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PubMed1991

Why is the driver rarely motion sick? The role of controllability in motion sickness.

The central hypothesis of the work is that the dimension of control-no control plays an important role in motion sickness. Although it is generally agreed that having control over a moving vehicle greatly reduces the likelihood of motion sickness, few studies have addressed this issue directly, and the theoretical explanation for this phenomenon is not completely clear. In this study, we equated groups differing in controllability for head movement, vision, activity, and predictability, which have often been suggested in the literature as explanations for the driver's immunity to motion sickness. Twenty-two pairs of yoked subjects were exposed to nauseogenic rotation. One subject of each pair had control over the rotation and head movements, while the other was exposed passively to the same motion stimulus. Subjects who had control reported significantly fewer motion sickness symptoms and less of a decrement in their well-being, as compared to the yoked subject without control. The results are discussed in relation to Reason's sensory rearrangement theory and the concept of feed-forward mechanisms in motion perception.

Adult↗
PubMed1977

The dying role: its relevance to improved patient care.

Society is failing to meet the obligation it has to its dying members. Persons with terminal illnesses suffer isolation and neglect in hospitals, receive overzealous treatment by physicians, and are kept in ignorance of their situation by families and medical personnel. Evidence for these statements has come from observers of the medical care system and from dying patients themselves (Kübler-Ross, 1969; Reynolds and Kalish, 1974; Sudnow, 1967); In the nineteenth century it was common for persons to die in the familiar environs of their homes, surrounded by grieving families from whom they parted in a meaningful manner (Blauner, 1966). Dying persons of today no longer fill a well-defined social role. Instead, the distinction between the roles of sick and dying persons has been lost and, in the resulting confusion, the care of dying people has suffered. The purpose of this article is to clarify the distinction between the dying and sick roles, identify the signs of existing role confusion, suggest ways in which this confusion may be corrected, and show how reestablishment of the dying role can result in improved care of dying people. The important part physicians play in defining sick and dying roles will be emphasized.

Adaptation, Psychological↗
PubMed1992

Interpersonal psychotherapy of depressed HIV-positive outpatients.

In an open pilot study, 23 depressed adults infected with human immunodeficiency virus were treated using interpersonal therapy. Twenty subjects recovered from depression after a mean of 16 sessions. The authors discuss six aspects of interpersonal therapy that make it useful with depressed HIV-infected persons: psychoeducation about the sick role; a here-and-now framework; formulation of problems from an interpersonal perspective; exploration of options for changing dysfunctional behavior patterns; identification of focused interpersonal problem areas (grief, role transition, interpersonal disputes, and interpersonal deficits); and the confidence therapists gain from a systematic approach to problem formulation and treatment. Results suggest that mental health professionals should consider interpersonal therapy as a treatment for depressed HIV-positive patients.

AIDS-Related Opportunistic Infections↗
PubMed2004

Sick leave certification: an unwelcome administrative burden for the family doctor? The role of sickness certification in Maltese family practice.

INTRODUCTION: In Malta, sickness certificates are needed from the first day of illness, and are issued by family doctors (FDs) either employed in the government primary healthcare system, or self-employed in private practice, or employed directly by an employer for this purpose alone. Patients visiting self-employed FDs pay directly, and are not reimbursed unless privately insured. We aimed to contribute to the discussion on the impact of sickness certification in family practice by studying the phenomenon using electronic data from an electronic patient record (EPR) used by self-employed FDs. We used this data to study the frequency of sickness certification and the relationship between the patient's reason for encounter, with or without a formal request for a certificate, and the doctor's diagnosis and certification practice. METHODS: We used data collected by FDs in day-to-day private family practice using an episode-oriented EPR. The EPR database included all encounters in all episodes of care over a period of one year (1 January to 31 December 2001) documented by ten self-employed FDs, comprehensively coded with ICPC-2-E (Electronic Version of the International Classification of Primary Care, version 2). RESULTS: The EPR database documented care for 7497 patients (45.4% male) over one year. During 15,781 encounters, sickness certificates were issued in 11.3% of 16,319 episodes of care. 5.7% of the reasons for encounter presented by the patient in new episodes were requests for administrative procedures, and this request was made in 8.2% of all new episodes of care. CONCLUSION: The distribution of morbidity seen by the FDs appeared to be very wide, with a dominance of acute respiratory, gastrointestinal and musculoskeletal symptoms and diagnoses, and the role of sickness certification was quite important. The frequency of sick leave certification in Malta is comparable with that in other European countries, but the average duration of episodes is shorter. Just over 11% of private FD encounters involve issuing a sickness certificate. The high proportion of reasons for encounter formulated as a request for a sickness certificate suggests that the active role of FDs in this form of social security in the Maltese population has supported the local development of family practice.

