Search

Objective: To obtain insight into adaptation processes of redefining normality and its influencing factors in relatives of patients with advanced cancer. Methods: An exploratory qualitative study among relatives of patients with advanced cancer was conducted. Participants were purposively recruited. Ten in‐depth individual (relative only) and 16 dyad (relative and patient together) interviews were conducted, transcribed verbatim, and analyzed by means of thematic analysis, drawing on elements of grounded theory, combining both inductive and deductive elements. Results: Two adaptation processes of (redefining) normality were identified: assimilation and accommodation. The latter was found to be the main way of adapting to new events. Assimilative coping strategies entailed "continuing to do the same activities as done before the disease," "difficulty accepting the situation," "avoiding to think about the disease," and "living in the short term." Accommodative strategies involved "arranging practical matters," "thinking about the future," "doing what is feasible," "engaging in new activities," "accepting the situation," "seeking distraction," "living in the short term," and "focusing on what truly matters in life." The interplay between the diagnosis and treatment of cancer, a deteriorating disease status, and the accompanying uncertainty about the future was of influence on the relatives' coping strategies. Conclusion: When the new situation is too divergent to assimilate, accommodation may be necessary for relatives to cope with the growing complexity of the consequences of their loved one's illness. Accommodative coping then involves accepting the changing reality and actively making the necessary adjustments to build resilience and cope with the new circumstances. [ABSTRACT FROM AUTHOR]

Rationale: The question of how to adaptively cope with chronic illnesses, aging, and other sources of bodily impairment is crucial for patients and clinicians alike, though sometimes overlooked in the focus on biomedical treatment. Aims and Objectives: To examine the array of strategies available to patients and their practitioners, to employ in the face of bodily breakdown. Method: Co‐written by a philosopher and cardiologist, this article uses a detailed case study of a patient suffering a myocardial infarction leading to chronic heart failure, with examples of effective or suboptimal care. This enables a discussion of how the clinician or clinical team can best facilitate existential healing, that is, adaptive and creative resilience in the face of chronic impairment. Results and Conclusions: We outline a "chessboard of healing," involving the possibility‐spaces for dealing constructively with bodily breakdown. This set of strategies is shown to be nonarbitrary, drawn directly from contemporary work on the phenomenology of the lived body. For example, as we both experience the body as that which 'I am', and as that which 'I have', separable from the self, patients can react to illness by moving towards their bodies in modes of listening and befriending, or away from their body, ignoring or detaching themselves from symptoms. Then too, as the body is ever changing in time, one can seek restoration to a previous state, or transformation to new patterns of bodily usage, including passage into a whole new life‐narrative. [ABSTRACT FROM AUTHOR]

Background: The long-term epidemic of COVID-19 and its recurrence has exposed frontline nurses to mental disorders such as stress and health anxiety. High levels of health anxiety associated with COVID-19 may lead to maladaptive behaviors. There is no agreement on which coping styles are most effective against stress. Therefore, more evidence is required to find better adaptive behaviors. The present study was conducted to investigate the correlation between the level of health anxiety and the type of coping strategies used by frontline nurses fighting COVID-19. Methods: This is a cross-sectional study that was performed on a convenience sample of 386 nurses who are working in the COVID department from October to December 2020, coinciding with the outbreak of the third COVID-19 peak in Iran. Data were collected through a demographic questionnaire, the short version of the health anxiety questionnaire, and coping inventory for stressful situations. Data were analyzed using independent T-test, U-Mann-Whitney, and Kruskal-Wallis statistical tests with SPSS version 23 software. Results: The mean score of nurses' health anxiety was 17.61 ± 9.26 which was more than the cut-off point for health anxiety and 59.1% of nurses had COVID-19-related health anxiety. The mean score of problem coping style (26.85 ± 5.19), was higher than emotion (18.48 ± 5.63) and avoidance (19.64 ± 5.88) coping styles and nurses mostly used problem-coping strategies to deal with anxiety caused by COVID-19. There was a positive significant correlation between the scores of health anxiety and emotion coping style (r = 0.54; P < 0.001). Conclusion: Based on the findings of this study, COVID-19-related health anxiety was high in front-line nurses and those with high health anxiety were more likely to use emotion-based coping strategies, which are ineffective. Therefore, considering strategies to reduce nurses' health anxiety and holding training programs on effective coping methods in epidemic conditions are recommended. [ABSTRACT FROM AUTHOR]

