Wealth and sexual behaviour among men in Zimbabwe

M.A. Faculty of Humanties, School of Social Sciences. University of the Witwatersrand, 2011INTRODUCTION: Zimbabwe has witnessed a decline in HIV prevalence in the general population estimated to be 27% in 2001, 19% in 2005, 16% in 2007 and 14% in 2009 (Mapingure et al., 2010). Whilst it is a notable decline the rate is still high. Sexual behaviour change has been reported as key to this HIV prevalence decline. Partner reduction has been advocated as an important strategy in HIV prevention. Understanding the socioeconomic and demographic factors influencing the sexual behaviours that are either sustaining the declining, yet still high, prevalence rates is critical to inform interventions. There is growing interest in the association between individual’s socioeconomic status and sexual risk taking behaviour in sub-Saharan Africa. The general objective was to examine the association between wealth and sexual behaviour among men in Zimbabwe. METHOD: Analysis of data from 7175 sexually active aged 15-54 years who participated in the Zimbabwe’s 2005/06 Demographic and Health Survey was done using logistic regression models and have reported odds ratios (OR) with Confidence intervals. In the multiple logistic regressions, two models were used. Model 1 included variables: wealth, age and education whilst in model 2 we controlled for: marital status, type of residence, region of residence and religion because these socio-demographic factors influence male sexual behaviour. The dependent variables included: unprotected sex at last encounter, multiple and concurrent sexual partnerships in last 12 months. RESULTS: When we controlled for potential confounding effects of education, age, marital status, type of residence, region of residence and religion, men in the middle wealth category of the population were less likely to have engaged in unprotected sex in the last encounter with a nonspousal cohabiting partner (OR 0.41, 95% CI 0.22 to 0.76). Wealth was found to be not statistically significantly associated with multiple and concurrent sexual partnerships. CONCLUSION: Wealthy men in Zimbabwe are less likely to engage in unprotected sex. Wealth’s association with multiple and concurrent sexual partnerships was not confirmed in this study. Equitable distribution of wealth and sound economic policies are critical in improving the general welfare of nationals so as to reduce or eliminate some of the factors that cloud the associations between socioeconomic and demographic factors and sexual behaviours of individuals. Policies and programs that recommend deferral of gratification remain critical in order to reduce number of partners

Compassion-facilitation after Trauma

Literature Review: Background: Compassion-facilitating interventions (CFIs) seek to increase feelings of reassurance, safeness and well-being, and are suggested as a new psychotherapeutic approach to treat post-traumatic stress. Objectives: This review summarises and synthesises the literature investigating CFIs for post-traumatic stress disorder (PTSD) in clinical adult populations. Method: A systematic review of the experimental and intervention literature to date was completed using PubMed, PsycINFO, and Web of Knowledge databases. Results: CFIs show large to medium effect sizes in reducing PTSD in traumatised populations. However, many studies did not compare these interventions to active control conditions, and for the few studies that did, compassion-facilitating interventions were not better at reducing PTSD than the active control conditions. There was also not enough evidence in these studies to indicate a mechanism of change in these interventions. Conclusions: CFIs may be an effective intervention in PTSD, but more high quality research is needed to establish their efficacy over and above well established PTSD treatments. More research is also needed to identify the psychological mechanisms at work in decreasing PTSD symptoms Empirical Paper: Objective: Compassion-facilitating interventions are thought to be promising for treating post-traumatic stress disorder (PTSD). It is theorised that inducing self compassion through a compassion-facilitating meditation task would interrupt the psychological processes that cause emotional distress and trauma-related intrusions that form post-trauma. Methods: A student sample (n = 72) was exposed to a trauma-film and then either listened to a neutral-emotion audio mediation or a compassion-facilitating meditation (CFM). Self-reported distress, self-compassion and self-criticism were measured at baseline, post-film, post-audio meditation and for seven days following the experiment. Measures of sympathetic arousal and parasympathetic activation were measured at baseline and during the trauma film and audio meditation. Trauma-related intrusions were measured for seven days following the experiment. Results: Lower self-reported distress and higher self-compassion were reported over the seven day follow-up, but not directly after the meditation. No statistical differences between conditions over time were found for any of the physiological measures but skin conductance was higher in the CFM group, contrary to predictions. There were also no statistical differences found between the two conditions in terms of sum daily intrusions following trauma-exposure. Conclusions: This research supports the hypothesis that facilitating self compassion can disrupt some of the observed processes post-trauma, namely felt distress, although only after a delay. These findings are relevant to the theoretical models of PTSD and future clinical interventions

Psychometric evaluation of the Disabilities of the Arm, Shoulder and Hand (DASH) with Dupuytren's contracture: validity evidence using Rasch modeling

