Recognizing and Appreciating the Partner's Support Protects Relationship Satisfaction during Cardiac Illness.

BACKGROUND: This study aimed to examine whether dyadic coping (DC) is associated with relationship satisfaction (RS) among couples facing cardiac diseases. Furthermore, the moderating role of both partners' anxiety and depression was tested. METHODS: One hundred cardiac patients (81.5% men) and their partners (81.5% women) completed a self-report questionnaire during hospitalization. The Actor-Partner Interdependence Model (APIM) and moderation analyses were used to assess the above associations. RESULTS: Results showed that positive DC was significantly related to higher levels of RS, and negative DC was related to lower levels of RS. Furthermore, patient and partner psychological distress significantly moderated the link between DC and RS: patient-perceived positive DC was associated with higher partner RS when partner depression was high; partner-perceived positive DC was associated with higher patient RS when patient anxiety was low; patient-perceived negative DC has associated with lower patient RS when patient anxiety and depression were high. CONCLUSION: This study showed that positive DC is associated with a more satisfying relationship and identified under what conditions of cardiac-related distress this can happen. Furthermore, this study underlined the importance of examining DC in addition to the individual coping skills as a process pertaining to personal well-being and couple's outcomes.

"The heart in a bag": The lived experience of patient-caregiver dyads with left ventricular assist device during cardiac rehabilitation.

Objective: The Left Ventricular Assist Device (LVAD) has increasingly become a primary therapeutic option for longer-waiting heart transplant lists. Although survival rates are growing, the device requires complex home care. Therefore, the presence of a caregiver trained in the LVAD management is important for the success of the therapy. The LVAD leads both patients and their caregivers to experience new challenges and adapt to new lifestyle changes and limitations - but their subjective beliefs before home management remained little explored. Design: This study identified, using a phenomenological hermeneutic approach, the main components of the LVAD experience of six patient-caregiver dyads interviewed during cardiac rehabilitation. Results: We identified 4 master themes: Being between life and death, Being human with a heart of steel, Sharing is caring (and a burden), and Being small and passive. Conclusion: The knowledge from this study can be used as a guide for healthcare providers in counseling LVAD recipients and their caregivers.

Taking care of who cares: Evaluation of a training program for home palliative care professionals.

OBJECTIVES: To evaluate an enrichment training program targeted at home palliative care professionals in terms of its effects and participants' satisfaction. The program had 2 main aims: give voice to professionals' emotional fatigue and promote their personal resources. METHODS: One hundred twenty-three home palliative care professionals participated in 12 parallel training courses; each course consisted of four 3-hour meetings led by 2 trainers and involved about 10-15 participants. The program adopted the method and tools typical of the enrichment approach, with the insertion of an art therapy exercise in the central meetings. The topics addressed were the following: emotional awareness in care relationship; the recognition of the needs of the patient, the family, and the professional himself; the inevitability of the death of the patient; and the challenges and resources of the multidisciplinary care team. At the first (T1) and last (T2) meetings, participants filled in a self-report questionnaire assessing work emotional fatigue, empowerment, generativity, and satisfaction with the course. RESULTS: Participants were highly satisfied with the course. They reported a higher level of work emotional fatigue and a higher perception of personal resources, in terms of empowerment (both individual-oriented and relationship-oriented) and generativity at the end of the program than before. SIGNIFICANCE OF RESULTS: Results confirm the need to provide home palliative care professionals with trainings in which they can express, share, and deal with personal and professional needs. This course gave voice to professionals' work emotional fatigue and promoted their personal resources, while enhancing collaboration in the multidisciplinary team.

Yes, I can (with you)! Dyadic coping and self-management outcomes in cardiovascular disease: The mediating role of health self-efficacy.

