCI units. RESULTS: Injury completeness, sleepiness, self-reported snoring and apnoeas were included in the modified questionnaire, which was highly predictive of MS-OSA (ROC area under the curve 0.87 (95% CI 0.79 to 0.95)). The 3% oxygen desaturation index was also highly predictive (0.93 (0.87-0.98)). The two-stage model with modified questionnaire had a sensitivity and specificity of 83% (66-93) and 88% (75-94) in the development group, and 77% (65-87) and 81% (68-90) in the validation group. Similar results were demonstrated with the original model. CONCLUSION: Implementation of this simple alternative to full PSG could substantially increase the detection of OSA in patients with tetraplegia and improve access to treatments. TRIAL REGISTRATION NUMBER: Results, ACTRN12615000896572 (The Australian and New Zealand Clinical Trials Registry) and pre-results, NCT02176928 (clinicaltrials.gov).
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Cuadriplejía/complicaciones , Apnea Obstructiva del Sueño/diagnóstico , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oximetría , Polisomnografía , Valor Predictivo de las Pruebas , Curva ROC , Apnea Obstructiva del Sueño/complicaciones , Encuestas y CuestionariosRESUMEN
Rheumatological manifestations complicate many benign and malignant blood disorders. Significant advances in haematology, with improved diagnostic techniques and newer musculoskeletal imaging, have occurred in the past two decades. This review focuses on the interrelationship between the major haematological diseases (haemochromatosis, haemophilia, sickle cell disease, thalassaemia, leukaemia, lymphoma, myelodysplastic syndromes, multiple myeloma and cryoglobulinaemia) and rheumatic manifestations.
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Enfermedades Hematológicas/complicaciones , Enfermedades Reumáticas/etiología , Hemocromatosis/complicaciones , Humanos , Leucemia/complicaciones , Linfoma/complicacionesRESUMEN
Two studies investigated retaliatory responses to actual honor threats among members of an honor culture (Turkey) and a dignity culture (northern United States). The honor threat in these studies was based on previous research which has shown that honesty is a key element of the conception of honor and that accusations of dishonesty are threatening to one's honor. In both studies, participants wrote an essay describing the role of honesty in their lives and received feedback on their essay accusing them of being dishonest (vs. neutral feedback). Turkish participants retaliated more strongly than did northern U.S. participants against the person who challenged their honesty by assigning him/her to solve more difficult tangrams over easy ones (Study 1) and by choosing sensory tasks of a higher level of intensity to complete (Study 2). Study 2 added a relational honor condition, in which participants wrote about honesty in their parents' lives and examined the role of individual differences in honor values in retaliation. Endorsement of honor values significantly predicted retaliation among Turkish participants in the relational honor attack condition, but not among northern U.S. participants.
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Agresión/psicología , Comparación Transcultural , Cultura , Principios Morales , Valores Sociales , Adulto , Femenino , Humanos , Masculino , Turquía/etnología , Estados Unidos/etnología , Adulto JovenRESUMEN
The main goal of the current research is to investigate emotional reactions to situations that implicate honour in Turkish and northern American cultural groups. In Studies 1A and 1B, participants rated the degree to which a variety of events fit their prototypes for honour-related situations. Both Turkish and American participants evaluated situations generated by their co-nationals as most central to their prototypes of honour-related situations. Study 2 examined emotional responses to Turkish or US-generated situations that varied in centrality to the prototype. Highly central situations and Turkish-generated situations elicited stronger emotions than less central situations and US-generated situations. Americans reported higher levels of positive emotions in response to honour-enhancing situations than did Turkish participants. These findings demonstrate that the prototypes of honour relevant situations differ for Turkish and northern American people, and that Turkish honour relevant situations are more emotion-laden than are northern American honour relevant situations.
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Comparación Transcultural , Emociones , Valores Sociales , Femenino , Humanos , Iowa , Masculino , Turquía , Adulto JovenRESUMEN
OBJECTIVE: People are overwhelmed with COVID-19 news every day, which induces stress but also makes people feel connected to others. The present study examined two conflicting pressures of COVID-19-stress and communion-on the link between COVID-19 saliency and psychological consequences in two cultures. Specifically, we aimed to examine whether COVID-19 saliency and daily emotional experiences are mediated by COVID-19 stress and communion, and whether the relation between communion and daily emotions is emphasized among Koreans compared to U.S. METHOD: We collected a 14-day daily diary from South Koreans (n = 201) and the U.S. participants (n = 128), measuring individuals' daily experiences of COVID-19 and emotions. RESULTS: COVID-19 saliency led to COVID-19-related stress, which was positively linked to daily negative emotions; COVID-19 saliency was also positively associated with communion, which led to decreased negative emotions in both cultures. As hypothesized, the opposite effect of COVID-19 stresses and communion emerged for positive emotions. Further, culture significantly moderated the relationship between communion and daily emotions, suggesting that communion is a more important coping mechanism for Koreans than U.S. CONCLUSIONS: The current study speaks to the importance of a sense of communion to cope with the negative consequences of the global crisis, especially for individuals from East Asian cultural context. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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COVID-19 , Humanos , Estrés Psicológico/psicología , EmocionesRESUMEN
Honor cultures are characterized by a heightened sensitivity to reputation threats and strong expectations for the defense of honor. U.S. states vary in the extent to which they express the cultural norms of honor, but researchers have frequently relied upon a dichotomous classification that differentiates states as honor or dignity states. We created and validated a continuous, six-item index of honor norms and values across all U.S. states (Study 1). In Study 2, our honor index was correlated with historical variables theoretically associated with the genesis of honor cultures. In Study 3, we validated our honor index further by showing that it predicted several race-/ethnicity-specific outcomes that prior research has connected with honor (e.g., homicide rates, suicide rates). This new index equips researchers with a more nuanced understanding of U.S. honor cultures and a measure that can be used in future investigations.
