Lump sum compensation for asbestos related lung disease.
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Asbestosis↗
Biomedical subjects
P Slade
Publications and source records attributed to P Slade.
Psychological aspects of chronic pelvic pain.
Chronic pelvic pain (CPP) is a common gynecological problem which is poorly understood. A physical cause for the pain often cannot be established and, consequently, it has been difficult to treat successfully. In the absence of an identifiable physical cause for pain, researchers have attempted to identify a psychopathological causation. Associations have been reported between CPP and factors including personality and mood disturbance, childhood events, particularly sexual abuse, and sexual and relationship difficulties. However, evidence that women with CPP without discernible pathology differ in personality, psychological state, or life experiences from women with an identifiable cause for the pain, or those without chronic pelvic pain, is inconclusive. This review highlights methodological flaws inherent in many of the studies. It suggests areas and approaches for future research adopting a broader biopsychosocial perspective, which may generate findings of greater clinical utility.
Causality↗
Patterns of progression and nonprogression through in vitro fertilization treatment.
PURPOSE: Increasing numbers of couples are consulting for infertility and, after some years of investigation and treatment, will become enrolled in in vitro fertilization (IVF) programs. The media have focused on successful outcomes or difficulties in accessing services because of health authority funding guidelines. Couples are often assumed to be highly motivated because of their long prior involvement in treatment. However, little is known about uptake of and continuation through IVF treatment programs. METHODS: One hundred forty-four couples were followed through the process of IVF in a service that allows three cycles of treatment, with a minimum gap of 3 months between treatment cycles. Patterns of engagement in and delay and withdrawal from treatment were examined. RESULTS: One in five couples withdrew from the program before completion of the available number of treatment cycles. A further one in three significantly delayed their involvement in treatment cycles. Mean deviations of the time between attempts increased as the numbers of treatment cycles progressed. A proportion of couples did not complete a single treatment cycle. CONCLUSIONS: The dramatic proportions of patients withdrawing from or very significantly delaying subsequent involvement are indicative of the often unacknowledged difficulties associated with IVF treatment. Implications for care are discussed.
Behavior↗
A prospective, longitudinal study of emotions and relationships in in-vitro fertilization treatment.
Emotional and relationship assessments were completed by 144 couples at intake for in-vitro fertilization (IVF) and 6 months after either the identification of pregnancy or the discontinuation of treatment following three unsuccessful cycles. Women also completed emotional assessments at the time of pre-oocyte recovery and post-embryo replacement within each treatment cycle. At intake, women were more anxious than their partners and comparative norms, and were less positive than men about their marital and sexual relationships. Initial emotional assessments were not related to subsequent pregnancy, but at follow-up those who were pregnant were less depressed and more positive about their relationships. Within treatment cycles scores for women were higher after embryo replacement and the failure of pregnancy. First and last treatment cycles were associated with greater anxiety. High levels of confusion and bewilderment found during the initial cycle may indicate the need for better pretreatment information. Services must recognize the presence of high anxiety at intake and provide psychological care for those identified as particularly distressed. Emotional difficulties after failure of IVF treatment can be considered to be iatrogenic effects, and psychological services should be provided to minimize any negative psychological consequences of treatment.
Adult↗
Impact of new methods on therapeutic abortion at the Royal Infirmary of Edinburgh.
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Abortion, Therapeutic↗
Miscarriage as a traumatic event: a review of the literature and new implications for intervention.
This review considers the psychological impact of miscarriage and follow-up care. A fifth of pregnancies end in miscarriage, and the experience leads to emotional consequences such as depression and anxiety, which may last for several months. Some have explored the focus of psychological morbidity and attempted to discover predictors of adjustment, but results are inconclusive. Grief has been identified as a feature of postmiscarriage distress, but trauma associated with the process of miscarriage has been neglected. Despite the recognized impact, there is dissatisfaction with professional emotional care, and there is no routine follow-up. There have been no controlled intervention studies with women who miscarry during early pregnancy, although anecdotal evidence suggests beneficial effects. Such studied have concentrated on loss, but perhaps future research should consider the whole experience of miscarriage. An intervention derived from trauma research has been suggested as a possible strategy for facilitating emotional adjustment and preventing longer term negative responses.
Abortion, Spontaneous↗
Body image, maternal fetal attachment, and breast feeding.
The aim of this study is to make a preliminary examination of the relationship between body satisfaction, maternal fetal attachment, and breast or bottle feeding plans in pregnancy. Thirty eight women between 32 and 38 weeks pregnant were examined by means of the Maternal Foetal Attachment Scale, the Eating Disorders Examination, and the Body Satisfaction Scale. Women intending to breast feed were more satisfied with their shape. Women intending to breast feed had higher levels of maternal fetal attachment. Body shape dissatisfaction and low maternal fetal attachment may account for why some women choose to bottle feed.
