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Instrumental help and caregivers' distress: effects of change in informal and formal help.

Family caregivers of persons with dementia rely on a range of resources to provide care and cope with caregiving stressors. Informal (unpaid) and formal (paid) instrumental support contribute to diverse caregiver outcomes. Previous research of caregiver support has focused on subjective measures of help or has compared caregivers receiving formal services to those who do not. We focused instead on the effects of change in the amount of formal and informal instrumental assistance on caregivers' distress. We expected that greater gains in assistance would be associated with greater reduction of caregivers' distress. Increases informal but not informal levels of assistance were associated with improvement in each measure of distress. Additional measures may be needed to fully understand the effects of informal and formal assistance.

Adaptation, Psychological↗
PubMed2006

The meaning of occupational health among human resources professionals--a qualitative study.

The study findings provide clear rationale for employing occupational health nurses as specialists in understanding occupational health, particularly in the areas of information seeking (e.g., identifying health resources and best practices) and illness or disability management (e.g., managing complex cases and addressing psychosocial factors). Occupational health nurses can assist human resources professionals to direct their energies to administrative and cultural features within their organizations that impact the health of employees and that clearly fall within their realm of expertise (e.g., working to create a workplace climate of genuine concern for employees). Occupational health nurses can provide aggregate information on the health of the work force to strategically encourage, direct, and harness employer investments in workplace health. Finding ways to translate and communicate workplace health information so it is accessible and useable by employers to direct decision making is a key role for occupational health nurses.

Adaptation, Psychological↗
PubMed2006

Social and demographic predictors of no transport prior to premature cardiac death: United States 1999-2000.

BACKGROUND: In the United States, over one-third of premature cardiac deaths occur outside of a hospital, without any transport prior to death. Transport prior to death is a strong, valid indicator of help-seeking behavior. We used national vital statistics data to examine social and demographic predictors of risk of no transport prior to cardiac death. We hypothesized that persons of lower social class, immigrants, non-metropolitan residents, racial/ethnic minorities, men, and younger decedents would be more likely to die prior to transport. METHODS: Our study population consisted of adult residents of the United States, aged 25 to 64 years, who died from heart disease during 1999-2000 (n = 242,406). We obtained transport status from the place of death variable on the death certificate. The independent effects of social and demographic predictor variables on the risk of a cardiac victim dying prior to transport vs. the risk of dying during or after transport to hospital were modeled using logistic regression. RESULTS: Results contradicted most of our a priori hypotheses. Persons of lower social class, immigrants, most non-metropolitan residents, and racial/ethnic minorities were all at lower risk of dying prior to transport. The greatest protective effect was found for racial/ethnic minority decedents compared with whites. The strongest adverse effect was found for marital status: the risk of dying with no transport was more than twice as high for those who were single (OR 2.35; 95% CI 2.29-2.40) or divorced (OR 2.29; 95% CI 2.24-2.34), compared with married decedents. Geographically, residents of the Western United States were at a 47% increased risk of dying prior to transport compared with residents of the metropolitan South. CONCLUSION: Our results suggest that marital status, a broad marker of household structure, social networks, and social support, is more important than social class or race/ethnicity as a predictor of access to emergency medical services for persons who suffer an acute cardiac event. Future research should focus on ascertaining "event histories" for all acute cardiac events that occur in a community, with the goal of identifying the residents most susceptible to cardiac fatalities prior to medical intervention and transport.

Adult↗
PubMed2005

Mental health first aid responses of the public: results from an Australian national survey.

BACKGROUND: The prevalence of mental disorders is so high that members of the public will commonly have contact with someone affected. How they respond to that person (the mental health first aid response) may affect outcomes. However, there is no information on what members of the public might do in such circumstances. METHODS: In a national survey of 3998 Australian adults, respondents were presented with one of four case vignettes and asked what they would do if that person was someone they had known for a long time and cared about. There were four types of vignette: depression, depression with suicidal thoughts, early schizophrenia, and chronic schizophrenia. Verbatim responses to the open-ended question were coded into categories. RESULTS: The most common responses to all vignettes were to encourage professional help-seeking and to listen to and support the person. However, a significant minority did not give these responses. Much less common responses were to assess the problem or risk of harm, to give or seek information, to encourage self-help, or to support the family. Few respondents mentioned contacting a professional on the person's behalf or accompanying them to a professional. First aid responses were generally more appropriate in women, those with less stigmatizing attitudes, and those who correctly identified the disorder in the vignette. CONCLUSIONS: There is room for improving the range of mental health first aid responses in the community. Lack of knowledge of mental disorders and stigmatizing attitudes are important barriers to effective first aid.

