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PubMedDate not supplied

Selection bias in the study of spouse similarity for psychiatric morbidity in clinical samples.

The existing literature on spouse similarity for health variables can be divided into two fields of application, high blood pressure and other coronary risk factors and psychiatric morbidity. In the former field, almost all studies have been conducted on general-population samples, whereas in the psychiatric field, most of the investigations studied clinical samples, i.e., where one or both members of the couple were under psychiatric treatment. In this report, we demonstrate that studies of spouse similarity for psychiatric morbidity are subject to selection bias whenever they are conducted on clinical samples. This selection bias has a double origin. First, some bias arises from the fact that the probability of a couple being drawn for a clinical sample is dependent on whether one or both spouses are afflicted with the illness in question. A second source of bias lies in the likelihood that each spouse's help-seeking behavior is not independent of the other's. It would appear then that, owing to this selection bias, it is preferable to restrict the study of spouse similarity for psychiatric morbidity to general-population samples.

Female↗
PubMed1991

An intercultural assessment of the type, intensity and number of crisis precipitating factors in three cultures: United States, Brazil and Taiwan.

The precipitating factors of crisis have cultural interpretations that make diagnostic criteria and intervention methods ethnologically different. The crisis precipitating factors of individuals seeking intervention in the Republic of China (Taiwan), Brazil and the United States (U.S.) were investigated toward the end of isolating correlates and discrepancies of ethnic-related precipitants of crisis. The primary objective of the study was to influence crisis intervention in the profession of nursing from the almost universally utilized Western Model, to one that takes cultural uniqueness into account. Stressors and stressor intensities which lead to help-seeking behavior of clients in selected crisis intervention facilities in the three countries were identified. A 60 question instrument ranked client responses according to Axis 4 of the Diagnostic and Statistical Manual-III of the American Psychiatric Association (APA, 1980; 1986). Each item also reflected one of four Human Response Patterns of the North American Nursing Diagnostic Association (NANDA) taxonomy, which was utilized as a clustering device in data analysis. Somatization versus psychologization of crisis precipitating factors was also measured through the NANDA categories. A convenience sample of 30 subjects were queried in each country by nurse interviewers. Data analysis through ANOVA showed cultural uniqueness and mutuality.

Adolescent↗
PubMed1991

Nurses' interpersonal behaviours and the development of helping skills.

This study investigates the interpersonal behaviours of general nurses and evaluates the effectiveness of a nine-week program in developing helping skills. Ninety-nine nurses undertaking tertiary studies were administered the FIRO-B Scale, which assesses six dimensions of interpersonal behaviours, before and after the skills program. Changes in interpersonal behaviours were examined for the total sample and for six clinical subgroups based on the nurse's area of clinical practice. Nurses' FIRO-B scores at pre-test were also compared with results from a sample of occupational therapy students. The results of this study showed that nurses, when compared with occupational therapists, had less desire to belong and a stronger need to influence or control interpersonal relationships. When clinical subgroups of nurses were contrasted, significant differences in the need for inclusion and affection were identified. Evaluation of the communication skills program demonstrated some significant improvements in helping attitudes for the sample as a whole, but no differences when specific nursing subgroups were examined. Findings from this study are discussed in relation to the helping role of nurses, methodological limitations, and directions for future investigation.

Adult↗
PubMed1993

Finnish nurse instructors' view of the core of nursing.

The purpose of this article is to describe how nurse instructors understand nursing and the necessary conditions for high quality nursing care. The approach of the study was inductive and based on phenomenology and a sociological field research method, i.e. grounded theory. It emerged that the core of nursing is a process, termed here caring, with three stages. Three types of caring emerged. Understanding the client, the art of nursing, co-operation between the nurse and other health care professionals were found to be necessary conditions for a high quality nursing care and it was also found that it is not possible to separate caring from the society and its history.

Attitude↗
PubMed1993

Subjectivity and culpability in the constitution of nurse-patient relationships.

The development and implementation of new modes of organizing nursing work, such as primary nursing, stress the quality of interpersonal relationships between nurses and their patients. It is important to recognize, however, that such relationships are inherently problematic. This paper explores, from a sociological perspective, nurses' orientations to interpersonal relations with patients and examines some of the sources of their problematic features.

Attitude of Health Personnel↗
PubMed1996

Expectations in giving and receiving help among nurses and Russian refugees.

Stimulated by the emergence of a new refugee group that is unknown and vulnerable to misunderstanding by health care providers, and the exigency in nursing to understand potential variance in nurse and client assumptions about helping, this paper reports exploratory research comparing helping orientations of Russian Protestant Pentecostal refugees (N = 28) with professional nurses (N = 32) in the United States. Findings based on the Brickman et al. (1982) theory of helping, which addresses attribution of responsibility in helping interactions, indicated differences among the nurse and Russian orientations. Contrasting with the nurses' primary selection of the moral orientation, which assumes high individual responsibility for the causes and solutions of problems, the Russian refugee group's first selection was the medical orientation, which assumes low individual responsibility for the causes and solutions of problems. The two groups' differing orientations are considered in the context of nurse-client interactions and divergent cultural values bearing on assumptions of individual responsibility.

