Engagement with Nature and the Home Environment: Wellbeing and Proenvironmental Behavior among Irish and Italian University Students during the COVID-19 Emergency.

Growing evidence shows that exposure to nature and psychological engagement with nature improve health and wellbeing and promote greater proenvironmental engagement. The unprecedented situation created by COVID-related lockdowns seems to have brought both potential distress with household confinements and greater research on experiences in nature. University students may have been particularly impacted as the quality of their home arrangements can vary substantially. The aim of the study was to examine how psychological engagement with nature (nature connectedness and noticing nature), time spent in nature, and household conditions relate to psychological wellbeing and proenvironmental behavior among university students. An online survey was administered to a sample of 566 university students from Italy and Ireland. Hierarchical multiple regressions were performed to investigate the relationships between variables. The results indicate that time spent in nature and psychological engagement with nature in terms of nature connectedness and noticing nature were associated with increased wellbeing and pro-nature-conservation behavior, controlling for demographic covariates. Moreover, the perception of chaos in one's household was related to decreased wellbeing during the prolonged COVID-19 emergency. The findings highlight the need to invest in accessible natural places for students and to focus campus sustainability practices on encouraging nature connectedness to promote wellbeing and proenvironmental engagement.

Does hydroxychloroquine improve patient reported outcomes in patients with lupus?

BACKGROUND: Hydroxychloroquine (HCQ) use is associated with less disease activity, flares, damage and improved survival in Systemic Lupus Erythematosus (SLE). However, its effect on patient reported health outcomes (PROs) such as quality of life (QOL) is not known. METHODS: International data from Study on Outcomes of Lupus (SOUL) from 2,161 SLE patients were compared by HCQ use. Disease activity and damage were assessed using SELENA-SLEDAI and SLICC-ACR/SDI. QOL was evaluated using LupusPRO and Lupus Impact Tracker (LIT). Linear regression analyses were performed with LupusPRO summary scores health related HRQOL, non-health related NHRQOL and LIT as dependent and HCQ use as independent variable. Analyses were undertaken to test mediation of effects of HCQ use on QOL through disease activity. RESULTS: Mean age was 40.5 ± 12.8 years, 93% were women. Sixty-three (1363/2161) percent were on HCQ. On univariate analysis, HCQ use was associated with (a) better QOL (LupusPRO-HRQOL: ß 6.19, 95% CI 4.15, 8.24, P ≤ 0.001, LupusPRO NHRQOL: ß 5.83, 95% CI 4.02, 7.64, P ≤ 0.001) and less impact on daily life (LIT: ß -9.37, 95% CI -12.24, -6.50, P ≤ 0.001). On multivariate and mediational analyses, the effects of HCQ on QOL were indirectly and completely mediated through disease activity. CONCLUSIONS: HCQ use in SLE is associated with better patient reported health outcomes (LupusPRO-HRQOL and NHRQOL and impact on daily life), and the effects are mediated through disease activity. This information can facilitate patients and physician's communication with decision-making regarding the use of HCQ for SLE management.

Evaluation of an Active Citizenship Intervention Based on Youth-Led Participatory Action Research.

Youth-led participatory action research (YPAR) is a theoretical-methodological approach that has been designed to promote positive development (e.g., well-being and health, social-emotional and cognitive development, academic or career advancement) and civic engagement among young people. Although YPAR holds particular promise, there has been little systematic assessment of its effects. Moreover, no study has investigated the role of YPAR in the promotion of active citizenship. We report on an effectiveness evaluation of a YPAR project designed to promote European active citizenship (i.e., identification and attitudes toward a political entity, institutional trust, participation, and political alienation) and social well-being among adolescents. Our sample included 69 Italian high school students (35 in the intervention group; 34 in the control group). We evaluated the impact of YPAR using a pretest-posttest control group design and fitting the generalized estimating equations procedure. The results showed that participants in the intervention group reported increased scores on social well-being, institutional trust, and participation and decreased scores on political alienation compared with the control group. We found no significant effects for identification as European and attitudes toward a political entity. Findings support the benefits of YPAR in terms of social well-being and active citizenship.

Psychometric properties of the Italian version of the sense of community responsibility scale.

The central aim of the present research was to examine the psychometric properties of adapted versions of the sense of community (SOC) responsibility scale in three Italian samples. We examined the psychometric properties of three modified versions of the sense of community responsibility (SOC-R) scale. Consistent with the original scale, exploratory and confirmatory factor analyses demonstrated that the scale was unidimensional and exhibited excellent internal consistency. In addition, factor analyses revealed that SOC responsibility and SOC are two separate, albeit related, constructs. The results also provided evidence of the discriminant validity of SOC and SOC-R on key outcomes. Taken together, these results provide support for the Community Experience Model, which posits that community experiences are a function of resource and responsibility components, as well as for the adaptable nature of the SOC-R scale to the Italian context.

