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PubMed1988

Unique relationships between the rates of oxidation and phosphorylation and the protonmotive force in rat-liver mitochondria.

The rate of ATP synthesis (JP) in isolated rat-liver mitochondria was strongly dependent on the magnitude of the protonmotive force (delta mu H+) across the mitochondrial inner membrane. Addition of different concentrations of various uncouplers or malonate to mitochondrial incubations in State 3 led to a depression of delta mu H+ and a concomitant decrease in JP. A unique relationship between JP and delta mu H+ was obtained, which was independent of the way in which delta mu H+ was varied. This unique relationship was observed when K+ (in the presence of valinomycin) was used as a probe for delta psi. Different relationships between JP and delta mu H+ were observed when K+ was used as a probe for delta psi and when K+ was measured after separation of the mitochondria by centrifugation without silicone oil. This led to a serious underestimation of delta psi, specifically when uncouplers were present, and non-unique flow-force relationships were thus obtained. Anomalous relationships between JP and delta mu H+ were also found when TPMP+ was used as a probe for delta psi. However, in uncoupler incubations the presence of TBP- strongly affected the TPMP+ accumulation ratio without any effect on the K+ accumulation or on JP and in the presence of TBP- unique relationships between JP and delta mu H+ were again obtained. This indicates that the accumulation of TPMP+ inside the mitochondria is not a straightforward function of delta psi but also depends on conditions like the presence of TBP- or uncouplers. We conclude that there is a unique relationship between the rate of phosphorylation and the protonmotive force in mitochondria and that under some conditions the behaviour of TPMP+ is anomalous.

Adenosine Triphosphate↗
PubMed1988

Social relationships and psychological well-being in rheumatoid arthritis.

This study examines the social relationships of a sample of 158 patients attending a hospital rheumatology clinic with rheumatoid arthritis (RA). Scores of the sample were compared with those of other samples on the Interview Schedule for Social Interaction (ISSI). In addition the effects of severity of disease activity and of disability upon social relationships were examined. Diffuse social relationships such as with friends and acquaintances, rather than more intimate ones appear to be more affected in individuals with RA. Psychological well-being was assessed by means of two measures. The more favourably patients scored for social relationships, the more favourable were their scores for psychological well-being using both scores. More diffuse social relationships were more strongly correlated with psychological well-being than were the scores for more intimate relationships. Despite the strong effects of social relationships upon well-being, no buffering action on the effects of disability upon well-being were found.

Activities of Daily Living↗
PubMed1995

Durations of adolescent sexual relationships before and after conception.

PURPOSE: To explore durations of young couples' relationships between meeting and first intercourse, before first conception and for two years following conception and the associations between these durations; to describe the association between these durations and the young women's perceptions of the nature of these relationships. METHODS: Three hundred and seven adolescent women were enrolled in a prospective study while presenting for pregnancy tests (the index event); they were followed for two years in three groups--those with negative tests, those who terminated the pregnancy and those who bore a child. Retrospective information about durations of relationships with first partners and partners at the index event was obtained at baseline; follow-up data was obtained on continuing relationships with the index partner. RESULTS: Durations of relationships between adolescent females and their partners in this sample, both before and after conception, are rarely brief; the median duration of a girl's prior relationship with a partner with whom she conceives is almost two years. Similarly, almost half of the sample is still in a relationship at two years following the index event, a proportion that rises to two-thirds among those who bore a child together. CONCLUSIONS: Contrary to common belief or practice, there may be sufficient time and commitment to include many male partners in intervention programs before, and in parenting programs after, a first conception--a practice which could have positive implications for both adolescent partners and, potentially, for their child.

Adolescent↗
PubMed2005

Relationship between the expression of various markers and prognostic factors in breast cancer.