Introduction. Autism is a severe and lifelong developmental disorder characterized by impaired social interaction and interpersonal communication, as well as characteristic repetitive patterns of interest and behavior. The purpose of this study is to point to the possibility of applying various techniques of adaptation of children with autism to dental interventions in order to maintain oral health. Material and Methods. A multidisciplinary project was carried out by the Dental Clinic of Vojvodina, Special Education School “Dr. Milan Petrović” and the Autism Society of Novi Sad. The following education models were used in the project: behaviororiented models, developmental strategies, therapy based interventions, and combined interventions. The success rate of applied education models and adaptation of children with autism spectrum disorders to dental interventions was examined. The success criteria included the ability to make contact, communicate, cooperate, and perform dental treatment. Results. The multidisciplinary project included 20 active members the Autism Society of Novi Sad and 20 members of the Special Education School “Dr. Milan Petrović” day care program. The results of the study showed a 95% success rate of the most commonly used applied behavior analysis. The success rate of the communication oriented interventions was 90%, while therapy based interventions showed an 85% success rate. The combined interventions showed a 100% success rate. Conclusion. Only integration of several methods, multidisciplinary cooperation and an individual approach to work with children with autism can lead to success in work and adaptation to dental interventions of persons with autism spectrum disorder. [ABSTRACT FROM AUTHOR]

Objectives: Disturbed sleep is a common complaint of lung cancer patients undergoing active oncologic treatment. We aimed to clarify the extent to which psychological symptoms, coping strategies, and social support interfere with sleep quality and whether they mediate the relationship between sleep quality and fatigue or functional capacity in a sample of chemotherapy treated lung cancer patients.Methods: Lung cancer patients attending an oncology unit for scheduled chemotherapy cycles completed questionnaires assessing their sleep quality, fatigue, depression, anxiety, stress, coping, social support, symptoms of pain, dyspnea, and cough, and sleep hygiene practices. Demographic and disease-related characteristics were obtained from patients' medical records and treating physicians rated their functional status. Multivariate regression and mediation analyses were applied to test the study's hypotheses.Results: One hundred nineteen patients were enrolled, 58.2% of whom were identified as poor sleepers. After adjusting for age, gender, comorbidities, concomitant medications, cancer stage, prior and ongoing treatment, sleep hygiene, and symptoms, there was a statistically significant association between poor sleep quality and anxiety (odd`s ratio [OR] 1.17 [95% CI, 1.01-1.35]), stress (OR 1.14 [95% CI, 1.04-1.25]), and positive coping (OR 1.15 [95% CI, 1.02-1.31]). Poor sleep quality was an independent correlate of fatigue (B 1.56 [95% CI, 0.61-2.50]) and low performance status (OR 5.17 [95% CI, 1.60-16.72]); stress symptoms partially mediated the relationship between sleep quality and fatigue (P = .030).Conclusions: Higher psychological burden predict sleep disturbances and contribute to increased fatigue in lung cancer patients undergoing chemotherapy. Effective psychoeducational interventions may benefit these populations. [ABSTRACT FROM AUTHOR]

Introduction: Spirituality in patients living with HIV helps to cope with the negative thoughts brought about by the illness. The purpose of the study was to understand the impact of spirituality on the lives of women living with HIV. Materials and Methods: This is a qualitative research on thematic life histories. The sample composed of seven women diagnosed with HIV/Aids for over a year. For the data collection, a semi-structured interview was used, with questions about the social context, sociodemographic and clinical situation, religion and spirituality. The content analysis technique was used for data analysis. The results were organized into two categories: seeking strength in spirituality and hope for healing. Results: In times of distress imposed by HIV/Aids, all the interviewees sought spirituality through prayer and even by materializing the presence of God as strategies to confront the disease. The yearning for healing by divine revelations is expressed in the interviewees' speeches. Discussion: According to the interviewees' life stories, the divine figure strengthened them in the face of challenges posed by HIV/Aids. Conclusions: Through this research, it was possible to verify that spirituality is present in the lives of women who live with HIV, and that it softens the adversities brought on by the disease. [ABSTRACT FROM AUTHOR]

Bаckground/Aim. Childhood exposure to various types of emotional, physical and sexual abuse in intimate partner violence (IPV) families is associated with difficulties in emotional and social adjustment, including conduct problems, internalized and externalized symptoms. The aim of this study was to determine the relationship between intimate partner violence and: family system functioning (cohesion and adaptability), conative functioning of adolescents and risk of psychopathological symptomatology development. The specific aim of this study was to establish the mental hygiene and preventive measures in order to reduce the negative consequences of growing up in the IPV families. Methods. The study was done on a sample of 308 adolescents, aged 15-18 years, divided into the IPV group (n = 68 adolescents growing up in families with the IPV and exposed to IPV in which the violence was reported and processed), and the control group (n = 240 adolescents coming from families in which there was not found any type of violence or psychosocial pathology on the basis of the results obtained on the Conners' Parent Rating Scale-Revised (CPRS-R) Questionnaire. The Faces III scale of measurement was used for measuring the dimensions of family functioning, and Cybernetic model of conative dimensions of personality (CON-6) for conative functioning of adolescents. The data was processed by using the discriminate and linear regressive analysis. Results. The adolescents growing up in the families with the IPV and exposed to IPV showed the statistically significant differences (p < 0.01) in conative functioning: psychosomatic β = -.509, anxiety β = -.393, aggressive β = -.398, dissociative β = -.509 and adaptive personality reactions β = -.455, as compared to the control group. There was 32.35% of adolescents exposed to IPV who showed the pronounced pathological values regarding social-adaption reaction, 23.53% regarding pathological anxiety and 23.53% dissociative reactions. The greatest negative relationship was found between intimate partner violence and family dimension of cohesion (β = -0.605, p < 0.01). Conclusion. Adolescents growing up and being exposed to the intimate partner violence were significantly associated with changes in the conative functioning and risk of externalized and internalized symptoms development in socially-adaptive, anxiety and dissociative reactions and the need to introduce the preventive mental-hygienic measures. The mediator between IPV and conative functioning of adolescents was family cohesion. [ABSTRACT FROM AUTHOR]

