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Psychology and the health of children.

Inappropriate behaviour and adverse social circumstances in childhood are responsible for a high proportion of physical morbidity and mortality not only in childhood itself but also in later life. Evidence is provided to support this statement, and the processes whereby social adversity in childhood lead to later ill health are considered. Recent evidence suggesting that, contrary to popular belief, health promotion in childhood could substantially reduce the prevalence of physical morbidity is reviewed. Emphasis is placed on the part played by techniques based on cognitive-behavioural approaches in the recent more successful examples of health promotion.

Accident Prevention↗

Lifestyle changes and coping patterns among caregivers of stroke survivors.

Although caregiving has been a major focus for research, little is known about the day-to-day changes in lifestyle faced by caregivers. Yet lifestyle, developed over time, manifests an individual's very identity. Using a multimethod approach, we assessed the perceptions of lifestyle changes and coping patterns of 20 caregivers of first-time stroke survivors in the early poststroke period. An outcome-oriented matrix was employed for qualitative analysis, and findings were expanded by additional quantitative analysis. Three themes emerged: pervasiveness of lifestyle change, cohort differences in the perception of lifestyle change and coping patterns, and primary issues of time and confinement. Findings suggest that strains relative to caregiving may not be confined to direct caregiving activities, but may be related to established patterns of daily life.

Adaptation, Psychological↗

Perceptions of body image and health status in persons with mitral valve prolapse.

Twenty subjects with diagnosed Mitral Valve Prolapse (MVP) were interviewed regarding self-care needs. Transcripts were analyzed for evidence of perceived health state and altered body image. The majority of subjects described experiences indicating that their perceptions of body image and health state were affected by the diagnosis of MVP. Using Smith's (1981) four categories of health perceptions, most subjects were judged to perceive their health state from a combination of clinical, role-performance and adaptive perspectives.

Adolescent↗

Balancing engagement/detachment in AIDS-related multiple losses.

The process gay persons use to manage the multiple losses and cumulative grief from losing lovers, friends, colleagues and clients to AIDS was explored. Interviews with gay individuals (n = 19) in a large urban area in the West provided data for conceptual coding and comparative analysis. Balancing engagement and detachment was identified as the basic social-psychological process that described how gay individuals struggled to reach an optimal balance in their involvement in the needs of individuals and the community. Four conceptual categories were identified: dysfunctional engagement, functional engagement, functional detachment and dysfunctional detachment. These four categories occur within the contexts of previous life style and redefinition of personal values.

Acquired Immunodeficiency Syndrome↗

Self-neglect: a proposed new NANDA diagnosis.

PURPOSE: To propose a new NANDA diagnosis, self-neglect. DATA SOURCES: Research studies and literature published from a variety of disciplines including nursing as well as primary research. DATA SYNTHESES: This diagnosis can be used to describe a constellation of self-care problems of varying severity and impact on the health and well-being of people who self-neglect. Included are two subtypes of self-neglect based on the degree of intentionality. Clarification of self-neglect is long overdue because self-neglect presents conceptual, identification, and intervention problems for nurses, healthcare workers, and for medicolegal systems across settings and in many countries. CONCLUSION: The proposed diagnosis, self-neglect, fills a gap in current standardized terminology. This diagnosis will contribute significantly to nurses leading the way in the explication of an interdisciplinary and international health concern. PRACTICE AND POLICY IMPLICATIONS: Developing self-neglect as a recognized nursing label is vital to clinicians and policy makers within and across countries. Appreciating less serious/non-life-threatening presentations will give nurses a care perspective to improve the health and well-being of those in earlier stages of self-neglect. Definitions for this phenomenon will contribute to care planning and interventions, leading to consistency in practice and research.

Activities of Daily Living↗

The perceptions of homeless people in Stockholm concerning oral health and consequences of dental treatment: a qualitative study.

This study investigated the perceptions of Swedish homeless people concerning their oral health and perceived consequences of dental treatment. Candid, tape-recorded interviews were conducted in a conversational style. A phenomenological-hermeneutical method was used to analyze the subjects' stories. New participants were recruited into the study, until the interviews provided no additional new information, which occurred after eight interviews. All narratives revealed expressions of loss as well as recovery in the informants' life. Both aspects highlighted the fact that homelessness equated to "loss" not only of a permanent residence but also of many values. Similarly, oral health was described and interpreted in terms of loss and recovery. During periods of drug abuse, study participants ranked oral health as a low priority and generally received only emergency dental attention. In more rehabilitative phases of life, however, they perceived oral health and dental treatment as a function to restore their human dignity and as a key to their holistic recovery of total body health.

