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BACKGROUND New registered nurses (RNs) are at risk of developing symptoms of stress-related ill health. OBJECTIVES To evaluate the effect of a 3 × 3 hour group intervention aiming to prevent symptoms of stress-related ill health among new RNs by increasing engagement in proactive behaviors. The intervention involves discussions and models of newcomer experiences and stress and the behavior change techniques reinforcing approach behaviors, systematic exposure, and action planning. DESIGN A randomized parallel group trial with an active control condition. PARTICIPANTS The study sample consisted of 239 new RNs participating in a transition-to-practice program for new RNs in a large county in Sweden. METHODS Participants were randomized to either the experimental intervention or a control intervention. Data on experiences of stress, avoidance of proactive behaviors, engagement in leisure activities, role clarity, task mastery, and social acceptance were collected before and after the intervention. Effects were evaluated using multilevel model analysis and regression analysis. Missing data were imputed using multiple imputation. RESULTS The control group experienced a statistically significant increase in experiences of stress during the period of the study (t(194.13) = 1.98, p = .049), whereas the level in the experimental group remained stable. Greater adherence to the intervention predicted a greater effect on experiences of stress (β = -0.15, p = .039) and social acceptance (β = 0.16, p = .027). LINKING EVIDENCE TO ACTION Transition-to-practice programs may benefit from adding an intervention that specifically addresses new RNs' experiences of stress to further support them as they adjust to their new professional role. However, replication studies with larger samples, more reliable measures, and longer periods of follow-up are needed.

Author(s): Kuhlman, Kate R; Robles, Theodore F; Haydon, Marcie D; Dooley, Larissa; Boyle, Chloe C; Bower, Julienne E | Abstract: BackgroundEarly life stress (ELS) has been linked to health disparities across the human lifespan, particularly increased risk for depression and its recurrence. In this study we explore two plausible and competing pathways through which ELS may lead to depression via inflammation.MethodsParticipants (ages 18-22; nn=n41) completed the Early Trauma Inventory as a measure of ELS. Participants then completed consecutive daily diaries of mood and other sickness behavior for the 7ndays prior to and 7ndays after receiving the annual influenza vaccine. Circulating concentrations of plasma interleukin-6 (IL-6) were measured immediately before and 24nhr after vaccination.ResultsELS was not associated with the magnitude of change in IL-6 from pre- to post-vaccine, however, exposure to ELS moderated the association between change in IL-6 from pre- to post-vaccine and changes in both cognitive difficulty and depressed mood. Individuals exposed to greater ELS showed greater psychological sensitivity to increases in IL-6.ConclusionsExposure to ELS may increase sensitivity to peripheral inflammation in the central nervous system. Future studies elaborating on the impact of ELS on the sensitivity of specific neural circuits and cells to inflammation are needed.

During infection, sickness behaviors, such as a hunched stance with piloerection, can facilitate host resistance by supporting the generation and maintenance of fever. Fever, in turn, is mediated by hypothalamic neuroimmune signaling. Sickness behaviors, however, can also be influenced by social stimuli. In the present study, guinea pig pups were injected with lipopolysaccharide to simulate a bacterial infection and then exposed to a novel, threatening environment while either with their mother or alone. We found the presence of the mother suppressed sickness behavior, but enhanced fever, and had no measureable effect on gene expression of hypothalamic mediators of fever. This 3-way dissociation induced by the mother’s presence is interpreted in terms of the differential adaptive consequences of behavioral and febrile responses for pups in this situation. The results contribute to a growing literature linking immunological and social processes.

Illness behaviour effects the quality of life of patients with chronic obstructive pulmonary disease (COPD) but is scarcely described in literature. The aim of this study was to explore self-reported illness behaviour of patients with COPD, who have declined nonpharmacological rehabilitation. The study has a qualitative design using semi-structured interviews. The subsequent analysis is a theory-guided mapping of actions reported by the patients in order to manage symptoms. These actions are understood and categorised according to the styles of coping described by Alonzo. Four categories of illness behaviour are identified: containment of symptoms, coping with symptoms through formal and informal interventions, adjustment of situations through compensating and economising interventions and crisis coping by surrendering. The analysis shows that behaviour that may seem unhelpful from a healthcare perspective may seem rational in the everyday life perspective of the patient. Findings show that reluctance to participation in rehabilitation should not only be interpreted as lack of motivation or health literacy. In the patients' perspective, nonpharmacological interventions might be perceived as a threat that could tip the delicate balance of everyday life with severe COPD.