Adolescent↗
PubMed1983

Sex differences in reports of illness and disability: a further test of the fixed role hypothesis.

Data from a longitudinal study of adult health behavior (N = 1088) were used to test the 'fixed role' hypothesis as an explanation for sex differences in reports of illness and disability. According to this hypothesis, the traditional female excess in reported morbidity is due to females having more flexible role obligations than men--thus making it easier for women to adopt the sick role. In this analysis, regression techniques were used to examine sex differentials in reports of both 'symptom episodes' and bed days, while controlling statistically for fixed roles such as employment status, head of household and % contribution to the total family income. Our findings showed that the three fixed role measures did not explain sex differences in reports of symptom episodes or total bed days (N = 1088). However, among people reporting at least one bed day (N = 503), such obligations did explain the female excess in reported bed days. These findings suggest that fixed role obligations may play a larger role in determining when to relinquish the sick role as opposed to its adoption. These analyses also suggest that role obligations associated with employment status have the major influence on such sick role behavior.

Adult↗
PubMed1986

Social learning influences on menstrual symptoms and illness behavior.

The contribution of learning to the adult experience of illness was investigated by asking 351 nursing students how their mothers reacted to menstrual symptoms and cold symptoms during their adolescence and how their mothers behaved when they themselves had menstrual symptoms. Mothers of respondents were independently asked the same questions. Nursing students who had been encouraged to adopt a sick role for menses or whose mothers modeled menstrual distress reported significantly more menstrual symptoms, clinic visits, and disability days for these symptoms as adults. Similarly, those encouraged to adopt a sick role for colds or who lived with a chronically ill person reported more clinic visits and disability days for nongynecological symptoms. Specific types of symptom reports and health care appeared to be learned: Encouragement and modeling of the menstrual sick role were more highly correlated with symptom reports, clinic visits, and absenteeism for menstrual than for nongynecological symptoms, and encouragement of the cold sick role was more highly correlated with nongynecological than with menstrual clinic visits and absenteeism.

Absenteeism↗
PubMed1992

Sex roles, occupational roles, and symptom-reporting: a test of competing hypotheses on sex differences.

The sick-role, fixed-role obligations, symptom-reporting, and nurturant-role hypotheses of sex differences in utilization of health services and symptom-reporting were tested against each other. Fifty-one nontraditional college students completed the Cornell Medical Index (CMI), the Bem Sex Role Inventory, and questions regarding their employment status. Employment status and feminine characteristics emerged as the best predictors of symptom-reporting on the CMI and suggested that the sick-role hypothesis may be empirically superior to the others.

Adolescent↗
PubMed1968

The localization of circulating immune complexes in experimental serum sickness. The role of vasoactive amines and hydrodynamic forces.

In serum sickness, mechanisms by which circulating immune complexes become localized in the walls of vessels and glomeruli have been studied. In affected arteries, morphologic observations showed that circulating marker particles of carbon would rapidly deposit along the luminal surface of the internal elastic lamina. This, as in previous studies, suggested an increase in vascular permeability during which large molecules were capable of being trapped by a filtering membrane in the vessel wall. In attempts to prevent the increase in vascular permeability, rabbits were treated with antagonists of histamine and serotonin. Such treatment markedly inhibited the localization of immune complexes in glomeruli, the development of proteinuria, and glomerular endothelial proliferation. Cardiovascular lesions also were largely prevented from developing. Depletion of platelets, the principal reservoir of vasoactive amines, had a similar though less pronounced effect. While the deposition of immune complexes was inhibited, allergic inflammation in general was not, since normal rabbits treated as above were found capable of developing full Arthus reactions and acute nephrotoxic nephritis. Hydrodynamic factors were noted to be important in determining the location of arterial lesions. Studies of aortas from unmodified rabbits and from those with surgically induced coarctations of the abdominal aorta revealed intimal lesions concentrated at areas of high turbulence, such as at branches, bifurcations, outflows and zones of configurational change. Lesions in these areas were also largely inhibitable by depletion of platelets or by antagonists of histamine and serotonin.

