Critically analyse access to a health services for a cultural group other than your own within our community. -- Aboriginal and/or Torres Strait Islanders (ATSI)

Table Of Contents

Title	1
1.  Introduction	3
2.   Aboriginal And Torres Strait Islander (ATSI) And Health Services	3
3.   Maternity Related Problems to Aboriginal And Torres Strait Islanders	4
4.   Difficulties In Offering Proper Maternity Care	6
5.   Recommendations: How maternity services and care can be improved for women of ATSI?	6
6.   Conclusion	8
7.   References	9

Introduction

A theory of social determinants identifies that health and inequality in population is established by several interrelated social factors. Similarly, it is a fundamental principle of human rights decree that all rights are integrated and that influencing on the pleasure of one right will influence the enjoyment of others. Due to this synergy, human rights discussion offers a framework for evaluating the likely health impacts of government programs and policies on Indigenous peoples. The social determinants affect the health status of the population indirectly and directly through lifestyle risk factors and access to, or/and utilisation of the health care system. In Australia, providing improvement and easy access to the health of the indigenous people is still a big challenge for the government of Australia. 

Aboriginal And Torres Strait Islander (ATSI) And Health Services

Aboriginal and Torres Strait Islander (ATSI) are the indigenous people of Australia with distinct histories, identities, and cultural practices.  The national statistics for them may mask significant geographic disparities in their health and social wellbeing. The health construct of ATSI is not merely regarding the physical wellbeing of the person. It is the cultural, emotional and social wellbeing of the whole community, a notion that is generally overlooked by conventional health services. It is thus expected that conventional health services suffer from added challenges in an attempt to gain the trust of Torres Strait Islander and Aboriginal people. The most prominent area suffering in this regard is the maternity.  Aboriginal and Torres Strait Islander females and children persist to experience greater rates of morbidity and mortality in comparison to non-Indigenous females and children (Kildea & Wardaguga, 2009). About delivery of such maternal care, ATSI health services put emphasis on the value of a holistic approach towards their health care, where mental, ethical and social wellbeing is associated with its cultural and historical context. Nevertheless, there is an uneven burden of unfavourable perinatal effects for mothers and their children of Aboriginal and Torres Strait Islander, including high maternal mortality rate.  And this rate is four fold high compared to Australian females. In ATSI there is wide difference in pre-term birth percentage (13.5% against 8.0%), perinatal deaths rates (17.1 percent against 8.8 percent per one thousands births) and low birth weight percentage (12.0 percent against 6.0 percent) ( Jongen,  McCalman , Bainbridge  & Tsey, 2014; Australian Bureau of Statistics, 2015).

The causes behind the sobering inequality are diverse and multifaceted.  This paper will critical analysis the maternity issue among ATSI women, difficulty to use maternity services for them owing to their culture and social determinant and will also present the recommendation to improve the current situation.

Maternity Related Problems to Aboriginal And Torres Strait Islanders

The maternity period is a unique stage of life for women since it may bring lots of challenges as well as opportunities with it. Since the reproductive health outcomes for mothers and infants of Aboriginal and Torres Strait Islander are considerably poorer; they even deteriorate with growing distance where the provision of such services becomes more difficult (Murphey & Best, 2012).  In fact, a lot of Aboriginal and Torres Strait Islander women at present do not have access to quality primary maternity care. Even in rural and distant areas such women in particular are being deprived of access to first-class care from the complete variety of health expertise. They can only receive such a care that is inconsistent and does not meet their social and cultural requirements.

At present the provision of maternity services to women of Aboriginal and Torres Strait Islander is greatly inadequate.  The pregnant women of ATSI often face seclusion from a partner, friends, family, and culture and society for the birth of their babies and this may cause a great impact on their wellbeing.  Too much stress, separation from familiar and fostering people, environment and cultural ways, brings about apprehension, sorrow and loneliness at a vital phase. While several urban promotes the values of family-friendly birth settings and offer choices for community midwifery services, a lot of female in remote areas and of Aboriginal and Torres Strait Islander face dislocation from the families (Hancock, 2009) and this serves as risk factors for causing high stress levels .  The use of alcohol tobacco and other drugs pregnancy in the women of this community is also found to be high which lack their proper health education and awareness.  Due to cultural difference women of ATSI feel uncomfortable for regular medical checkups and suffer from such unhealthy activities.

Difficulties In Offering Proper Maternity Care

The magnitude and lasting nature of disparity in provision of maternity care to Aboriginal and Torres Strait Islander women is partially due to cultural and traditional values of these people. The notion of gender specific scaffolds among ATSI people conveys that women and men have dissimilar needs, life experiences, degrees of authority, access to information from diverse sources to help decision making and approaches of expressing sickness(Kildea, Kruske, Barclay, & Tracy, 2010). Those dissimilarities impact on the manner that women and men of ATSI interact with the health services.  Furthermore, culturally, it is not easy for women of Aboriginal and Torres Strait Islander to seek medical help early in their pregnancy. For a large number of Indigenous women, their primary visit to a medical centre or hospital is on the day of labour.  As a result it becomes difficult to recognise antenatal complications in such women as early as possible and likewise, premature birth rates and mortality rates rise in them.

As with the Indigenous Australian population, family violence is an unseen concern. A study demonstrated that family violence causes major influence on the health of Indigenous women compared to women of other Australian groups.  Due to the family fear, they avoid consulting a health service and therefore escape those issues which can be prevented if detected earlier. Early and ongoing maternity care facilitates a plan of care to be made in the first trimester. Lack of care and late visiting to get the antenatal care increases the rates of perinatal morbidity and mortality (Rumbold et al, 2012). This also affects their reproductive health outcomes and presents challenges to healthcare provider to identify them and offer them with pertinent treatment accordingly. The ATSI women have least awareness regarding how to be cautious in pregnancy because they lack a proper health education due to less exposure to it. Women with comorbidities need to be conscious of the effect of their diseases on pregnancy, in addition to, the effect of pregnancy on their existing health comorbidity.  

Additionally, social, financial and psychological problems which generate stress, a lack of control over situations and unproductive self-management are believed to be the greater determinants (Whiteside, Tsey & Cadet, 2009).  Their financial resources are less which also prevent them for undergoing proper medical advice and help.

Recommendations: How maternity services and care can be improved for women of ATSI?

In spite of cultural and social resistance, it is the duty of the health care provider to provide culturally safe maternity health care. A policy should be developed which tackle such issues and endorses education of not only indigenous women but also of practitioners regarding delivery of maternity services to challenging patients.  Since cultural, spiritual, and social wellbeing is very important to the people of Aboriginal and Torres Strait Islander it is imperative that their health needs be considered in this background. Cultural safety offers a practical framework to improve the provision of maternity services to ATSI women and their families (Reibel & Walker, 2010).  This can be offered by developing a multi-agency move towards service delivery in line with the fact that maternity services for indigenous people cannot address health inequalities singly.