In this paper, I will consider, from a number of philosophical and real-life perspectives, what happens to us when we fall ill and what the experience of falling ill tells us about the nature of our being. I will take up the oft used Myth of the Cave from Plato's Republic and use this as a means to interpret the experience of falling ill. Plato gave us the allegory to show that what we think we know might not be all there is to know and that what we take for truth may not, at least, be the whole truth. I will argue that The Myth of the Cave provides an allegorical basis for coming to understand ourselves as finite and mortal through the experience of illness. We emerge from the dark safety of our everyday lives into the world of illness; this brings us up short as we come face to face with our own mortality. To make the argument, I will use examples from my own experience of illness and some of those other which have been recounted to me. I will also refer to the work of Havi Carel on illness and mortality, the conception of illness as leading to a feeling of not-being-at-home with our bodies (unheimlich) discussed by Frederick Svenaeus, and Gadamer's notion of illness as a loss of equilibrium. Underpinning the argument throughout will be Heidegger's existential analysis of dying in which he discusses the experience of anxiety and the way that separates us from the world of involvements.

During vertebrate development, the immune function is inefficient and is mainly controlled by innate defense. While there have been detailed studies of various aspects of innate immune function, the effects of this function in the growth of vertebrates is still not well known. Similarly, there is little information regarding how early endotoxin exposure would affect juvenile phenotypes, specifically in a non-model mammal like a precocial rodent. We evaluated the response to an antigen and its cost in offspring of the rodent Octodon degus. We inoculated pups at 4 different ages (8, 15, 22 and 30 days after birth) with an antigen to determine the ontogeny and costs of the response to an endotoxin. We assessed changes in body mass, body temperature, sickness behavior and the levels of a key mediator of the inflammatory response, the cytokine interleukin-1β. We also determined the effects of early endotoxin exposure on the resting metabolic rate of juvenile animals (i.e. 90 days after birth). The cytokine levels, body mass and body temperature were unaffected by time of inoculation and treatment. However, pups subjected to inoculation at 22 days after birth with the antigen showed reduced locomotion. Juvenile resting metabolic rate was not affected by early endotoxin exposure. These results suggest that the magnitude of O. degus responses would not change with age. We discuss whether the lack of effect of the response on body mass or body condition is caused by environmental variables or by the precocial characteristics of O. degus.

In this collaborative autoethnography, we examine the processes whereby people may reframe their interpretations and understandings of health and illness as a result of new diagnostic information. In so doing, we utilise the first author's experience receiving a conclusive diagnosis of cystic fibrosis after years of misdiagnosis to outline some ways changes in diagnosis facilitate shifts in illness management, the nature of health and illness and the experience of the self in relation to health and medicine. Furthermore, we discuss the ways this case reveals the importance of examining and comparing the social construction and transformation of health and illness within and between different individual and collective lived experiences over time. In closing, we draw out theoretical and empirical implications for understanding transformations in the nature of health and illness over the life course as well as future directions for research investigating shifts in illness management and understanding over time (A virtual abstract of this paper is available to view at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA).

Puberty is a critical developmental period that is characterized by significant brain development. Exposure to stress during this time can alter brain functioning setting the stage for long-lasting behavioural outcomes. The objective of this study was to investigate age and sex differences in the peripheral and central immune responses, along with sickness behaviour, following immune stress. The results showed that LPS treatment increased serum cytokine levels and sickness symptoms in all mice. Pubertal males displayed increased IL-1β concentrations at 2 h and increased IL-6 concentrations at 8 h post-treatment whereas increased concentrations of TNFα, IL-10, IL-12, IL-1β, IFNγ, and IL-6 persisted at 8 and 24 h in adult females. Consistent with peripheral cytokines, pubertal males displayed greater IL-1β, TNFα, and IL-6 mRNA expression in the prefrontal cortex at 2 h, whereas adult males expressed more of the aforementioned cytokines at 8 h compared to saline controls. Adult males also displayed greater IL-1β mRNA expression compared to their female counterparts, and adult females displayed greater TNFα mRNA expression compared to their male counterparts. These results not only provide a better understanding of the age and sex differences in acute immune response, but also show important region- and time-specific differences in the response to an immune challenge, and that the peripheral immune response differs from the central response. This highlights the need to examine immune markers in both the periphery and the central nervous system for an accurate depiction of acute immune response following an immune challenge.

Objective To identify validated measures that capture illness perception and behavior and have been used to assess people who have knee pain/osteoarthritis. Methods A scoping review was performed. Nine electronic databases were searched for records from inception through April 19, 2015. Search terms included illness perception, illness behavior, knee, pain, osteoarthritis, and their related terms. This review included English language publications of primary data on people with knee pain/osteoarthritis who were assessed with validated measures capturing any of 4 components of illness perception and behavior: monitor body, define and interpret symptoms, take remedial action, and utilize sources of help. Seventy-one publications included relevant measures. Two reviewers independently coded and analyzed each relevant measure within the 4 components. Results Sixteen measures were identified that capture components of illness perception and behavior in the target population. These measures were originally developed to capture constructs that include coping strategies/skills/styles, illness belief, illness perception, self-efficacy, and pain behavior. Coding results indicated that 5, 11, 12, and 5 of these measures included the monitor body, define and interpret symptoms, take remedial action, and utilize sources of help components, respectively. Conclusions Several validated measures were interpreted as capturing some components, and only 1 measure was interpreted as capturing all of the components of illness perception and behavior in the target population. A measure that comprehensively captures illness perception and behavior could be valuable for informing and evaluating therapy for patients along a continuum of symptomatic knee osteoarthritis.