Cardiac patients show alarming levels of nonadherence to medications. It is important to consider also patient activation levels. Furthermore, the partner could have a supporting role in these processes. The aim of this study was to investigate the mediating role of patient health self-efficacy (HSE) in the link between dyadic coping (DC) and two self-management outcomes (i.e. medication adherence and patient activation) across the first 6 months of cardiac disease. One hundred couples completed two self-report questionnaires during the hospitalisation for cardiac disease and 6 months after discharge. A longitudinal and dyadic research design was adopted. Cross-sectional analyses at T0 revealed that patient-provided and perceived positive DC and common DC are positively associated with HSE, which in turn is positively associated with medication adherence. HSE mediated the association between patient positive and common DC styles, with the only exception of Patient-provided positive DC, and patient activation. Conversely, patient-provided and perceived negative DC are negatively associated with HSE, which in turns is positively associated with medication adherence and patient activation. Prospective analyses showed that only patient-perceived negative DC at discharge is negatively associated with HSE at T1, which in turns is positively associated with patient activation over time. These results suggest to consider patient perceived and provided DC as antecedents of self-management outcomes via patient HSE. Furthermore, our results recommend to pay particular attention to negative DC, whose negative consequences are manifested also over time, planning interventions targeting partners' awareness of their own DC style.

The Association Between Cardiac Illness-Related Distress and Partner Support: The Moderating Role of Dyadic Coping.

Managing cardiac illness is not easy because it dramatically disrupts people's daily life and both the patient and his/her spouse are at risk for experiencing distress, which, in turn, may affect the support provided by the partner as caregiver. The partner, in fact, is the main source of support, but his/her support may sometimes be inadequate. In addition, dyadic coping (i.e., the way partners cope together against stress and support each other in times of difficulty) could likely be a moderating factor. The main aim of the present study was to examine the role that dyadic coping (DC, in terms of positive, negative, and common dyadic coping responses) plays in moderating the link between patient and partner cardiac illness-related distress (in terms of anxiety and depression) and partner support (in terms of overprotection, hostility, and partner support for patient engagement). The study included 100 married couples faced with cardiac illness who completed a self-report questionnaire. We analyzed our data in PROCESS using multiple regressions in order to assess the moderating effects of DC responses in the relationship between the couple's cardiac illness-related distress and partner support. With regard to patient distress, results showed that higher levels of patient anxiety and depression were linked with ineffective partner support (i.e., overprotection and hostility). With regard to partner distress, higher levels of partner depression were linked with hostility; higher levels of partner depression and anxiety were associated with less partner support for patient engagement. Moreover, the association between distress and partner support was moderated by the quality of DC. In particular, low positive DC represented a risk factor for both the patient and the partner during a cardiac illness, as low positive DC exacerbated the link between patient and partner distress and less effective partner support styles. Also, higher levels of negative DC were risky for couples: The association between distress and less adequate partner supportive behaviors was stronger in the case of higher negative DC. These results imply a need for psychosocial interventions for couples in cardiac illness, especially for couples lacking relational competences, such as positive dyadic coping.

Glioblastoma epigenome profiling identifies SOX10 as a master regulator of molecular tumour subtype.

Glioblastoma frequently exhibits therapy-associated subtype transitions to mesenchymal phenotypes with adverse prognosis. Here, we perform multi-omic profiling of 60 glioblastoma primary tumours and use orthogonal analysis of chromatin and RNA-derived gene regulatory networks to identify 38 subtype master regulators, whose cell population-specific activities we further map in published single-cell RNA sequencing data. These analyses identify the oligodendrocyte precursor marker and chromatin modifier SOX10 as a master regulator in RTK I-subtype tumours. In vitro functional studies demonstrate that SOX10 loss causes a subtype switch analogous to the proneural-mesenchymal transition observed in patients at the transcriptomic, epigenetic and phenotypic levels. SOX10 repression in an in vivo syngeneic graft glioblastoma mouse model results in increased tumour invasion, immune cell infiltration and significantly reduced survival, reminiscent of progressive human glioblastoma. These results identify SOX10 as a bona fide master regulator of the RTK I subtype, with both tumour cell-intrinsic and microenvironmental effects.