Quality of collaboration within health promotion partnerships: Impact on sense of community, empowerment, and perceived projects' outcomes.

Community coalitions or intersectoral partnerships have long been advocated for the promotion of population health. In the present study, we assessed the quality of the functioning of health promotion partnerships created within a large community health promotion program implemented by the Emilia-Romagna region located in the north-east of Italy (2014-2016). In particular, we aimed to test the effectiveness of partnership working in strengthening participants' empowerment, sense of community and ultimately, the outcomes of a well-functioning partnership, conceptualized as including perceived effectiveness of health promotion interventions developed by the partnership, trust in their implementation and personal commitment in health promotion in the future. Participants were 238 stakeholders (e.g., health professionals, representatives of local administrations, teachers, representative of community and volunteer organizations, and citizens) formally included in six partnerships lead by six major local health services. Using Bayesian structural equation modeling, we found that a higher perceived quality of collaboration within the partnership enhances the outcomes of a well-functioning partnership, by strengthening their sense of a health-promoting community and empowerment. Sense of community responsibility did not predict future commitment in health promotion. The study findings suggest that community members' ownership and feeling of responsibility, as well as empowerment constitute positive partnership processes.

Drivers of Satisfaction With Care for Patients With Lupus.

OBJECTIVE: Quality of life (QOL) and quality of care (QOC) in systemic lupus erythematosus (SLE) remains poor. Satisfaction with care (SC), a QOC surrogate, correlates with health behaviors and outcomes. This study aimed to determine correlates of SC in SLE. METHODS: A total of 1262 patients with SLE were recruited from various countries. Demographics, disease activity (modified Systemic Lupus Erythematosus Disease Activity Index for the Safety of Estrogens in Lupus Erythematosus: National Assessment trial [SELENA-SLEDAI]), and QOL (LupusPRO version 1.7) were collected. SC was collected using LupusPRO version 1.7. Regression analyses were conducted using demographic, disease (duration, disease activity, damage, and medications), geographic (eg, China vs United States), and QOL factors as independent predictors. RESULTS: The mean (SD) age was 41.7 (13.5) years; 93% of patients were women. On the univariate analysis, age, ethnicity, current steroid use, disease activity, and QOL (social support, coping) were associated with SC. On the multivariate analysis, Asian participants had worse SC, whereas African American and Hispanic patients had better SC. Greater disease activity, better coping, and social support remained independent correlates of better SC. Compared with US patients, patients from China and Canada had worse SC on the univariate analysis. In the multivariate models, Asian ethnicity remained independently associated with worse SC, even after we adjusted for geographic background (China). No associations between African American or Hispanic ethnicity and SC were retained when geographic location (Canada) was added to the multivariate model. Canadian patients had worse SC when compared with US patients. Higher disease activity, better social support, and coping remained associated with better SC. CONCLUSION: Greater social support, coping, and, paradoxically, SLE disease activity are associated with better SC. Social support and coping are modifiable factors that should be addressed by the provider, especially in the Asian population. Therefore, evaluation of a patient's external and internal resources using a biopsychosocial model is recommended. Higher disease activity correlated with better SC, suggesting that the latter may not be a good surrogate for QOC or health outcomes.

Sex Differences in Quality of Life in Patients With Systemic Lupus Erythematosus.

OBJECTIVE: Systemic lupus erythematosus (SLE) predominantly affects women. Clinical phenotype and outcomes in SLE may vary by sex and are further complicated by unique concerns that are dependent upon sex-defined roles. We aimed to describe sex differences in disease-specific quality of life (QoL) assessment scores using the Lupus Patient-Reported Outcome (LupusPRO) tool in a large international study. METHODS: Cross-sectional data from 1,803 patients with SLE on demographics, self-identified sex status, LupusPRO, and disease activity were analyzed. The LupusPRO tool has 2 constructs: health-related QoL (HRQoL) and non-HRQoL. Disease activity and damage were evaluated using the Safety of Estrogens in Lupus Erythematosus National Assessment version of the Systemic Lupus Erythematosus Disease Activity Index and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, respectively. Nonparametric tests were used to compare QoL and disease activity by sex. RESULTS: A total of 122 men and 1,681 women with SLE participated. The mean age was similar by sex, but the damage scores were greater among men. Men fared worse on the non-HRQoL social support domain than women (P = 0.02). When comparing disease and QoL among men and women ages ≤45 years, men were found to have greater damage and worse social support than women. However, women fared significantly worse on lupus symptoms, cognition, and procreation domains with trends for worse functioning on physical health and pain-vitality domains. CONCLUSION: In the largest study of a diverse group of SLE patients, utilizing a disease-specific QoL tool, sex differences in QoL were observed on both HRQoL and non-HRQoL constructs. Although men performed worse in the social support domain, women (especially those in the reproductive age group) fared worse in other domains. These observations may assist physicians in appropriately addressing QoL issues in a sex-focused manner.