First-person accounts of the illnesses experienced by sociologists have taken hybrid experimental forms. I add my voice to this growing tradition with a story about the discovery and treatment of a soft tissue sarcoma in my thigh, chronicled in a journal I kept over many months. The fragments scribbled in the journal became the basis of an extended illness narrative. I interrogate features of the narrative itself, including the handling of time and imagined audiences - those I was writing for. The illness narrative traces how cancer transformed the many identities I enact on a daily basis and how the invisible labour of particular health workers enabled the restoration of several prized identities. These workers - radiation, occupational and physical therapists - are typically subordinated in the medical hierarchy and the interactional work that they do with patients to restore and reconfigure ruptured identities after serious illness needs attention in medical sociology.

Those who undergo health screening often experience physical and emotional effects as a result of the screening process. However, the effects of health screening go beyond these physical and mental complications, often having profound social effects for those who are screened. This study explores the social implications of health screening for people who undergo it and are designated as being at risk for potential disease. Through a qualitative analysis of the experiences of individuals with elevated cholesterol levels and men with elevated prostate-specific antigen (PSA) levels, this research offers a description of the experience of being at risk, identifying three primary components: increased medical contact, a restructuring of everyday routines and altered social relationships. Whereas the at-risk health status engendered by current clinical approaches to screening and surveillance has been characterised as proto-disease, this study develops a companion definition of proto-illness to characterise the social experience of life with an identified health risk. Those who are at risk act in ways that are similar to those who are ill. The concept of proto-illness implies that the experience of risk is parallel to the experience of illness and contributes to the sociology of medical screening by establishing a much needed bridge between the two experiences.

Background: Understanding children’s views of illness and health is vital to a child-centred approach in patient education and care. Paediatric healthcare providers should incorporate children’s views of health and illness to enable children and their families to participate in selfmanagement plans and achieve better health outcomes. However, there is limited scientific knowledge regarding the views of children with specific diseases. Method: This comparative study investigated whether and in what ways the experience of having different chronic diseases influenced children’s views of being ill and healthy. The participants were 82 children aged 8– 13 years diagnosed with a chronic disease (31 had asthma, 27 had diabetes and 24 had cancer). A group of 81 healthy children participated as a comparison group. The ‘draw-and-write’ technique was used to collect the children’s views, and the data were analysed using a previously validated coding system (inter-rater agreement of 93%) and subsequently quantified for the examination of any differences in relation to illness. Results: Statistically significant differences were found in all dimensions of the children’s conceptions of health and illness according to whether they had a chronic condition (effect sizes calculated with Cohen’s d ranged from 0.35 to 1.22). Globally, the chronically ill children expressed a narrower definition of being healthy and ill than their healthy peers. Moreover, the comparison among the children with asthma, diabetes and cancer showed differences that seemed to reflect their specific experiences with their type of chronic disease and the associated treatments (effect sizes calculated with Etasquared ranged from 0.07 to 0.25). Conclusions: This study’s findings can be used to guide education and clinical services tailored to ill children suffering from different chronic conditions info:eu-repo/semantics/publishedVersion

In this paper, I will explore the concept that healing activities shape the objects of therapy and seek to construct those objects through therapeutic activities. Objects of therapy are the persons, patients, human bodies, diseases, physiological processes and personal suffering-that which clinical medicine constructs through its distinctive formative processes, practices and knowledge. The rationale for choice of philosophical sources namely, Cassirer, Foucault, the anthropological perspective of Good and the sociological account of Frank will be discussed. The claim articulated by Good will be examined and its relationship to culture, illness, medical knowledge, practice, truth, and science. I then focus on Frank's concepts of the patient and the body and how medical knowledge and practices affects it. The concept that the medicalization of the illness narrative silences the patient's voice requiring an ethic of listening will be emphasized, described and further supported by Charon's (2006, Narrative medicine: Honoring the stories of illness. New York, NY: Oxford University Press) and Cassell's (2015, The nature of suffering and the goals of medicine. New York, NY: Oxford University Press) thoughts on narrative of illness in clinical medicine. My position concludes that healing activities construct the objects of therapy: as the medical culture's way of seeking truth; as medicine's way of mediating and organizing forms of reality through culture and symbolic forms; and, as medicine's way of entering the body and constructing the disease. Lastly, I suggest that in spite of the remarkable progress in the control of disease, the failure to address the interpretation of illness meanings is a fundamental flaw in the work of "doctoring." The experience and meanings of illness are at the centre of clinical practice and is a moral, political, ethical and professional obligation. The person is a cultural construct, a complex and culturally shaped way of experiencing self and other, and cultural "work" is required to constitute the person who is the object of medical attention and it also necessitates the ethic of listening.