A Postcard From Italy: Challenges and Psychosocial Resources of Partners Living With and Without a Chronic Disease During COVID-19 Epidemic.

The new Coronavirus (COVID-19) has been declared a global pandemic by the World Health Organization (WHO). The sudden outbreak of this new virus and the measure of lockdown adopted to contain the epidemic have profoundly changed the lifestyles of the Italian population, with an impact on people's quality of life and on their social relationships. In particular, due to forced and prolonged cohabitation, couples may be subject to specific stressors during the epidemic. In addition, living with a chronic health condition may add specific challenges to the ones posed by the epidemic itself. The present cross-sectional study aimed to provide a picture of the challenges as well as the resources for both individual and relational well-being of Italian individuals in a couple relationship (N = 1921), with a specific attention to the comparison between individuals living with and without a chronic disease. Results showed that people with a chronic disease had lower psychological well-being and more fears and worries about the COVID-19. People with a chronic disease perceived fewer resources than healthy people. Moreover, the challenges are shown to be associated with less psychological well-being and high pessimism about the future. Instead individual, relational, and social resources play a protective role during the pandemic for both healthy and chronically ill people.

Trajectories of perceived superiority across the transition to marriage.

Perceived superiority, the tendency to regard one's own relationship as better than other people's relationships, is a key relationship maintenance mechanism. Little is known about whether and how it changes during the transition to marriage, a pivotal moment in most couples' life cycle. In a longitudinal study following 97 couples for three waves across the transition, men presented stable perceived superiority, whereas women presented a curvilinear change in superiority perceptions, with a substantial increase in perceived superiority between T1 and T2 and a significantly reduced change between T2 and T3. In addition, trajectories differed according to partners' commitment level. More committed and less committed partners both showed a curvilinear change in perceived superiority, though following different patterns. Results point to the functional value of perceived superiority, which emerges as a strategy aimed at sustaining partners through the challenges deriving from the transition to marriage.

The Combined Effect of Psychological and Relational Aspects on Cardiac Patient Activation.

The literature assumes that activating patients in the treatment is associated with positive health-related outcomes, such as clinical indicators in the normal range, high medication adherence, and low emergency department utilization. In the cardiac population, patient activation, that is the patient's knowledge, skills, confidence, and behaviors needed for managing one's own health and health care, has been less investigated. In addition, limited attention has been given to the role of the partner as an informal caregiver. However, the patient in the care process is rarely alone, and the partner may play a key role in this process. The goal of this dyadic study (N = 100 heterosexual couples with one partner suffering from an acute cardiac event) is to analyze how individual factors (patients' anxiety, depression, medication adherence, pessimistic perception of illness) and the couple's relationship functioning (e.g., different kinds of partner support and dyadic coping) are associated with patient activation. The results showed that patient activation is not a mere question of age. It is positively related to medication adherence and to the partner's support patient activation. It is negatively correlated with the patient's psychological distress, pessimistic perception of illness, and to the partner's hostility. The need for a dyadic approach to both research and intervention with this population is discussed.

Explicit Stress Communication Facilitates Perceived Responsiveness in Dyadic Coping.

The present study was aimed at examining the role of explicit stress communication in the context of dyadic coping. The general aim of the present study was to test (a) whether explicit communication of daily stressful events predicted relationship satisfaction and (b) whether the perception of responsiveness in dyadic coping mediated the association between explicit stress communication and partners' satisfaction. We analyzed daily diary data from 55 married couples and multilevel analyses suggested that, although explicit stress communication was not associated with relationship satisfaction, it predicted both partners' responsiveness in dyadic coping behaviors. Finally, responsive dyadic coping behaviors mediated the relationship between explicit stress communication and relationship satisfaction. On the whole, our findings showed that perceived responsiveness in dyadic coping with daily stressors was facilitated by explicit stress communication and that this contributed to the effectiveness of dyadic coping behaviors in fostering partners' relationship satisfaction. We discussed how the current study contributes to the understanding of the dyadic coping process and its contribution to partners' satisfaction, underscoring the importance of communication skills.