The immunohistochemical detection of six markers of breast cancer has been compared in the present study with known prognostic factors of the disease to establish locally a standard panel of markers for the management of breast cancer. Sections of tissue of 114 consecutive breast cancer cases were studied immunohistochemically, using antibodies against oestrogen receptor (ER), progesterone receptor (PR), androgen receptor, c-erbB2, cathepsin D, and cyclin D. Marker labelling was graded as recommended in the literature. Using the chi(2)-test, relationships were determined between marker labelling and histological type of cancer, tumour grade, tumour size, axillary lymph node status and age of patient. A p value below 0.05 was considered significant. A positive relationship was found between ER and PR and lower grades of cancer, and a negative relationship was found with medullary and atypical medullary carcinoma. The four other markers showed no relationship with grade or type of cancer. All markers showed no significant relationship with size of tumour, presence of axillary node metastasis or age of patient. There was positive correlation between c-erbB2 and cathepsin D. Our study confirms the association between ER and PR and histological type and grade of breast cancer, both known parameters of good prognosis. We found no consistent relationship between the other four markers and prognostic factors studied, other than the suggestion that c-erbB2 and cathepsin D may be useful markers for poor prognosis and can be usefully applied locally, especially in the light of the current availability of trastuzumab (Herceptin) for management of c-erbB2-positive cases. We found no relationship between the markers and tumour size, axillary lymph node status or age.

Adult↗
PubMed2004

Quantitative inter-specific chemical activity relationships of pesticides in the aquatic environment.

Inter-species correlations could be a useful tool for predicting toxicity and for establishing sensitivity ratios among species. In this paper, quantitative inter-specific chemical activity relationships (QICAR) for aquatic organisms were developed to verify if such an approach could be utilised for estimating toxicological data when no other information is available. Inter-specific toxicity relationships on fish, Daphnia and algae were performed for pesticides considering a large data set (more than 600 compounds) and grouping the data either on a functional (herbicides, fungicides and insecticides) or chemical class base. Good correlations were found between several fish species and they were improved by excluding, from the data set, highly specific compounds such as organophosphorus insecticides. Relationship between fish (rainbow trout) and Daphnia was significant for the whole data set, but clearly improves if congeneric classes of pesticides are considered. The most significant results were found for azoles (fungicides) and for all data set of pesticides with the exclusion of organophosphorus and carbamate insecticides. As expected, toxicity on algae does not correlate either with fish or with Daphnia on the whole data set, but excluding the classes acting specifically toward one organism (insecticides and several classes of herbicides), good relationships were found. The analysis of the data permits the conclusion that the specificity in the mode action of pesticides is the key parameter for expecting or not inter-specific relationships. By the relative specificity of action of a group of compounds towards two species, the probability of obtaining a QICAR for this group can be derived. In general, compounds acting with the same level of specificity towards two different species, have a higher probability of showing inter-specific relationships and the lower the specificity of the mode of action of the compounds (e.g. narcotics or less inert chemicals), then the stronger are the relationships.

Animals↗
PubMed2005

The relationship between social anxiety disorder and alcohol use disorders: a critical review.

Epidemiological studies have demonstrated a significant co-morbidity between social anxiety disorder (SAD) and alcohol use disorders (AUDs). Despite the fact that many studies have demonstrated strong relationships between SAD and AUD diagnoses, there has been much inconsistency in demonstrating causality or even directionality of the relationship between social anxiety and alcohol-related variables. For example, some studies have showed a positive relationship between social anxiety and alcohol-related variables, while others have shown a negative relationship or no relationship whatsoever. In an attempt to better understand the relationship between social anxiety and alcohol, some researchers have explored potential moderating variables such as gender or alcohol expectancies. The present review reports on what has been found with regard to explaining the high co-morbidity between social anxiety and alcohol problems, in both clinical and non-clinical socially anxious individuals. With a better understanding of this complex relationship, treatment programs will be able to better target specific individuals for treatment and potentially improve the efficacy of the treatments currently available for individuals with co-morbid SAD and AUD.

Adaptation, Psychological↗
PubMed2006

The relationship between restrained eating and poor psychological health is moderated by pleasure normally associated with eating.

This study investigated the relationship between restrained eating and poor psychological health, and the importance of pleasure normally associated with eating in this relationship. Pleasure normally associated with eating, restrained eating, and anxiety, depression and satisfaction with life were assessed concurrently by questionnaire. A relationship between restrained eating and poor psychological health was found--greater restrained eating was significantly independently associated with greater anxiety (B=1.099, p<0.01). Furthermore, pleasure associated with eating was an important moderator in this relationship--greater pleasure associated with eating combined with greater restrained eating was also significantly independently associated with greater anxiety (B=1.067, p=0.02). No effects were found for depression or satisfaction with life. These findings suggest that the pleasure normally associated with eating is important in the relationship between restrained eating and poor psychological health. Subsidiary exploratory analyses also suggest that the relationship between restrained eating and poor psychological health, and the importance of pleasure in that relationship, may differ in males and females.