“The Council of Australian Governments (COAG) recognises that strategies aimed at achieving improvements in any particular area will not work in isolation – the building blocks must fit together through the integration of policy ideas and an agreed approach to their implementation” (Aboriginal Health Council of Western Australia, 2011)

It is the duty of the government as well as health practitioner to make sure that Aboriginal and Torres Strait Islander women should have access to first-rate maternity services. And, these services must be culturally safe, offer continuous care and access to the greatest expertise (Australian Government, 2009). Nurses can help filled the gap by enhancing communication, by addressing social, cultural and emotional health needs of and Aboriginal and Torres Strait Islander women.  Considering the disparity in health services to indigenous community, the nurses can play a role in improving the care of Aboriginal and Torres Strait Islander pregnant women by removing those disparities and giving equal treatment opportunities.  They can encourage women living in rural or remote areas to get an early maternal care and can work to get them access to such services. Early access to maternity service is a sign of the victory of this approach (Bar-Zeev, Barclay, Farrington & Kildea, 2012).

Conclusion

In conclusion, there are growing rather than declining challenges to the provision of safe maternity services to Aboriginal and Torres Strait Islander women. Transforming the approach care is delivered could endorse significant improvements. The cultural aspect should be considered because it is from within the community and culture that actual optimistic changes in the people’s health commence.

References

AHMAC (2012). Aboriginal and Torres Strait Islander Health Performance Framework 2012 report. Canberra: AHMAC.

Australian Bureau of Statistics (2015). 'Births, Australia, 2014', ABS, Canberra, Retrieved from: <www.abs.gov.au>.

Australian Government (2009). Steering Committee for the Review of Government Service Provision, Overcoming Indigenous Disadvantage Report. Canberra, ACT: Commonwealth of Australia: Retrieved from: http://www.pc.gov.au/research/ongoing/overcoming-indigenous-disadvantage/key-indicators-2014

Bar-Zeev SJ, Barclay L, Farrington C, Kildea S. (2012). From hospital to home: the quality and safety of a postnatal discharge system used for remote dwelling Aboriginal mothers and infants in the top end of Australia. Midwifery 28, 366–373.

Hancock, H. (2009). Low birth weight in Aboriginal babies: A need for rethinking Aboriginal women’s pregnancies and birthing. Women and Birth 20, 77–80.

Heffernan, B., Iskandar, D. & Freemantle, J. (2012), The History of Indigenous Identification in Victorian Health Datasets, 1980-2011: Initiatives and Policies Reported by Key Informants. Lowitja Institute, Melbourne.

Jongen C,  McCalman J , Bainbridge R and Tsey K. (2014). Aboriginal and Torres Strait Islander maternal and child health and wellbeing: a systematic search of programs and services in Australian primary health care settings. BMC Pregnancy and Childbirth, 14, 251.

Kildea S, Kruske S, Barclay L, Tracy S (2010) ‘Closing the Gap’: How maternity services can contribute to reducing poor maternal infant health outcomes for Aboriginal and Torres Strait Islander women Rural and Remote Health 10, 1383. 

Kildea S, Wardaguga M. (2009). Childbirth in Australia: Aboriginal and Torres Strait Islander Women. In: H Selin, P Stone (Eds). Childbirth across cultures, ideas of pregnancy, childbirth and the postpartum period in many of the worlds cultures. Amherst: Springer, 275-287.

Murphey E, Best E. (2012).  The Aboriginal Maternal and Infant Health Service: a decade of achievement in the health of women and babies in NSW. N S W Pub Health Bull 23, 68–72.

Reibel, T & Walker, R. (2010). Antenatal services for Aboriginal women: the relevance of cultural competence. Quality in Primary Care 18, 65–74.

Rumbold, A, Bailie, R, Si, D, Dowden, M, Kennedy, C, Cox, R, O’Donoghue, L, Liddle, H, Kwedza, R & Thompson, S. (2011).Delivery of maternal health care in Indigenous primary care services: baseline data for an ongoing quality improvement initiative’, BMC pregnancy and childbirth 11, 1, 16.

Whiteside M, Tsey K, Cadet-James Y. (2009). Empowerment as a social determinant of Indigenous Australian health - the case of the Family Wellbeing Programme. In Social Work and Global Health Inequalities. Edited by Bywaters P, McLeod E, Napier L. Bristol, UK: Policy Press; 165–171.

Diagnostic Accuracy

Diagnostic Accuracy

Diagnosis and management of cardiac disease represents most important challenges to the present health care system, influencing a great number of patients every year. However, the accurate diagnosis of cardiac disease has been possible now by means of several important tests, including Exercise test, Routine Echo study, Coronary CT study, Stress Echo and Cardiac Catheterization. Additionally, early diagnosis of chest pain and assessment of risk for heart attacks can help prevent complications in the long run.

Exercise or stress testing is one of the simple yet well-established tests that have been in common clinical use for several decades. Exercise stress testing offers a less expensive, non-invasive technique of risk stratification before coronary angiography, and if it comes to be negative, then it may actually suggest avoiding angiography (Ellestad, 2003). Exercise testing has a specificity of 70% and a sensitivity of 78% for identifying any disease in the coronary artery. Therefore, it cannot be employed to diagnose ischaemic heart disease unless the chance of coronary artery disease is taken into consideration (Whaley, Brubaker, Otto and Armstrong, 2006).

Stress testing is often performed for an early assessment of patients with suspected heart disease, particularly coronary heart disease. Stress testing has been in use since the late 1920s as a suitable, non-invasive way to evaluate exercise induced myocardial ischemia (Master and Oppenheimer, 1929).  The myocardial oxygen demand is increased by the exercise increases and it may not be met when a stenosis of a coronary artery is present, leading to ischemia of the heart muscles. This is presented as a change in ST segment on the ECG, in addition to symptoms. ST segment depression is the most consistent indicator of ischaemia induced by exercise.  

Echocardiography, on the other hand, has raised the diagnostic precision of non-invasive cardiac assessment. It helps to monitor cardiac functions. By the help of sound waves Echocardiography differentiates body tissues of dissimilar density.  This test is required where there is complaint of heart murmur, heart attack, unexplained chest pains, congenital heart defect and rheumatic fever. It determines the shape and size of the heart along with how well it is working (Yong, Wu, Fernandes, Kopelen, Shimoni, Nagueh et al., 2002). It also helps to identify the problems with the heart’s valves and thrombosis formation within the vessels. A number of different types of echocardiography are performed nowadays, including Doppler echocardiography, M-mode echocardiography, Stress echocardiography, etc. The sensitivity and specificity of echocardiography are 80% and 100% with regard to ventricular dysfunction and heart failure respectively (Yong, Wu, Fernandes, Kopelen, Shimoni, Nagueh et al., 2002).

Stress echo usually involves the utilisation of Doppler and 2-D echocardiography to verify the doubt of coronary artery disease, and in case the disease is present, it helps to find out its severity (Elhendy, Windle and Porter, 2001). This test is carried out at rest and following pharmacological or physical stress and the images obtained are then compared with each other. It is performed as soon as the patient is asked to stop exercising in order take images of the heart functioning under stress. This test is harmless non-invasive and has rare complications. The results from echocardiography stress test are quite reliable.

Coronary computed tomography is a cardiac imaging test that assists in determining if thrombosis formed has constricted the coronary arteries of a patient (Hoffmann, Shi and Schmitz, 2005). Coronary arteries are the main blood vessels that supply blood to the heart. Thrombosis or plaque is composed of different substances present in the blood, for example calcium, cholesterol, and fat that deposit inside the arteries.

