Experience and perspective of the patient.
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Activities of Daily Living↗
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Physicians mutual aid group: a response to AIDS-related burnout.
Physicians providing primary health care to people with AIDS are exposed to the same stressful experiences as other AIDS caregivers. Although mutual aid groups have proved useful in relieving stress for AIDS caregivers in general, physicians as a professional group present particular problems that impede their access to mutual aid. This article describes the origins and functioning of a physician's mutual aid group facilitated by the author. It offers suggestions related to overcoming resistance physicians might have to participating in such a group and reviews modalities that were found helpful in facilitating participants' ability to share emotional stresses within the group. The commitment of the physicians to the group over a prolonged period and their own testimony indicate that with appropriate facilitation, physicians under stress from providing care to people with AIDS can benefit from the experience of mutual aid that has been so beneficial to other caregivers.
Acquired Immunodeficiency Syndrome↗
First person account: a voice from another closet.
The article that follows is part of the Schizophrenia Bulletin's ongoing First Person Accounts series. We hope that mental health professionals--the Bulletin's primary audience--will take this opportunity to learn about the issues and difficulties confronted by consumers of mental health care. In addition, we hope that these accounts will give patients and families a better sense of not being alone in confronting the problems that can be anticipated by persons with serious emotional difficulties. We welcome other contributions from patients, ex-patients, or family members. Our major editorial requirement is that such contributions be clearly written and organized, and that a novel or unique aspect of schizophrenia be described, with special emphasis on points that will be important for professionals. Clinicians who see articulate patients, with experiences they believe should be shared, might encourage these patients to submit their article to First Person Accounts, Division of Clinical and Treatment Research, NIMH, 5600 Fishers Lane, Rm. 18C-06, Rockville, MD 20857.
Autobiographies as Topic↗
Developing a community-based reminiscence group for the elderly.
Advanced practice nurses expect to care for many older adults in a variety of community settings. Through the process of reminiscence, older adults can actively evaluate their life experiences and explore the meaning of memorable events. This paper discusses the experiences of two advanced practice nurses who collaborated to conduct a reminiscence therapy group with community-based senior citizens. The process of reminiscence and group theory will be examined as applied to the well elderly in a community setting.
Aged↗
The relationships among risk recognition, autonomic and self-reported arousal, and posttraumatic stress symptomatology in acknowledged and unacknowledged victims of sexual assault.
OBJECTIVE: This study examined differences among acknowledged sexual assault victims, unacknowledged sexual assault victims, and nonvictims in risk recognition and its psychophysiological correlates. METHODS: Acknowledged and unacknowledged victims of sexual assault and nonvictims (n = 97) listened to a hypothetical date rape interaction and were asked to indicate the point at which the man had become sexually inappropriate. Self-report and physiological measures of emotional responding and a measure of risk recognition were used to evaluate both between- and within-subjects' differences. RESULTS: Relative to nonvictims and acknowledged victims, unacknowledged victims of sexual assault took significantly longer to recognize risk. Acknowledged victims displayed decreased heart rate activity to a portion of the hypothetical interaction, but self-reported greater arousal in response to the interaction and greater posttraumatic stress arousal symptomatology relative to nonvictims only. Posttraumatic stress symptomatology was related to self-reported emotional reactivity and response latency. CONCLUSIONS: The findings suggest that acknowledged and unacknowledged victims exhibit specific autonomic and behavioral response patterns that may perpetuate the cycle of traumatization.
Adolescent↗
When remembering is not enough: reflecting on self-defining memories in late adolescence.
This study examined which kinds of self-defining memories show spontaneous references to larger meanings, and listener responses to two kinds of meaning-lessons and insights. Narratives of three self-defining memories and episodes of telling the memories to others were collected from each of 168 late adolescents (M age=19). Narratives were coded for event type (relationship, mortality, achievement, and leisure) and for references to tension and to meaning (lesson or insight). Narratives of memorable episodes of having told the memories to others were coded for listener response (positive or negative). References to meaning emerged in one-fourth of the memory narratives, and meaning was more common for self-defining memory narratives that contained references to tension. Memories that reportedly had not been told to others in the past showed the same proportion of meaning as did memories that had been told to others (23%), with insights more prevalent than lessons. For memories that had been told to others, insights were more likely to be accepted by listeners than lessons. Implications were discussed for understanding the development of meaning in self-defining memories and the collaborative construction of identity.