Adult↗
PubMed1983

The gagging problem in prosthodontic treatment. Part II: Patient management.

The most serious problem associated with the patient with an overactive gag reflex is the strong potential for compromised treatment. A complete oral examination, medical history, and conversation with the patient are important sources of information that assist with the management of gagging problems. Many techniques are available for controlling the exaggerated gag reflex, and no single technique will solve each patient's problem. The technique or techniques used should be dictated by the cause or causes involved. If organic disturbances, anatomic anomalies, or biomechanical inadequacies of existing prostheses are not key causes, the services of trained specialists are needed to help with behavioral management of the problem.

Anesthetics, Local↗
PubMedDate not supplied

Reliability and validity studies of the WHO--Composite International Diagnostic Interview (CIDI): a critical review.

This paper reviews reliability and validity studies of the WHO - Composite International Diagnostic Interview (CIDI). The CIDI is a comprehensive and fully standardized diagnostic interview designed for assessing mental disorders according to the definitions of the Diagnostic Criteria for Research of ICD-10 and DSM-III-R. The instrument contains 276 symptom questions many of which are coupled with probe questions to evaluate symptom severity, as well as questions for assessing help-seeking behavior, psychosocial impairments, and other episode-related questions. Although primarily intended for use in epidemiological studies of mental disorders, it is also being used extensively for clinical and other research purposes. The review documents the wide spread use of the instrument and discusses several test-retest and interrater reliability studies of the CIDI. Both types of studies have confirmed good to excellent Kappa coefficients for most diagnostic sections. In international multicenter studies as well as several smaller center studies the CIDI was judged to be acceptable for most subjects and was found to be appropriate for use in different kinds of settings and countries. There is however still a need for reliability studies in general population samples, the area the CIDI was primary intended for. Only a few selected aspects of validity have been examined so far, mostly in smaller selected clinical samples. The need for further procedural validity studies of the CIDI with clinical instruments such as the SCAN as well as cognitive validation studies is emphasized. The latter should focus on specific aspects, such as the use of standardized questions in the elderly, cognitive probes to improve recall of episodes and their timing, as well as the role of order effects in the presentation of diagnostic sections.

Cross-Cultural Comparison↗
PubMed1988

Personal health habits and symptoms of depression at the community level.

This investigation examined the relationship between lifestyle, as defined by common health habits, and symptoms of depression in a general community sample. The study was conducted using data from a longitudinal survey involving four interviews of 1,003 Los Angeles County adults. The survey focused on the epidemiology of depression and help-seeking behavior, which included questions about seven health habits identified in the Alameda County Study as predictive of health status. The group used for this analysis comprised 752 adults who participated in and had usable depression scores (as measured with the 20-item CES-D scale) at all interviews. Depression prevalence rates were higher for six of the seven "poor" health habits examined compared with the "good" health habit. Prevalence odds ratios were greater than 2.0 for poor sleeping and drinking habits (both sexes) and equaled 1.8, among women only, for poor physical activity and smoking habits. Multivariate regression analyses showed a simple sum of the total number of good habits to be a significant independent predictor of depression after controlling for prior depression and various sociodemographic factors. The finding of an independent contribution of health habits to depression status emphasizes that lifestyle may influence mental as well as physical health.

Adult↗
PubMed1995

The impact of a media campaign on public action to help maltreated children in addictive families.

Developed because of the need to promote public understanding of the link between addictions and child maltreatment, a multimedia campaign helped to increase by 62% the average monthly number of people who called a telephone service for information about how to aid abused and neglected children. The campaign was supported by market research and professional experience that indicated the campaign should focus on easy action a citizen could take, avoid inducing fear or blame, and target third party helpers and younger families-at-risk. Campaign exposure was promoted through the support of corporate partners. A random household survey found that 61% of the general population had seen or heard the campaign slogan. The average monthly calls to the child maltreatment information service regarding alcohol and other drug abuse tripled and the requests regarding at-risk children almost doubled. An auxiliary project provided interprofessional education to increase the probability that people seeking help would get it when referrals were made. The project yielded several lessons for future public awareness campaigns: focus on helping action rather than the problem; use of client-based market research; a strategic plan to assure necessary exposure; reliance on public-private-nonprofit sector partnerships; preparation of the service system; promotion of personal ways of helping.

Alcoholism↗
PubMed1991

Integration of medical and psychiatric management in self-mutilation.