Computed tomography, also known as a CT scan, is a similar diagnostic test to conventional x-rays, but it generates numerous images of the inside of the body.  Coronary CT angiogram procedure utilizes intravenous dye containing iodine (Kuettner, Beck, Drosch, et al., 2005). Coronary CT serves as a major new test in the diagnosis of coronary artery disease. This test plays a great role in the diagnosing of diseases in patients with high risk of developing coronary disease, and in those patients who have undecided findings with treadmill or other medical testing (Achenbach, Giesler, Ropers,et al., 2001). The patients at high risk are usually cigarette smokers, diabetics, patients with high levels of cholesterol and hypertensive patients.

In case the CT scan comes out normal or shows only mildly abnormality, the chances of a severe obstruction of the coronary arteries decrease. On the other hand, if the CT scan is considerably abnormal, then the need of cardiac catheterization may occur, in order to see if stenting, angioplasty, or coronary bypass surgery is required.

A cardiac catheterization, also known as angiogram, is a procedure that helps to get the direct information of the patterns of blood flow and blood pressures within the heart. The catheterization is basically placing of small intravenous tubes in the artery and vein of a leg, neck or the arm (Leopold and Faxon, 2015). Via these intravenous tubes the thinner tubes, known as catheters, are passed into the circulation. This catheter is then moved slowly via the circulation so that it reaches the heart. From the heart it is then passed to certain chambers of the heart and to the arteries and veins joined to the heart. The pressures in the cardiac chambers can be measured.   Most of the time during this process of catheterization an angiogram is also carried out. This is performed by injecting a dye or contrast via the catheter into a chamber or a blood vessel of the heart.  As the dye is perceptible by X-ray, the blood flow through the heart is noted. Valves and blood vessels also become visible and evaluated for abnormalities. An angiogram needs much more X-rays compared to a simple chest X-ray’s need (Leopold and Faxon, 2015). Hence, the test is done only when there is an absolute indication. Nevertheless, a number of studies have been established no long-term adverse effects of angiography and cardiac catheterization in people who had undergone such tests.

Thus, a prompt and precise assessment of acute chest pain has enormous implications for morbidity and mortality of the patient as well as health care economics (Schillinger, Sodeck, Meron, Janata et al., 2004).  The majority of patients with chest pain in the emergency department have no bothersome electrocardiographic abnormalities, in addition to any history of coronary artery disease. Same is the case with Fed and this presents a little challenge to physicians. In this regard, for this particular patient, the most appropriate tests would be Echocardiography and Coronary CT. These tests are chosen because via echo the structure and function of heart of the patient can be evaluated and through Coronary CT the coronary arteries can be assessed. In this way, several causes of chest pain pertaining to heart can be indentified and excluded.

The principal goal of the assessment of patients with sudden chest pain in the emergency department is precise risk stratification and detection or exclusion of acute coronary syndromes, rather than the identification of coronary artery disease (Sun, Lin, Davidson, Dong et al., 2008). According to a research by Tong, Kaul, Wang et al (2005) echocardiography not only provides information regarding the shape and size of the heart but also reveals areas of scanty blood flow to the heart, regions of cardiac heart muscle not contracting normally, and preceding injury to the cardiac muscle as a result of poor blood flow. Overall, it gives a complete picture and is simple to detect the causes of chest pain by detecting poor flow of blood to the cardiac muscles.

Likewise, coronary CT approach helps established the immediate cause of chest pain i.e. acute coronary syndrome and also reveals cardiac problems in high risk patients as mentioned above.  A study by Laudon et al (2010) found cardiac coronary CT approach specific for the evaluation of possible acute coronary syndrome; the quantification of coronary artery calcium. The elevated the coronary artery calcium score, the greater the likelihood of an unstable plaque present in the coronary artery tree that may associate with a patient's chest pain. A studies by Chang, Choi, Choi, et al. (2008) and Goldstein, Gallagher, O'Neill, et al. (2007) stated that cardiac CT angiography facilitate early discharge of patients and also lower the cost than common standard assessment algorithms. Hoffmann U, Nagurney, Moselewski, et al. (2006) studied coronary CT angiography and found the 100% sensitivity for distinguishing acute coronary syndrome while the specificity found was 54%.

Conversely, other tests like Stress echo and stress testing require patient being stable and capable of undergoing a physical activity. Since Fred is in pain and has an arthritis and walk with the support of a cane, therefore he cannot undergo such testings. No doubt, stress testing is the first line diagnostic test, yet considering the condition of the patient, this test cannot be advised here.  It is his right to be comfortable while undergoing cardiac evaluation. Cardiac catheterization is little invasive and is not needed for now when non-invasive can help established the diagnosis. Furthermore, it is done when other factors or tests suggest that a person has chronic heart disease (Maron, Stone, Berman, Mancini, et al., 2011).

In Fred, the test will carried out with the following order. At First, the routine Echo study will be carried out in order to check the function and structure of the heart. It is better to go with the non-invasive first considering the condition of this patient (Sharples, Hughes, Crean, Dyer et al., 2007).  Following this coronary CT study will be conducted to determine the cause within the coronary arteries since the use of coronary calcium scoring via coronary CT is a first line testing approach for lower risk groups, as it is expected to be cost-effective.

The probable outcomes from echocardiography and coronary CT scan would be helpful for the detection of cause of chest pain associated with the heart. Patients with chest pain of sudden origin may have vague results from tests like ECG and thus needs not only functional imaging but further testing. Also, early testing has been shown to improve the health outcomes of the patients.  The most probable outcomes in Fred would be the detection of presence of areas of heart where blood supply is poor or presence of plaque or thrombosis in the coronary artery causing obstruction to blood flow and a chest pain. These tests will help in either detecting or excluding possible cause of chest pain related to heart. If the cause is linked to the problems in the heart, it can be easily detected via both of the selected tests. Since, the frequency of non-cardiac causes of chest pain is common too, these test will help to find whether the cause of chest pain is cardiac or non-cardiac.

References

Achenbach S, Giesler T, Ropers D, et al. Detection of coronary artery stenoses by contrast-enhanced, retrospectively electrocardiographically-gated, multislice spiral computed tomography. Circulation. 2001; 103:2535–2538.

Chang SA, Choi SI, Choi EK, et al. Usefulness of 64-slice multidetector computed tomography as an initial diagnostic approach in patients with acute chest pain. Am Heart J. 2008;156:375-383 

Elhendy A, Windle J, Porter T. Safety and feasibility of dobutamine stress echocardiography in patients with implantable cardioverter defibrillators. Am J Cardiol 2003;92: 475-7.

Ellestad MH. Stress testing : principles and practice. Oxford; New York: Oxford University Press; 2003.

Goldstein JA, Gallagher MJ, O'Neill WW, et al. A randomized controlled trial of multi-slice coronary computed tomography for evaluation of acute chest pain. J Am Coll Cardiol. 2007;49:863-871 

Hoffmann MH, Shi H, Schmitz BL, et al. Noninvasive coronary angiography with multislice computed tomography. JAMA. 2005; 293:2471–2478.

