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PubMed1997

Clinical and developmental dimensions of hate.

Bridging concepts of aggression, affect, and attitude, hate emerges during the process of separation-individuation concurrent with ego development and persisting intrapsychic conflict and fantasy. Rage precedes hate developmentally, though later the two are amalgamated both developmentally and clinically. Hate is the negative pole of ambivalence and is a component of all self- and object representations and object relationships. When excessive and unmodulated, hate interferes with object relations and personality development. Paradoxically, hate may also subserve adaptation and personality organization. Transference hate is often a greater problem for the psychoanalyst or psychotherapist than is transference love. Transference hate threatens the analyst's narcissism and neutrality and tests the analyst's tolerance and patience. The patient's intense hate is often experienced as a direct assault on the analytic relationship and the analytic process. Countertransference hate and the need to defend against it are of great clinical importance. Because it runs counter to analytic ideals and values, the analyst's hatred of the patient may be denied, minimized, rationalized, enacted, or vicariously gratified and may occasion great resistance to analytic self-scrutiny. Countertransference hate is often an unrecognized determinant in cases of analytic and therapeutic impasse. A classic contribution by D.W. Winnicott to the recognition and elucidation of countertransference hate is reevaluated.

Adult↗
PubMed2006

Risk factors for developing leprosy--a population-based cohort study in Indonesia.

We identified risk factors associated with increased yearly incidence rates of leprosy in five island populations. Age, sex, household size and Mycobacterium leprae-specific antibodies as well as contact factors were studied. Of 94 index patients (patients diagnosed in 2000), 43 (46%) were classified as multibacillary (MB), 17 (19%) were seropositive for PGL-1 [corrected] antibodies and 6 (7%) had M. leprae DNA in nasal swabs as determined by polymerase chain reaction (PCR) testing. All PCR positive patients were also seropositive. Forty-four of 4903 initially symptom free persons developed leprosy within 4 years, giving an incidence rate of 298 per 1000 person-years. Men had a 22 times higher risk [95% confidence interval (CI): 1.2-4.1] of developing leprosy than women. People living in households with more than 7 members had a 3.1 times higher risk (95% CI: 1.3-7.3) than households of 1-4 members. Persons who were seropositive in 2000 had a 3.8 times higher risk (95% CI: 1.1-12.6) than seronegative persons. Household contacts of MB patients had an adjusted hazard ratio (aHR) of 4.6 (95% CI: 1.6-12.9) and household contacts of PCR positive patients an aHR of 9.36 (95% CI: 2.5-34.9) compared with non-contacts. Patients with PCR positive nasal swabs, suggesting nasal excretion of M. leprae, are probably the patients with the highest transmission potential. Since all index patients who were PCR positive were also seropositive, serology seems an adequate tool to identify these patients. Preventing seropositive persons from becoming seropositive and infectious patients might break the chain of transmission.

Adolescent↗
PubMed1997

Personality characteristics of mental health professionals who have engaged in sexualized dual relationships: a Rorschach investigation.

This study is the first to empirically investigate the psychological characteristics of mental health professionals who have engaged in sexualized dual relationships. Twenty mental health professionals were administered the Rorschach as part of a comprehensive evaluation to assess rehabilitation potential during or after a disciplinary hearing. The Rorschach protocols were scored according to Exner's (1993) Comprehensive System. Results included a total of seven scores that differed by more than 3 standard deviations from the normative mean. These included measures of distress (especially interpersonal longing, helplessness, and generalized dysphoria), primitive sexualization, and idiosyncratic reality contact. Other indicators differing by 2 standard deviations from the normative mean included measures of vulnerable self-boundaries and long-standing, characterological dysphoria. These characteristics and vulnerabilities are consistent with previous observations emphasizing long-standing conflicts involving interpersonal longing and deprivation, anxiety regarding body integrity or self-boundaries, primitive sexualization of anxiety-provoking issues, and depression (Celenza, 1995b). Awareness of such vulnerabilities may represent useful guidelines to supervisors and educators as a focus of concern in an individual's training and personal development.