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We tested the validity of 6 methods (mean difference, variance difference, bivariate, profile agreement, pattern similarity, and intraclass) to assess change in a personality profile. During their first 2 months of college, 372 students completed reactive and spontaneous measures of their personality. Eight weeks later, 300 returned to complete a second set of the same measures and noted change in their spontaneous personality list. Sixty participants returned during their second semester to complete a third set of assessments. The bivariate and intraclass change coefficients showed consistent convergent, discriminant, and concurrent validity across time points. Recommendations and caveats for using these coefficients are discussed.
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Retroalimentación Psicológica , Determinación de la Personalidad/estadística & datos numéricos , Desarrollo de la Personalidad , Autoimagen , Medio Social , Femenino , Humanos , Masculino , Inventario de Personalidad/estadística & datos numéricos , Psicometría/estadística & datos numéricos , Reproducibilidad de los Resultados , Estudiantes/psicología , Adulto JovenRESUMEN
In this article, we review research in psychology and other related social science fields that has adopted an honor framework to examine intrapersonal, interpersonal, and intergroup processes taking a culture-comparative or individual differences approach. In the sections below, we will first review research on the role of honor in interpersonal processes focusing primarily on interpersonal aggression including in close relationships, non-aggressive ways of responding to threats (e.g., forgiveness), and reciprocity. Next, we move onto reviewing research on the role of honor in intrapersonal processes, specifically in the domains of emotional responses to honor-threatening situations, mental, and physical health. Finally, we review research emerging from social and political psychology and political science that have utilized the honor framework to understand and explain group processes and intergroup relations at different level of analyses (e.g., social groups, nations). Given the limited space, our goal was to emphasize major and emerging areas of research on honor and provide food for thought for future research.
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To whom do we turn for support in times of need, and what does the support from close others convey? The present research investigated how the structure and function of attachment differ for individuals in East Asian and Western cultures. In three studies, using survey and daily diary data, we examined the role of the romantic partner as an attachment figure, and the consequences of receiving responsive support in close relationships among individuals in Korea and the United States. As expected, the role of the romantic partner as an attachment figure was less emphasized for Koreans compared with U.S. participants. Also, responsive support from close others was more strongly linked to affiliation-related end states (i.e., in-group agency) for Koreans than U.S. individuals. The present research demonstrates the need to consider nuanced cultural influences in the attachment literature for the broader application of the theory.
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Social science research has highlighted "honor" as a central value driving social behavior in Mediterranean societies, which requires individuals to develop and protect a sense of their personal self-worth and their social reputation, through assertiveness, competitiveness, and retaliation in the face of threats. We predicted that members of Mediterranean societies may exhibit a distinctive combination of independent and interdependent social orientation, self-construal, and cognitive style, compared to more commonly studied East Asian and Anglo-Western cultural groups. We compared participants from eight Mediterranean societies (Spain, Italy, Greece, Turkey, Cyprus [Turkish Cypriot and Greek Cypriot communities], Lebanon, Egypt) to participants from East Asian (Korea, Japan) and Anglo-Western (the United Kingdom, the United States) societies, using six implicit social orientation indicators, an eight-dimensional self-construal scale, and four cognitive style indicators. Compared with both East Asian and Anglo-Western samples, samples from Mediterranean societies distinctively emphasized several forms of independence (relative intensity of disengaging [vs. engaging] emotions, happiness based on disengaging [vs. engaging] emotions, dispositional [vs. situational] attribution style, self-construal as different from others, self-directed, self-reliant, self-expressive, and consistent) and interdependence (closeness to in-group [vs. out-group] members, self-construal as connected and committed to close others). Our findings extend previous insights into patterns of cultural orientation beyond commonly examined East-West comparisons to an understudied world region. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Emociones , Conducta Social , Humanos , Estados Unidos , Japón , Grupos Raciales , Reino Unido , AutoimagenRESUMEN
Three studies examined cultural perceptions of self-change in romantic relationships. In Study 1 (N = 191), Chinese participants perceived hypothetical couples who changed for the sake of the relationship to have better relationship quality than couples who did not, compared to European American participants. In Study 2 (N = 396), Chinese individuals in a dating relationship were more likely to perceive that they had changed in the relationship, and self-change was a stronger predictor of relationship quality for them than for American dating individuals. In Study 3 (N = 115 dyads), Chinese married couples perceived greater self-change, and their perceived self-change was due in part to higher endorsement of dutiful adjustment beliefs than American couples. Self-change was a stronger predictor of relationship quality for Chinese married couples than American couples. Our studies provide support for cultural differences in the role of self-change in romantic relationships, which have implications for partner regulation and relationship counseling across cultures.
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Comparación Transcultural , Población Blanca , Pueblo Asiatico , Hong Kong , Humanos , EspososRESUMEN
Since the publication of Markus and Kitayama's pivotal article on culture and the self, the concepts of independent, relational, and interdependent self-construal have become important constructs in cultural psychology and research on the self. The authors review the history of these constructs, their measurement and manipulation, and their roles in cognition, emotion, motivation, and social behavior. They make suggestions for future research and point to problems still to be sorted out. Researchers interested in these constructs have many opportunities to make important contributions to the literature in a variety of fields, including health psychology, education, counseling, and international relations.