Hoffmann U, Nagurney JT, Moselewski F, et al. Coronary multidetector computed tomography in the assessment of patients with acute chest pain. Circulation 2006; 114:2251-2260.

Kuettner A, Beck T, Drosch T, et al. Diagnostic accuracy of noninvasive coronary imaging using 16-detector slice spiral computed tomography with 188 ms temporal resolution. J Am Coll Cardiol. 2005; 45:123–127.

Laudon DA, Behrenbeck TR, Wood CM, et al. Computed tomographic coronary artery calcium assessment for evaluating chest pain in the emergency department: long-term outcome of a prospective blind study. Mayo Clin Proc. 2010; 85(4):314-322

 Leopold JA, Faxon DP. Diagnostic Cardiac Catheterization and Coronary Angiography. In: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J.eds. 'Harrison's Principles of Internal Medicine, 19e. New York, NY: McGraw-Hill2015.

Maron DJ, Stone GW, Berman DS, Mancini GB, Scott TA, Byrne DW, Harrell FE Jr, Shaw LJ, Hachamovitch R, Boden WE, Weintraub WS, Spertus JA. Is cardiac catheterization necessary before initial management of patients with stable ischemic heart disease? Results from a Web-based survey of cardiologists. Am Heart J.  2011, Dec; 162(6):1034-1043.

Master A, Oppenheimer E. A simple exercise tolerance test for circulatory efficiency with standard tables for normal individuals. Am J Med Sci. 1929; 177:223–43.

Schillinger M, Sodeck G, Meron G, Janata K et al. Acute chest pain-- identification of patients at low risk for coronary events. The impact of symptoms, medical history and risk factors. Wiener klinische Wochenschrift. 2004, 116 (3) :83-89.

Sharples L, Hughes V, Crean A, Dyer M et al. Cost-effectiveness of functional cardiac testing in the diagnosis and management of coronary artery disease: a randomised controlled trial. The CECaT trial. Health Technol Assess. 2007; 11 (49):1-115.

Sun Z, Lin C, Davidson R, Dong C et al. Diagnostic value of 64-slice CT angiography in coronary artery disease: A systematic review. Eur J Radiol. 2008; 67 (1):78-84.

Tong KL, Kaul S, Wang ZQ, et al. Myocardial contrast echocardiography versus thrombolysis in myocardial infarction score in patients presenting to the emergency department with chest pain and a nondiagnostic electrocardiogram. J Am Coll Cardiol. 2005; 46:920-927

Whaley MH, Brubaker PH, Otto RM, Armstrong LE. ACSM's guidelines for exercise testing and prescription. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2006

Yong Y, Wu D, Fernandes V, Kopelen HA, Shimoni S, Nagueh SF et al. Diagnostic accuracy and cost-effectiveness of contrast echocardiography on evaluation of cardiac function in technically very difficult patients in the intensive care unit. Am J Cardiol 2002; 89:711–8.

Obesity

Obesity is a medical situation  in which unnecessary body fat accumulates to the level that it may have an unfavorable effect on health that pave the way to reduced life expectancy and/or increased health problems. A dimension which evaluates and compares weight and height is the Body mass index (BMI).  It classifies people as overweight i.e. pre-obese if their BMI ranges between 25 and 30 kg/m2, and classifies as obese when it is more than 30 kg/m2. Obesity increases the incidence of various diseases like, Heart problems, Obstructive sleep apnea, Type 2 diabetes Mellitus, Osteoarthritis, hypertension, etc.

Causes
Weight gain or obesity is the hallmark of a sedentary lifestyle and intake of too much food energy like fast and junk foods.  Gaining a weight is very easy in contrast to losing it. People spend an indolent life devoid of any exercise. Genetic susceptibility is also responsible while few cases are primarily due to psychiatric illness, due to endocrine disorders, or certain medications. Stress, depression, anxiety, or improper sleep are some of the other factors that can lead to gain of weight.

For most of the women:
 Menopause -- during menopause women may gain 12-15 pounds
 Not losing the weight that is gained during pregnancy

How You can Loss or Maintain weight?
Diet programs may induce weight loss over the short period, but sustaining and maintaining this weight loss is difficult and often requires exercise and lower food energy diet as a permanent part of a person's lifestyle. Lifestyle changes and dietary changes are effective in restricting excessive weight gain in pregnancy and improve effects and outcomes for both the mother and the child.
Increase the body metabolism can also help. The great way to make your metabolism speedy is to select those foods that facilitate quick digestion such as fiber rich foods. It is also a great to lose weight fast. You need to do certain exercises as well. Your metabolism will become fast if you lift weights or do aerobic exercises. Their combination would be more perfect in increasing the rate of your body metabolism.
There are some drugs that help in lowering extra fat from the body such as:
 Orlistat: One medication is widely available and approved for long term use. Its use is associated with high rates of gastrointestinal side effect and concerns have been raised about negative effects on the kidneys.
Two other medications available are:
 Lorcaserin brings about loss 3.1 kg weight (3% of the total body mass).
 A combination of phentermine and topiramate is also effective.
Several recommended weight loss drugs are available. Many people lose between 5 and 10 pounds by taking these drugs. Even most people also regain the weight when they stop taking the medicine, unless they have made permanent lifestyle changes, like exercising and cutting unhealthy foods from their diet.
The most efficient and effectual treatment for obesity is bariatric surgery. Surgery for severe obesity is concerned with long-term weight loss and decreased overall mortality. However, because of its cost and the risk of complications, researchers are searching for other effectual yet less insidious treatments.

Changing Lifestyle
Regular exercise and an active lifestyle with healthy eating are the best methods to lose weight. Even moderate weight loss can improve health. When dieting, the main focus should be to learn healthy and new ways of eating and make them a part of daily routine.
Follow the advices of dietitian and health care provider to set practical daily calorie counts that help to lose weight while staying healthy. If pounds are dropped slowly and gradually, you are more likely to keep them off. The dietitian can teach you about:
• Sweetened drinks
• Healthy food choices
• Portion sizes
• Healthy snacks
• New ways to prepare food
• How to read the nutrition labels
Learn effective and new ways to manage stress, rather than eating. Examples include yoga, meditation or exercise.

References
1. No evidence that popular slimming supplements facilitate weight loss, new research finds. July 14, 2010. http://www.sciencedaily.com/releases/2010/07/100712103445.htm. Retrieved 2010-07-19.
2. Curioni C, André C, Veras R; (Metabolic and Endocrine Disorders Group)  (2006). Weight reduction for primary prevention of stroke in adults with overweight or obesity.
3. Being underweight poses health risks. Mayo Clinic. Archived from the original on March 4, 2007. http://web.archive.org/web/20070304150801/http://www.mayoclinic.org/news2005-mchi/2796.html. Retrieved January 13, 2007.
4. De Mello Meirelles, C.; Gomes, P.S.C. (2004). "Acute effects of resistance exercise on energy expenditure: revisiting the impact of the training variables" (pdf). Rev Bras Med Esporte 10: 131–8. http://www.scielo.br/pdf/rbme/v10n2/en_a06v10n2.pdf. Retrieved 2008-02-06
5. National Nutrition Survey, Nutrition Divison, National Institue of Health, Govt of Pakistant, Islamabad 2000.