Global Study of Social Odor Awareness.

Olfaction plays an important role in human social communication, including multiple domains in which people often rely on their sense of smell in the social context. The importance of the sense of smell and its role can however vary inter-individually and culturally. Despite the growing body of literature on differences in olfactory performance or hedonic preferences across the globe, the aspects of a given culture as well as culturally universal individual differences affecting odor awareness in human social life remain unknown. Here, we conducted a large-scale analysis of data collected from 10 794 participants from 52 study sites from 44 countries all over the world. The aim of our research was to explore the potential individual and country-level correlates of odor awareness in the social context. The results show that the individual characteristics were more strongly related than country-level factors to self-reported odor awareness in different social contexts. A model including individual-level predictors (gender, age, material situation, education, and preferred social distance) provided a relatively good fit to the data, but adding country-level predictors (Human Development Index, population density, and average temperature) did not improve model parameters. Although there were some cross-cultural differences in social odor awareness, the main differentiating role was played by the individual differences. This suggests that people living in different cultures and different climate conditions may still share some similar patterns of odor awareness if they share other individual-level characteristics.

The associations for separated parents in Italy: Their role for parents' well-being and coparenting.

After separation or divorce, people generally experience a deterioration of health, not only in terms of physical well-being but also in terms of emotional and social well-being. In addition, when separated, individuals are parents as well and they are concerned with the well-being of their children. The main task for separated parents is to maintain a parental alliance (coparenting) for the sake of their children's well-being. Social support is a critical resource, which helps parents face their new life condition, promoting their psychological well-being. In recent years in Italy, many associations targeting separated and divorced parents have been founded: They support ex-partners during and after separation and are active in defending their rights. These associations are voluntary associations/non-profit organisations and self-help groups, which are constituted by parents themselves who associate to support each other in the tasks connected with separation. The present study investigated, with an explorative aim, the role of these associations for separated parents' well-being and coparenting abilities. In particular, drawing on a sample of 318 Italian separated parents (73.30% fathers; 26.70% mothers) belonging to a formal association targeting separated parents, the study analysed whether and how the perception of being supported by the association was related to psychological and relational well-being and to coparenting. Results showed that the more parents perceived to be supported by the association the less they were depressed, the more they were satisfied with the relationship with children and friends, and the more they displayed coparenting abilities. Our findings suggest that social support from these associations is a resource for separated parents' health.

Corrigendum: Marital Satisfaction, Sex, Age, Marriage Duration, Religion, Number of Children, Economic Status, Education, and Collectivistic Values: Data from 33 Countries.

[This corrects the article on p. 1199 in vol. 8, PMID: 28785230.].

Fertilizing a Patient Engagement Ecosystem to Innovate Healthcare: Toward the First Italian Consensus Conference on Patient Engagement.

Currently we observe a gap between theory and practices of patient engagement. If both scholars and health practitioners do agree on the urgency to realize patient engagement, no shared guidelines exist so far to orient clinical practice. Despite a supportive policy context, progress to achieve greater patient engagement is patchy and slow and often concentrated at the level of policy regulation without dialoguing with practitioners from the clinical field as well as patients and families. Though individual clinicians, care teams and health organizations may be interested and deeply committed to engage patients and family members in the medical course, they may lack clarity about how to achieve this goal. This contributes to a wide "system" inertia-really difficult to be overcome-and put at risk any form of innovation in this filed. As a result, patient engagement risk today to be a buzz words, rather than a real guidance for practice. To make the field clearer, we promoted an Italian Consensus Conference on Patient Engagement (ICCPE) in order to set the ground for drafting recommendations for the provision of effective patient engagement interventions. The ICCPE will conclude in June 2017. This document reports on the preliminary phases of this process. In the paper, we advise the importance of "fertilizing a patient engagement ecosystem": an oversimplifying approach to patient engagement promotion appears the result of a common illusion. Patient "disengagement" is a symptom that needs a more holistic and complex approach to solve its underlined causes. Preliminary principles to promote a patient engagement ecosystem are provided in the paper.