Adolescent↗
PubMed2006

Helping each other to learn--a process evaluation of peer assisted learning.

BACKGROUND: The benefits of Peer Assisted Learning (PAL) are well established with positive effects on examination scores, student satisfaction and personal and professional development reported. PAL is increasingly utilised as a resource within medical education where the restrictions on resources have forced teachers to look at creating new educational environments which can be delivered at a lower cost. This study sought to evaluate the processes at work as the emphasis of PAL research to date has largely been on the consideration of student outcomes. METHODS: Fifth-year medical undergraduates, who had completed their communication skills modular training and attended a preparatory workshop, facilitated a role-play session for their second-year colleagues within an Early Patient Contact programme. Semi-structured interviews and focus groups were used to collect data at different time points in order to establish the views of peer learners and tutors towards this new method of teaching. The data was analysed according to the principles framework analysis using N-vivo software. Themes were shared and debated with the multidisciplinary team of authors and a concordance of views on common themes was reached after discussion and debate. RESULTS: Analysis of the data resulted in the emergence of three thematic categories: Learning Environment, Educational Exchange and Communication and Modelling. The data demonstrated a concordance of the views between peer tutors and learners on barriers and levers of this approach as well as a heightened awareness of the learning environment and the educational exchange occurring therein. CONCLUSION: The data is significant as it not only demonstrates a high level of acceptability among tutors and learners for PAL but also indicates the reciprocity of educational exchange that appears to occur within the PAL setting. This study highlights some of the unique characteristics of PAL and we recommend the development of further qualitative studies around peer learners and tutors views of this process.

Adult↗
PubMed2003

The feasibility of using pattern recognition software to measure the influence of computer use on the consultation.

BACKGROUND: A key feature of a good general practice consultation is that it is patient-centred. A number of verbal and non-verbal behaviours have been identified as important to establish a good relationship with the patient. However, the use of the computer detracts the doctor's attention away from the patient, compromising these essential elements of the consultation. Current methods to assess the consultation and the influence of the computer on them are time consuming and subjective. If it were possible to measure these quantitatively, it could provide the basis for the first truly objective way of studying the influence of the computer on the consultation. The aim was to assess whether pattern recognition software could be used to measure the influence and pattern of computer use in the consultation. If this proved possible it would provide, for the first time, an objective quantitative measure of computer use and a measure of the attention and responsiveness of the general practitioner towards the patient. METHODS: A feasibility study using pattern recognition software to analyse a consultation was conducted. A web camera, linked to a data-gathering node was used to film a simulated consultation in a standard office. Members of the research team enacted the role of the doctor and the patient, using pattern recognition software to try and capture patient-centred, non-verbal behaviour. As this was a feasibility study detailed results of the analysis are not presented. RESULTS: It was revealed that pattern recognition software could be used to analyse certain aspects of a simulated consultation. For example, trigger lines enabled the number of times the clinician's hand covered the keyboard to be counted and wrapping recorded the number of times the clinician nodded his head. It was also possible to measure time sequences and whether the movement was brief or lingering. CONCLUSION: Pattern recognition software enables movements associated with patient-centredness to be recorded. Pattern recognition software has the potential to provide an objective, quantitative measure of the influence of the computer on the consultation.

Computers↗
PubMed2005

Public beliefs about treatment and outcome of mental disorders: a comparison of Australia and Japan.