6. Natl.Acad. of Science.1999. Recommended Dietary Allowances: Reports of Food and Nutrtion Board, Washington, D.C, 7th Edition.

Comparison

Companies in todays world strive with their competitive strategies, their prevailing cultural and structure in order to lead their specific industry. Doing a comparison helps understand the difference in operation and culture of the companies. It helps to see how each company's objectives and aims assist them to be victorious. Perceptibly the objectives, culture, structure and operation of each company often vary but definitely there would be certain similarities among them. The two companies selected for comparison are Barking Engineering (BE) Ltd and Oticon. This paper will review both the companies to make a comparison with respect to their organizational culture, structure, motivation and job design.

Organizational culture is the component of assumptions, beliefs and values all of which symbolize organizational behaviour working under the shell of organizational behaviour (Grossi, Dignum , Dastani, Royakkers 2005). Though, they are not directly viewed, however their effects are prevalent all over the organisation. Assumptions correspond to the deepest element of organizational culture since they are unmindful and taken for granted. Same is found in Barking Engineering (BE) Ltd.  Though Barking Engineering (BE) Ltd comprises of around 500 workers of different cultures, but there is not much very health cultural bond exists among them. There is in fact a long history of broken relations between the unions, management and industry workers. The most important problem appears to be the lack of trust among them. There was a number of different views prevailing onto which conflicts arises in BE. And even if complaint is done, the management does not bother to attend the complaint with positive answer. Nevertheless, the worker turnover is elevated at BE, regardless of being positioned in a position of above-average redundancy.

Oticon is distributed with the conventional aspects of a mechanistic structure. The whole environment of the organization is not well-organized. No job titles are there and workers are allowed to do whatever they want or consider suitable at the time.  An organization’s cultural values and beliefs are somewhat simple to interpret than assumptions since people are conscious of them. Beliefs stand for the person’s insights of reality while values are regarded more constant, long-lasting faiths concerning what is vital. However, Oticon’s cultural beliefs and values lack this. They value face-to-face contact without dictating its location or form. Oticon’s organisation structure imitates its own requirements and own culture, and varied practical and tangible constituents which permit the utmost utilization of human capital and knowledge, and simultaneously, raising competence. 

Coming to the organizational structure, Barking has about 493 staff, which are divided into different specialities, for example, the production side, marketing, finance, and human resources. The majority is in the production side and remaining are in the clerical and managerial side. There are two trade unions for plants, namely AMICUS for managerial and clerical employees and TGWU for manual employees. However, BE lacks proper communication. The production manager of the BE is of the opinion that this is annoyance to see the lack of successful communication channels between divisions of the business. Skills of communication have long been acknowledged as a important constituent of every sphere of life and, with several arguing that successful communication is elementary to quality business practice. Addressing communication barriers must be one of the important constituent of an organization. Therefore, Ahmad did desire for proper communication as well as the creation of a more flexible and integrated production system that is more customized to the requirements of individual customers.

Oticon Company was regarded as a bureaucratic one once.  It is divided into vertical and horizontal divisions. The vertical division comprises of six levels of management hierarchy. The horizontal levels are further separated into more division, of which two important includes International (sales) and Electronics (product manufacturing). Both are not communicated properly. There lies a bridge between them. However, within each division, workers have an organised work within specific departments. The company uses its headquarters building containing about 120 staff.  Inside this building there are few formal offices.  Each employee owns a small personal trolley for their individual use.  There is a conference room in the building for teams to meet for analytical solutions and brainstorming.

Certainly, the culture metaphor has a number of strengths, one of which is that it directs concentration to the symbolic importance of almost every feature of organizational life (Zalami 2005). This can be observed in Oticon where a focus on each comprehensive aspect that causes the working flow of the organization explicable via the routines, structures, hierarchies and rules, what are essential for its daily based functionality. Oticon’s organisation structure is a fluid affair with no divisions or departments which can give confidence to local interests, obstruct communications, or make alterations in workloads. 

Modifying corporate culture is not at all times trouble-free because of the resistance against alteration (Montana, and Charnov 2008). Same is the case for both companies Oticon and BE, where not only the management team is tremendously negative but also the workers.

Furthermore, motivation is one of the important aspects behind person’s career and life (Pintrich 2003). It arouses people to accomplish something because People are otherwise dubious to alter a behavior or carry out something special unless they are inspired to do so. Motivation leads people to pay attention on a preferred end-result or objective (Dignum, Meyer, Wieringa, Kuiper 1996). It fuels the determination required to show continued effort on a task. Further, there is a link between job performance and motivation. According to the job performance model of motivation has an influence on the job performance as well as behaviors.

Considering the spur of motivation and job design with regard to both BE and Oticon, variations exists. In BE people are not much motivated though this won’t affect the turnover.  Absenteeism is a very much common problem among the employees of BE. Job design is little change compared to that Oticon. In BE six teams are present comprising 50 and 12 members in each tea. The team are supervised by a  supervisor. Then there is a product co-ordinator’s job. There is a setter as well. There is a project leaders (on the whole, anyone can be a project leader with a convincing idea). they are selected by management team comprising 10 people.

On the other hand, the employees of Oticon appear to be very much active and motivated. Their whole setting pays attention on activity and motion. They prefer for something to ensue.  There are project leaders who have to attract resources and employ people to deliver outcomes.  Then are the employees whose duty is to work according to the agreement of their present project leaders.  Project owners who are basically the management team members give advice and help however makes few definite decisions.  There is a potential issues  of managed chaos’ but still Oticon offers a clear purpose with a definite set of values, which all workers are aware of and abide by.

Thus, both companies mostly differ with respect to various aspects, yet both are still operating successfully. Though, there is some bad aspects in both companies not only at management level but also at employee level, still they try to maintain their position. This is their quality and for which they are still ruling the world.

References

Montana, P. and Charnov, B. 2008, Management (4th ed.), Barrons Educational SeriesHauppauge: NY

Zalami, A. 2005,  Alignment of Organisational Cultures in the Public and Private Sectors, Presentation given at Excellence in Public Service, Amman, Jordan in September,2005

Schein, E.H.1990, Innovative cultures and adaptive organisations, Sri Lanka Journal of Development Administration, 7(2), 9-39

Dignum F, Meyer J-J Ch, Wieringa R, Kuiper R. 1996, A modal approach to intentions commitments and obligations: intention plus commitment yields obligation. In: Brown MA, Carmo J (eds) Deontic logic, agency and normative systems. Springer, London, pp 80–97

Grossi D, Dignum F, Dastani M, Royakkers L. 2005, Foundations of organizational structure in multiagent systems. In: Dignum F, Dignum V, Koenig S, Kraus S, Singh MP, Woolridge M (eds) Proceedings of AAMAS’05. ACM Press, New York, pp 690–697

Pintrich, P. R. 2003, A motivational science perspective on the role of student motivation in learning and teaching contexts. Journal of Educational Psychology, 95(4), 667–686.

