Heart Failure in the Elderly: the Role of Biological and Sociocultural Aspects Related to Sex.

PURPOSE OF REVIEW: Heart failure (HF) entails poor prognosis, with high morbidity and mortality burden, particularly in elderly patients. Notably, important sex differences have been described between men and women with HF. In this regard, some biological and sociocultural aspects related to sex may play a key role in the different development and prognosis of HF in elderly men and women. RECENT FINDINGS: Important differences between men and women with HF, especially in the elderly population, have been specifically addressed in recent studies. Consequently, specific differences in biological and sociocultural aspects have been found to associate differences in pathophysiology, baseline clinical profile, and prognosis according to sex. Moreover, differences in comorbidities and frailty and other geriatric conditions, frequent in elderly population with HF, have also been described. Biological and sociocultural differences related to sex are key in the different clinical presentation and prognosis of heart failure in elderly women. Further studies will be required to better understand some other underlying reasons that may differently impact prognosis in elderly patients with HF.

How do Patients Diagnosed with Dissociative Identity Disorder Experience Conflict? A Qualitative Study.

The role and nature of conflict in the development and manifestation of dissociative identity disorder (DID) remains underexplored beyond theoretical deduction. In this qualitative instrumental case study, we explored the subjective experience and nature of conflict in a group of adult psychiatric patients diagnosed with DID. We purposively selected typed transcriptions of 28 previously recorded in-depth individual interviews with 15 patients, their audio recordings and associated field notes. The data were thematically analyzed and constant comparison was applied. Two main themes emerged from the transcriptions, namely, participants' experiences of having one or more incompatible and conflicting worldviews about their DID, and the type and nature of conflict that arises between dissociative identities, i.e., conflict of information in awareness, conflicting actions or behaviors, conflicting emotions, conflicting goals, conflicting values, and a battle of wills. Patients with DID have contextually and culturally variable comprehension of the origin of their DID. Conflict between dissociative identities was pervasive, multifaceted, and exacerbated by a lack of awareness between identities. The study provides insight into the complexities of conflict between dissociative identities, as well as highlights the role of inter-identity awareness in conflict.

Perceptions and knowledge regarding the COVID-19 pandemic between U.S. and China: a mixed methods study.

BACKGROUND: SARS-CoV-2, a new coronavirus first reported by China on December 31st, 2019, has led to a global health crisis that continues to challenge governments and public health organizations. Understanding COVID-19 knowledge, attitudes, and practices (KAP) is key for informing messaging strategies to contain the pandemic. Cross-national studies (e.g.: comparing China to the U.S.) are needed to better understand how trans-cultural differences may drive differences in pandemic response and behaviors. The goal of the study is to compare knowledge and perceptions of COVID-19 between adults in China and the U.S. These data will provide insight into challenges these nations may face in coordinating pandemic response. METHODS: This is a convergent mixed methods study comparing responses from China and the U.S. to a multinational COVID-19 KAP online survey. The survey included five quantitative constructs and five open-ended questions. Chinese respondents (n = 56) were matched for gender, age, education, perceived social standing, and time of survey completion with a U.S. cohort (n = 57) drawn from 10,620 U.S. RESPONDENTS: Quantitative responses were compared using T-test & Fisher-Exact tests. Inductive thematic analysis was applied to open-ended questions. RESULTS: Both U.S. and Chinese samples had relatively high intention to follow preventive behaviors overall. Differences in intended compliance with a specific recommendation appear to be driven by the different cultural norms in U.S. and China. Both groups expressed trepidation about the speed of COVID-19 vaccine development, driven by concern for safety among Chinese respondents, and concern for efficacy among U.S. RESPONDENTS: The Chinese cohort expressed worries about other countries' passive handling of the pandemic while the U.S. cohort focused on domestic responses from individuals and government. U.S. participants appeared more knowledgeable on some aspects of COVID-19. Different perspectives regarding COVID-19 origins were identified among the two groups. Participants from both samples reported high trust in health professionals and international health organizations. CONCLUSIONS: Mixed methods data from this cross-national analysis suggests sociocultural differences likely influence perceptions and knowledge of COVID-19 and its related public health policies. Discovering and addressing these culturally-based differences and perceptions are essential to coordinate a global pandemic response.

Giving Voice to Silence: Empowerment and Disempowerment in the Developmental Shift from Trauma 'Victim' to 'Survivor-Advocate'.