Animals↗
PubMed1979

Doomed status: observations on the segregation of impaired old people.

The antecedents and consequences of the segregation of severely impaired old people within institutions is a problem that deserves more research attention than it has so far received. Given that such segregation exists and that it has some positive benefits for both staff and residents in homes for the aged, it is proposed that there exist among administration and ward staff impulses to avoid the mentally impaired aged, and that these impulses are part of a more general phylogenetic residue. Many animals show avoidance reactions in the presence of strange objects or strange conspecific individuals, and the more advanced the animal, the more disturbed he seems to be. It is suggested that the segregation of impaired old people consigns them to a doomed role, rather than a sick role, and that the process operates largely through the impact of the activation of the emergency team and the withdrawal of community support and can result in the death of the individual, partly by means of suggestion. Examples of sudden unexplained deaths are drawn from material on simpler societies.

Aged↗
PubMed1991

Health and illness behavior of Type A persons.

The complex and controversial relationship of type A behavior to myocardial infarction and other illnesses may be mediated through health habits and illness behavior. We hypothesized that type A persons tend to reject the sick role, delay in seeking medical care, seek convenient medical care facilities, are impatient for recovery, return to work before they have fully recovered, and are less likely to engage in positive health habits. A cross-sectional survey was conducted at a large corporation in Cleveland, Ohio. A detailed questionnaire that examined health-promoting and illness behaviors was sent to 385 managers, 54% of whom responded. Models tested using path analysis supported the hypotheses that type A persons are more likely than are type B employees to reject the sick role, delay in seeking medical care, be impatient for recovery, and return to work before a full recovery. The study findings imply that type A employees may be less likely to miss work for minor illnesses, but they may be prone to adverse outcomes from illnesses that require early care or assumption of the sick role. The hypothesis that type A persons are less likely to engage in positive health-habits behavior was not supported.

Adult↗
PubMed1976

Living with the dying: use of the technique of participant observation.

Through participant observation, questions concerning optimal care of dying patients and needs of their families were answered. A general surgical ward and a palliative care unit were the sites of observation. The observations support the belief that a palliative care unit, specifically designed to meet the known needs of dying patients and their families, is preferable to a general surgical ward. The main findings, of less concern in the palliative care unit than on the surgical ward, were the following: the importance of patient-to-patient support; the discomfort of sick-role behaviour; the impersonal and sometimes intimidating nature of patient care; the limitation of the patient's need (as a person) to give as well as to receive; and the value of families, student nurses and volunteers in total care. These findings emphasize the importance of personal interest in relieving the distress suffered by many terminally ill patients.

Anxiety↗
PubMed1985

Women's "sickness": a case of secondary gains or primary losses.

The functionalist view of the sick role is analyzed in terms of its applicability to women. Rather than focusing on the so-called secondary gains of the sick role, attention is given to the primary losses incurred when women's problems are subject to medical definitions and interventions. Women's "sickness" is placed in a historical and sociopolitical context. The "sickness" of the nursing profession and the "sickness" of women are seen as sharing similar symptoms, the same etiology, and hence a common cure.

Female↗
PubMed1994

Pain behavior in industrial subacute low back pain. Part I. Reliability: concurrent and predictive validity of pain behavior assessments.

The reproducibility of overt pain behavior ratings was shown to be reliable between independent observers. In the clinical evaluation of 103 blue collar workers with subacute low back pain (LBP), concurrent validity was high between Behavioural Signs (Waddell et al. 1980) and UAB Pain Behavior Rating scale (Richards et al. 1982). Correlations with pain rated on visual analogue scales (Scott and Huskisson 1976) were generally lower. Behavioural Signs correlated separately with covert pain behavior (general convictions concerning back strength and general health). It seems that subacute LBP patients do not behave as a homogenous group since pain behaviors predicted occupational handicap (absenteeism) in a non-linear fashion. Return to work was best predicted by UAB and covert pain behavior, absenteeism up to 2 years by covert pain behavior. The findings emphasize the potential social implications of overt pain behaviors and the importance of covert pain behavior in maintaining the sick role. The conclusion is that, in secondary prevention, where the main targets are to interfere with somatic deconditioning and sick-role development, a more diversified primary approach may be possible, based on supplementary use of relatively easy observational tests and quick self-reports.

Absenteeism↗
PubMed1982

Rat serum sickness: possible role of inflammatory mediators allowing deposition of immune complexes in the glomerular basement membrane.