Construct validity and internal consistency reliability of the Humour Styles Questionnaire

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Introduction

There has been a current push to inspect useful sides of the human state. Martin, Puhlik-Doris, Larsen, Gray, & Weir (2003) supported the optimistic psychology faction in which psychologists were asked to pay attention on the fundamentals of human resilience and flexibility. Research scrutinised such topics as optimism coping, hope, and courage (Lefcourt, 2003). Until of late humour has been principally left out of the optimistic psychologist’s area of interest. This is unexpected since it could be stated that humour is the essence of the optimistic psychology faction since it is the exact opposite to melancholy and hopelessness. It is omnipresent in daily lives and human experience.  No group or culture has been found by the anthropologists that does not have mirth or humour. Humour has the supremacy to lessen physical and mental pain (Martin, 2001). According to de Koning & Weiss (2002) and Richman (1995) humour has been associated with a broad array of positive outcomes, for instant, life satisfaction, martial pleasure, coping with tension, diseases survival such as cancer, and suicide prevention. Regrettably, the scientific knowledge of humour influences the anecdotal faith that it is a unanimously imperative element of the human state.  The majority of research on this subject is sporadic, requires solid methodology, and falls short to be reproduced.

Also, a good sense of humour is regarded as a personal quality that can restrained the influence of stressors in a life of a person (Lefcourt, 2001). It is believed to help an individual engage in optimistic reframing, and imaginative reinterpretation of happenings to reduce the pessimistic impact linked to stressors and tensions of life (Abel & Maxwell, 2002). These are comparatively simple uses of humour to improve the self and to improve one's relationships with others, utilisation of humour to augment the self at the cost of others, and use of humour to make the relationships better at the cost of self.

Humour has been the great interest of psychologists as well who have been studying it all the way through the 20th century. They have been focusing on the likely benefits of humour on psychosocial well-being and health of individuals (Snyder & McCullough, 2000; Martin, 2001). Due to this interest, researchers have worked to develop some sort of measuring tools to measure the humour. These measures purportedly evaluate such aspects of humour as the extent to which people smile and laugh in a broad range of situations, utilise humour as a mean of coping issues, perceive and benefit from humour, etc. A significant level of validation support has been also been discovered for a number of these measurements (Martin, 1996). The intention of this paper is to develop a humour measure that triumphs flaws over the present measures.

Humour Styles Questionnaire (HSQ) is one of the most valuable means of measurement of humour and this questionnaire considers humour as a multidimensional trait.  It aims at people’s sense of humour that may be positive or negative in nature. The Humour Styles Questionnaire is the result of work by Rod A. Martin (et al., 2003).  It tries to capture the dissimilarities in how persons characteristically use or convey humour and whether its utilisation is helpful or deleterious for the happiness of individual’s social surroundings.  Its development is mainly derived from a sense-of-humour model which regards humor as adaptive against maladaptive and self- against other-directed as, and it hypothesizes four individual difference aspects of humor, namely, affiliative, self-enhancing, aggressive and self-defeating humor (Martin et al, 2003).  

(1) Affiliative, in which humour is used to encourage group unity and is characterised by jokes telling and making fun at which everyone can securely laugh at and experience included in a happy-companionship. It is the benign and non-competitive humour style. People who are high on this aspect are inclined to say humorous things, tell jokes, and take on a duty to amuse others, to make relationships possible, and to decrease interpersonal apprehensions (Lefcourt, 2001).

(2)  Self-enhancing humour: This style is characterised by the use of humour by an individual on an individual level. It is an inclination to be entertained by a variety of things in a person’s life, also when an individual faces with complicated or worrying situations (Frewen, Brinker, Martin, & Dozois, 2008).

(3) Aggressive humour.  The aggressive humour style is related to using humour to disparage, manipulate or threat others; it is destructive for group cohesion and can lead to in-group divisions and suffering of certain individuals (Cann, & Calhoun, 2001).

(4) Self-defeating humour. This humour style could, sequentially, be utilized by the poor ginger kid to aim to alleviate the consequences of the aggressive humour: the self-defeating style entails permuting others to make jokes at an individual’s expense and pretending that the individual having fun along the way; it is also a tendency to use the self-deprecating humour to amuse others (Snyder & McCullough, 2000).

Two of these dimensions are regarded to be encouraging to psychosocial well-being, while the rest of the two are assumed to be less benign and likely deleterious to human welfare.

Several studies have often tried to validate these four different styles. A study by Saroglou and Scariot (2002) validated the all four humour styles by the Humor Styles Questionnaire (HSQ). They found four humour styles distinct with respect to the personality. Self-enhancing and social humour styles were found to be positively linked to self-esteem, Openness, and Agreeableness, while hostile humour style was found to be negatively linked to Conscientiousness and Agreeableness. Self-defeating humour was negatively related to Emotional Stability, Conscientiousness, and self-esteem. Likewise, Fox, Dean and Lyford (2011) developed a reliable as well as valid scale i.e. Humour Styles Questionnaire to evaluate maladaptive and adaptive humor in children and remained successful in developing it.  They found self-defeating and affiliative humor to be related to all four psychosocial adjustment measures. On the other hand, aggressive humour was discovered to be related to reduced anxiety and increased self-perceived social capability for boys, and increased depression with reduced global self-worth for girls. A number of other studies also provide strong evidence for the validity of these four different styles across miscellaneous cultures and groups (Kazarian & Martin, 2004; Chen & Martin, 2007; Vernon, Martin, Schermer, & Mackie, 2008; Hampes, 2006; Saroglou & Scariot, 2002). On the other hand, at certain places, it was not found to be reliable, for example, a research by Sullivan, Philip and Dithurbide (2007) was based on validating the psychometric properties of the HSQ on several athletes’ samples. They determined the four styles of HSQ for internal consistency. However, the HSQ did not emerge to comprise satisfactory psychometric properties for utilization in sport psychology. 

Thus, the current study was designed to examine the validity and internal consistency reliability properties of the Humour Styles Questionnaire among psychology students.

Method

Participants

Data used in this study were collected as part of assessment in the third year psychology unit, Advanced Research Methods at the University of Western Sydney, between 2009 and 2015. The sample (N = 974, participated ones =902, 539 were female, males= 363, age 16-65, M = .6, SD = .49) was drawn from students undertaking the unit. Participation was voluntary and respondents remained anonymous. Detailed demographic information was not collected, but a diverse multicultural sample is assumed.

Materials

Humour Styles Questionnaire. Derived from the situations, the HSQ-32 was developed. The HSQ comprised of 32 items (questions), testing all four styles of humours. Participants were asked to respond via a 7-point Likert scale ranging from 1 (1 means Strongly Disagree) to 7 (7 stands for Strongly Agree). The 32 items contained 8 items from each of the four styles of humour.

Procedure

The present study is an analysis of existing data, originally collected with the same general procedure: students were asked to complete the HSQ online. Instructions for completing the survey were taken from Martin et al (2003). Means and standard deviations were first found out for four humour styles and for genders. An independence T test was performed to determine the difference between gender difference and four types of humours. In order to find out correlation of HSQ, a Pearson’s correlation was used and for internal consistencies of the HSQ Cronbach alphas was performed. All the statistical analysis was performed via SPSS.

Results

Means and standard deviations for the four Humour Styles Questionnaire for all contributors, and for genders (males and females individually) are presented in Table 1 in appendix.