Adult↗

Counselling should be offered to people with end-stage renal failure.

Having a counsellor as a member of the multiprofessional team has made a positive contribution to the way in which people with end-stage renal failure manage their illness. This paper will show how families can be supported when someone close to them develops renal failure. A self-report questionnaire was sent to those who used the renal counselling service over a one-year period. Findings suggest that those who received a period of short-term counselling were able to cope more effectively with their illness and lifestyle changes and felt less stress as a result. The limitations of the evaluation will be discussed, however, we are not seeking to generalise our results but to describe our experience in our unit. This points to the value and necessity of having someone with the requisite skills, to offer people a place to talk about often difficult and painful emotions. In our professional opinion, all renal units should consider having a counsellor as part of an integrated approach to patient care.

Adaptation, Psychological↗

Level of education, lifestyle, and morbidity in two groups of white collar workers.

STUDY OBJECTIVE: The aim was to examine the relationship between level of education, lifestyle, and morbidity in two groups of male white collar workers, and to determine whether any differences found could be related to objective differences in working conditions. DESIGN: The study was a survey of a random sample of commercial travellers and a sample of men with sedentary occupations, representing two different groups of white collar workers. Survey interviews were conducted during the annual compulsory medical examination. Subjects were classified into three levels of education and differences according to level of education were studied in relation to 40 frequent health problems, lifestyle variables, body mass index, height, and working conditions. SUBJECTS: There were 1364 men in the commercial traveller group, mean age 39.5 years, and 525 men in the sedentary group, mean age 36.2 years. There were 22 exclusions because of unclassifiable levels of education and four refused to be interviewed. SETTING: The study took place in 11 towns in France. MAIN RESULTS: When age was taken into account there were only minor differences in the prevalence of health disorders. Lifestyle variables and height were clearly related to the level of education. Observed differences could not be explained by constraints or declared difficulties in working conditions. CONCLUSIONS: Differences in health practices related to level of education are observed even in groups that are relatively homogeneous socially. Lifestyle may be important as an intermediate determinant of health disorders among less educated people.

Adult↗

Stress management: a multimodal approach.

This newly developed stress-management program evolved from study of the three major trends in stress research: psychological, physiological and sociological. Primarily geared to managers in an industrial setting, this program helps the individuals to reduce physiological tension via autohypnosis and alter stress-producing behaviors through a number of cognitive restructuring techniques. A variety of philosophical issues are raised that relate to 'type A' behavior focusing on 'the hurry syndrome', aggression and a general balance in 'life tasks'. In addition, there is an educational component and participants are acquainted with their 'health probabilities' in terms of life style, weight, smoking and other factors. This multimodal program follows participants over a 2-year period to reinforce psycho-behavioral changes.

Cognition↗

Life planning: an educational approach to change.

Life-planning methods that have emerged over the past several years offer alternatives to psychotherapy for the person experiencing the crises of mid-life and mid-career. The author describes several approaches to life planning and presents details regarding the implementation of life-planning methods.

Achievement↗

Posttraumatic stress disorder in abused and neglected children grown up.

OBJECTIVE: The purpose of this study was to describe the extent to which childhood abuse and neglect increase a person's risk for subsequent posttraumatic stress disorder (PTSD) and to determine whether the relationship to PTSD persists despite controls for family, individual, and lifestyle characteristics associated with both childhood victimization and PTSD. METHOD: Victims of substantiated child abuse and neglect from 1967 to 1971 in a Midwestern metropolitan county area were matched on the basis of age, race, sex, and approximate family socioeconomic class with a group of nonabused and nonneglected children and followed prospectively into young adulthood. Subjects (N = 1,196) were located and administered a 2-hour interview that included the National Institute of Mental Health Diagnostic Interview Schedule to assess PTSD. RESULTS: Childhood victimization was associated with increased risk for lifetime and current PTSD. Slightly more than a third of the childhood victims of sexual abuse (37.5%), 32.7% of those physically abused, and 30.6% of victims of childhood neglect met DSM-III-R criteria for lifetime PTSD. The relationship between childhood victimization and number of PTSD symptoms persisted despite the introduction of covariates associated with risk for both. CONCLUSIONS: Victims of child abuse (sexual and physical) and neglect are at increased risk for developing PTSD, but childhood victimization is not a sufficient condition. Family, individual, and lifestyle variables also place individuals at risk and contribute to the symptoms of PTSD.

Adult↗