Exploring attachment security in a sample of Lebanese adolescents: The validation of the Arabic IPPA-R

Despite growing evidence supporting the importance of the quality of attachment during adolescence, no studies have been conducted to date in the Arab world due to an absence of valid and reliable tools to measure this construct in Arabic. The Inventory of Parent and Peer Attachment-Revised (IPPA-R) was devised as a self-report questionnaire in English to assess the quality of adolescent attachment to mother, father, and peers, each scale consisting of 25 items. The current study sets out to determine the psychometric properties of the Arabic IPPA-R and to explore attachment styles in Lebanon in a sample of 765 Lebanese adolescents. Results suggested a modified three-factor structure to reach satisfactory reliability of the Arabic IPPA-R, resulting in a modified questionnaire consisting of 19 items for each of mother (α = .82) and father (α = .85), and 21 items for peers (α = .89). Strict measurement invariance across gender was achieved for the IPPA-R parental forms, while only scalar invariance was achieved for the IPPA-R peers form. Overall, there were significant differences in attachment scores to mother and father, with adolescents scoring higher on attachment to mother, with both scores being significantly lower than attachment to peers. Gender differences were found on the peer scale with girls scoring significantly higher than boys. Results are interpreted from a cultural lens, emphasizing the importance of accounting for cultural, religious, and socio-economic factors in understanding adolescent attachment. This study is the first conducted in the Arab region and provides a road map to understanding gender-roles, parental expectations and adolescent perceived parenting, and their impact on adolescent attachment scores.

Reliability and validity of the Arabic version of the Consultation and Relational Empathy (CARE) measure

PURPOSE

Empathy is the ability to communicate an understanding of an individual's subjective experience. It plays a vital role in the physician-patient relationship and improves clinical outcomes. This increases the importance of measuring and studying empathy in the clinical setting. The Consultation and Relational Empathy (CARE) is a 10-item questionnaire that measures patient assessment of physician's empathy in primary care. To our knowledge, there are no validated measures of empathy in the clinical setting in Arabic. This study aims at validating the CARE in Arabic.

METHODS

Data collection took place between October 2019 and February 2020. A total of 220 patients completed the questionnaire which consisted of the 10 CARE items, participants' opinions regarding the importance of each item, demographic information, and information about the consultation. The reliability and validity of the Arabic CARE were measured using Cronbach alpha, item-total correlations, and factor analysis. Construct validity was measured based on the overall patient satisfaction, and their satisfaction with the length of the consultation.

RESULTS

High Cronbach alpha and item-total correlation reveal the internal consistency and homogeneity of the Arabic version. Our findings showed significant positive correlations between CARE score and each of the characteristics: overall satisfaction with the consultation, duration of the consultation, patients' satisfaction with consultation duration and whether they would recommend the doctor to others.

CONCLUSION

The Arabic version of the CARE measure appears to be valid and reliable. It is available for use in research, education, and assessment of physicians' empathy.

The Psychological Impact of the COVID-19 Outbreak on Pregnancy and Mother-infant Prenatal Bonding

This study aimed to assess the impact of the COVID-19 stress and anxiety on prenatal attachment during the second trimester of gestation. Pregnancy is an important stage for mothers-to-be in creating representations of themselves as a “mother”, with the developing attachment relationship to the unborn child considered as a milestone in the future parent’s developmental trajectory. The outbreak of the COVID-19 pandemic and the national health measures installed can hence have consequences on these representations and on prenatal attachment. Our sample consisted of 95 mothers that were recruited from a prenatal ultrasound screening center. Results suggested that the COVID-19 pandemic significantly affected prenatal attachment (PAI) with significant correlations between PAI total score and age, anxiety (DASS) and stress (IES-R). When entered in one model looking for predictors of PAI total score, age and COVID-19 stress were the only variables found to significantly predict prenatal attachment. We argue for a cultural component in explaining these results, hypothesizing that stress could trigger defensive strategies, leading to more investment in the attachment relationship, potentially playing the role of a protective factor.

Health Literacy Levels and Predictors Among Lebanese Adults Visiting Outpatient Clinics in Beirut

BACKGROUND

To date, there has been a dearth of research on health literacy in the Eastern Mediterranean Region and in particular Lebanon.

OBJECTIVES

This cross-sectional study assessed the levels and correlates of health literacy in Lebanese adults.

METHODS

A total of 587 participants (54.5% women) were recruited from the outpatient clinics of five health facilities in Beirut. The questionnaire consisted of the Arabic version of the Functional Health literacy Scale, the Arabic short version of the European Health Literacy Survey, and questions on sociodemographic and health-related factors. Descriptive and inferential statistics were performed to assess the association of these factors with functional health literacy (FHL) and comprehensive health literacy (CHL) levels.

KEY RESULTS

About 65.8% had inadequate or problematic FHL and 43.8% had inadequate or problematic CHL. Although FHL was negatively correlated with long-term illness, it was positively correlated with ability to pay and health status. CHL was positively correlated with education, income, ability to pay for treatment, health status, and FHL level, whereas it was negatively correlated with long-term illness. Binary logistic regression showed that low education, low socioeconomic status, and being a widow were predictive of inadequate FHL. Moreover, having inadequate FHL and low income increased the likelihood of having inadequate CHL.