HSQ Factor Analysis

By means of Varimax rotation a principal components analysis was calculated on the 32 items. The scree plot pointed that a use of 4-factor solution for this study was most favorable. The Rotation Sums for first four factors were 4.259, 3.809, 3.769 and 3.187 and comprising 13.309%, 11.904%, 11.779% and 9.961% of the total variance (Table 4). The items were examined loaded on all of four rotated factors and highlighted those factor that were loaded most strongly on (Table 5). Four items were found to be more strongly loaded items on first factor corresponded to the original affiliative scale and included Aff1 (Q1), Aff4 (Q13), Aff6 (Q21), and Aff6 (Q21). Five of the items were loaded on the second factor with respect to the original self-enhancing humour while seven were on the third factor with regard to self-defeating humor scale. Likewise, five items were loaded strongly on the fourth factor corresponding to the aggressive humour. 

Deviation Of Types Vs. Gender Difference

In order to check the gender differences the significance levels of t test was applied. The following results were obtained as shown in Table 2 (see appendix).

Males and females both attained almost equal scores on all four types of humours, although there was a mild difference due to difference in the sample size of male and female population.  A significant difference was nevertheless noticed among males and females with respect to Affiliative and Aggressive humour. Expectedly, males population reported a much greater inclination to indulge in aggressive types of humour for example ridicule, mockery, and ‘critical remark humour, as designated by higher mean scores on the Aggressive humour type (male M= 4.01, female M = 3.36, t (902) p < 0.05). The same was found for the Affiliative humour type (male M= 6.05, female M= 5.88, t (902) p >0.05).

Correlations Of The Validity Of HSQ

In order to construct validity of HSQ a Pearson’s correlation was performed using the only one part of four types of humours out of eight for the purpose of easiness. The following results were obtained as shown in table 3.

The Pearson correlation coefficient r for Aff1 and SE1 is 0.261, and it is statistically significant because p < 0.0005. The Pearson correlation coefficient r for Agg1 and SD1 is 0.67 and it is also statistically significant.

Cronbach Alphas For Internal Consistencies

The internal consistencies of the HSQ based on the data from 902 participants using Cronbach alphas showed that all four types of humours have adequate internal consistencies, as presented in table 4 (appendix).

The Cronbach's alpha is 0.855, which specifies a high level of internal consistency for the given four scales with this particular sample. The intercorrelations among these four types of humour were generally quite high, indicating that they determined dimensions that were comparatively similar from one another.

Discussion

The adult Humor Styles Questionnaire was adapted for students of psychology aged 19 years and upwards. Males and females showed almost equal scores but the only different finding were the gender difference for affiliative and aggressive humour. The findings of this study have revealed that the HSQ is suitable for use with the psychology student of mean age 25.  The findings have also shown a validity of use of HSQ in psychology. Furthermore, the males’ population demonstrated higher tendency towards an aggressive style of humour compared to female population. This was corresponding to the findings of Underwood (2003) and Martin et al. (2003), which have found that males are usually more aggressive as compared to females, at least when there is a physical and verbal kinds of aggression.  A tendency towards affiliative type of humour was also found to be higher among males. This study has showed on an acceptable level of internal reliability as well consistency of Humor Styles Questionnaire (HSQ) scale.

The Humor Styles Questionnaire (HSQ) explores humour considering it as a multidimensional attribute. It measures individuals normally engage in four diverse styles of humour. It may be negative or positive in content. The consequential four styles are affiliative humor, self-enhancing humor, self-defeating humor and aggressive humor. Self-enhancing humour can be regarded as an ability employed to tackle stress in a practical way (Frewen, Brinker, Martin, & Dozois, 2008). This type entails a commonly humorous viewpoint on life, an inclination to be recurrently entertained by the incongruities of life and to preserve a funny perspective despite the stress or hardship.Aggressive humour basically relates to the utilisation of ridicule, sarcasm, derision, teasing, disparagement, critical remark humour. It also involves the use of humour to influence others via an implied warning of mockery (Janes & Olson, 2000). Affiliative style of humour is anticipated to be associated with cheerfulness, extraversion, self-worth, closeness, relationship contentment, and chiefly positive emotions and moods (Kwon, 2002). Self-defeating humour style makes fun of other.  The findings of this study suggest that HSQ reliably can be measured using these four styles of humour.

Conclusion

A validity and reliability of HSQ scale were determined among psychology students and it was found to be valid and reliable. Future work and more research are needed to evaluate the longitudinal relationships among psychosocial adjustment measures and the four styles of humour including the usage of peer ratings of humour to offer further validation of this HSQ.

Reference list

Cann, A., & Calhoun, L. G. (2001). Perceived personality associations with differences in sense of humor: Stereotypes of hypothetical others with high or low senses of humor. Humor: International Journal of Humor Research, 14(2), 117-130.

Cayirdag, N., & Acar, S. (2010). Relationship between styles of humor and divergent thinking. Procedia Social and Behavioral Sciences, 2, 3236–3240. doi:10.1016/j.sbspro.2010.03.494

Chen, G.-H., & Martin, R. A. (2007). A comparison of humor styles, coping humor, and mental health between Chinese and Canadian university students. Humor, 20, 215–234.

de Koning, E., & Weiss, R. L. (2002). The Relational Humor Inventory: Functions of humor in close relationships. American Journal of Family Therapy, 30(1), 1-18.

Dews, S., Kaplan, J., & Winner, E. (1995). Why Not Say It Directly? The Social Functions of Irony. Discourse Processes(19), 347-367.

Eysenck, H. J. (1972). Foreword. In J. H. Goldstein, & P. E. McGhee (Eds.), The psychology of humor: Theoretical perspectives and empirical issues. (pp. xxii-xvii). New York: Academic Press.

Fox, C.L., Dean, S & Lyford, K. (2011). Development of a Humour Styles Questionnaire for children. International Journal of Humor Studies, 1-38.

Hampes, W. P. (2006). Humor and shyness: The relation between humor styles and shyness. Humor, 19, 179–187.

Janes, L.M. , & Olson, J. M.(2000). Jeer pressure: The behavioral effects of observing ridicule of others.Personality and Social Psychology Bulletin, 26, 474–485.

Kazarian, S. S., & Martin, R. A. (2004). Humor styles, personality, and well-being among Lebanese university students. European Journal of Personality, 18, 209–219.

Kwon, P. (2002). Hope, defense mechanisms, and adjustment: Implications for false hope and defensive hopelessness. Journal of Personality, 70(2), 207-231.

Lefcourt, H. M. (2003). Humor as a Moderator of Life Stress in Adults. In C. E. Schaefer (Ed.), Play Therapy with Adults (pp. 144-165). Hoboken, NJ: John Wiley & Sons, Inc.

Liu, K. W. (2012). Humor Styles, Self-Esteem and Subjective Happiness. Discovery – SS Student E-Journal, 1, 21-41.

Long, D. C., & Greaser, A. C. (1988). Wit and Humor in Discourse Processing. Discourse Processes, 35-60.

Martin, A. R., Puhlik-Doris, P., Larsen, G., Gray, J., & Weir, K. (2003). Individual differences in uses of humor and their relation to psychological well-being: Development of the Humor Styles Questionnaire. Journal of Research in Personality(37), 48-75.

