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This study tested whether upper-body endurance training (ET) is feasible and can be performed at sufficient intensity to induce cardiovascular adaptations in severely disabled patients with progressive multiple sclerosis (MS). Eleven progressive MS patients (6.5 ≤ EDSS ≤ 8.0) scheduled for a four-week inpatient rehabilitation program were randomized to a control group (CON, n = 5) that received standard individualized MS rehabilitation or an intervention group (EXE, n = 6) that in addition received 10 sessions of predominantly upper-body ET. One patient dropped out of the EXE group (drop-out rate: 1/6~17%) and no adverse events were recorded. The EXE group completed on average 9.3±0.8 sessions (~96.0±5%). During the ET sessions an average heart rate of 93.9±9.3beats*min–1 were sustained corresponding to 91.6±6.8% of the maximal pre-intervention heart rate. In the EXE group a trend toward a time*group interaction was seen for VO2peak (p = 0.06). ET is feasible in severely disabled patients with progressive MS and it can probably be performed at sufficient intensity to induce cardiovascular adaptations. [ABSTRACT FROM PUBLISHER]

We conducted this study to explore communication between pregnant women and health care providers at an antenatal clinic in Zimbabwe. We adopted a field research approach using qualitative strategies for data collection and analysis. Using content analysis, we identified impersonal communication, nonprivate communication, rigid communication, uninformed communication, and authoritative communication as characteristic components of the interaction between the pregnant women and the health care providers. The attitudes reflected by the communication styles at the antenatal clinic must be viewed in relationship to the culture and tradition of Zimbabwe. With further research, we may identify obstacles to communication that are not related to culture. This knowledge may lead to a better understanding of appropriate communication strategies to promote healthy pregnancy. [ABSTRACT FROM AUTHOR]

The aim of this article is to present re-enactment interviewing and to propose that it can be used to reveal tacit caring knowledge. This approach generates knowledge not readily attainable by other research methods, which we demonstrate by analysing the epistemological and methodological underpinnings of re-enactment interviewing. We also give examples from a study where re-enactment was used. As tacit knowledge is often characteristic of care, re-enactment interviewing has the potential to engage the informant in a holistic mode and thereby reveal wisdom of the body. When the care provider recalls an event, the details are articulated, which contributes to in-depth data, which subsequently serves as a basis for trustworthy analysis. [ABSTRACT FROM AUTHOR]

Abstract Background A better understanding is needed of factors behind the long-term outcome of dysthymic and panic disorders. Combining patients' perceptions of factors that help and hind remission with objective assessments of outcome may give greater insight into mechanisms for maintaining recovery. Methods Twenty-three dysthymic and 15 panic disorder patients participated in a 9-year follow-up investigation of a naturalistic study with psychotherapy and antidepressants. Degree of remission was determined by reassessments with SCID-I & II interviews, self-reported symptoms and life-charting (aided by case records). Qualitative content analysis of in-depth interviews with all 38 patients was done to examine the phenomenon of enduring remission by exploring: 1) perceived helpful and hindering factors, 2) factors common to and specific for the diagnostic groups, 3) convergence between patients' subjective views on remission with objective diagnostic assessments. Results About 50% of the patients were in full or partial remission. Subjective and objective views on degree of remission generally converged, and remission was perceived as receiving 'Tools to handle life'. Common helpful factors were self-understanding, enhanced flexibility of thinking, and antidepressant medication, as well as confidence in the therapist and social support. The perceived main obstacle was difficulty in negotiating treatments. Remitted had overcome the obstacles, whereas many non-remitted had problems expressing their needs. Patients with dysthymia and panic disorder described specific helpful relationships with the therapist: 'As a parent' versus 'As a coach', and specific central areas for change: self-acceptance and resolution of relational problems versus awareness and handling of feelings. Conclusion A general model for recovery from dysthymic and panic disorders is proposed, involving: 1) understanding self and illness mechanisms, 2) enhanced flexibility of thinking, and 3) change from avoidance coping to approach coping; and recognising that a vehicle for this change is a helpful relationship to the health care provider. The perceived needs of specific treatment ingredients suggest that it is essential to differentiate between early-onset dysthymia and secondary depressions. The perceived access problems will be further investigated.