Adolescent↗
PubMed2006

Doctor-patient relationship as motivation and outcome: examining uses of an Interactive Cancer Communication System.

OBJECTIVE: To examine how the pre-existing doctor-patient relationship predicts conceptually distinct service use within an Interactive Cancer Communication System (ICCS) for underserved women with breast cancer and in turn how service utilization influences the doctor-patient relationship. METHODS: Study sample included 231 recently diagnosed, lower income breast cancer patients. Participants were provided a free computer, Internet access and training in how to use an ICCS called the Comprehensive Health Enhancement Support System (CHESS) "Living with Breast Cancer" program. Survey data was collected at pre-test and 4-months after using the system, and use data about how women used the system was also collected. RESULTS: The only statistically significant predictor of service use was that patients with a more negative appraisal about the doctor-patient relationship used the Ask an Expert service more frequently, and there were trends toward a more negative appraisal of the doctor-patient relationship being associated with higher use of Information and Interactive services. Conversely, there was a trend toward a more positive appraisal predicting higher use of the Discussion Group service. In terms of statistically significant effects, more frequent utilization of Information services was associated with a more positive appraisal of the doctor relationship. CONCLUSION: While a more negative perception of the doctor-patient relationships at pre-test was associated with higher use of most of the conceptually distinct services within this ICCS, use of the Information services was associated with having a more positive appraisal of the doctor-patient relationship at post-test suggesting that high-quality information on the Internet can serve to improve patients' satisfaction with their doctor.

Adult↗
PubMed2004

Children of a cohort of depressed patients 25 years later: psychopathology and relationships.

BACKGROUND: While many studies have examined cross-sectional or short-term effects of parental depression on children, few have studied such children many years later when they reach adulthood. It was hypothesised that children of patients hospitalised for depression 25 years ago would have more psychological morbidity and relationship difficulties than children of a surgical comparison group. METHOD: Children (n=94) of depressed patients and a surgical control group (n=31) admitted to a teaching hospital 25 years ago were compared on measures of psychiatric morbidity, personality, marital and family relationships. RESULTS: Compared with control children, children of depressed patients demonstrated trends for higher rates of non-phobic anxiety and substance disorders, but neither psychological morbidity overall nor affective disorder specifically. Compared with control children, children of depressed patients rated their relationships with fathers who were spouses of female patients more negatively. Having consciously tried to make their own intimate relationships different from that of their parents, children of depressed patients and their partners reported significantly more caring in their relationships compared with control children and their partners. CONCLUSION: In this study of the effects of parental depression on children 25 years on, adult children of depressed patients demonstrated significant resilience as evidenced by similar rates of overall psychiatric morbidity and quality of intimate relationships to controls. They may be at risk for specific disorders such as anxiety and substance disorder and have problematic relationships with the "well" spouses of depressed patients particularly if the "well" spouse is their father.

Adult↗
PubMed2006

The developmental association of relationship quality, hormonal contraceptive choice and condom non-use among adolescent women.

PURPOSE: Consistent condom use is critical to efforts to prevent sexually transmitted infections among adolescents, but condom use may decline as relationships and contraceptive needs change. The purpose of this research is to assess changes in condom non-use longitudinally in the context of changes in relationship quality, coital frequency and hormonal contraceptive choice. METHODS: Participants were women (aged 14-17 years at enrollment) recruited from three urban adolescent medicine clinics. Data were collected at three-month intervals using a face-to-face structured interview. Participants were able to contribute up to 10 interviews, but on average contributed 4.2 interviews over the 27-month period. Independent variables assessed partner-specific relationship quality (five items; scale range 5-25; alpha = .92, e.g., this partner is a very important person to me); and, number of coital events with a specific partner. Additional items assessed experience with oral contraceptive pills (OCP) use and injected depo medroxy-progesterone acetate (DMPA). The outcome variable was number of coital events without condom use during the past three months. Analyses were conducted as a three-level hierarchical linear growth curve model using HLM 6. The Level 1 predictor was time, to test the hypothesis that condom non-use increases over time. Level 2 predictors assessed relationship quality and coital frequency across all partners to assess hypotheses that participants' condom non-use increases over time as a function of relationship quality and coital frequency. Level 3 predictors assessed the participant-level influence of OCP or DMPA experience on time-related changes in condom non-use. RESULTS: A total of 176 women reported 279 sex partners and contributed 478 visits. Both average coital frequency and average condom non-use linearly increased during the 27-month follow-up. At any given follow-up, about 35% reported recent OCP use, and 65% reported DMPA use. HLM analyses showed that condom non-use increased as a function of time (beta = .12; p = .03, Level 1 analysis). Increased condom non-use over time was primarily a function of increased coital frequency (beta = .01; p = .00), although higher levels of relationship quality were associated with increased condom non-use at enrollment (beta = .44; p = .00, Level 2 analysis). The temporal rise in condom non-use significantly increased among DMPA users (beta = .06; p = .00) but not OCP users (Level 3 analysis) (beta = -.04; p = .06). CONCLUSIONS: Developmentally, relationship characteristics and coital frequency appear to have increasing weight in decisions about condom use. Hormonal contraceptive methods are not equivalently associated with the overall temporal decline in condom use. Future research associated with dual contraceptive/condom use should address differential factors associated condom use in combination with different hormonal methods.