Introduction: Diagnosis of cancer in children and adolescents may affect relationships and family dynamics, apart from provoking suffering and fears due to mistrust on the discovery, treatment, and control of the disease. Considering the above, the purpose of this study is to understand what families face when cancer is diagnosed in children and adolescents. Materials and Methods: A descriptive, cross-cutting and qualitative study was carried out at the Oncology High Complexity Center Irmã Malvina de Montes Claros-MG. For the purposes of this research, a semi-structured interview was conducted with 27 family caregivers of children and adolescents with cancer who met the inclusion criteria. Later, the data were tabulated and analyzed using the content analysis technique. This study was authorized by the Research Ethics Committee under report 2.536.184/2018. Results: Once data had been analyzed, it was possible to draw up a socioeconomic profile of the family member and an epidemiological profile of the child patient. Most of the family members were female who were related to the child patient in the first grade of consanguinity and devoted their time to activities related to the care of the child. With respect to the epidemiology, about 55% of the cases were related to Acute Lymphoblastic Leukemia. Discussion: Results were grouped into three categories covering the initial impact of the diagnosis, knowledge as a form of relief, and strategies for coping with the disease. Conclusions: It was observed that the diagnosis of cancer in children and adolescents has a great impact on family dynamics, generating hurtful and desperate feelings in these families, which trigger the search for alternatives to face this illness that can be adapted to this new reality. [ABSTRACT FROM AUTHOR]

Background: Health hazard and insalubrity characterize the work in a shipyard Objective: To know about the perception shipyard workers have of the many risks to which they are exposed, including metals, and the strategies they use to deal with such risks. Method: Qualitative research conducted by semi-structured interviews with 14 workers directly exposed to metals at a shipyard in Rio de Janeiro. The script approached issues related to work/health, risks, work accidents and defensive strategies. We performed a thematic analysis based on Work Psychodynamics. Results: Perceptions about organization of the tasks in the workplace, risks of accidents, health problems related to work and exposure risks to metals. We identified the following defensive strategies: religiosity, contempt for danger, submission and passivity, control, denial, cooperation/trust, rationalization and use of drugs at work. Workers held little technical information on the risks of exposure to metals and only the older ones knew how to recognize such elements. Conclusion: The workers' risk perception is based on practice, deductions, and conversations with colleagues. The majority says they do not receive information about exposure to metals, and they are unable to identify the metals to which they are exposed. [ABSTRACT FROM AUTHOR]

Characterizing psychological factors that contribute to persistent symptoms after mild traumatic brain injury (MTBI) can inform early intervention. To determine whether fear avoidance, a known risk factor for chronic disability after musculoskeletal injury, is associated with worse clinical outcomes from MTBI, adults were recruited from four outpatient MTBI clinics and assessed at their first clinic visit (mean = 2.7, standard deviation = 1.5 weeks post-injury) and again four to five months later. Of 273 patients screened, 102 completed the initial assessment, and 87 returned for the outcome assessment. The initial assessment included a battery of questionnaires that measure activity avoidance and associated fears. Endurance, an opposite behavior pattern, was measured with the Behavioral Response to Illness Questionnaire. The multi-dimensional outcome assessment included measures of post-concussion symptoms (British Columbia Postconcussion Symptom Inventory), functional disability (World Health Organization Disability Assessment Schedule-12 2.0), return to work status, and psychiatric complications (MINI Neuropsychiatric Interview). A single component was retained from principal components analysis of the six avoidance subscales. In generalized linear modeling, the avoidance composite score predicted symptom severity (95% confidence interval [CI] for B = 1.22–6.33) and disability (95% CI for B = 2.16–5.48), but not return to work (95% CI for B = −0.68–0.24). The avoidance composite was also associated with an increased risk for depression (odds ratio [OR] = 1.76, 95% CI = 1.02–3.02) and anxiety disorders (OR = 1.89, 95% CI = 1.16–3.19). Endurance behavior predicted the same outcomes, except for depression. In summary, avoidance and endurance behavior were associated with a range of adverse clinical outcomes from MTBI. These may represent early intervention targets. [ABSTRACT FROM AUTHOR]