Adult↗
PubMed1983

Demographic correlates and factor structure of the Family Environment Scale.

Since traditional psychological assessment instruments focus mainly on the characteristics of individuals, techniques for systematically measuring social environments may help to increase assessment validity. One of the best developed environmental measures is the Family Environment Scale (FES), a 90-item inventory with 10 subscales that assess interpersonal relationships, personal development goals, and organizational structure. A study was conducted in which FES subscale scores of 204 families were factor analyzed and correlated with family demographic characteristics. The obtained factor structure showed two major factors similar to "control" and "acceptance-rejection" dimensions found in previous research. Number of children in a family was related positively to control and negatively to acceptance. Family socioeconomic status was correlated positively with the degree of participation in cultural and recreational activities. The results are seen as supporting the use of the FES as part of multimethod assessments of family environment and indicating the need for FES norms to be adjusted for relevant demographic characteristics.

Adult↗
PubMed1983

The rarity of cryptococcosis in Northern California: the 10-year experience of a large defined population.

The incidence of clinically manifest cryptococcosis was determined among over one million subscribers to the Kaiser-Permanente Medical Care Program in Northern California during the 10-year period 1971-1980. A total of 10 persons developed the disease, of whom two had no underlying immunosuppressive disease or therapy. The overall incidence was 0.8 per million persons per year; for nonimmunosuppressed individuals the incidence was estimated to be 0.2 per million per year. Incidence increased with age into the seventh decade of life and was greater in men than in women. The overall case fatality rate was 40 per cent. The data are not consistent with the view that cryptococcosis usually occurs in persons without obvious predisposing factors.

Adult↗
PubMed2000

High-risk behavior among gay adolescents: implications for treatment and support.

This article contrasts the experiences of most adolescents during social and psychological development with the special challenges faced by those developing an awareness of their homosexuality. Emphasis is placed upon the interplay between societal prejudices and discrimination toward homosexuality and personal development and risk-taking behavior in gay adolescents. The implications of these life stressors for gay adolescents are also discussed in terms of their consequences for mental health policy and treatment.

Adolescent↗
PubMedDate not supplied

The utility of CPD for older adult mental health nurses.

AIM: To investigate how mental health nurses working with older adults perceive the benefits and realities of developing the outcomes of current continuing professional development training into actual clinical practice. METHOD: A structured questionnaire was used with a convenience sample of nursing staff. Qualitative analysis was performed using a grounded theory approach in order to identify emergent themes, concepts and categories of data. Four randomly selected nurses were subjected to a voluntary semistructured interview using the questionnaire as a basis for information gathering. RESULTS: The main reason for attending courses was developing skills. Of those attending courses, 42 per cent of qualified and 35 per cent of unqualified staff had a personal development plan (PDP) or individual performance review (IPR). Significantly, all unqualified staff who had not been on a course had no PDP or IPR. Learning was described as applicable to practice by 85 per cent of unqualified and 70 per cent of qualified staff. However, 28 per cent of unqualified staff and 20 per cent of qualified staff felt their practice had not changed as a result of their learning. CONCLUSION: CPD can be a positive experience, providing nurses with the opportunity to direct their professional development.

Aged↗
PubMedDate not supplied

Use of serum and vaccine in combination for prophylaxis following exposure to rabies.

Persons seriously wounded by rabid animals in China were administered postexposure rabies treatment with serum and vaccine. Some of these exposures were similar to those described in an attack by a rabid wolf in Iran in 1954, in which some persons developed rabies. Postexposure treatment consisted of the administration of primary hamster kidney cell rabies vaccine and purified equine antirabies serum. Persons with severe wounds from the bites of rabid animals survived without sequelae when the serum and vaccine were administered together within 3 days of the bite, and persons with superficial exposures survived after treatment with vaccine alone. Serum neutralizing antibodies were present 1 year after the patients had received a full course of treatment. Some persons with severe wounds who had not received antiserum and vaccine died of rabies.