Background Depressive symptoms are associated with distress, but research has not focused on the processes underlying this association. Method We interviewed 18 patients experiencing depressive symptoms to identify the various reasons why depressive symptoms cause distress. Digital recordings were transcribed and grounded theory methods were used in analyzing the data and building theory. Results We identified 14 reasons for why patients find depressive symptoms distressing. These reasons frequently were particular thoughts, behaviors, or subsequent outcomes in response to the symptom; in other cases, the experience of the symptom itself directly caused distress. Conclusions We present a general model of direct and indirect symptom-distress relationships that may help target clinical interventions for depression. © 2012 Wiley Periodicals, Inc. J. Clin. Psychol. 68:860-874, 2012

Background: Chronic Kidney Disease (CKD) is associated with the development of serious co-morbidities. Patients with CKD are encouraged to adhere to regimens to lower this risk. This study aimed to explore the experiences of patients attempting to integrate lifestyle changes into their lives. Method: Face-to-face recorded interviews were conducted with nine consenting patients with CKD Stage 4 under the care of a consultant nephrologist. Each recording was analysed by two independent investigators using thematic analysis. Results: Five themes emerged: Self in relation to others, Control, Adherence, Beliefs about treatment and illness and Uncertainty. Participants highlighted the importance of personal support and recounted their sense of being a burden on close family. They described how they approached disclosure about their condition, their beliefs regarding treatment and their decision making processes and how these factors impacted on adherence to behaviour change. Conclusion: Practical support from family and healthcare professionals, a willingness to disclose their condition and help to make good decisions in difficult circumstances were identified as important factors in supporting success with behaviour change.

Glycoprotein gp130 is involved in the interleukin-6 (IL-6) and related cytokines' signaling. Linkage between the gp130 coding gene and freezing reaction (catalepsy) was shown. Here, we compared the expression and function of the gp130 in male mice of catalepsy-resistant AKR/J strain and catalepsy-prone congenic AKR.CBA-D13Mit76 strain created by transferring the gp130 gene allele from catalepsy-prone CBA/Lac to the genome of AKR/J strain. No difference in the gp130 expression in the frontal cortex, hippocampus and midbrain between AKR and AKR.CBA-D13Mit76 mice was found. However, AKR.CBA-D13Mit76 mice were more sensitive to bacterial lipopolysaccharide (LPS). The administration of LPS (50 µg/kg, ip) significantly increased mRNA level of the gene coding IL-6-regulated glial fibrillary acidic protein (GFAP) in the midbrain, induced catalepsy and decreased locomotion in the open field and social investigation tests in AKR.CBA-D13Mit76, but not in AKR mice. The result indicates (1) the association between gp130 and hereditary catalepsy, (2) increased functional activity rather than expression of gp130 in AKR.CBA-D13Mit76 mice and (3) the involvement of gp130 in the mechanism of LPS-induced alteration of behavior.

Objectives. Anorexia nervosa (AN) is an eating disorder characterized by the egosyntonic nature of symptoms, denial of illness, and ambivalence about treatment engagement. Within the physical health literature, people's beliefs about their illness have been found to impact upon coping and treatment outcomes and this has largely been explored using the self-regulation model. This model has also been applied to mental health and more recently to AN, with beliefs about the disorder being associated with readiness to change. However, qualitative investigations have indicated that physical health models have limited applicability for assessing people's beliefs about mental illness. This may be particularly pertinent to AN, given the complexity of the disorder. Therefore, this study explored illness perceptions in AN using a qualitative design which was not restricted by a physical illness model but focused on personal models of AN from the perspective of those experiencing the disorder. Design. Semi-structured interviews were conducted with thirteen participants who were currently in treatment for AN. Method. Interview transcripts were analysed using grounded theory methodology. Results. An interpretative theory of illness perceptions in AN was developed and comprised four related categories: ‘making sense of AN’, ‘the relationship between AN and the self’, ‘the recovery struggle’, and ‘coping with treatment’. Conclusion. Patient's accounts transcended the dimensions offered by physical illness models, with the implication that methods for assessing illness beliefs in AN require adaptation for a full understanding to be gained and the complexity of perceptions to be captured.

Objectives. (1) To examine the relationship of personality traits and diabetes health threat communication (DHTC) to the coping strategies of newly diagnosed diabetes patients; (2) to determine to what extent these postulated effects are mediated by illness representations (IRs). Design. A longitudinal prospective study based on the common sense model. Methods. Patients were assessed shortly after diagnosis and 2 years after the diagnosis of diabetes. Personality traits (Mini-markers) were assessed at baseline. The DHTC Questionnaire was completed at baseline and 2 years. The Revised Illness Perception Questionnaire and the coping orientation to problems experienced were completed at 2 years. Mediation by IRs of the potential influence of personality and DHTC on coping behaviour was assessed by the method of Baron and Kenny. Results. Multiple regression analyses showed that educational level, agreeableness, openness/intellect, conscientiousness, and perceptions of a more reassuring health message since diagnosis were related to more adaptive coping (e.g., active coping, planning). The association of openness and perceived reassuring health message with active coping showed complete mediation by illness coherence and personal control. Openness led to seeking emotional support mediated by perceived personal control. Coherence associated with (partial mediation) the relation of openness to planning. Similarly, personal control and coherence mediated the relation of openness to positive reinterpretation and growth (PRG). Agreeableness had a direct relationship with active coping and PRG but led to planning and seeking instrumental support mediated by perceived treatment effectiveness. Perceptions of a threatening health message were associated with seeking instrumental and emotional support and this was mediated by symptom perception but threat had a direct relationship with planning. Conclusions. Both personality traits and health threat communication predict the way individuals cope with diabetes. The relationships of these factors are largely mediated through measurable IRs. The results suggest targets for intervention to achieve greater problem-focused coping.