Introduction: Coping is characterized by the combination of cognitive and behavioral strategies used by individuals to control internal and external demands; when such strategies are not used assertively, they predispose the individual to illness. This study sought to conduct a systematic review of the instruments to evaluate coping strategies adapted to the Brazilian context. Materials and Methods: Systematic literature review carried out on the EBSCO, MEDLINE/PubMed, Web of Science, and Scopus databases, during the period from 2002 to 2017. Results: The review found 305 articles (Portuguese, Spanish, and English), 33 articles fulfilled eligibility criteria and 11 articles were included dealing with validated instruments that evaluate coping strategies; with these instruments being: Scale on the Mode of Coping with Problems and Inventory of Coping Strategies. Discussion: The instruments comprised transcultural adaptations, psychometric style, and self-application. In general, the instruments presented good validity and reliability evidence. The validity and internal consistency (reliability) properties of the instruments were considered satisfactory. Conclusions: It is expected that this work will encourage progress in the search for tools to evaluate coping strategies and that it will provide aids in the planning of more assertive interventions to help individuals in coping with conflicting situations, minimizing the impact of illness. [ABSTRACT FROM AUTHOR]

There is a need for robust outcome measures for use in psychiatric services. Particularly lacking are self-rated recovery measures with evidence of sensitivity to change. This study was established to examine the convergent validity and sensitivity to change over time (responsiveness) of the Recovery Assessment Scale – Domains and Stages (RAS-DS), in comparison to level of unmet need as measured by the Camberwell Assessment of Need – Short Appraisal Scale (CANSAS). Convergent validity was examined through cross-sectional correlations between 540 CANSAS and RAS-DS scores collected on the same day for the same individuals. Sensitivity to change was examined using correlations between change scores in CANSAS and RAS-DS where both were collected on the same day and the two time points were separated by 90 days or more ( n = 498). Results demonstrated moderate, significant cross-sectional correlations between CANSAS scores and RAS-DS total and domain scores and between change scores of both instruments. Results suggest that the RAS-DS is sensitive enough to detect change over time. Only moderate correlation between the RAS-DS and CANSAS suggests that, in the context of recovery-oriented service provision, it is important to measure self-reported recovery in addition to level of unmet needs. [ABSTRACT FROM AUTHOR]

Objective: To know the dimension of spirituality in the confrontation of patients submitted to chemotherapy. Methods: This was a descriptive, transversal and exploratory study with a qualitative approach performed with 15 patients submitted to chemotherapy in a public hospital institution of both sexes, over 18 years of age. A semi-structured interview was used, with open questions, whose answers were recorded, transcribed and organized through the Discourse of the Collective Subject. Results: The results revealed that the feelings are varied, dividing up into optimistic feelings, mostly, as well as negative ones. Conclusion: Spirituality/religiosity exerts significant influence during the chemotherapy treatment, contributing to the person passing through this moment with more optimism. [ABSTRACT FROM AUTHOR]

Objective: To determine the correlations between coping strategies, depression, stress levels and pain perception in patients with endometriosis. Methods: This prospective and exploratory study included 171 women undergoing treatment for endometriosis between April and August 2014. The questionnaires used were Brief COPE, Beck Depression Inventory, Lipp's Stress Symptom Inventory for Adults and Visual Analogue Scale. Clinical data were collected from electronic medical records. Results: Patients with endometriosis who used positive coping strategies had better adaptation to stress (p<0.004) and less depression (p<0.004). The presence and intensity of depression, stress and acyclic pelvic pain were directly associated (p<0.05). The intensity of dysmenorrhea was associated with the degree of depression (p<0.001), whereas acyclic pelvic pain was associated with the degree of depression (p<0.001), stress level (p<0.001) and stress type (p<0.001). Conclusion: We found a positive association between coping, depression levels, type and levels of stress and pain intensity in patients with endometriosis. The use of maladaptive coping strategies focused on emotion is correlated with increase in depression and stress. [ABSTRACT FROM AUTHOR]

Objective: the objective in this study was to describe the strategies developed by digestive stoma patients to cope with their situation. Method: a qualitative and descriptive study was undertaken, involving 21 stoma patients living in the provinces of Málaga and Granada (Spain). The informants were selected in accordance with criteria of appropriateness and diversity, through intentional sampling. The data were collected by means of semistructured interviews. Results: the content analysis revealed three categories around which the distinct strategies were developed: Self-care, Adaptation to the bodily change and Self-help. Conclusion: the strategies developed are focusing on achieving the effective management of the stoma and are closely linked with the achievement of autonomy. Discovering the strategies applied is fundamental for the nursing professionals to offer high-quality care, centered on people and their process. [ABSTRACT FROM AUTHOR]