Acute Disease↗
PubMed1995

The preschool "passage". An overview of dental health.

Children undergo major transformations between birth and approximately 5 years of age. The most common examples are personality development and the potential explosiveness of the course of the disease caries. Each demands recognition, assessment of degree of difficulty, and an adaptation by the dentist. Starting dental care for children early is based on the anticipated time children can develop disease, the fact that most dental disease is preventable, and the desire to gain the trust of the child by first, minimizing the need for invasive procedures. Dental trends set in the preschool period tend to carry for many years. The dentist's assessment of the degree of difficulty is the first key in successful care for each child. The general dentist and pediatric dentist both play important and complementary roles in the care of children. There are differences in the practice habits between the two. Self assessment of skills for common situations leads to improved care. Because children don't vote, a responsibility falls on the health care provider to advocate for children in the political and professional arenas.

Child Behavior↗
PubMed2006

Policy for prevention of oral manifestations in HIV/AIDS: the approach of the WHO Global Oral Health Program.

The HIV/AIDS pandemic has become a human and social disaster, particularly affecting the developing countries of Africa, Southeast Asia, and Latin America. By the end of 2004, about 40 million people were estimated to be infected by HIV globally. The health sectors in many affected countries are facing severe shortages of human and financial resources, and are struggling to cope with the growing impact of HIV/AIDS. In most developed countries, the availability of antiretroviral treatment has resulted in a dramatic reduction in HIV/AIDS-related mortality and morbidity. In contrast, in the developing countries, there is little access to treatment, and access to HIV-prevention services is poor. The '3 by 5' initiative was launched by the WHO and UNAIDS in 2003 with the aim of providing antiretrovirals to three million people in developing countries by the year 2005. HIV infection has a significant negative impact on oral health, with approximately 40-50% of HIV-positive persons developing oral fungal, bacterial, or viral infections early in the course of the disease. Oral health services and professionals can contribute effectively to the control of HIV/AIDS through health education and health promotion, patient care, effective infection control, and surveillance. The WHO Global Oral Health Program has strengthened its work for prevention of HIV/AIDS-related oral disease. The WHO co-sponsored conference, Oral Health and Disease in AIDS, held in Phuket, Thailand (2004), issued a declaration calling for action by national and international health authorities. The aim is to strengthen oral health promotion and the care of HIV-infected persons, and to encourage research on the impact that HIV/AIDS, public health initiatives, and surveillance have on oral health.

AIDS-Related Opportunistic Infections↗
PubMed1992

[The readiness of the young teacher for the job].

The study aims at studying the professional readiness of the young teachers concerning their psychic state. It includes subjective-individual determinants--attitude to the profession, professional choice and steadiness, professional skills and satisfaction. The investigation is part of a broad complex study. The method used is directed first of all to self-estimation of the teacher concerning the structural system of the pedagogic activity which embraces supplementary questionnaire, revealing the motivation side of the scales for self-estimation. The subject of the examination are teachers from primary schools with length of service one to five years--time for completing their adaptation to the profession. The investigation includes 40 teachers from the cities of Sofia and Burgas. A general conclusion could be made, that there is professional readiness of the young teacher to be up to the requirements. His/her self-estimation corresponds to the adaptive behaviour and the choice of profession has a considerable effect on the professional steadiness. The general low satisfaction is not a sign for dysadaptation, but this low level presupposes lack of stimuli for personal development and perfection.

Adaptation, Psychological↗
PubMedDate not supplied

Volunteerism: 'community mothers' in action.