Objectives. The present study uses a cognitive behavioural framework to explore the idea that people with pain and sleep disturbances share a common cognitive vulnerability. Design. A longitudinal classification of people (N =592) in a community sample reporting on symptoms of pain and sleep at baseline, 3 and 12 months after the initial survey. Method. Cluster analysis was used to classify people reporting different degrees of symptoms, and their endorsement of cognitive behavioural processes, and consequences at each time point. Groups in similar clusters were linked at adjacent time points to document patterns of stability and change. The clusters are described at baseline on a range of indices not used to form them (problem duration, problem frequency, anxiety, and depression). Reliable change in reports of symptom-related interference was cross tabulated with reliable change in cognitive behavioural processes and consequences. Results. Cluster analyses resulted in six homogenous and distinct profiles at each time point. Linking the clusters over time showed partial individual stability in cluster membership at adjacent time points. Reliable change in symptom-related interference was associated with reliable change in endorsement of cognitive behavioural processes and consequences on the short term. Conclusion. The character and partial individual stability of symptom cluster membership suggests that problems with pain and sleep may share mutually maintaining cognitive behavioural processes and consequences. Future research should examine the utility of identifying mutually maintaining factors in the treatment of concomitant pain and sleep disturbances.

Background: Theoretically, acceptance of chronic pain (CP) is an important determinant in the functional status and well-being of patients with CP. Several questionnaires that aim to measure acceptance of CP have been developed. An overview of the psychometric properties of these questionnaires is unavailable. Methods: A systematic review of the literature of the psychometric properties of questionnaires that aim to measure acceptance of CP was performed. Psychometric properties including content construct and criterion validity, internal consistency. agreement, reliability, responsiveness, floor/ceiling effects and interpretability, were assessed using a standardized protocol. All studies were assessed by two observers independent from each other. Results: A total of 23 studies including 4 questionnaires or subscales were identified. The questionnaires/subscales included were the Chronic Pain Acceptance Questionnaire (CPAQ), Illness Cognitions Questionnaire (ICQ), Pain Solutions Questionnaire (PASOL) and Acceptance of Illness Scale (AIS) adapted to pain. When applying the criteria of the protocol, results indicate that none of the questionnaires are currently able to meet all 9 criteria for psychometric quality. Individual questionnaires met between 0 and 3 of the criteria. Conclusions: If strict psychometric quality criteria are applied, none of the questionnaires are currently able to meet all nine criteria for psychometric quality, but overlooking the cumulative results over all the studies conducted, especially for the CPAQ, it can be concluded that information on several important characteristics has been reported and a fairly clear picture emerges about the psychometric properties of the CPAQ. (C) 2009 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved.

Psychological distress may be causally related to multiple, unexplained somatic symptoms. We have investigated job stress, coping strategies and subjective health complaints in patients with subjective food hypersensitivity. Sixty-four patients were compared with 65 controls. All participants filled in questionnaires focusing on job stress, job demands and control, work environment, coping strategies and subjective health complaints. Compared with controls, patients scored significantly lower on job stress and job demands, and significantly higher on authority over job decisions. Coping strategies and satisfaction with work environment did not differ significantly between the two groups, but the patients reported significantly more subjective health complaints than the controls. Scores on job stress and job demands were generally low in patients with subjective food hypersensitivity. It is unlikely, therefore, that the patients' high scores on subjective health complaints are causally related to the work situation.

(Headache 2010;50:273-289) Objective.— The objective of this study is to present a view of the primary headaches as genetically determined behavioral responses consistent with sickness behavior and defense reaction, respectively. Background and Design.— A review of the literature bearing on the behavioral, humoral, and functional imaging aspects of the primary headaches shows that migraine and cluster headache (CH) are pain conditions characterized by different behaviors during the attacks. Here it is postulated that the behavioral responses to migraine and CH are evolutionary conserved reactions consistent with sickness behavior and defense reaction. Results.— The sickness behavior observed during migraine attacks is a pan-mammalian adaptive response to internal and external stressors, characterized by withdrawal and motor quiescence, sympatho-inhibition and lethargy, in which visceral pain signals a homeostatic imbalance of the body and/or brain. In contrast, the defense reaction in CH consists of a fight-or-flight reaction, with motor restlessness and agitation, in which pain is exteroceptive in kind. Conclusion.— These different behavioral responses are thus specific to different kinds of pain, distinguished by the behavioral significance of the pain (visceral pain in migraine vs exteroceptive pain in CH), and imply brain matrices involving different networks in the brainstem, hypothalamus, and forebrain regions that engender evolutionarily conserved adaptive genetic responses. Cytokines play an important role in their development. Predictions and limitations of the hypothesis are discussed together with implications for genetic studies on headaches.