Adolescent↗
The principles and processes of inspiring hope in bereavement counselling: a modified grounded theory study--part two.
This second part of a two-part paper attempts to answer the question: do bereavement counsellors inspire hope in their clients and if so, how? Using a modified grounded theory method data were collected by means of semi-structured interviews; undertaken with a theoretical sample of bereavement counsellors and ex-clients who had received bereavement counselling. In keeping with the tenets of grounded theory, the data were coded and analysed using the constant comparison method, and this produced an emerging, substantive theory of the principles and processes of hope inspiration for this client group. This theory is comprised of a core variable: the implicit projection of hope and hopefulness, and three sub-core variables: forging the connection and the relationship; facilitating a cathartic release; and experiencing a healthy (good) ending. Part one of this paper included a review of the literature and focused on stage one. Part two on the other hand, focuses on stages two and three, and highlights the categories therein. The paper concludes by highlighting implications arising from the findings (other discussion points have been published elsewhere).
Attitude of Health Personnel↗
HIV knowledge and practices among rural South Africans.
PURPOSE: To explore the knowledge and practices related to HIV/AIDS by rural South Africans in Limpopo Province. DESIGN AND METHODS: Qualitative research methods were used. Twenty-eight key and general informants participated in individual interviews in summer 2001. The setting was a hospital-based HIV clinic in rural Limpopo Province. FINDINGS: All participants were members of a support group, and they had basic knowledge about HIV/AIDS; however, participants indicated that they lacked basic knowledge of HIV/AIDS until they joined the support group. CONCLUSIONS: Support groups were effective in educating people about HIV/AIDS.
Adaptation, Psychological↗
Fathers' perspectives during pregnancy, postperinatal loss.
OBJECTIVE: To present information about the father's perspective during the experience of a pregnancy following perinatal loss. DESIGN: Descriptive phenomenology. SETTING: Interviews were done in a venue chosen by fathers (home, clinic). PARTICIPANTS: Ten fathers who had experienced a loss within the prior year and were currently with that partner in a subsequent pregnancy. FOUR THEMES EMERGED: Recognition, preoccupation, stoicism, and support. CONCLUSIONS: Participants describe the need to be recognized by others. The orderly conduct of their daily lives is disrupted by preoccupation with the pregnancy. They feel unable to share their own anxiety and fear because they want to protect the mothers. Societal pressure to "be strong" and the belief that "men don't share" appear to inhibit fathers from getting support. Strategies to assess and support fathers emotionally at the time of loss and in the subsequent pregnancy need to be explored.
Adaptation, Psychological↗
The sensitivity of event logs, self-administered questionnaires and photoplethysmography to detect treatment-induced changes in female sexual arousal disorder (FSAD) diagnosis.
INTRODUCTION: The literature provides little evidence on what type of endpoints should be used to assess treatment-induced improvement in female sexual function. AIM: The main goal of this study was to provide empiric evidence on the sensitivity of different types of measures for detecting treatment-induced changes in female sexual dysfunction diagnosis. METHODS: The measures investigated in this study included event logs, self-administered questionnaires (Female Sexual Functioning Index; FSFI), vaginal photoplethysmography, and continuous subjective sexual arousal measured during exposure to erotic videos. Participants were 24 women with female sexual arousal disorder (FSAD) who received sex therapy, placebo, or gingko biloba in a four-arm double-blind placebo-controlled clinical trial. FSAD was diagnosed utilizing a semistructured interview administered at pre- and post-treatment. Those women who did not meet FSAD criteria at post-treatment (N = 10) were labeled as "improved," while women who still met FSAD criteria (N = 14) were categorized as "not improved" even if they showed signs of improvements. MAIN OUTCOME MEASURE: Change scores from pre- to post-treatment on the FSFI, event logs, vaginal photoplethysmography, and continuous subjective levels of sexual arousal were used to predict whether women improved at post-treatment. Results were checked with exact logistic regression to control for the small sample size. RESULTS: The FSFI was the only measure to significantly predict whether women improved at post-treatment. The findings from this study lend support for the use of validated questionnaires as endpoint criteria in detecting treatment-induced changes in women's sexual dysfunction.