Adult↗
A questionnaire examining learning in general practice.
Vocational training is a key element of professional development in general practice. Learner-centred approaches to teaching bring a need for greater understanding of the individual learning styles and preferences of trainees. This paper reports the findings of a pilot study undertaken to determine factors that may influence learning among general practice trainees. A questionnaire survey of 261 trainees in six regions in the UK was carried out to explore attitudes to a series of themes identified in semi-structured interviews with trainees at the end of their training. Six distinct subscales were identified using principal components analysis. These are named 'Learning from Patients', 'Openness to Criticism', 'Negative Attitudes', 'Desire for Clear Guidelines', 'Peer Support', and 'Academic Approach'. Males scored significantly higher on 'Academic Approach' (P < 0.05). Each of the subscales reflects themes that permeate the atmosphere of general practice training. Further work is required to establish relationships between the subscales and the outcomes of learning and to explore the implications for continuing professional development. The questionnaire is an instrument that may prove useful in the future investigation of learning in general practice.
Family Practice↗
The factor structure of "schizotypal' traits: a large replication study.
The heterogeneity of schizotypal traits, suggested in previous research, was further investigated in a sample of subjects (N = 1095) administered a composite questionnaire consisting of a large number of published scales the majority of which were designed to measure psychotic characteristics. Factor analysis confirmed the four components previously indicated in our work with the same instrument; namely, "aberrant perceptions and beliefs', "cognitive disorganization', "introvertive anhedonia' and "asocial behaviour'. This structure was maintained regardless of whether or not the analysis included scales from the Eysenck Personality Questionnaire, which might otherwise have been held to explain the variance. "Aberrant perceptions and beliefs'-reminiscent of the positive symptoms of schizophrenia-was the strongest component; but, given the multidimensional nature of the data, together with the pattern of factor loadings and intercorrelations for the scales involved, it was concluded that the broader term "psychosis-proneness' or "psychoticism' (in a non-Eysenckian sense) might be a better descriptor of the clinical and personality domain sampled.
Adult↗
The influence of psychological debriefing on emotional adaptation in women following early miscarriage: a preliminary study.
About a fifth of pregnancies end in miscarriage, leading to emotional consequences, such as anxiety and depression, which may last for a number of months. Despite this, women are not routinely provided with follow-up care. Anecdotal evidence suggests that follow-up focusing on emotional experiences may have beneficial effects. This study tests the hypothesis that the psychological debriefing process has a positive influence on emotional adaptation. Women were assessed, using the Hospital Anxiety and Depression Scale and Impact of Events Scale, at one week and four months post-miscarriage. Half the women also received psychological debriefing at two weeks. Intrusion and avoidance scores were initially as high as those of post-trauma victims, but had significantly decreased by four months. Depression was not detected at any time point, but anxiety was significantly higher than community sample estimates at one week and four months. Psychological debriefing was perceived to be helpful, but did not influence emotional adaptation. A number of hypotheses are provided to explain these results. Outcome scores at one week significantly predicted outcome at four months, suggesting that early assessment would be important in determining which women should be offered intervention.
Abortion, Spontaneous↗
Relationships between cleft severity and attractiveness of newborns with unrepaired clefts.
Perceptions of attractiveness of newborns with unrepaired clefts were investigated by using a range of photographs with clefts of differing severity as ordered by a rule of thumb system commonly adopted by surgeons. The investigation involved a combination of factors such as completeness, unilaterality or bilaterality, and palate involvement. Orderings of attractiveness by surgeons, nursing staff, and adult groups unfamiliar with clefts were remarkably consistent. In addition, the responses reflected the rule of thumb system with ranked preferences of the raters being significantly related to the severity of cleft impairment. The scale devised could be used for comparative treatment outcome studies requiring assessments of initial infant attractiveness.
Adult↗
Preliminary development of a questionnaire designed to measure neurotic perfectionism in the eating disorders.
The preliminary development and validation of a new self-report questionnaire (the NPQ) for measuring neurotic perfectionism in the eating-disorder population is described. The 42-item instrument demonstrated satisfactory internal consistency. All test items correlated significantly with both SCANS P and SCANS D (subscales of the SCANS [Slade & Dewey, 1986]), thus indicating neurotic perfectionism according to Slade, Newton, Butler, and Murphy (1991), and discriminated well between controls and eating-disorder patients. NPQ scores demonstrated significant group differences on comparison of neurotic perfectionists with normal and non-perfectionists (defined by the SCANS) and with subjects who scored above the EAT-26 (Garner, Olmsted, Bohr, & Garfinkel, 1982) subscale cut-offs when compared with those who scored below.
