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The post-antiretroviral therapy era has transformed HIV into a chronic disease and non-HIV comorbidities (i.e., cardiovascular and mental diseases) are more prevalent in PLWH. The source of these non-HIV comorbidities aside from traditional risk factor include HIV infection, inflammation, distorted immune activation, burden of chronic diseases, and unhealthy lifestyle like sedentarism. Exercise is known for its beneficial effects in mental and physical health; reasons why exercise is recommended to prevent and treat difference cardiovascular and mental diseases in the general population. This cumulative thesis aimed to comprehend the relation exercise has to non-HIV comorbidities in German PLWH. Four studies were conducted to 1) understand exercise effects in cardiorespiratory fitness and muscle strength on PLWH through a systematic review and meta-analyses and 2) determine the likelihood of German PLWH developing non-HIV comorbidities, in a cross-sectional study. Meta-analytic examination indicates PLWH cardiorespiratory fitness (VO2max SMD = 0.61 ml·kg·min-1, 95% CI: 0.35-0.88, z = 4.47, p < 0.001, I2 = 50%) and strength (of remark lowerbody strength by 16.8 kg, 95% CI: 13–20.6, p< 0.001) improves after an exercise intervention in comparison to a control group. Cross-sectional data suggest exercise has a positive effect on German PLWH mental health (less anxiety and depressive symptoms) and protects against the development of anxiety (PR: 0.57, 95%IC: 0.36 – 0.91, p = 0.01) and depression (PR: 0.62, 95%IC: 0.41 – 0.94, p = 0.01). Likewise, exercise duration is related to a lower likelihood of reporting heart arrhythmias (PR: 0.20, 95%IC: 0.10 – 0.60, p < 0.01) and exercise frequency to a lower likelihood of reporting diabetes mellitus (PR: 0.40, 95%IC: 0.10 – 1, p < 0.01) in German PLWH. A preliminary recommendation for German PLWH who want to engage in exercise can be to exercise ≥ 1 time per week, at an intensity of 5 METs per session or > 103 MET·min·day-1, with a duration ≥ 150 minutes per week. Nevertheless, further research is needed to comprehend exercise dose response and protective effect for cardiovascular diseases, anxiety, and depression in German PLWH.
Background
Depression is one of the key factors contributing to difficulties in one’s ability to work, and serves as one of the major reasons why employees apply for psychotherapy and receive insurance subsidization of treatments. Hence, an increasing and growing number of studies rely on workability assessment scales as their primary outcome measure. The Work and Social Assessment Scale (WSAS) has been documented as one of the most psychometrically reliable and valid tools especially developed to assess workability and social functioning in patients with mental health problems. Yet, the application of the WSAS in Germany has been limited due to the paucity of a valid questionnaire in the German language. The objective of the present study was to translate the WSAS, as a brief and easy administrable tool into German and test its psychometric properties in a sample of adults with depression.
Methods
Two hundred seventy-seven patients (M = 48.3 years, SD = 11.1) with mild to moderately severe depression were recruited. A multistep translation from English into the German language was performed and the factorial validity, criterion validity, convergent validity, discriminant validity, internal consistency, and floor and ceiling effects were examined.
Results
The confirmatory factor analysis results confirmed the one-factor structure of the WSAS. Significant correlations with the WHODAS 2–0 questionnaire, a measure of functionality, demonstrated good convergent validity. Significant correlations with depression and quality of life demonstrated good criterion validity. The WSAS also demonstrated strong internal consistency (α = .89), and the absence of floor and ceiling effects indicated good sensitivity of the instrument.
Conclusions
The results of the present study demonstrated that the German version of the WSAS has good psychometric properties comparable to other international versions of this scale. The findings recommend a global assessment of psychosocial functioning with the sum score of the WSAS.
The primary focus on the present study was to identify early risk factors for infant aggression in a sample of high risk, low-income teenager mothers and their infants. Despite the amount of research on externalizing behavior, relatively little is known about its development in early childhood. Because chronically aggressive school-age children tend to be those who first display symptoms during preschool years, an examination of the early manifestations of aggressive behavior and the development of measurements for infants is needed. The present study explored a model of infant aggression development that emphasized infant aggression developing largely through the interaction of infant′s dispositional characteristics with their caregiving environment. The study addressed the following relations: (1) Maternal psychosocial functioning with reported and observed infant aggression and negative emotionality, (2) reported measurements of infant aggression and negative emotionality with observed infant measurements of infant aggression and negative emotionality, (3) infant negative emotionality and infant aggression, (4) infant emotion regulation with infant aggression and negative emotionality, (5) the interaction between emotion regulation and negative emotionality in relation to infant aggression, and (6) attachment classification with infant aggression and negative emotionality. Finally, the question of whether these six relations would differ by gender was also addressed. Maternal psychosocial functioning was assessed with self-reported measurements. Infant aggression, negative emotionality and emotion regulation were measured during two standardized assessments, the Strange Situation and the Bayley Scales of Infant Development Assessment and maternal reported with the Infant-Toddler Social and Emotional Assessment. Several interesting findings emerged. One of the main findings concerned maternal attribution and its possible role as a risk factor for later externalizing behaviors. That is, mothers, especially depressed and stressed mothers, tended to report higher levels of infant aggression and negative emotionality than was noted by more objective observers. This tendency was particularly evident in mothers with girl infants. Another important finding concerned emotion regulation. Even at this early age, clear differences in emotion regulation could be seen. Interestingly, infants with high negative emotionality and low emotion regulation were observed to be the most aggressive. Also significant relations emerged for infant negative emotionality and aggression and vise versa. Thus, for purposes of treatment and scientific study, the three constructs (emotion regulation, negative emotionality, and aggression) should be considered in combination. Investigating each alone may not prove fruitful in future examinations. Additionally, different emotion regulation behaviors were observed for girl and boy infants. Aggressive girls looked more at the environment, their toys and their mother, whereas aggressive boys looked less at the environment and their mother and explored their toys more, although looked at the toys less. Although difficult to interpret at this point, it is nonetheless interesting that gender differences exist at this young age in emotion regulatory behaviors. In conclusion, although preliminary, findings from the present study provide intriguing directions for future research. More studies need to conducted focusing on infant aggression, as well as longitudinal studies following the infants over time.