CONCLUSION

This study has identified those with risk factors for inadequate health literacy and unfavorable health outcomes. A national action plan can guide the promotion of health literacy and its embeddedness in society to instill competencies and the environment that would eliminate health inequities and sustain health in Lebanon. [HLRP: Health Literacy Research and Practice. 2021;5(4):e295-e309.] Plain Language Summary: This study examined health literacy levels and correlates in 587 Lebanese adults using two recognized screening tools. The first tool measured functional health literacy (FHL), which represents the ability of a person to acquire information on health through reading or writing. The second tool assessed comprehensive health literacy (CHL), which encompasses the ability of a person to use their social skills to acquire health information from different media and make appropriate health decisions based on this information. Close to two-thirds of the participants had inadequate or problematic FHL. More specifically, low education, low socioeconomic status, and widowhood were predictive of inadequate FHL. Nearly one-half of the participants had inadequate or problematic CHL with an increased likelihood of inadequate levels in people with low FHL and low income.

Trait Emotional Intelligence and Wellbeing During the Pandemic: The Mediating Role of Meaning-Centered Coping

Studies investigating the COVID-19 pandemic from a psychological point of view have mostly focused on psychological distress. This study adopts the framework of existential positive psychology, a second wave of positive psychology that emphasizes the importance of effective coping with the negative aspects of living in order to achieve greater wellbeing. Trait emotional intelligence (trait EI) can be crucial in this context as it refers to emotion-related personality dispositions concerning the understanding and regulation of one's emotions and those of others. The present study investigated the relationship between trait EI and both wellbeing and psychological distress (i.e., depression, anxiety, and stress), while exploring the mediating role of meaning-centered coping (proactive transformative strategies based on meaning in life) and maladaptive coping (i.e., behavioral disengagement and self-blame) during the first few months of the COVID-19 pandemic. A sample of 326 Lebanese adults completed measures of trait EI, wellbeing, psychological distress, coping, and meaning-centered coping. Results showed a strong positive correlation between trait EI and meaning-centered coping. Trait EI also correlated positively with wellbeing and negatively with psychological distress. Structural equation modeling showed that meaning-centered coping partially mediated the relationship between trait EI and wellbeing. Maladaptive coping fully mediated the relationship between trait EI and psychological distress. Findings indicate that trait EI is positively related to dealing with a stressful situation such as the pandemic in positive ways at both the cognitive level, by reformulating the situation to see something valuable in it, and behavioral level, by being proactive about it. Trait EI was positively linked to seeing the situation as an opportunity for personal growth, finding personal meaning in this situation, maintaining an attitude of hope and courage, and acting more responsibly with one's self and others during the current crisis. In turn, this coping formula was related to lower psychological distress and improved mental health. These results are consistent with the existential positive psychology framework and can inform implementation programs and policies aiming at raising awareness and promoting healthy and successful coping during the pandemic.

Phenotypic lag and population extinction in the moving-optimum model: insights from a small-jumps limit

Continuous environmental change-such as slowly rising temperatures-may create permanent maladaptation of natural populations: Even if a population adapts evolutionarily, its mean phenotype will usually lag behind the phenotype favored in the current environment, and if the resulting phenotypic lag becomes too large, the population risks extinction. We analyze this scenario using a moving-optimum model, in which one or more quantitative traits are under stabilizing selection towards an optimal value that increases at a constant rate. We have recently shown that, in the limit of infinitely small mutations and high mutation rate, the evolution of the phenotypic lag converges to an Ornstein-Uhlenbeck process around a long-term equilibrium value. Both the mean and the variance of this equilibrium lag have simple analytical formulas. Here, we study the properties of this limit and compare it to simulations of an evolving population with finite mutational effects. We find that the "small-jumps limit" provides a reasonable approximation, provided the mean lag is so large that the optimum cannot be reached by a single mutation. This is the case for fast environmental change and/or weak selection. Our analysis also provides insights into population extinction: Even if the mean lag is small enough to allow a positive growth rate, stochastic fluctuations of the lag will eventually cause extinction. We show that the time until this event follows an exponential distribution, whose mean depends strongly on a composite parameter that relates the speed of environmental change to the adaptive potential of the population.

Leprosy in a trachomatous population

In an Egyptian leprosy hospital, 17% of 133 patients had a visual acuity of less than 3/60. Corneal opacity, phthisis bulbi, and cataract accounted for 85% of blindness. Leprosy and trachoma together produce blinding corneal opacity by exposure, leprous keratitis, and trichiasis and entropion. Inturned lids, a late result of conjunctival scarring due to childhood trachoma, were less frequent in patients with lepromatous leprosy than in patients with tuberculoid leprosy; because conjunctival scarring from trachoma depends on cell-mediated immunity, patients with lepromatous leprosy may not have had severe trachomatous scarring develop due to their lifelong abnormality in cellular immunity. In patients with leprosy, even when complicated by trachoma, simple measures to prevent or restore vision include medical treatment of leprosy, surgical correction of lid deformities, sector iridectomy for constricted pupils or central corneal opacities, and cataract extraction.