Adolescent↗
Detecting the faking of amnesia: performance differences between simulators and patients with memory impairment.
This study attempted to establish criteria for distinguishing patients with genuine memory problems from those who are attempting to simulate amnesia. The performance of simulators and genuine amnesics was compared under distraction conditions in which subjects had to count backwards between presentation and recall, and under no-distraction conditions in which the retention interval was unfilled. Genuine amnesics performed significantly worse than controls under distraction conditions, but did not perform significantly worse than controls under no-distraction conditions. However, those attempting to fake amnesia performed significantly worse than controls under no-distraction as well as under distraction conditions. They also exaggerated the memory deficit overall relative to genuine amnesics. It is suggested that these two criteria might be used successfully in clinical settings to assist in the detection of simulators.
Adult↗
Expectations, experiences and satisfaction with labour.
Emotional, medical and control aspects of labour were explored in 81 primiparous women. Expectations were assessed antenatally and compared with postnatal reports of experiences. Expectations of positive emotions were significantly greater than experience while negative emotional expectations were paralleled by experience. There was a major discrepancy between expectations and experiences of the occurrence of interventions, with the proportion of women expecting interventions being greatly exceeded by those actually undergoing such experiences. In addition, expectations concerning personal control together with the use and efficacy of breathing and relaxation exercises in labour were elevated in relation to experience. Positive emotional expectations were strong predictors of positive emotional experiences and unrelated to negative emotional expectations. Expectations in general were positively related to experience but the strength of the association was weak. Personal satisfaction (i.e. satisfaction with self) in labour was strongly associated with the ability to control panic and other aspects of personal control. The ability to control panic was mainly influenced by the use of exercises. Attenders and non-attenders at antenatal preparation classes showed no significant differences in their experiences or personal satisfaction levels. Possible explanations for this absence of impact are discussed together with issues concerning the relevance of psychological theory to midwifery practice and the need for greater integration.
Adolescent↗
Infants born at risk: consequences for maternal post-partum adjustment.
The role of infant risk and social support as predictors of post-partum adjustment was investigated. Fifty-three mothers whose infants reflected the range of neonatal conditions were interviewed six weeks after discharge of their infant from hospital. They were assessed on measures of emotional distress, depressive symptoms, social support and perceptions of, and concerns about, their infant and themselves. The results indicated that mothers of higher risk infants reported higher levels of emotional distress and depressive symptomatology, more concerns about themselves and their baby, more difficulty in expressing affection towards their baby and greater dissatisfaction with their social support. Using multiple regression techniques, depressive symptoms were predicted by neonatal risk and dissatisfaction with social support from family and friends, while emotional distress was predicted by neonatal risk and dissatisfaction with social support from the infant's father. The study underlines the need to place more emphasis on infant variables as factors in maternal post-partum adjustment.
Adaptation, Psychological↗
Who knows best? Family interaction and eating disorders.
Links have been established between eating disorders and abnormal patterns of interaction between members of the sufferer's family. Faced with often contradictory information, the clinician needs to know which member of the family will give the most valid description of that family's interaction. This study demonstrated the value of the Family Assessment Device (FAD) as a measure of 'pathology' in the families of anorectic and bulimic women. Using the ability to predict the eating disorder as an index of concurrent validity, the sufferers themselves had the most realistic perceptions of their families' interactional styles.
Adult↗
Eating disorders and family interaction.
The McMaster Model of Family Functioning was used to compare women with eating disorders with a normal comparison group. The anorexia nervosa and bulimia nervosa groups showed similar perceived family pathologies but bulimics with no history of anorexia showed a pattern of family interaction that was more severely 'unhealthy' than that of the other clinical groups. The McMaster Model could be a useful tool in clinical assessment and in planning therapy in this particular area.
Adaptation, Psychological↗
Psychological treatments for negative symptoms.
Psychological training programmes for patients presenting with negative symptoms have developed from an environmentally based approach (the token economy) through interactive programmes (social and life skills training) to programmes which focus directly on facilitating and enhancing the cognitive skills of the individual patient (self-instructional training and problem-solving). It is clear that this sequence of research has generated a range of approaches which are probably undervalued in the management of patients suffering from negative symptoms. Problems remain with respect to the generalisation of some procedures but it seems likely that these problems may be overcome by tailoring treatments to the particular cognitive deficits of different groups of patients. This will obviously require a detailed analysis of the structure of negative symptoms and the deficits associated with them. The distinction between difficulties in initiating behavior and difficulties in organising behaviour may prove to be particularly important in this respect.
Behavior Therapy↗