Adult↗
Ten ways for a self-help group to fail.
The importance of self-help groups as a competence-enhancing community resource is described--with the reservation that many developing groups are destined for failure due to their organizers' inexperience or lack of commitment. Ten effective techniques of group failure are presented to assist such groups in overcoming even the remote chance of success.
Group Processes↗
Self-reported versus measured height, weight and body mass index in Spanish Mediterranean teenagers: effects of gender, age and weight on perceptual measures of body image.
BACKGROUND: To have a good physical appearance is a determining factor by which adolescents show a tendency to worry excessively about their weight. The aim of this work is to study the possible relationship between actual and perceived body weight, how it is considered and what strategies are followed for weight control among adolescents residing in Valencia. METHODS: A sample of 568 students, 325 girls and 243 boys, aged 14-20 years, were selected from public high schools in Valencia. Their height and weight were used to calculate their actual body mass index (BMIO). The subjective perception of their physical measurements (BMIS) was evaluated by means of a questionnaire. The statistical treatment of data was done with commercially available software. RESULTS: There is a relatively large proportion of underweight subjects among the participants of the survey. Differences between the BMIO and BMIS indicate a misperception of height (overestimated) and weight (underestimated) that is greater in girls than in boys. Girls tend to undergo restrictive dietary measures when they consider themselves overweight. A general lack of knowledge about adequate weight was observed. CONCLUSION: Valencia teenagers show a poor knowledge of their body size and of the weight that should be adequate for their age and tallness.
Adolescent↗
Experiencing personality disorder: a participative research.
As Personality Disorder continues to be a subject of intense public and professional debate, this study has explored by means of an in-depth interview the views of fifty people to whom this diagnosis has been attributed, to include: demographic data, type of personality disorder and other diagnoses; its meaning for them; how they found out about the diagnosis; its impact; related life events, and value of different types of support. The interviewers were also people with the same diagnosis, who have been trained specifically for this purpose. The findings highlight the mainly negative impact of the label, and the gap between the users' perception of the problems they face in the context of having this diagnosis, and professional perspectives. The likely implications of the findings for the validity and usefulness of the diagnosis are outlined. The methodological innovation of engaging service users with personality disorder is looked at in terms of usefulness and feasibility.
Adolescent↗
Self-injurious behaviors, PTSD arousal, and general health complaints within a treatment-seeking sample of sexually abused women.
Eighty-nine adult female survivors of childhood sexual abuse, presenting for psychological treatment, were assessed for self-reported rates of self-injurious behaviors (SIB), health complaints, and posttraumatic stress disorder (PTSD) symptoms of physiological arousal. A composite measure of current SIB was significantly and positively associated with health complaints, PTSD arousal, and three measures of sexual abuse severity: age of onset for sexual abuse, injury experienced during the sexual abuse, and perceived life threat. Tests of mediation revealed that symptoms of PTSD arousal mediated the relationship between earlier age of onset for sexual abuse and SIB. PTSD arousal moderated the relationship between sexual-abuse-related injury and SIB. SIB was a unique predictor of health complaints, even after controlling for sexual abuse severity and PTSD arousal.
Adult↗
Assessing sexual arousal with adolescent males who have offended sexually: self-report and unobtrusively measured viewing time.
Sexual arousal was assessed using three approaches: the Affinity (Version. 1.0) computerized assessment of unobtrusively measured viewing time (VT), Affinity self-report ratings of sexual attractiveness, and a self-report sexual arousal graphing procedure. Data were collected from 78 males, aged 12-18 (M=15.09; SD=1.62), who acknowledged their sexual assaults. The pattern of responses to all three assessment techniques was remarkably similar, with maximal sexual interest demonstrated and reported for adolescent and adult females. Both self-report procedures could significantly distinguish those adolescents who assaulted a child from those who assaulted peers or adults. The self-report procedures could also significantly discriminate those adolescents with male child victims. The Affinity VT approach significantly differentiated those adolescents who assaulted male children from those who assaulted other individuals. No assessment technique could accurately identify those adolescents with exclusively female child victims. Overall, the results suggest that structured, self-report data regarding sexual interests can be useful in the assessment of adolescents who have offended sexually.