Aims. This study aimed to elucidate the illness representations of patients with traumatic injury and to examine what extent their illness representations change over time. Background. Traumatic injury has attracted global concern because it is the major reason for death and disability in people under 45 years old. One model, the Common Sense Model of Illness Representation (CSMIR), has the potential to help individuals adjust to changes in health status such as traumatic injury. Design. Longitudinal study design. Methods. This study was conducted using a and collected data prior to hospital discharge and at three and six months after hospital discharge. One individual question form and the Chinese Illness Perception Questionnaire Revised (IPQ-R) (Trauma) were used to collect demographic data, clinical data and illness representations. Results. A total of 114 participants completed the survey three times. The overall response rate was 79·7%. Six subscales of the Chinese (Trauma): identity, emotional representations, consequences, controllability, illness coherence and causes of the Chinese IPQ-R (Trauma) changed significantly over time. Two subscales, Timeline (acute/chronic) and Timeline Cyclical, did not change significantly. Conclusions. Based on these findings, there may be a window of opportunity to provide appropriate interventions to individuals with traumatic injury at each time point. The results of this study have implications for nursing practice and further nursing research. Relevance to clinical practice. Understanding illness representation in patients with traumatic injury may help nurses to provide anticipatory guidance and to design nursing interventions before and after hospital discharge, ultimately to improve health outcomes of those patients.

The neurological changes elicited by bacterial infection are called sickness behavior. Minocycline (MIN) is neuroprotective with a remarkable brain tissue penetration. MIN was orally administered at a dose 90 mg/kg for 3 days, whereas Escherichia coli was given as a single intraperitoneal injection (0.2 mL of 24 h growth) on the third day. After 24 h of bacterial infection, behavioral tests namely open field and forced swimming were carried out, then animals were decapitated. Rats infected with E. coli displayed reduced struggling time in forced swimming test, as well as, exploration and locomotion in open field test with reduction in neurotransmitters (norepinephrine, dopamine, and serotonin) versus elevation in the inflammatory (tumor necrosis factor-alpha, interferon-gamma) and oxidative stress (thiobarbituric acid reactive substance, reduced glutathione) biomarkers. Inflammatory infiltrates of nuclear cells were observed in brains of infected rats. MIN administration prevented the deleterious effects of E. coli infection, thus protects against sickness behavior possibly via defending from neuroinflammation.

To describe the care-seeking process from interpretation of an initial symptom to the decision to seek medical care in patients with an acute myocardial infarction.Patients afflicted by symptoms of an acute myocardial infarction delay in seeking care far exceeding the desired time limits. This results in avoidable loss of life. There is thus a need to understand these patients' initial discomfort, appraisal and behaviour to design interventions that could reduce delay in care-seeking.Focus group discussions with patients who had had a recent acute myocardial infarction.The analysis of the transcribed text was inspired by the self-regulatory model of illness behaviour.Patients with acute myocardial infarction describe problems to identify the exact time of onset of often vague symptoms. Their experiences of symptoms did not match their expectations. These patients exhibit self-regulatory illness behaviour that seems to cause a considerable delay in care-seeking.We found indications of a pertinent shift in appraisal and coping-strategy when a patient changes from self-regulative illness behaviour to seeking care - the turning point. This shift seems to be affected by several partly contradictory influences and it takes a considerable time for a person to reach this stage. All aspects of the patients' self-regulative illness behaviour have to be considered if we want patients to seek medical care more rapidly.Our findings are important to consider in future design of public health and rehabilitation strategies to save patient lives. To identify the turning point is a profitable way to deepen the understanding of patient behaviour during the initial phase of an acute myocardial infarction.

Objective: Participation in an exercise intervention during cancer treatment diminishes the side effects associated with cancer therapies, although such benefits vary according to the disease and the patient characteristics. A structured exercise program providing an individualized fitness program tailored to the patients' illness, treatment, and fitness level would address this variability. However, the need, desired components, and anticipated barriers of such a program have not been systematically explored from either the point of view of cancer patients or treating oncologists. Methods: Sixty-six cancer patients and 18 medical and radiation oncologists were surveyed on the above variables. Results: Cancer patients and oncologists alike perceived a need for a structured exercise program during and after medical treatment for cancer. Among cancer patients, the most commonly preferred feature was access to consultation with an exercise specialist who could take into account the patient's previous exercise and medical history. Over a third of patients reported interest in a hospital-based fitness program. Oncologists were in favor of appropriate supervision of patients during exercise, and noted insufficient time to discuss exercise in their practice. Respondents noted time and parking as barriers to participation. Conclusion: Overall, results support the need for a supervised exercise program during active treatment for cancer and highlight the desired features of such a program. Copyright © 2008 John Wiley & Sons, Ltd.