The aim of this study was to investigate barriers to diagnosis and adequate treatment of patients with early-onset dysthymia by studying how understandings of illness by patients and providers have evolved and how treatments have been negotiated over time. A theory-testing and explorative multiple-case study design was used with developmental cognitive theory as framework. Data pertaining 10 non-remission dysthymic patients were analyzed using five sources: 1) case records, 2) interviews, 3) self-report questionnaires, 4) observations, and 5) life-charting, eliciting life events, course and treatments. The analysis comprised qualitative content analysis and a coding scheme of knowledge structures. Barriers could be explained by misunderstandings as patients mainly expressed illness in concrete, perceptually bound knowledge structures and providers focused on one aspect, instead of on the complexity of concurrent aspects. Another barrier, associated to comorbid personality disorder, was a core pattern of concealing due to fear of rejection and mistrust. Other barriers were connected to providers' attitudes and contextual factors such as access problems and lack of follow-up. A theoretical model that involves patients' understanding of illness in preoperational thinking and providers' cognitive errors can explain communication barriers. Means of shared understanding and treatment planning are suggested. Future treatment research could elucidate the impact of the core belief of rejection with associated strategy of concealing by assessing these variables as predictors and as targets for change.

This article focuses on encounters that become violent, a problem in health care that has been the issue of many debates but is still not fully understood. Violent encounters refer to events where the patient expresses an aggressive and hostile attitude toward the caregiver. This study is part of a bigger project that aims to elucidate violent encounters from the caregivers' as well as the patients' perspectives. The purpose of this particular study was to describe the essence of violent encounters from the caregivers' perspective. Guided by a phenomenological method, data were analyzed within a reflective lifeworld approach. The essence of a violent encounter between caregivers and patients, as experienced by the caregivers, is a critical moment characterized by a tension between presence and distance, a moment where everything is happening at the same time. There are important meaning differences in relation to the violent encounter being viewed as positive rather than negative, based on the caregivers' ability to be present and their capacity in these trying situations to manage their fear. The findings also make explicit the particular knowledge that is needed for the caregiver to manage the threat of violence in a creative way.

The goal of this study was to identify, through the application of Watson's 10 carative factors, the caring needs specific to the human experience of having rheumatoid arthritis and undergoing acupuncture treatment. The study was conducted at a large university hospital in Stockholm, Sweden. Interviews were conducted during manual acupuncture treatment employing a conversation guide derived from Watson's theory of caring. Six women had 20 sessions each over an 11-week period. A thematic analysis of the resulting 120 audiotaped sessions revealed four predominant themes: seeking help, searching for meaning, uncertainty, and fear of being disappointed. These four phenomena captured the complexities of the physical, emotional, social, and existential experiences of the patients.

The article discusses the trajectory of lesbian and gay politics in Denmark, from the 1970s to the 1990s. It argues that, as part of the social and cultural change, marriage has become an empty institution; hence the ostensibly remarkable progress that gay and lesbian couples have also been conceded a marriage-like status. However, while pursuing this right, lesbian and gay organizations may have been too compliant with middle-class ideals of "decent" lifestyles; entering a registered partnership may become a new norm which excludes "less respectable" modes of homosexual lifestyles. The radical potential of homosexuality as a manifestation of the variety of lifestyles should not be jettisoned in the name of politics of assimilation.

Comparatively little is known about the experiential aspect of moral decision making in psychiatric nursing. Earlier research in this area has mainly focused on the cognitive aspects of moral reasoning, using hypothetical cases. The purpose of this study was to examine the experience of moral decision making in psychiatric nursing practice. In-depth interviews with fourteen nurses, purposively selected for their reputed competency and long experience in psychiatric care, were conducted. By using the strategy of 'constant comparative analysis', the grounded theory, 'structuring moral meaning' was derived, which consists of three interrelated processes, perceiving, knowing and judging. This process identifies the nurse's manner of making sense of a perceived moral conflict and justifying 'good' actions within the nurse-patient framework.