Background Dupuytren’s contracture is a progressive, fibroproliferative disorder that causes fixed finger contractures and can lead to disability. With the advances of new therapeutic interventions, the necessity to assess the functional repercussions of this condition using valid, reliable and sensitive outcome measures is of growing interest. The Disabilities of the Arm, Shoulder and Hand (DASH) is one frequently used patient-reported outcome measure but its reliability and validity have never been demonstrated specifically for a population affected with Dupuytren’s contracture. The objective of this study was to evaluate the psychometric properties of the DASH, with focus on validity evidence using the Rasch measurement model. Methods Secondary analysis was performed on data collected as part of a randomised clinical trial. One hundred fifty-three participants diagnosed with Dupuytren’s contracture completed the DASH at four time points (pre-op, 3, 6 and 12 months post-op). Baseline data were analysed using traditional analysis and to test whether they adhered to the expectations of the Rasch model. Post-intervention data were subsequently included and analyzed to determine the effect of the intervention on the items. Results DASH scores demonstrated large ceiling effects at all time points. Initial fit to the Rasch model revealed that the DASH did not adhere to the expectations of the Rasch partial credit model (χ2 = 119.92; p < 0.05). Multiple items displayed inadequate response categories and two items displayed differential item functioning by gender. Items were transformed and one item deleted leading to an adequate fit. Remaining items fit the Rasch model but still do not target well the population under study. Conclusions The original version of the 30-item DASH did not display adequate validity evidence for use in a population with Dupuytren’s contracture. Further development is required to improve the DASH for this population

Transforming the academic library: creating an organizational culture that fosters staff success [article]

Culture plays a critical role in creating a work environment where employees are committed and contribute to the success of the organization. A research study assessed organizational culture in an academic library to identify current and preferred organizational cultures. Specific actions to implement culture change, achieve organizational transformation, and facilitate a positive, creative and rewarding working environment are proposed

Assessing organizational culture: moving towards organizational change and renewal [article]

Published in Building Effective, Sustainable, Practical Assessment: Proceedings of the 2006 ARL Library Assessment Conference, Charlottesville, Virgini

Learning to live with a hand nerve disorder: A constructed grounded theory

Introduction: The broader perspective of health offered by the World Health Organization’s Classification of Functioning, Disability and Health (WHO ICF), has had a significant bearing on how we view the measurement of health outcomes after surgical or therapy interventions for peripheral nerve disorders affecting the hand. The value of the patient’s perspective is now recognised and outcomes which reflect this are being advocated in the clinical management and support of this population. Purpose of the Study: This qualitative study sought to explore the lived experience of a hand nerve disorder and in particular the impact on body structure/function, activities and participation. Methods: In depth, one to one interviews with fourteen people with a range of hand nerve disorders were conducted. Constructivist grounded theory methods were used to collect and analyse the data. Patients were also given the option of taking photographs to visually represent what it is like to live with a nerve disorder, to bring with them for discussion during the interview. Results: The impact of hand nerve disorders forms part of a wider narrative on adaptation. A process of ‘struggling’ and then ‘overcoming’ was experienced. This was followed by an interior aspect of adaptation described as ‘accepting’. This gave rise to participants ‘transforming’; being changed as a result of the journey that they had been on. Conclusions: This study provides an explanatory theory on the adaptive process following a hand nerve disorder which may inform future patient-therapist interactions

Rasch model analysis gives new insights into the structural validity of the Quick-DASH in patients with musculoskeletal shoulder pain

Study Design: Cross-sectional secondary analysis of a prospective cohort study Background: The Quick-DASH is a widely used outcome measure which has been extensively evaluated using classical test theory (CTT). Rasch model analysis can identify strengths and weaknesses of rating scales which goes beyond CTT approaches. It uses a mathematical model to test the fit between the observed data and expected responses and converts ordinal-level scores into interval-level measurement. Objective: To test the structural validity of the Quick-DASH using Rasch analysis Methods: A prospective cohort study of 1030 patients with shoulder pain provided baseline data. Rasch analysis was conducted to i) assess how the Quick-DASH fits the Rasch model, ii) identify sources of misfit and iii) explore potential solutions to these. Results: There was evidence of multidimensionality and significant misfit to the Rasch model (χ²=331.04, p<0.001). Two items had disordered threshold responses with strong flooring effects. Response bias was detected in most items for age and gender. Rescoring resulted in ordered thresholds, however the 11-item scale still did not meet the expectations of the Rasch model. Conclusion: Rasch model analysis on the Quick-DASH has identified a number of problems which cannot be easily detected using traditional analyses. Whilst revisions to the Quick-DASH resulted in better fit, a ‘shoulder-specific’ version is not advocated at present. Caution needs to be exercised when interpreting results of the Quick-DASH outcome measure as it does not meet the criteria for interval level measurement and shows significant response bias by age and gender

Development and validation of a new patient-reported outcome measure for peripheral nerve disorders of the hand, the I-HaND© Scale

Following guidelines from the Patient-Centred Outcomes Research Institute and using a mixed methods study, a new patient-reported outcome measure (PROM) for both nerve trauma and compression affecting the hand, the Impact of a Hand Nerve Disorders (I-HaND) Scale, was developed. Face-to-face interviews with 14 patients and subsequent pilot-testing with 61 patients resulted in the development of the 32-item PROM. A longitudinal validation study with 82 patients assessed the psychometric properties of the I-HaND. Content and construct validity was confirmed by cognitive interviews with patients and through principal component analysis. The I-HaND has high internal consistency (α = 0.98) and excellent test–retest reliability (intraclass correlation coefficient = 0.97). Responsiveness statistics showed that the I-HaND can detect change over 3 months and discriminate between improvers and non-improvers. We conclude that the I-HaND can be used as a PROM for people with a range of hand nerve disorders

Prognostic value of troponins in acute coronary syndrome depends upon patient age

Peer reviewedPostprin