Adolescent↗
PubMed2005

Characteristics of pathogenic and mutualistic relationships of ascoviruses in field populations of parasitoid wasps.

Ascoviruses are disseminated among larvae in lepidopteran populations by parasitic wasps during oviposition. Ascovirus relationships with these wasps vary from pathogenic to mutualistic, and experimentally can be shown possibly to be commensal non-pathogenic virus having little or no effect. Most ascoviruses are pathogens that female wasps vector mechanically. Other ascoviruses have a more intimate relationship with their wasp vectors in that their genome is stably maintained in all wasp nuclei through several generations by vertical transmission. In this relationship, these viruses are mutualistic, enhancing the successful development of the wasp larvae by suppressing lepidopteran defence mechanisms. The DpAV4 ascovirus is a mutualist in certain Diadromus wasps but is pathogenic or not when vectored by other species of this genus. These various biologies suggest that ascovirus/wasp relationships depend on wasp regulatory factors that control virus replication. Thus, certain ascoviruses can potentially have either a pathogenic, mutualistic, or non-pathogenic relationship with a specific wasp vector, the type of relationship being dependent upon the species system in which the relationship evolved. Finally, because ascoviruses appear to be related to ichnoviruses (Polydnaviridae), the DpAV4/Diadromus system constitutes a possible interesting intermediate between the pathogenic ascoviruses and symbiotic viruses that evolved to be ichnoviruses.

Animals↗
PubMed2004

Having a good relationship with their mother: a protective factor against sexual risk behavior among adolescent females?

STUDY OBJECTIVE: To assess whether having a good relationship with their mother was a protective factor against risky sexual behavior for female adolescents and whether it was independent of family structure. DESIGN: Cross-sectional survey of in-school adolescents aged 14-19 years. SETTING: Catalonia, in northeast Spain. PARTICIPANTS: A total of 3677 females divided according on whether they had a good (n=3335) or a bad (n=342) relationship with their mother. MAIN OUTCOME MEASURES: Rates of sexual activity and sexual behavior. RESULTS: Adolescents in the good relationship group were significantly younger, more likely to live in an intact family, to have a good relationship with their father and siblings, and to talk about sexuality and their partner with their mother. They were also less likely to have ever had sexual intercourse. Among those sexually experienced, they were significantly older at first intercourse and less likely to have multiple partners or a history of STI. After adjusting for potential confounders, females in the good relationship group were less likely to be sexually active and to have had multiple partners, independently of family structure. CONCLUSIONS: Having a good relationship with their mother is a protective factor against sexual intercourse and having multiple sexual partners independently of family structure. Communication between generations and having a good relationship with their father and siblings also play an important role.

Adolescent↗
PubMed1996

Sexual adjustment and quality of relationship in spinal paraplegia: a controlled study.