Youth Participation in Psychological Literature: A Semantic Analysis of Scholarly Publications in the PsycInfo Database.

The topic of youth participation in the public sphere has received increasing attention within recent psychological research. The literature remains somewhat fragmented between different conceptualizations varying in their specificity or broadness. The present study aims to map the current state of debate in psychology regarding youth civic and political participation and to identify the prevalent themes that characterize the research in the discipline from 1990 to 2016. A semantic content analysis with the software T-Lab was performed on a corpus of 1,777 publications retrieved from the PsycInfo database. The results highlight the increasing number of academic contributions on the topic, confirming the growing importance of the issue within psychology. The study sheds light on the spheres of participation, in which the discipline has attempted to make a contribution, namely: traditional and online political context, institutional civic education, adolescent development, and rights-based activism. Moreover, the findings reveal the existing opposing priorities of research that focus either on the explanation of specific forms of involvement or on the formation of future citizens. Within the thematic attention to young people's civic and political development, there seem to be two general approaches that see youth in divergent ways: as citizens whose civic capacities are to be fostered or as targets for top-down training interventions. This systematic thematic review calls attention to the disparate ways in which youth participation is being addressed in psychology and highlights the need for greater theoretical integration in the field of study.

A Cross-Lagged Panel Analysis of the Relationship Between Neighborhood Sense of Community and School Sense of Community.

Neighborhood sense of community and school sense of community have been associated with important outcomes for adolescents. However, the complex interplay between neighborhood sense of community and school sense of community among adolescents is not clear. Moreover, the studies showing an association between neighborhood sense of community and school sense of community have been cross-sectional. The present study investigated the directionality of the relationship between neighborhood sense of community and school sense of community using a longitudinal cross-lagged design. Using structural equation modeling, a cross-lagged panel analysis revealed that school sense of community at Time 1 significantly predicts neighborhood sense of community at Time 2 even after controlling for neighborhood sense of community at Time 1. However, neighborhood sense of community at Time 1 did not predict school sense of community at Time 2. Results of this study support the theory that school sense of community can provide students with a bridge between school and community.

The influence of school sense of community on students' well-being: A multilevel analysis.

Previous studies have demonstrated the role of students' school sense of community (i.e., emotional connection and bonds with other students at school and sense of belonging to the school as a community) in predicting well-being (presence of positive feelings and positive functioning in life). Specifically, these studies have found that individual sense of community in the school is associated with well-being. However, individual sense of community in the school does not constitute a school-level characteristic, and the influence of sense of community at the school level on students' well-being was not investigated. To address this gap in the literature, we conducted a study investigating the influence of sense of community at the school level on students' well-being, using multilevel analysis. Our sample comprised 1,800 students (age ranged from 11 to 20 years) from public lower and upper secondary schools in Italy. Results showed that higher sense of community scores at the school level were associated with higher well-being scores, while controlling for individual sense of community, gender, and age. These results provide support for a school-level theory of school sense of community (i.e., moving school sense of community theory from the individual to the school level).

The relationship between sense of community in the school and students' aggressive behavior: A multilevel analysis.

School sense of community has been associated with lower levels of students' aggressive behaviors. The main aim of the study was to examine whether the magnitude of the influence of school sense of community on students' aggressive behavior is similar or different across schools with different levels of aggressive behaviors. Participants were 1,800 Italian students attending 44 middle and high schools. Using multilevel modeling (a random intercepts and slopes model), we found that the magnitude of the negative relationship between sense of community in the school and students' aggressive behaviors was stronger in schools with high levels of aggressive behavior. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Living with systemic lupus erythematosus: A patient engagement perspective.