Social maturity is defi ned and assessed through the adaptive behavior domains of communication, daily living skills, socialization and maladaptive behaviors, which consist of social-emotional, cognitive, and behavioral skills needed for successful coping in social situations. The aim of the study was to assess social maturity defi ned through adaptive behaviors in the samples of children and youth with autism spectrum disorders and those with intellectual disability without autism spectrum disorders (N=98, aged 7-21, both male and female, from the Center for Autism in Zagreb). Adaptive behavior developmental level was assessed on the Vineland- II Social Maturity Scale. Statistically signifi cant diff erences in the space of adaptive behavior as an indicator of social maturity between the tested samples were obtained. Participants with autistic spectrum disorders had lower adaptive behavior levels and exhibited more maladaptive behaviors than participants with intellectual disability. This study proved the structure of social maturity and adaptive skills between children and youth with autistic spectrum disorders and those with intellectual disability to be signifi cantly diff erent. The data obtained also indicate that the lower adaptive behavior level, as well as maladaptive behavior poses a greater risk of mental health problems and as such they can be used for prevention concerning the choice and application of educational and rehabilitation support programs. It contributes to better quality of life of such children and their families. [ABSTRACT FROM AUTHOR]

Introduction. Information on being diagnosed to have cancer is always shocking for the patient, and it always causes a lot of psychosocial problems during its treatment. In these moments, patients need understanding, support and someone who can help them to apprehend all available options and choices clearly. The purpose of this study is to show the psychological states of patients with breast cancer after breast surgery, the importance of the psychological support, and first experiences in psycho-oncological management of breast cancer patients. Material and Methods. The study sample included 46 women, their average age being 52.32 (± 8.98), who had answered questions in a questionnaire in the period after surgery. Results. The patients experienced fears and worries associated with almost every part of cancer treatment likely to happen in the near future. The fear of chemotherapy and radiotherapy (67%), the horror of losing hair (59%) and the fear of relapse or disease progression (57%) were evident. Moreover, the patients dreaded the forthcoming pathological results and the decisions to be made by the Oncology Commission (57%), with accompanying insomnia caused by disturbing thoughts in 39% of the patients. Conclusion. These findings suggest that psychological support is important in this early period after breast surgery due to the vulnerability of the patients, and because it can diminish the risk of potential escalation of distress. [ABSTRACT FROM AUTHOR]

Objective. To examine the direct and mediated relationships between religious coping, spirituality, social developmental factors, and violence among high-risk and gang-involved youth in a high-crime, Latin American country. Methods. Using a community sample of 290 high-risk and gang-involved youth in San Salvador, El Salvador, structural equation modeling was employed to examine the relationships between religious coping, spirituality, social developmental factors (e.g., antisocial bond and antisocial beliefs), and violence. Results. Religious coping (β = -0.14, P < 0.05) and spirituality (β = -0.20, P < 0.01) were both significantly associated with antisocial bond. Antisocial bond, in turn, was directly associated with violence (β = 0.70, P < 0.001) and was associated with antisocial beliefs (β = 0.54, P < 0.001); however, the path from antisocial beliefs to violence was not statistically significant. No direct paths were identified from religiosity and spirituality to violence. The goodness-of-fit statistics (root mean square error of approximation, 0.034; comparative fit index, 0.974; and Tucker-Lewis index, 0.966) suggest that the final model had acceptable fit. Conclusions. This study is among the first to shed light on the relationship between religiosity, spirituality, and youth violence in the Latin American context. Elevated levels of religious coping and spirituality are associated with less antisocial bonding, which, in turn, is associated with lower levels of violent behavior among high-risk and gang-involved Salvadoran youth. Study findings suggest that religious coping and spirituality are indirectly protective for youth violence among this high-risk population. [ABSTRACT FROM AUTHOR]

Background: Critical incidents in clinical medicine can have far-reaching consequences on patient health. In cases of severe medical errors they can seriously harm the patient or even lead to death. The involvement in such an event can result in a stress reaction, a so-called acute posttraumatic stress disorder in the healthcare provider, the so-called second victim of an adverse event. Psychological distress may not only have a long lasting impact on quality of life of the physician or caregiver involved but it may also affect the ability to provide safe patient care in the aftermath of adverse events. Methods: A literature review was performed to obtain information on care giver responses to medical errors and to determine possible supportive strategies to mitigate negative consequences of an adverse event on the second victim. An internet search and a search in Medline/Pubmed for scientific studies were conducted using the key words 'second victim, 'medical error', 'critical incident stress management' (CISM) and 'critical incident stress reporting system' (CIRS). Sources from academic medical societies and public institutions which offer crisis management programs where analyzed. The data were sorted by main categories and relevance for hospitals. Analysis was carried out using descriptive measures. Results: In disaster medicine and aviation navigation services the implementation of a CISM program is an efficient intervention to help staff to recover after a traumatic event and to return to normal functioning and behavior. Several other concepts for a clinical crisis management plan were identified. Conclusions: The integration of CISM and CISM-related programs in a clinical setting may provide efficient support in an acute crisis and may help the caregiver to deal effectively with future error events and employee safety. [ABSTRACT FROM AUTHOR]