OBJECTIVE: To identify determinants of sexual adjustment by persons with spinal cord injury (SCI) and quality of the relationship compared with persons in the general population. DESIGN: Controlled survey. SETTING: Postdischarge community setting. PARTICIPANTS: A consecutive series of 252 persons admitted to our spinal unit between November 1982 and July 1991 with traumatic SCI were contacted, 85 of whom persons were excluded: 36 were dead, 37 had recovered, 5 could not be located, 4 were younger than 18 years, 2 had language difficulties, and 1 had a psychiatric illness. Of the remaining 167 persons with SCI, 85 had a stable partner relationship, 75 of whom (88%) completed and returned the questionnaires (median age, 33 years; range 19 to 76). An age- and sex-matched control group was randomly selected from the general population. Of the 264 respondents, 155 (59%) had a stable partner relationship. MAIN OUTCOME MEASURES: The 80-item questionnaire addressed experiences concerning sexual functioning, desire, and activity, sexual behavior, satisfaction with sex life, and aspects of the emotional quality of the relationship. RESULTS: Sexual activity and satisfaction was lower among persons with SCI compared with the controls; the emotional quality of the relationship did not differ. The most important correlates for sexual fulfillment in both groups were found to be the use of a varied repertoire of sexual behaviors and the perception that the partner enjoys and is satisfied with the sexual part of the relationship. CONCLUSION: Psychosocial rather than physical factors were important for a satisfying sexual life and relationship. A qualitative study should be undertaken to further explore the complexity of sexual adjustment after SCI.

Adaptation, Psychological↗
PubMed1995

Linear end-systolic pressure-volume relationship during pulsatile left ventricular bypass represents native heart function.

This study assessed whether the end-systolic pressure-volume relationship obtained without any interventions during pulsatile left ventricular bypass adequately represents native heart function. In 11 anesthetized Holstein calves, left ventricular pressure was measured with a micromanometer while left ventricular volume was simultaneously calculated from orthogonal left ventricular diameters measured with ultrasonic dimension transducers. End-systolic pressure and volume data were subjected to linear regression analysis to achieve an end-systolic pressure-volume relationship. Data from both caval occlusions and aortic occlusion were used for the control end-systolic pressure-volume relationship (median r = 0.941, slope = 7.4 +/- 0.8 mm Hg per milliliter per 100 gm left ventricular weight; mean +/- standard error of the mean). During left atrial-aortic bypass with a Pierce-Donachy pneumatic assist pump in the asynchronous mode, the end-systolic pressure-volume relationships were obtained without interventions to change ventricular loading conditions. During maximal ventricular unloading during full to empty pumping, termed 100%, the resulting narrow range of pressure and volume data did not yield highly linear end-systolic pressure-volume relationships (median r = 0.669, slope = 4.9 +/- 0.9 mm Hg per milliliter per 100 gm left ventricular weight). However, at reduced rates off pumping, the end-systolic pressure-volume relationships were considerably linear (80%, median r = 0.819; 60%, median r = 0.868; 40%, median r = 0.899). Slopes did not significantly differ from control values (80%, 6.9 +/- 1.1; 60%, 8.2 +/- 1.1; 40%, 7.8 +/- 1.1). The end-systolic pressure-volume relationship obtained without exogenous load changes during asynchronous, pulsatile left ventricular bypass represents native left ventricular systolic function.

Animals↗
PubMed2001

The effects of left- versus right-hemisphere lesions on the sensitivity to intra- and interconceptual semantic relationships.

Studies on split-brain, normal and brain-damaged subjects suggest differences in the processing of semantic relationships by the two hemispheres. Various authors have conceived of this distinction in terms of the paradigmatic/syntagmatic dissociation, and the connotative and denotative meanings of words, and as reflecting different types of links between words. Drews has suggested that a left-hemisphere lesion would affect the processing of intraconceptual relationships, while a right-hemisphere lesion would impair the processing of interconceptual relationships. The goal of this study was to test this hypothesis, using a number of intra- and interconceptual semantic relationships. Pairs of common words were submitted to left-hemisphere brain-damaged and right-hemisphere brain-damaged subjects. The task required subjects to indicate whether or not there was any relationship between the words. The results only partially support the hypothesis. The right/left opposition applied to only one of three types of intraconceptual relationships (whole-part relation) and to one of two types of interconceptual relationship (same location relation). This partially unexpected result is discussed in reference to other studies.

Aged↗
PubMed2003

Treatment responsiveness of the Self-Esteem And Relationship questionnaire in erectile dysfunction.