In the past several years, a public conversation in the United States about interpersonal violence has flourished, sustained by the work of advocates who are themselves survivors. This surge in public sharing of trauma stories is a rhetorical form of resistance to ideologies in mainstream American culture that impose silence on survivors (e.g., the "just world" belief). However, the developmental progression from trauma 'victim' to empowered public 'survivor/advocate' accommodates to dominant American cultural preferences that stories of adversity have a redemptive story line. In a redemptive story, negative experiences are followed by something positive (e.g., personal growth, lessons learned, strength gained). In this paper, we draw from theory and the sparse relevant literature across multiple disciplines to conceptualize when and for whom the redemptive storying of trauma (or, redemptive master narrative) is available, advantageous, and systemically encouraged. Among the proposed advantages of redemptive storying are its psychological health benefits; potential to empower self and others; promotion of meaning-making, mission, and communal solidarity; and the larger social/political changes that can emerge from giving voice to silenced experiences. Proposed challenges to redemptive storying include layers of societal oppression and marginalization that shape the redemption stories of many survivor-advocates; ongoing connection to or dependence on relationships and communities that enable abuse; and the reality of historical trauma and other forms of intergenerational trauma, which complicate the linear, individualistic story of redemption. With this theory-driven framework, we wish to promote compassion for survivors, along with interdisciplinary, inclusive, and intersectional research in this understudied area.

Diferencias socioculturales en la terapia de pareja: la perspectiva de terapeutas y parejas consultantes / Sociocultural differences within couple's therapy: the perspective of therapists and consultant couples / Diferenças socioculturais em terapia de casal: a perspectiva de terapeutas e casais

El presente estudio tuvo como objetivo describir cómo participan, en el proceso terapéutico de parejas, las diferencias socioculturales entre terapeutas y parejas consultantes de niveles socioeconómicos (NSE) distintos. Se empleó una metodología cualitativa con un diseño analítico-relacional. La muestra consistió en nueve terapeutas de NSE alto y medio-alto y cinco parejas de NSE bajo y medio-bajo de Santiago de Chile. Se realizaron entrevistas semi-estructuradas y los datos fueron analizados mediante las tres etapas de la técnica Teoría Fundamentada. Los resultados apuntan a que, a pesar de que las diferencias socioeconómicas y socioculturales no se perciben como perjudiciales para el tratamiento cuando se mantiene un vínculo cercano, éstas sí pueden influir las vivencias y tipo de intervenciones de los terapeutas, la alianza terapéutica y simetría de la relación, la evaluación que las parejas hacen sobre el profesional y la terapia, así como la posibilidad de abandono. Aquello depende, en su mayoría, del manejo y características del terapeuta. Los hallazgos adquieren relevancia para la formación y la práctica de terapeutas de pareja, así como de otras modalidades.

The aim of the present study was to describe how sociocultural differences between therapists and consultant couples of different socioeconomic levels (SEL) participate in the couple's therapeutic process. A qualitative methodology with a relational-analytic design was used. The sample consisted of nine therapists of high and middle-high SEL and five couples of low and middle-low SEL of Santiago de Chile. Semi-structured interviews were carried out and data were analyzed by the three stages of the Grounded Theory technique. Results indicate that despite the socioeconomic and sociocultural differences are not perceived as damaging for the treatment when a close bond is held, they can influence the therapists' experiences and interventions, the therapeutic alliance and symmetry of the relationship, the couples' evaluation of the therapist and the possibility of attrition. This mostly depends on the guidance and characteristics of the therapist. The findings become relevant for the training and practice of couple's therapists, as well as other modalities.

Este estudo teve como objetivo descrever como afetam o processo de terapia de casal, as diferenças socioculturais entre terapeutas e casais de nível socioeconômico (NSE) diferente. Foi utilizada uma metodologia qualitativa com um desenho analítico-relacional. A amostra foi composta por nove terapeutas de NSE alto e médio-alto e cinco casais de NSE baixo e médio-baixo de Santiago de Chile. Foram realizadas entrevistas semiestruturadas e os dados foram analisados utilizando os três estágios da Grounded Theory. Os resultados sugerem que, apesar de as diferenças socioeconômicas e socioculturais não serem percebidas como prejudiciais para o tratamento quando uma ligação estreita seja mantida, elas podem influenciar o tipo de experiências e intervenções de terapeutas, a aliança terapêutica e a simetria da relação, a avaliação que os casais fazem do profissional e da terapia, bem como favorecer o abandono. Isso depende principalmente das características e da gestão do terapeuta. Os resultados tornam-se relevantes para a formação e prática de terapeutas de casais e outras modalidades.