Patient engagement is recognized as a crucial component of high-quality healthcare services. Among rheumatic diseases, systemic lupus erythematosus (SLE) appears particularly challenging for the engagement of patients in their own care. According to the patient health engagement (PHE) model, patient engagement is a dynamic phenomenon that proceeds through four experiential positions (blackout, arousal, adhesion and eudaimonic project). The aim of the present study was to describe the engagement process from the point of view and the experiences of SLE patients. Ten in-depth interviews and four focus groups were conducted with an international sample of SLE patients from different European countries. Transcripts were analysed through thematic content analysis. Findings showed that a fully engaged patient results from reframing emotional, cognitive and behavioural dimensions. The advances along the process depends on how the patient succeeds in each position. In conclusion, PHE represents an appropriate model by which to understand the engagement process of SLE patients. In order to meet patients' needs, healthcare providers and patient support groups should consider the specific position of SLE patients, providing adequate and tailored support.

Psychometric Properties of a Multidimensional Scale of Sense of Community in the School.

Sense of community in the school has been associated with a range of important outcomes for students. However, there are currently no standard definitions of sense of community in the school with corresponding measures with established psychometric properties. To fill this gap, the main aim of the present study was to propose a model of sense of community in the school, its operationalization and to examine its key psychometric properties (factorial structure, reliability, differential item functioning, differential test functioning of the scale and discriminant, convergent, and criterion validity). Participants were 1,076 students from 22 public middle schools and 724 students from 22 public high schools located in the Italian city of Genoa and its province. To test the dimensionality of the scale, we conducted exploratory and confirmatory factor analysis under the Item Response Theory paradigm. Exploratory factor analysis confirmed three dimensions: Membership, Emotional connection, and Opportunities. A confirmatory factor analysis revealed that the bifactor model exhibited the largest improvement in fit. Cronbach's alpha, omega total, and omega hierarchical indicated a good reliability for the measure. Internal consistency was satisfactory, considering Cronbach's alpha and omega. Analysis of differential item/test functioning of the scale showed that girls and boys as well as students attending middle school and those attending high school responded in largely similar ways to the measure. Finally, the instrument demonstrated good discriminant, convergent, and criterion validity. Together, these findings indicate that our theory driven model of sense of community in the school is valid and that the instrument is a reliable measure for assessing sense of community in the school.

Evaluating the Persuasiveness of an HIV Mass Communication Campaign Using Gain-Framed Messages and Aimed at Creating a Superordinate Identity.

This research assesses the coverage and impact of "United Against AIDS," the 2012-2013 Italian National HIV/AIDS prevention campaign to promote safer sex behavior and voluntary HIV counseling and testing. The campaign used gain-framed messages and aimed at creating a superordinate identity. We conducted two studies. The first study employed a quasi-experimental design involving three groups of participants: general population (n = 858), men who have sex with men (MSM; n = 109), and migrants (n = 211). In the second study, we carried out a time-series design to analyze the archival data of the Italian National AIDS Help-Line. Exposure to the campaign was reported by 78.3%, 67.5%, and 57.8% of the general population, MSM, and migrant respondents, respectively. The probability of having unprotected sexual intercourse with multiple partners decreased significantly in the subsample of the general populations that was exposed to the campaign (compared to the nonexposed participants), but the same effect was not found among MSM and migrant participants. The probability of having unprotected sexual intercourse with someone of unknown HIV status decreased after the campaign in the exposed MSM subsample (compared to the nonexposed participants), but the same effect was not found among the general population and migrant participants. In addition, the probability of undertaking HIV testing increased significantly in the exposed participants belonging to the general population but not among MSM and migrant participants. Time-series analysis revealed that the number of calls at the Italian National AIDS Help-Line significantly increased during the campaign. This research provides evidence that the effect of the campaign was complex and varied across participants.

Positive and problematic support, stress and quality of life in patients with systemic lupus erythematosus.

BACKGROUND AND OBJECTIVES: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease. Previous studies showed that perceived social support has an important role in enhancing patient's quality of life (QOL). However, the precise mechanisms through which social support exerts such an effect are not completely understood. The aim of this paper is to test two alternative models explaining the relationship between social support (positive and problematic) and two dimensions of QOL: Health-Related (HR-QOL) and Non-Health-Related (NHR-QOL). DESIGN: Model A (mediation) hypothesized that positive support would reduce stress while problematic support would increase stress), and that this in turn would reduce QOL. Model B (moderation) hypothesized that the effect of support on QOL would be moderated by the experience of stress in that more stressed individuals would show stronger effects. METHODS: Three hundred and forty-four Italian patients with SLE completed an online questionnaire. RESULTS: Stress partially mediated the relationship between support and QOL dimensions (either HR-QOL and NHR-QOL) thus supporting Model B. As hypothesized, positive support reduced stress, while problematic support increased stress. CONCLUSIONS: These findings help to explain the complex relationship between social support, stress and QOL in patients with SLE.