OBJECTIVES: To determine the treatment responsiveness of the disease-specific Self-Esteem And Relationship (SEAR) questionnaire in erectile dysfunction. METHODS: The SEAR questionnaire was administered at baseline and at the end of the study in 93 patients with erectile dysfunction enrolled in a 10-week, open-label, flexible-dose (50-mg sildenafil, adjustable to 25 mg or 100 mg) trial. Changes from the baseline score were analyzed using the paired t test. The correlation between the changes from baseline on the SEAR questionnaire and the Erectile Function domain of the International Index of Erectile Function was examined. RESULTS: Significant and meaningful differences (P = 0.0001) from baseline were observed in the two primary domains (Sexual Relationship and Confidence) and the two Confidence domain subscales (Self-Esteem and Overall Relationship). The magnitude of the change was quite high for most aspects (Sexual Relationship, effect size [ES] = 1.6; Confidence, ES = 1.0; Self-Esteem, ES = 1.1) and moderate for one (Overall Relationship, ES = 0.6). Changes in Erectile Function domain score correlated moderately with changes in the SEAR domain and subscale scores (Sexual Relationship, r = 0.69; Confidence, r = 0.48; Self-Esteem, r = 0.47; and Overall Relationship, r = 0.35; P <or=0.001). CONCLUSIONS: The SEAR questionnaire is responsive to effective treatment of erectile dysfunction. These data suggest that the SEAR questionnaire is a valid instrument for detecting psychosocial gains from beneficial intervention.

Adult↗
PubMed2002

Abnormal temporal dynamics of blood pressure and RR interval regulation in patients with chronic heart failure: relationship to baroreflex sensitivity.

It is not known whether the temporal relationship between blood pressure (BP) and RR interval is modulated by the same mechanisms in normal controls and patients with chronic heart failure (CHF). We investigated this under conditions of controlled slow breathing. Fifty patients with CHF and 17 age-matched normals underwent recordings of BP and RR interval during 0.1 Hz controlled breathing. Fourier analysis was used to determine the phase relationships between the oscillations in respiration, BP and RR interval. There was no significant difference between patients and normals in the distribution of phase angle between respiration and BP (P=0.06) or between respiration and RR interval (P=0.21). There was, however, a significant difference in the phase relationship between BP and RR interval (P=0.03): in normals, BP led RR interval by a mean phase angle of 48.4 degrees (S.D. 16.8 degrees ). In patients with CHF, the distribution of phase difference was much wider [34.4 degrees (S.D. 62.8 degrees )]. The source of this wide distribution was patients with attenuated baroreflex sensitivity (BRS), with those with preserved BRS showing a relationship between BP and RR interval similar to the normal group. During controlled respiration, normal subjects exhibit a stereotyped relationship between oscillations in BP and RR interval, which is mediated by the baroreflex. This relationship is maintained in those patients with CHF who have a preserved BRS. In contrast, patients with an attenuated BRS show a wide distribution in the relationship between BP and RR interval ranging from completely in phase, to anti-phase. This may have important implications for the measurement and interpretation of BRS in patient groups where BRS is weak.

Adult↗
PubMedDate not supplied

[Cognitive structure of family doctors in training concerning the doctor-patient relationship].

OBJECTIVES: To find and compare thought structures of family doctors in training concerning the doctor-patient relationship. DESIGN: Qualitative and descriptive. SETTING: Primary care. PARTICIPANTS: 10 first-year residents selected through intentional sampling. MEASUREMENTS: Piaget interview modified by Pinies evaluated with the propositional analysis technique of concepts and conceptual maps. Five thematic areas concerning doctor-patient relationship were defined: importance and repercussions, characteristics and requisites, model of relationship, patient behaviour and doctor's behaviour. RESULTS: The concepts were not sufficiently elaborated. The importance of the doctor-patient relationship was recognised, but not all its repercussions. Its most oft cited desirable requisite was patient confidence. Those interviewed opted for a relationship in which the patient is passive, although they were aware of the danger of leading questions. The personality of the patient was the most commonly cited determinant of his/her behaviour, but other determinants were mentioned, such as beliefs and expectations. The decision to go for a consultation was not seen just as a product of the symptoms. Denial was the most widely recognised defence mechanism. The role of the doctor's feelings was indicated, but not about how to neutralise them. Training was not emphasised, either. CONCLUSIONS: There was insufficient appreciation of the practical importance of the doctor-patient relationship. A directive model of relationship was most common, lacking any biopsychosocial orientation. Training in this area, even though its need is not perceived, should be prioritised. The kind of knowledge underlying doctors' cognitive structure and its role in their behaviour should be investigated.

Cognition↗