Volunteers represent a growing, but often undervalued, section of service delivery in many areas in the community, particularly in health care. This paper is centred on volunteers' perceptions and experiences of home visiting gained through the implementation of the Community Mothers (CM) program in Western Australia (WA). Further, the paper aims to inform debate about the issue of professional versus non-professional home visitors and offers a perspective on the issue that may provide direction for policy makers and practitioners. This qualitative study involved individual telephone interviews with a volunteer sample of 12 participants, purposefully selected. Transcription data from each interview were examined and coded utilising an adapted method of content analysis described by Burnard (1991). Three main themes emerged in the findings as to why volunteers became involved in the Community Mothers Program: (1) Empathetic concern; (2) Contribution to community life; and (3) Lifecourse issues and personal development. With experiences of volunteers in home visiting, four main themes reflected the participants' views: (1) Facilitating client empowerment; (2) Facilitating personal empowerment; (3) Promoting social connectedness; and (4) Enabling goal setting. Although programs such as the Community Mothers Program aim to benefit and support mothers in the parenting role it is clear that there are benefits that emerge also for the individual volunteer, such as increased self-esteem, self-efficacy and satisfaction. Hence, measuring the overall outcomes that result from such program remains a major challenge.

Adult↗
PubMed2006

[The newly graduated doctor.Is he or she sufficiently prepared to fulfill a doctor's responsibilities?].

INTRODUCTION: The goal of this study was to illuminate how a group of newly graduated medical doctors experienced their knowledge and resources in their work shortly after they had graduated. MATERIALS AND METHODS: We performed a prospective study of the students who started medical school in 1992. 252 students (79%) answered questionnaire 1, which was sent to them at the beginning of medical school in 1992. Questionnaire 4 was sent to the students at their graduation in 2002, and 57% answered. 80% (n = 143) of those who had graduated answered questionnaire 4. 111 of those who had graduated had been practising medicine for more than 1 year and were included in the study. RESULTS: 72% of the medical doctors stated that the theoretical part of medical school had given them a solid foundation for clinical work but too little direction toward clinical work. They did not feel that they had developed a good foundation for collaborating with other professionals, did not have good role models or had not received good enough support for personal development. Only 55% felt that it was easy to talk about professional issues. At the start of medical school, many of the students reported having had psychological problems; this percentage fell during the course of medical school but was again high at graduation. 60% of the medical doctors stated that the clinical work had strengthened their self-esteem, but 41% felt that the clinical work had caused them personal problems. The study showed that conditions in the students' private life as well as at the university were important to the results. Women doctors had the most serious problems. CONCLUSION: The medical doctors did not feel that they were well enough equipped for their clinical work. The study points out that it is important to make clinical education better and to give more personal support to the students during their time in medical school. Furthermore, focus is directed at the pattern of the gender roles, where women in particular are having problems.

Clinical Competence↗
PubMed2005

Applying the developmental perspective in the psychiatric assessment and diagnosis of persons with intellectual disability: part II--diagnosis.

BACKGROUND: The descriptive phenomenological categorical psychiatric diagnostic systems that are currently being used in the field of intellectual disability do not adequately provide for the special needs of persons with intellectual disability. Many relevant diagnostic questions are left unanswered or are only partially accounted for. This is particularly true for persons with low developmental levels. METHOD: A solution to these stumbling blocks is sought in enhancing the contemporary categorical diagnostic systems by also applying methods derived from the developmental perspective. RESULT: By taking the levels of emotional and personality development, in addition to other developmental aspects into account, the clinical picture becomes more comprehensible and explainable. CONCLUSION: The integrative diagnosis that results from this combined approach provides an insight into the processes that have led to the disorder and enriches one's understanding of the presentation form of the disorder. This diagnosis is process- rather than symptom-oriented and is particularly useful with persons who have a low level of psychosocial development.

Adolescent↗
PubMed2001

The experience of practice development: an exploratory telephone interview study.