Objective: While the population in the western world is aging and cancer survival rates are increasing, there is a lack of knowledge concerning factors affecting social support and its relation to coping and distress among older patients. The aim of the current study is to assess the impact of marital status and gender upon levels of psychological distress, coping, and social support among middle-aged and older unmarried (divorced/widowed) and married colorectal cancer patients. Methods: Samples of 339 male and female colorectal patients were recruited from three major cancer centers in Israel. Participants' psychological distress, coping styles and social support were assessed using four self-report standardized instruments. Results: Two-way MANOVAs and Pearson's correlation coefficient were used to assess the relationships between the study variables. High levels of distress were found among unmarried and male patients. Married men reported on significantly higher levels of spouse support than married women. Family support was correlated with psychological distress only among married patients. Surprisingly, spiritual-religious support was found to be correlated among some of the study groups with Helplessness and Fatalism. Conclusions: The results support the assumption that married patients cope better with cancer than unmarried patients and that women cope better than men. These differences may be related to the cultural mores of Israeli society in which men are expected to play the ‘hero’ role or to a generally lower ability of men to use social support and of unmarried patients to get family support. Practical conclusions in terms of intervention are discussed. Copyright © 2008 John Wiley & Sons, Ltd.

During a 3-hr period of social isolation in a novel environment, guinea pig pups exhibit an initial active phase of behavioral responsiveness, characterized primarily by vocalizing, which is then followed by a stage of passive responsiveness in which pups display a distinctive crouch, eye-closing, and extensive piloerection. Prior treatment of pups with alpha-melanocyte-stimulating hormone (alpha-MSH) reduces each of the passive behaviors. The onset of passive responding during separation can be accelerated with peripheral injection of corticotropin-releasing factor (CRF). To examine whether CRF produces its effects through a mechanism similar to that of prolonged separation, we examined the effect of administering alpha-MSH to pups injected with CRF. As expected, CRF markedly enhanced passive responding during a 60-min period of separation. alpha-MSH delivered by either intracerebroventricular infusion or intraperitoneal injection significantly reduced each of the passive behavioral responses without significantly affecting active behavior. These findings, together with previous results indicating that it is the anti-inflammatory property of alpha-MSH that is responsible for its behavioral effects during prolonged separation, suggest that peripheral CRF speeds the induction of passive responding through a mechanism involving enhanced proinflammatory activity.

Objective: The objective of this study was to examine the psychometric properties of the Danish version of the Barriers Questionnaire-II (DBQ-II). Methods: The validated Norwegian version of the DBQ-II was translated into Danish. Cancer patients for the study were recruited from specialized pain management facilities. Thirty-three patients responded to the DBQ-II, Hospital Anxiety and Depression Scale, and Brief Pain Inventory pain severity scale. Results: A factor analysis of the DBQ-II resulted in six scales. Scale one, Fatalism, consisted of three items addressing fatalistic beliefs regarding cancer pain management. Scale two, Immune System, consisted of three items addressing the belief that pain medications harm the immune system. Scale three, Monitor, consisted of three items addressing the fear that pain medicine masks changes in one's body. Scale four, Communication, consisted of five items addressing the concern that reports of pain distract the physician from treating the cancer, and the belief that “good” patients do not complain. Scale five, Addiction, consisted of two items addressing the fear of becoming addicted to pain medication. Finally, scale six, Tolerance, consisted of three items addressing the fear of getting tolerant to analgesic effect of pain medicine. Items related to medication side effects were analyzed as separate units. The DBQ-II total had an internal consistency of 0.87. The DBQ-II total score was related to measures of pain relief and anxiety. Conclusions: The DBQ-II seems to be a reliable and valid measure of the barriers to pain management among Danish cancer patients.

Beliefs about pain conditions appear to influence recovery in a variety of musculoskeletal conditions. Little is known about population beliefs about neck and arm pain.To evaluate population beliefs of three common musculoskeletal conditions: work-related neck and arm pain and whiplash injury (WAD).Mail-out surveys were delivered to 2000 adult residents of two Canadian provinces cross-sectionally. To evaluate beliefs about the three conditions, the back beliefs questionnaire was modified yielding three comparable 10-item measures. In addition, we inquired about the belief about how quickly the condition settles. Respondents indicated their level of agreement on a 5-point Likert scale with lower scores interpreted as negative or pessimistic. Overall and item specific descriptive statistics are reported. A one-way repeated measures ANOVA was performed to compare beliefs across conditions.Three hundred (15%) surveys were returned. Overall belief scores were different across conditions (p0.001). Post-hoc tests revealed beliefs about whiplash injury were more negative compared to the other conditions (p0.017). There were moderate levels of uncertainty in the responses, especially in regard to whiplash injury. For items related to active coping, over 55% of respondents agreed that remaining active and exercising was important. The sample was pessimistic in regard to recovery and resuming usual activities for all conditions, but more so in the case of WAD.Population beliefs related to neck pain, arm pain, and WAD in the two Canadian provinces sampled were consistent with the literature in regard to remaining active, but appeared misinformed relating to the prognosis of these conditions. Strategies for reeducating the public are indicated.