Objective. This article introduces a Spanish version of the Generalized Expectancies for Negative Mood Regulation Scale (NMR-S) and tests the reliability and the validity of the new questionnaire. Methods. A sample of 360 students from Chile completed the NMR-S along with instruments measuring depressive symptoms, social desirability, coping, and emotion regulation. Results. A factor analysis indicated that the NMR-S has a one-dimensional structure. The reliability of the new instrument was a = 0.89. The concurrent validity of the NMR-S was supported by correlations with measures of coping, emotion regulation, and depressive symptoms. Furthermore, the NMR-S predicted depressive symptoms when controlling for emotion regulation and coping. Conclusions. The findings are the first evidence to support the reliability and validity of the NMR-S. [ABSTRACT FROM AUTHOR]

Prevalence of depression is associated inversely with some indicators of socioeconomic position, and the stress of social disadvantage is hypothesized to mediate this relation. Relative to whites, blacks have a higher burden of most physical health conditions but, unexpectedly, a lower burden of depression. This study evaluated an etiologic model that integrates mental and physical health to account for this counterintuitive patterning. The Baltimore Epidemiologic Catchment Area Study (Maryland, 1993–2004) was used to evaluate the interaction between stress and poor health behaviors (smoking, alcohol use, poor diet, and obesity) and risk of depression 12 years later for 341 blacks and 601 whites. At baseline, blacks engaged in more poor health behaviors and had a lower prevalence of depression compared with whites (5.9% vs. 9.2%). The interaction between health behaviors and stress was nonsignificant for whites (odds ratio (OR = 1.04, 95% confidence interval: 0.98, 1.11); for blacks, the interaction term was significant and negative (β: −0.18, P < 0.014). For blacks, the association between median stress and depression was stronger for those who engaged in zero (OR = 1.34) relative to 1 (OR = 1.12) and ≥2 (OR = 0.94) poor health behaviors. Findings are consistent with the proposed model of mental and physical health disparities. [ABSTRACT FROM PUBLISHER]

As many patients experience distress after breast cancer, we investigated whether perceived self-efficacy predicts breast cancer patients’ emotional, physical and social well-being and whether mental adjustment styles mediate this association. A sample of 684 women with breast cancer completed a questionnaire including the general self-efficacy scale at baseline, the Mini-MAC at 1-month follow-up and the EORTC QLQ-C30 at 12-month follow-up. Multiple linear regression was used to assess associations between self-efficacy, mental adjustment style and well-being. Disease-related and sociodemographic factors were examined as confounders. Greater self-efficacy at baseline was associated with emotional well-being after 12 months (β = 0.59; 95% CI, 0.35–0.82). Fighting spirit, anxious preoccupation and helplessness–hopelessness partly mediated the effect of self-efficacy, but self-efficacy also had a direct effect on emotional functioning (β = 0.26; 95% CI, 0.02–0.51). No association was found between self-efficacy and physical and social well-being. Significant associations were observed between self-efficacy and education and time since diagnosis and also between well-being and age, education, relapse and time since diagnosis. Self-efficacy was a significant predictor of an active adjustment style and emotional well-being in breast cancer patients. Hence, it could be a valuable target of rehabilitation programs. [ABSTRACT FROM AUTHOR]

With the increasing effectiveness of breast cancer treatment, the scientific interest in investigating the quality of life of survivors has increased. However, research addressing the post-treatment period is still scarce. The aim of this study was to identify the Stressors present in the lives of women in the one to five years post-diagnosis period. The sample was composed of 16 women assisted at a specialized mastectomy rehabilitation service. Data were collected through semi-structured interviews and analyzed using content analysis. The results indicate conflicts with self-image and alteration in the feeling of autonomy, fear in relation to the evolution of the condition, feelings of guilt about the disorder generated in the family, experience of disturbing social situations and a desire to return to their professional occupation. These results reveal the existence of Stressors in this phase and the importance of support offered by psychosocial rehabilitation services for this population. [ABSTRACT FROM AUTHOR]

Objective Globalisation and severe doctor shortages in many countries have resulted in increased numbers of international medical graduates (IMGs) in medical training programmes in major recipient countries such as Canada. Much of the literature on IMGs is written from the perspective of the doctor workforce. Less is known about the recertification training experiences of IMGs in recipient countries. This study aims to describe the recertification training experiences of IMGs in Canada in order to help medical training programmes understand how to facilitate the integration of IMGs into recipient medical communities. Methods A phenomenological (qualitative) research approach was undertaken for this study. International medical graduates undergoing recertification training in order to practise in Canada were individually interviewed about their experiences. Data collection and analysis followed the procedures of interpretive phenomenology. Results Twelve IMGs participated. Analysis of the interviews revealed 4 themes that typified IMG recertification training experiences: training entry barriers; and a 3-phase process of loss, disorientation and adaptation. International medical graduates must complete this 3-phase process in order to feel fully integrated into their professional environments. Conclusions This study provided a description of IMGs’ training experiences during certification for practice in Canada and revealed that these experiences were characterised by a 3-phase process of adjustment. Using this framework, a series of recommendations were proposed for medical training programmes to help IMGs with this process. [ABSTRACT FROM AUTHOR]