Martin, R. A. (2007). The psychology of humor: an integrative approach. Burlington: Elsevier Academic Press.

Martin, R. A., Puhlik-Doris, P., Larsen, G., Gray, J., & Weir, K. (2003). Individual differences in uses of humor and their relation to psychological well-being: Development of the Humor Styles Questionnaire. Journal of Research in Personality, 37(1), 48-75

Martin, R.A. (2001).Humor, laughter, and physical health: Methodological issues and research findings. Psychological Bulletin, 127, 504–519.

Martin, R.A., & Kuiper, N.A.(1999). Daily occurrence of laughter: Relationships with age, gender, and Type A personality. Humor: International Journal of Humor Research, 12, 355–384.

Richman, J. (1996). Jokes as a projective technique: The humor of psychiatric patients. American Journal of Psychotherapy, 50(3), 336-346

Ruch, W. (1992). Assessment of appreciation of humor: Studies with the 3 WD Humor Test. In C. D. Spielberger, & J. N. Butcher (Eds.), Advances in personality assessment (Vol. 9, pp. 27-75). Hillsdale, NJ: Lawrence Erlbaum Associates.

Saroglou, V., & Scariot, C. (2002). Humor Styles Questionnaire: Personality and educational correlates in Belgian high school and college students. European Journal of Personality, 16, 43–54

Saroglou, V. and Scariot, C. (2002). Humor Styles Questionnaire: personality and educational correlates in Belgian high school and college students. 16 (1), 43–54

Snyder, C.R., & McCullough, M.E.(2000). A positive psychology field of dreams: If you build it, they will come. Journal of Social and Clinical Psychology, 19, 151–160.

Sullivan, Philip J., and Lori Dithurbide. (2007). The psychometric properties of the humor styles questionnaire with a sample of athletes. Journal of Sport & Exercise Psychology 29, 207-207.

Underwood, Marion K. (2003). Social aggression among girls. New York: Guilford.

Vernon, P. A., Martin, R. A., Schermer, J. A., & Mackie, A. (2008). A behavioral genetic investigation of humor styles and their correlations with the Big Five personality dimensions. Personality and Individual Differences, 44, 116–125.

Appendix

Table 1 Descriptive Statistic
	Participant Gender N	Mean	Std. Deviation
Aff	Male	6.05	1.140
	Female	5.88	1.171
SEQ	Male	4.87	1.614
	Female	4.75	1.542
SD	Male	3.75	1.778
	Female	3.5	1.806
Agg	Male	4.01	1.774
	Female	3.36	1.766

Table 2
Independent T Test
Total sample                                                T test
		Males  (Mean)	Females (Mean)	Signif. (2 tail)
Aff	902	6.05	5.88	>0.05
SEQ	902	4.87	4.75	>0.05
Agg	902	4.01	3.36	<0.05
SD	902	3.75	3.5	=0.05

Table 4
Cronbach alpha for all contributors (n = 902) Reliability Statistics
Cronbach's Alpha	Cronbach's Alpha Based on Standardized Items	N of Items
.855	.864	32

Table 3
Pearson’s Correlations
		Aff1 (Q1)	SE1 (Q2)	Agg1 (Q3)	SD1 (Q4)
Aff1 (Q1)	Pearson Correlation	1	.261**	.126**	.067*
	Sig. (2-tailed)		.000	.000	.042
	N	902	902	902	902
SE1 (Q2)	Pearson Correlation	.261**	1	.097**	.013
	Sig. (2-tailed)	.000		.003	.692
	N	908	908	908	902
Agg1 (Q3)	Pearson Correlation	.126**	.097**	1	.131**
	Sig. (2-tailed)	.000	.003		.000
	N	908	908	908	902
SD1 (Q4)	Pearson Correlation	.067*	.013	.131**	1
	Sig. (2-tailed)	.042	.692	.000
	N	902	902	902	902

Table 4
Total Variance Explained
Component	Initial Eigenvalues			Rotation Sums of Squared Loadings
	Total	% of Variance	Cumulative %	Total	% of Variance	Cumulative %
1	6.359	19.872	19.872	4.259	13.309	13.309
2	3.797	11.866	31.738	3.809	11.904	25.213
3	2.688	8.399	40.137	3.769	11.779	36.992
4	2.181	6.817	46.953	3.187	9.961	46.953
5	1.133	3.540	50.493
6	1.053	3.290	53.783
7	.990	3.095	56.878
8	.943	2.948	59.826
9	.839	2.623	62.449
10	.806	2.517	64.967
11	.790	2.468	67.435
12	.721	2.253	69.687
13	.704	2.199	71.886
14	.670	2.095	73.981
15	.650	2.030	76.011
16	.626	1.956	77.967
17	.591	1.847	79.814
18	.580	1.813	81.626
19	.554	1.730	83.356
20	.546	1.705	85.062
21	.515	1.609	86.671
22	.504	1.574	88.245
23	.488	1.525	89.770
24	.461	1.441	91.211
25	.440	1.376	92.587
26	.428	1.338	93.926
27	.413	1.292	95.217
28	.389	1.215	96.432
29	.356	1.113	97.545
30	.293	.916	98.460
31	.263	.821	99.282
32	.230	.718	100.000
Extraction Method: Principal Component Analysis.

Table 5 Rotated Component Matrixa
	Component
	1	2	3	4
Aff1 (Q1)	.720	.109	.042	.061
Agg1 (Q3)	.137	.062	.119	.640
SD1 (Q4)	-.004	-.007	.647	.027
SE1 (Q2)	.217	.666	-.006	-.016
Aff2 (Q5)	.598	.211	.018	.144
SE2 (Q6)	.268	.429	.204	.039
Agg2 (Q7)	-.067	-.046	.066	.529
SD2 (Q8)	.082	.063	.795	.109
Aff3 (Q9)	.519	.071	.227	.035
SE3 (Q10)	.030	.815	.064	.005
Agg3 (Q11)	-.049	.151	.008	.617
SD3 (Q12)	.046	.062	.696	.098
Aff4 (Q13)	.763	.158	-.020	.081
SE4 (Q14)	.240	.646	-.026	.007
Agg4 (Q15)	.083	-.002	.128	.612
SD4 (Q16)	.138	-.020	.646	.191
Aff5 (Q17)	.795	.099	.076	.088
SE5 (Q18)	.037	.825	.038	.001
Agg5 (Q19)	.158	.228	.229	.512
SD5 (Q20)	-.032	.090	.784	.173
Aff6 (Q21)	.731	.142	.086	-.070
SE6 (Q22)	.095	.544	-.030	.091
Agg6 (Q23)	.172	.010	.107	.656
SD6 (Q24)	-.138	-.020	.604	.110
Aff6 (Q21)	.807	.116	-.011	.082
SE7 (Q26)	.089	.735	.173	-.017
Agg7 (Q27)	.005	.005	.219	.594
SD7 (Q28)	.106	.237	.276	.051
Aff8 (Q29)	.567	.170	-.123	.136
SE8 (Q30)	.134	.507	.033	.126
Agg8 (Q31)	.146	-.022	.003	.699
SD8 (Q32)	.115	.119	.672	.100