Practice development is a widely used term within British nursing. However, there is a lack of consistency and clarity in the way that the term is used. A small-scale qualitative telephone interview study was therefore conceived to explore practitioners' views of practice development. Qualitative telephone interviews were carried out with 26 nurses working in a range of settings and roles around the UK. Informants reported varying degrees of awareness of practice development roles and activities ranging from little awareness to being closely involved. Most informants seemed to place more emphasis on issues of personal development and educational aspects of practice development than is found in the literature. Practice development staff were seen as having a range of functions ranging from working with individual practitioners to the co-ordination of education and training within an organization. The credibility of practice development staff was closely related to their clinical experience and ability.

Attitude of Health Personnel↗
PubMedDate not supplied

Complications of adapting pressure ulcer risk assessment scales.

This article challenges recommendations to adapt a pressure ulcer risk assessment scale (RAS) according to the clinical context. The transformation of the Cubbin and Jackson (1991) RAS is used to illustrate problems in scale development. When new factors are added to an existing scale, this can lead to unnecessary complexity. When words are changed by a person developing a scale this illustrates their differing beliefs and value judgements. Arbitrary scores for factors are misleading and in some cases mystifying, yet appear to be objective. This article suggests that the relationship between sub-scales and the whole scale have not been adequately accounted for -- they can't simply be added up arithmetically. The paradox of risk is debated, namely, that the more something is thought to be a risk, the less risky it becomes. RASs should be replaced by risk reduction scales linking a risk factor with its outcome following intervention.

Activities of Daily Living↗
PubMed2002

The development of mental processing: efficiency, working memory, and thinking.

This Monograph aims to contribute to the information processing, the differential, and the developmental modeling of the mind, and to work these into an integrated theory. Toward this aim, a longitudinal study is presented that investigates the relations between processing efficiency, working memory, and problem solving from the age of 8 years to to the age of 16 years. The study involved 113 participants, about equally drawn among 8-, 10-, 12-, and 14-year-olds at the first testing; these participants were tested two more times spaced one year apart. Participants were tested with a large array of tasks addressed to processing efficiency (i.e., speed of processing and inhibition), working memory (in terms of Baddeley's model, phonological storage, visual storage, and the central executive of working memory), and problem solving (quantitative, spatial, and verbal reasoning). Confirmatory factor analysis validated the presence of each of the above dimensions and indicated that they are organized in a three-stratum hierarchy. The first stratum includes all of the individual dimensions mentioned above. These dimensions are organized, at the second stratum, in three constructs: processing efficiency, working memory, and problem solving. Finally, all second-order constructs are strongly related to a third-order general factor. This structure was stable in time. Structural equation modeling indicated that the various dimensions are interrelated in a cascade fashion so that more fundamental dimensions are part of more complex dimensions. That is, speed of processing is the most important aspect of processing efficiency, and it perfectly relates to the condition of inhibition, indicating that the more efficient one is in stimulus encoding and identification, the more efficient one is in inhibition. In turn, processing efficiency is strongly related to the condition of executive processes in working memory, which, in turn, is related to the condition of the two modality-specific stores (phonological and visual). Finally, problem solving is related to processing efficiency and working memory, the central executive in particular. All dimensions appear to change systematically with time. Growth modeling suggested that there are significant individual differences in attainment in each of the three aspects of the mind investigated. Moreover, each of the three aspects of the mind as well as their interrelations change differently during development. Mixture growth modeling suggested that there are four types of developing persons, each defined by a different combination of performance in these aspects of the mind. Some types are more efficient and stable developers than others. These analyses indicated that processing efficiency is a factor closely associated with developmental differences in problem solving, whereas working memory is associated with individual differences. Modeling by logistic equations uncovered the rates and form of change in the various dimensions and their reciprocal interactions during development. These findings are discussed from the point of view of information processing, differential, and developmental models of thinking, and an integrative model is proposed.

Age Factors↗
PubMedDate not supplied

Implementing a staff nurse development programme.

A project was undertaken to implement a staff nurse development programme that was transferable across the Black Country, and which would assure the development of a competent and confident practitioner. This consisted of a core set of competencies, supported by effective supervision, performance management and personal development planning.

Clinical Competence↗