Objectives To investigate the reactions experienced by hospital doctors following a recent memorable patient death, defined as a patient death that had occurred in the previous few months that the doctor recollected for any particular reason, the coping strategies employed to deal with these reactions, the impact of training, and the need for support in future situations. Methods We carried out a descriptive survey in 2 teaching hospitals and 1 district general hospital in West Yorkshire, UK. Subjects comprised 188 hospital doctors of all grades (from pre-registration house officer to consultant) who were attending 12 educational lunchtime meetings. Main outcome measures included the associations between the intensity of emotional and physical reactions measured using a categorical rating scale, and exposure to previous training, gender, seniority and medical specialty. Results Reactions of moderate to severe intensity to a patient death were experienced by 5.0–17.5% of doctors, regardless of gender, seniority or medical specialty. Perceived need for both training and increased support from team members was significantly associated with more intense reactions. Common coping strategies included talking, spending time alone and exercise. There was no relationship between respondents' exposure to previous training and the intensity of emotional or physical responses. Conclusions Many doctors perceive that they deal with death well. In a minority of doctors, more supportive approaches are necessary that may include both proactive and reactive measures. Examples include raising awareness of support services and establishing formal training programmes, and increasing awareness among senior clinicians of the need to support some team members after a patient's death, which may include ensuring that timely access to a counsellor is provided. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence and the factors associated with common mental disorders among adolescents in Pelotas, a southern Brazilian city. Method: A population based cross-sectional study was carried out in the urban area of Pelotas. Multistage sampling was used to obtain a sample of adolescents aged between 15 and 18 years. Adolescents were interviewed using a serf-report confidential questionnaire. The presence of common mental disorders was assessed using the Self-Reporting Questionnaire 20 (SRQ-20). Multivariate analysis was carried out using the Poisson regression with a robust adjustment of variance and control for design effect. Results: Nine hundred and sixty adolescents were interviewed. The prevalence of common mental disorders was 28.8%. Adolescents aged 17 years showed prevalence of 1.37 (95% CI 1.06-1.78) times greater than the 15 year olds. Adolescents whose mothers had between 5 and 8 years of schooling had a prevalence 1.42 (95% CI 1.01-1.51) times greater than those whose mothers had more than 8 years of schooling. Smoking and sedentary behavior were also associated with an increased prevalence of common mental disorders. Those who were dissatisfied with their body image showed a prevalence of 1.47 (95 % CI 1.07-2.02). Conclusions: Maternal schooling, tobacco smoking, sedentary behavior and body image dissatisfaction were factors associated with the presence of common mental disorders. [ABSTRACT FROM AUTHOR]

Soldier's social adaptation includes his interpersonal relationships with his environment integration into the military community and the ability to fulfill his role in the military environment and to function adequately outside of it. The aim of this study was to establish the dynamics of soldier's social adaptation during the military service. The study involved soldiers of two platoons of the Armed Forces of Serbia and Montenegro, divided into three groups according to the period of the study: after the first month, after the basic training and at the end of the military service. The instruments applied for the study were sociodemografic questionnaire and Social Adaptation Self-evaluation Scale. Statistical analysis of the obtained data was done using Stident's t-test. The results of the study that soldier's contentment with his professional role and with the quality of his interpersonal relations was highest during the basic training, but the quality of leisure activities was lowest at the end of the military service. [ABSTRACT FROM AUTHOR]

Introduction Medicine has traditionally been considered a masculine pursuit and its undergraduate curriculum criticised as being inherently sexist. Overt sexism, though diminished, still occurs and students report offensive sexual remarks, unwanted sexual advances and unequal learning opportunities. Sexual discrimination also colludes with attitudes that promote the stereotyping of the roles of women both in medicine and in society itself. This study aimed to ascertain medical students' own experience of sexism during undergraduate training, their understanding of these events, what effects the events had on them and, specifically, how they coped. Methods Twelve in-depth interviews, each focusing on a critical incident, with individual self-selecting Year 5 medical students took place. Initial qualitative analysis of transcripts produced themes that were further subsetted. Results Students described situations where they felt their learning had been jeopardised. Male students reported frequent difficulties whilst attached to obstetric and gynaecology firms. Students commented that their gender did sometimes affect their relationships with teaching staff and that affirmation from their teachers was important. Female students coped well with their experiences of sexism, often supporting each other. Male students often felt resigned to being excluded from certain learning opportunities and this sometimes resulted in unresolved frustration. Conclusions Developing a non-sexist undergraduate curriculum should be prioritised. Encouraging teaching staff to reflect on their attitudes to gender, approaches to teaching and providing support, such as mentoring, especially for female students frequently lacking appropriate role models, is advised. [ABSTRACT FROM AUTHOR]