Background People with intellectual disabilities (ID) have higher levels of health needs compared with the general population, many of which are unrecognised and unmet. While there has been interest and research into the primary health provision for this group, there has been a more limited focus on addressing their care received in general hospitals. Access to health care has predominated in the literature, with less attention being paid to the experiences of people with ID as users of general hospital care. Method A qualitative focus group methodology was used. Eleven adults with ID, nine parents and five paid carers of adults with ID participated. The focus groups were audiotaped and transcriptions were analysed using principles of grounded theory. Results The analysed data highlighted key themes identified from the experiences of participants. These were the interrelated issues of feelings, particularly anxiety and fear, communication and behaviour problems; the practicalities of being in or attending hospitals, including the role played by carers; and issues around perceived discrimination and negative comments. Conclusions The experiences of participants in this study concur with and add to concern expressed in recent reports and published research. Wide ranging implications are discussed for further research, wider policy development, clinical practice, local health service provision and education of health professionals.

In remote Aboriginal communities in Australia, researchers cast health beliefs and treatments as belonging to either an Aboriginal or biomedical system, which are considered to be irreconcilable and in conflict. Warlpiri people also speak of two distinct traditions that, they claim, are able to heal only specific classes of illness. Nevertheless, both Aboriginal and biomedical systems can be used simultaneously. An examination of two illness episodes will illustrate the complexity of how both Aboriginal and biomedical diagnoses and treatments are employed in a similar manner. I argue that while diagnosis is often stressed in statements regarding illness, it is only one of many factors that influence the treatment choices of individuals.

The discriminant validity of measures of abnormal illness behaviors and psychopathology was examined in three samples differing in illness proneness: a sample of young healthy university students (n = 38), a general community sample (n = 36), and a sample of clinical psychiatric outpatients (n = 36). Adjustment to illness was measured using the Illness Behaviour Questionnaire (IBQ; Pilowsky & Spence, 1994), while the Millon Clinical Multiaxial Inventory-III (MCMI-III; Millon, 1994) was used to measure clinical syndromes and personality. MANCOVAs were performed across the three groups on the IBQ and the MCMI-III categories, separately. As expected, clinical outpatients obtained significantly higher scores than did nonclinical groups on most of the IBQ scales, suggesting discernible discriminant validity. However, the lack of discrimination between groups on several of the MCMI-III scales raises questions about the test validity of this multidimensional instrument.

Objective To evaluate the effects of parents' avoidant illness behaviors on their adult children's adjustment to arthritis. Methods Men and women attending a rheumatology clinic completed arthritis health status questionnaires and described how their parents generally responded to their own minor illnesses. Some participants rated their parents as never avoiding routine activities when confronting minor illness and were assigned to the non-avoidant group. Participants in the avoidant group reported that their parents avoided routine activities in response to minor illness. Those in the mixed group rated one parent as avoidant and the other parent as non-avoidant. Results Relative to the non-avoidant group, participants in the avoidant group reported more behavioral restrictions, helplessness, and depression. All groups were similar with respect to disease severity. Conclusion Even after the passage of several decades, early observations of parents' illness behaviors appear to affect adjustment to arthritis.

Numerous authors have obtained significant, but low correlations between life events and specific health status measures. Even with the inclusion of moderating variables, such as coping, the relationship between life stress and health status measures has rarely exceeded .50. It has been argued that failure to enhance the correlation has occurred because response specificity has not been controlled. A representative community sample of 184 adults from London, Ontario, was surveyed with respect to life stress variables, stress-response specificity, and various illness behaviors. First-order factor analysis of the stress-response specificity measure indicated an emotional/psychological response factor, an eating response factor, a drug/alcohol response factor, and several physical response factors. Second-order factor analysis indicated a psychological response and a physical response factor. Each of the illness behaviors was regressed, in a stepwise procedure, upon the life stress measures and related first- and second-order stress-response specificity factors. As predicted, significant relationships were found between the related stress-response specificity and illness behavior measures. These results support the importance of stress-response specificity as a moderator variable in investigations of the relationship between life stress and illness behavior.

Tested the accuracy of the MMPI and the FAM for predicting appropriate vs. inappropriate disability (illness behavior) in low back pain patients (N = 123). When the Hypochondriasis and Hysteria scales were used, both versions had a 79% hit rate for inappropriate disability and at least an 80% overall correct classification rate. The resulting brief screening measure included 52 items.