Adolescent↗
Cancer narratives and the cancer support group.
We conceptualize the experience of cancer as requiring 'biographical work' and examine the nature of this work in the context of peer support groups. Interviews with participants and leaders of support groups were used to theorize the importance of support to cancer patients with varying stages and length of disease. Patient interviews led us to describe the process of joining, belonging, and identifying with, support groups as an important process within patients' ongoing biographical work and encompassing a search for a 'separate social space'. We discuss the implications for understanding the stigmatizing nature of cancer and the 'civic life' these groups support.
Adult↗
How young can children reliably and validly self-report their health-related quality of life?: an analysis of 8,591 children across age subgroups with the PedsQL 4.0 Generic Core Scales.
BACKGROUND: The last decade has evidenced a dramatic increase in the development and utilization of pediatric health-related quality of life (HRQOL) measures in an effort to improve pediatric patient health and well-being and determine the value of healthcare services. The emerging paradigm shift toward patient-reported outcomes (PROs) in clinical trials has provided the opportunity to further emphasize the value and essential need for pediatric patient self-reported outcomes measurement. Data from the PedsQL DatabaseSM were utilized to test the hypothesis that children as young as 5 years of age can reliably and validly report their HRQOL. METHODS: The sample analyzed represented child self-report age data on 8,591 children ages 5 to 16 years from the PedsQL 4.0 Generic Core Scales DatabaseSM. Participants were recruited from general pediatric clinics, subspecialty clinics, and hospitals in which children were being seen for well-child checks, mild acute illness, or chronic illness care (n = 2,603, 30.3%), and from a State Children's Health Insurance Program (SCHIP) in California (n = 5,988, 69.7%). RESULTS: Items on the PedsQL 4.0 Generic Core Scales had minimal missing responses for children as young as 5 years old, supporting feasibility. The majority of the child self-report scales across the age subgroups, including for children as young as 5 years, exceeded the minimum internal consistency reliability standard of 0.70 required for group comparisons, while the Total Scale Scores across the age subgroups approached or exceeded the reliability criterion of 0.90 recommended for analyzing individual patient scale scores. Construct validity was demonstrated utilizing the known groups approach. For each PedsQL scale and summary score, across age subgroups, including children as young as 5 years, healthy children demonstrated a statistically significant difference in HRQOL (better HRQOL) than children with a known chronic health condition, with most effect sizes in the medium to large effect size range. CONCLUSION: The results demonstrate that children as young as the 5 year old age subgroup can reliably and validly self-report their HRQOL when given the opportunity to do so with an age-appropriate instrument. These analyses are consistent with recent FDA guidelines which require instrument development and validation testing for children and adolescents within fairly narrow age groupings and which determine the lower age limit at which children can provide reliable and valid responses across age categories.
Adolescent↗
Effects of estrogen, androgen, and progestin on sexual psychophysiology and behavior in postmenopausal women.
To assess the contribution of gonadal steroids to sexual behavior in aging women, we conducted a 10-week, double-blind, hormone replacement study of 40 naturally menopausal women (mean age, 58.3 yr). Prospective measurements of basal and stimulated vaginal vasocongestion and daily self-reports of mood, physical symptoms, sexual behavior, and perceived sexual pleasure were collected. Daily treatments were either conjugated equine estrogen, i.e. Premarin (P; 0.625 mg), Premarin and medroxyprogesterone acetate, i.e. Provera (PP; 0.625 and 5 mg, respectively), Premarin and methyltestosterone (PT; 0.625 and 5 mg, respectively), or placebo (PL). Compared to placebo, hormone treatment had significantly reduced hot flashes in the P and PP groups by week 4 and in the PT group by week 5. Headaches were reduced in the P vs. PL group, only. Hormone treatment did not significantly alter mood ratings, sexual behaviors, or psychophysiologically measured sexual arousal. PT treatment significantly increased reports of pleasure from masturbation compared to the other three groups, underscoring the apparent contribution of androgens to self-stimulatory behavior. However, the data suggest that in these physically and sexually healthy women, gonadal steroids do not influence major components of sexual functioning, including arousal and a wide variety of sexual activity and experience.
Analysis of Variance↗