ContextPrevious studies have drawn attention to the importance of the trainee/trainer relationship in determining job satisfaction and motivation to learn. ObjectivesTo study the relationship between pre-registration house officers and their consultants through exploring an interpersonal exchange and the emotional context in which the exchange took place. To consider any association between the type of relationship implied and the trainee's attitude to their career. DesignPostal questionnaire covering a wide range of issues. This study focused on an open question about a significant or interesting exchange, followed by supplementary questions exploring the emotional context of the exchange. Setting336 hospitals throughout the United Kingdom. SubjectsA cohort of doctors were followed from the time of their application to medical school, and studied towards the end of their pre-registration year (n =2456). ResultsThe response rate to the questionnaire was 58·4%. Responses were categorised as Support and supervision; Unreasonable behaviour; Consultant fallibility; Fair criticism and No exchange. Over half the responses described an interaction that made them feel positive. Trainees particularly appreciated positive feedback, clinical support, teaching, career advice, patronage, or social interaction. The importance of formal appraisal or review sessions in providing the setting for a positive exchange was confirmed. Positive interactions were associated with a positive view of medicine as a career. A minority described an interaction that was negative, involving unreasonable demands, criticism (whether perceived as fair or unfair), humiliation, or sexism. These were associated with a more negative view of medicine as a career, and of themselves as doctors. [ABSTRACT FROM AUTHOR]

ContextPrevious studies have drawn attention to the stresses experienced by doctors in their first year. ObjectivesTo gain a deeper understanding of the causes of stress in newly qualified doctors, how they cope, and what interventions might make the year less traumatic. DesignPostal questionnaire. This study focused on an open question asking about a stressful incident, the coping strategy used to deal with it, stressors in general and current levels of stress using the General Health Questionnaire. Setting336 hospitals throughout the United Kingdom. SubjectsA cohort of doctors followed from the time of their application to medical school, studied towards the end of their pre-registration year (n =2456). ResultsThe response rate to the questionnaire was 58·4%. The incidents were categorised into the major groups Responsibility (33·6%), Interpersonal (29·7%), Overwork (17·0%), Death and disease (13·0%), and Self (6·7%). GHQ revealed psychological morbidity in 31% of respondents. Stress levels were highest in those reporting an incident about Responsibility or Self, lowest in those describing Death or disease. Stressors in general and preferred coping strategies differed between the groups. ConclusionThe incidents suggested the following interventions to reduce stress: better supervision in the first few weeks in post, at night, and for medical problems on surgical wards; more attention to avoiding sleep deprivation; more time for discussion with colleagues at work; more personal time with friends and family. The choice of incident described was influenced by the personal characteristics of the respondent. [ABSTRACT FROM AUTHOR]

ObjectiveTo perform a screening, follow-up and comparative evaluation of depression and anxiety symptoms in a group of 59 first-year internal medicine residents of a teaching hospital and evaluate the influence of their rotation, nature of rotation, subgroup, sex and the time of year on these symptoms. MethodsWe used the Spielberger State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI), applied seven times, in the last week of every rotation. Results and conclusionWe obtained two identical averages (P =0·98) of trait-anxiety, six months apart one from the other. There was a significant correlation (R =0·65, P < 0·001) between the indexes of state-anxiety and depression. Women had higher levels of symptoms of both anxiety and depression (P < 0·001) compared to men. A cluster of three subgroups of residents with higher trait-anxiety levels (P =0·001) also showed significantly higher levels of symptoms of state-anxiety and depression (P < 0·001). The time of the year and the nature of the rotation (emergency or not) did not interfere with the levels of depression (P =0·47). We detected rotations where there was greater frequency of residents with symptoms compatible with moderate and severe depression. There were 2·1% of residents with symptoms compatible with severe, 4·2% with moderate and 27% with mild depression. It was possible to graduate symptoms of anxiety and depression in residents, evaluate factors involved in their genesis and locate residents with moderate and severe depression. [ABSTRACT FROM AUTHOR]

Purpose Explanatory (i.e. attributional) style has been shown to be related to performance, especially when attributions are pessimistic. This study tested whether this relationship was present for residents. Method The Attributional Style Questionnaire and the Brief Symptom Inventory were completed by 45 residents. Clinical rotation evaluations and in-training examination scores were used as performance measures. Results Explanatory style and emotional distress were not related to performance, although explanatory style was correlated with emotional distress. Overall, residents displayed an optimistic explanatory style. Conclusion The absence of a relationship between explanatory style and performance may be due to the tendency for this resident sample to be optimistic. Also, common indicators of residency performance may not accurately measure clinical and academic performance. [ABSTRACT FROM AUTHOR]