Positive parenting as responsible care: Risks, protective factors, and intervention evaluation.

In this themed issue of the Journal of Prevention & Intervention in the Community, the first four contributions provide knowledge on factors that can support or hinder positive parenting throughout children's lives. In particular, the first article examined the spillover of work stressors on parenting behaviors and the role of spousal support as a moderator of stress spillover. The second contribution examines the association between parents' promotion of volitional functioning and adopted children's sense of strength of family bonds and belonging to the adoptive family. The third article analyzes the negative impact of intrusive parenting on young adult children's romantic relationship quality and couple identity, and the fourth article examines parents' autonomous and controlled motivations to transmit values to their adolescent children and their associations with parents' socialization goals. Finally, the last two articles present the contents and evaluation of two parenting programs. The fifth article illustrates the development, content, and efficacy of an attachment-based intervention for parenting: the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD); the sixth article presents a qualitative evaluation of a group-based program focused on promoting parents' identity together with parenting skills: The Groups for Family Enrichment_Parent version (GFE_P).

A qualitative evaluation of a preventive intervention for parents: The Groups for Family Enrichment_Parent version (GFE_P).

The traditional objective of parenting enrichment programs is to train parents' abilities and specific competences, but less attention is paid to promoting participants' reflection on their parental identity. These programs are generally delivered to groups of parents, though the group is rarely considered a specific tool to promote changes in participants' relational functioning. The Groups for Family Enrichment_Parent version (GFE_P; Iafrate, Donato, & Bertoni, 2010 ; Iafrate & Rosnati, 2007 ) focus on parental identity in addition to parental competences and skills and purposely use the group of parents as an educational tool, adopting a semistructured format. In this article, we first introduce the characteristics of GFE_P, then we present the results of a qualitative evaluation of an application of this intervention to a group of Italian parents. Findings from the process evaluation showed that participants actively contributed to the development of themes during the intervention. Result evaluation suggested that the recognition of key aspects of parental identity can be an important prerequisite to the acquisition of better parenting skills. Implications for parenting programs design are discussed.

Corrigendum: The Associations of Dyadic Coping and Relationship Satisfaction Vary between and within Nations: A 35-Nation Study.

[This corrects the article on p. 1106 in vol. 7, PMID: 27551269.].

The Associations of Dyadic Coping and Relationship Satisfaction Vary between and within Nations: A 35-Nation Study.

OBJECTIVE: Theories about how couples help each other to cope with stress, such as the systemic transactional model of dyadic coping, suggest that the cultural context in which couples live influences how their coping behavior affects their relationship satisfaction. In contrast to the theoretical assumptions, a recent meta-analysis provides evidence that neither culture, nor gender, influences the association between dyadic coping and relationship satisfaction, at least based on their samples of couples living in North America and West Europe. Thus, it is an open questions whether the theoretical assumptions of cultural influences are false or whether cultural influences on couple behavior just occur in cultures outside of the Western world. METHOD: In order to examine the cultural influence, using a sample of married individuals (N = 7973) from 35 nations, we used multilevel modeling to test whether the positive association between dyadic coping and relationship satisfaction varies across nations and whether gender might moderate the association. RESULTS: RESULTS reveal that the association between dyadic coping and relationship satisfaction varies between nations. In addition, results show that in some nations the association is higher for men and in other nations it is higher for women. CONCLUSIONS: Cultural and gender differences across the globe influence how couples' coping behavior affects relationship outcomes. This crucial finding indicates that couple relationship education programs and interventions need to be culturally adapted, as skill trainings such as dyadic coping lead to differential effects on relationship satisfaction based on the culture in which couples live.