Serum sickness was induced in rats by a modification of previously described methods avoiding i.v. administration of the antigen. All the animals developed a progressive disease characterized by an initial pattern of deposition of IC in the mesangium followed by the appearance of GBM deposits. This change in the deposition of IC was associated with the onset of massive proteinuria and a fall in the titre of precipitating antibodies. Simultaneously, specific desensitization of platelets for a rat PAF could be demonstrated and platelet aggregates were seen in the glomeruli. The presence of homocytotropic IgGa anti-ovalbumin antibodies in rat sera during the induction of the disease was demonstrated by 2 hr PCA. Accordingly, this antibody together with the antigen ovalbumin induced the release of histamine from peritoneal mast cells, suggesting that a similar mechanism might occur in vivo during the induction of the disease. Rat PAF and beta glucuronidase could be obtained from peritoneal macrophages under similar conditions to those required for the release of histamine. The data support a role for inflammatory mediators in the increase in vascular permeability needed for the deposition of IC in the GBM and provide evidence for a new role of macrophages and PMNs in glomerular pathology in contributing to an increase in permeability of GBM.

Animals↗
PubMed1994

The pursuit of illness for secondary gain.

Secondary gain is defined as the advantage that occurs secondary to stated or real illness. Transition into the sick role may have some incidental secondary gains for patients. Types of secondary gain include using illness for personal advantage, exaggerating symptoms, consciously using symptoms for gain, and unconsciously presenting symptoms with no physiological basis. These symptoms may contribute to the social breakdown syndrome and the patient's choice to remain in the sick role.

Dependency, Psychological↗
PubMed2001

Cognitive theory and illness behavior in disability syndromes.

There are many controversial disability syndromes, representing medicolegal and social dilemmas for a variety of medical disciplines. While illness behavior and sick role phenomena are often invoked to explain many of these syndromes, the extent to which such phenomena are under volitional control has not been thoroughly explored. The volitional control of illness behavior has important treatment implications, and may explain why cognitive therapy can be effective in these patients. Further understanding of the relevance of cognitive theory to illness behavior, the sick role, secondary gain, and disability may render even more effective cognitive therapy approaches. This review explores the consciousness states, the role of each state in information processing (in this case processing illness information), the automaticity and hence volitional state of each level of information processing, and the likelihood that illness behavior in disability syndromes is volitional. The cognitive model of these syndromes considers the interaction of automaticity, volition, and illness behavior and likely has numerous clinical, social, and legal applications.

Cognition↗
PubMed1999

Functional somatic syndromes.

The term functional somatic syndrome has been applied to several related syndromes characterized more by symptoms, suffering, and disability than by consistently demonstrable tissue abnormality. These syndromes include multiple chemical sensitivity, the sick building syndrome, repetition stress injury, the side effects of silicone breast implants, the Gulf War syndrome, chronic whiplash, the chronic fatigue syndrome, the irritable bowel syndrome, and fibromyalgia. Patients with functional somatic syndromes have explicit and highly elaborated self-diagnoses, and their symptoms are often refractory to reassurance, explanation, and standard treatment of symptoms. They share similar phenomenologies, high rates of co-occurrence, similar epidemiologic characteristics, and higher-than-expected prevalences of psychiatric comorbidity. Although discrete pathophysiologic causes may ultimately be found in some patients with functional somatic syndromes, the suffering of these patients is exacerbated by a self-perpetuating, self-validating cycle in which common, endemic, somatic symptoms are incorrectly attributed to serious abnormality, reinforcing the patient's belief that he or she has a serious disease. Four psychosocial factors propel this cycle of symptom amplification: the belief that one has a serious disease; the expectation that one's condition is likely to worsen; the "sick role," including the effects of litigation and compensation; and the alarming portrayal of the condition as catastrophic and disabling. The climate surrounding functional somatic syndromes includes sensationalized media coverage, profound suspicion of medical expertise and physicians, the mobilization of parties with a vested self-interest in the status of functional somatic syndromes, litigation, and a clinical approach that overemphasizes the biomedical and ignores psychosocial factors. All of these influences exacerbate and perpetuate the somatic distress of patients with functional somatic syndromes, heighten their fears and pessimistic expectations, prolong their disability, and reinforce their sick role. A six-step strategy for helping patients with functional somatic syndromes is presented here.

Environmental Illness↗