The Problematic Support Scale: A validation among patients with systemic lupus erythematosus.

The aim of the study was to develop and to assess the psychometric properties of the Problematic Support Scale, among patients with systemic lupus erythematosus. An online questionnaire was filled in by 344 systemic lupus erythematosus patients with a mean age of 39.66 years. Explorative factor analysis, later validated by confirmative factor analysis, showed the emergence of a two-factor structure in types of support provided: denying/uninformed support and oppressive support. Denying/uninformed support includes offers of support that neglect the disease manifestations and consequences. Oppressive support describes social support offers which are perceived as excessive and oppressive. Results confirm previous qualitative evidence and demonstrate good reliability and concurrent validity of the Problematic Support Scale. Theoretical and methodological implications for the study of social support are discussed.

Health-related quality of life after solid organ transplantation: the role of sport activity.

The aim of the study was to investigate the effects of sport activity on health-related quality of life (HRQoL) of solid organ transplant recipients participating in sports competitions. A group of 168 sportive transplanted patients (STP), a group of 97 nonsportive transplanted patients (NSTP), and a group of 152 sportive healthy controls (SHC) were compared on the eight scales of the SF-36 questionnaire. STP and NSTP reported significantly lower scores than SHC on the physical functioning scale. STP did not differ from SHC in the Role-Physical, General Health, and Vitality scales, while NSTP reported significantly lower scores. STP obtained higher scores than NSTP and SHC on Mental Health. Among STP, the effect of quantity of sport activity was significant on General Health and Role Emotional, with more sport activity associated with higher HRQoL. Organ failure and post-transplant therapies may have negative consequences on HRQoL. Sports activities and participation in sports competitions can reduce this impact, improving general and psychological functioning of solid organ transplant recipients.

Problematic social support from patients' perspective: the case of systemic lupus erythematosus.

Several studies demonstrated the importance of psychosocial factors, like social support, for understanding the experience of people with Systemic Lupus Erythematosus (SLE). Less information is available on "problematic support"; that is, instances of support that are perceived as non-supportive, even though the provider's actions may be well intended. Aim of this qualitative study was to explore the experiences of problematic support from SLE patients' perspective. Nine women with SLE were interviewed and transcripts were analyzed through qualitative content analysis. Three main types of problematic social support were indentified. Oppressive support describes social support offers characterized by excessive worries and unwanted advices. Support denying the illness is characterized by a neglect of the disease or of its consequences. Support based on divergent illness representations is perceived as not punctual and not in line with patients' actual clinical condition. This study confirms the complexity of providing useful support to SLE patients and suggest that also people living close to patients should represent a target of interventions.

Patients' direction, empowerment and quality of life in haemodialysis.

The maintenance of an adequate of quality of life (QoL) represents a critical issue in the management of patients in haemodialysis and is also used to assess the effectiveness of health care programmes. The Consumer Direction Theory of Empowerment (CDTE) implies that greater patient direction in policy formulation and services delivery, together with an increased community integration, endorses a process which leads to a better QOL. The aim of the study was to test a contextualized version of CDTE in an ambulatory for patients in haemodialysis. Sixty-nine patients completed a questionnaire measuring the following variables: Patient direction, family integration, self-efficacy in managing the disease, mental and physical health. The results showed that patient direction and family integration have an indirect effect on QoL, through self-efficacy in managing the disease. The hypotheses were thus confirmed, providing support for the potential of CDTE in the context of health services for haemodialysis patients. Implications for the implementation of health programmes aimed at improving QoL of patients in haemodialysis are discussed, including interventions focused on psychological and contextual factors.

Sharing experiences and social support requests in an Internet forum for patients with systemic lupus erythematosus.

Internet forums represent a useful but understudied resource to understand psychosocial aspects of living with systemic lupus erythematosus. This study was aimed to describe the demand/supply of social support through the Internet in relation with the description of personal illness experiences. All the posts (118) from an Italian forum for systemic lupus erythematosus patients were collected and analyzed combining qualitative content analysis with statistical textual analysis. The results showed different purposes for posts: starting new relationships, seeking information, receiving emotional support, and giving a contribution. Lexical analysis identified three ways of describing patients' experiences. Discussion focuses on the relationship between the requested/offered support and systemic lupus erythematosus experiences.