The traditional management of factitious patients with self-inflicted injuries consists of medical/surgical treatment of the physical lesions, followed by psychiatric referral. The former is assigned to the dermatologist, the surgeon, or the primary care physician. More often than not, the subsequent psychiatric referral for treatment of the psychiatric disorder underlying and actually causing the self-mutilation fails because of self-mutilators' notorious resistance to psychiatric help. The integration of a psychiatric strategy into the medical management is more effective than a sequential division of medical/surgical and psychiatric treatment. This integrated treatment strategy is based on three key issues: education of the medical team in understanding the self-mutilation as a morbid form of help-seeking behavior, the judicious use of confrontation as a therapeutic tool, and the combination of psychotropic drug treatment with psychotherapeutic techniques.

Adult↗
PubMed1982

Prevalence of treated and untreated psychiatric disorders in three ethnic groups.

The pattern and overlap of treated and untreated rates of psychiatric symptoms and disorders were examined in a sample of whites, blacks, and Mexican-Americans. In addition, we compared treatment sources for family or personal problems for the three groups. The results suggest caution in substituting treated for untreated rates and also in interchanging rates based on symptom scales with rates from clinical diagnostic instruments. Underutilization was assessed by linking psychiatric status with reports of help-seeking behavior. Comparisons indicated that all groups underuse services relative to need, but underutilization is greater for blacks and Mexican-Americans. With the exception of nonpsychiatric physicians, use of treatment sources was similar for all groups. Whites were much more likely than blacks or Mexican-Americans to use this source of care. Possible reasons for this difference are discussed in the context of the methodology employed in the study.

Black or African American↗
PubMed1984

Multiple therapeutic use in urban Nepal.

Studies of resort to healers in medically pluralistic settings in different geographic and cultural areas reveal two basic patterns of resort--illness specific and multiple use. This paper suggests that the particular pattern inferred from a study may depend largely upon whether the data consist of general attitudes and preferences or actual therapeutic choices. Moreover, it proposes that interview responses concerning general attitudes toward and preferences for available therapies tend to show illness-specific patterns, while observations of actual therapeutic choices during illness episodes more often portray multiple use. Consistent with this proposition are findings presented here from a recent study of attitudes and help seeking behavior in Kathmandu, Nepal as well as the overall results of twenty-four other ethnographic studies reviewed of therapeutic resort in medically pluralistic settings. An important implication of these findings for the validity of ethnographic description is that attitudes and preferences of individual patients do not necessarily predict or describe actual strategies of resort. Finally, this paper present a partial explanation for the pervasiveness of multiple therapeutic use and the disparity between attitudes and behavior in Kathmandu.

Attitude to Health↗
PubMed1987

Arab-American patients: a medical record review.

This exploratory study consisted of a medical record review of patients with Arabic surnames who utilized outpatient, inpatient, or emergency facilities of a university medical center and a public teaching hospital from 1975 to 1981. The purposes of the study were to describe help-seeking behavior of Arab-American patients, including why they sought care and whether they posed problems for providers, and to determine if the medical records identified culturally-related care needs. This report describes data from 106 charts reviewed with reference to demographic data, illness behavior, and use of facilities. The findings revealed more about charting habits of health professionals than about unique characteristics of patients in this ethnic group.

Cultural Characteristics↗
PubMed1989

Social support: diverse theoretical perspectives.

The useful predictions and interpretations about social support which can be derived from attribution, coping, equity, loneliness and social comparison theories have typically not been recognized. Attribution theory can enable explanation of motives of donors, the phenomena of help-seeking and helping, and negative effects of support efforts. Coping theory demonstrates how social support and coping interface in the stress process; adds a cognitive dimension to support; and considers costs of support. Equity theory explains reactions to support from donor and recipient viewpoints and the reciprocal nature of social support. Loneliness theory attests to the significance of social relationships and emphasizes the affective dimension of support. Social comparison theory is helpful in interpreting positive and debilitating effects of support when the donor is a peer. Further, these five theories enhance theoretical interpretation of social support through their distinctive explanations of the concepts of 'appraisal' and 'helping'. Relevance to health professional assessment and practice can be delineated.

Adaptation, Psychological↗
PubMed1990

A model of empathic understanding and adherence to treatment regimens in practitioner-patient relationships.

Empathic understanding in practitioner relationships is postulated as necessary for adherence to therapeutic regimens. It is considered to be one of the most important practitioner relationship skills leading ultimately to patient health benefit. Research literature from a wide-range of health disciplines including personality theory, social psychology, psychotherapy, psycho-analysis, and practitioner-patient communication highlights the key role of empathic processes in personal health care. A model of empathic understanding is described which attempts to integrate the substantive findings in the research literature and seeks to generate new ideas for further investigation. The model addresses theoretical relationships between practitioners' empathic understanding, patients' knowledge of their illness and motivation to get better, adherence to treatment advice, and outcome. Recent work on the selection and training of medical and nursing staff in empathic skills is reviewed. A number of areas for future research are outlined including the effect of individual practitioner differences in the components of empathy, empathic compatibility in practitioner-patient dyads, fluctuations in levels of practitioner empathy during long-term care, specific practitioner behaviours which communicate empathy, and the relationship between factors of patient satisfaction and the perception of empathic understanding.

Communication↗