BACKGROUND: Surveys of the public in a number of countries have shown poor recognition of mental disorders and beliefs about treatment that often diverge from those of health professionals. This lack of mental health literacy can limit the optimal use of treatment services. Australia and Japan are countries with very different mental health care systems, with Japan emphasising hospital care and Australia more oriented to community care. Japan is also more collectivist and Australia more individualist in values. These differences might influence recognition of disorders and beliefs about treatment in the two countries. METHODS: Surveys of the public were carried out in each country using as similar a methodology as feasible. In both countries, household interviews were carried out concerning beliefs in relation to one of four case vignettes, describing either depression, depression with suicidal thoughts, early schizophrenia or chronic schizophrenia. In Australia, the survey involved a national sample of 3998 adults aged 18 years or over. In Japan, the survey involved 2000 adults aged between 20 and 69 from 25 regional sites spread across the country. RESULTS: The Japanese public were found to be more reluctant to use psychiatric labels, particularly for the depression cases. The Japanese were also more reluctant to discuss mental disorders with others outside the family. They had a strong belief in counsellors, but not in GPs. They generally believe in the benefits of treatment, but are not optimistic about full recovery. By contrast, Australians used psychiatric labels more often, particularly "depression". They were also more positive about the benefits of seeking professional help, but had a strong preference for lifestyle interventions and tended to be negative about some psychiatric medications. Australians were positive about both counsellors and GPs. Psychiatric hospitalization and ECT were seen negatively in both countries. CONCLUSION: There are some major differences between Australia and Japan in recognition of disorders and beliefs about treatment. Some of these may relate to the different health care systems, but the increasing openness about mental health in Australia is also likely to be an explanatory factor.

Attitude to Health↗
PubMed2006

Death and help expected from nurses when dying.

This project was undertaken to ascertain the perceptions of a group of Taiwan's fourth-year bachelor of science in nursing (BSN) students regarding death and help expected from nurses during the dying process. Within the Chinese culture, death is one of the most important life issues. However, in many Chinese societies it is difficult for people to reveal their deepest feelings to their significant others or loved ones. It was in this context that this project was developed because little is known about how Taiwan's nursing students perceive death and the dying process. Using an open-ended, self-report questionnaire, 110 senior BSN students recorded their thoughts on: (1) their fears before physical death; (2) afterlife destinations; and (3) the help they would expect from nurses when dying. The data were analyzed using a three-layer qualitative thematic analysis. The students' reported needs during the dying process were directed towards three main goals: (1) help in reaching the 'triple targets of individual life'; (2) help in facilitating in-depth support so that both the dying person and significant others can experience a blessed farewell; and (3) help in reaching a destination in the afterlife. The results support the belief of dying as a transition occurring when life weans itself from the mortal world and prepares for an afterlife.

Adult↗
PubMed1975

Attitudes towards self-poisoning among physicians and nurses in a general hospital.

Twenty-five doctors and 50 nurses working in the medical wards of a general hospital were interviewed. They were asked to indicate typical motives for self-poisoning and were then shown brief accounts of four typical case histories. They were asked to choose from a list of motives those they considered applied to each case. They then rated each motive for acceptability and understandability, and each case for sympathy and readiness to help. Motives were of two principal types--"manipulative' (i.e. aimed at eliciting a response from others) and "depressive' (i.e. communicating despair and aimed at withdrawal, escape or death). "Depressive' motives were more acceptable and evoked more sympathy or readiness to help in both doctors and nurses than "manipulative' motives. Doctors and nurses differed in various ways. Nurses were generally more accepting, more sympathetic and more likely to seek professional help as an alternative way of coping. Doctors distinguished more clearly between "suicidal' motives, of which they were relatively accepting, and "manipulative' motives, which they accepted less. Attitudes to the four cases differed, primarily in the motives attributed. Those differences may also reflect differing severity of problems, personal responsibility for problems, social class, sex or age.

Adaptation, Psychological↗
PubMed1975

Individual differences in helping dispositions.

The intent of this report is to present research relevant to developing an instrument to assess helping dispositions (HDS). In its final form, 55 items can be dimensionalized into 20 component scales and 14 composite indicators of predispositions to help. Discriminations included in HDS include: psychological versus task help; helping in group settings versus helping in individual settings; and wanting to help, having the ability to help, being able to recognize when help is needed, having reasons for not helping, and actually helping. Evidence of both high internal consistency and different types of validity have been generated through four administrations of HDS involving a total of 611 college and noncollege subjects. The most robust scales appeared to be the motivation to help scales and the helping in group situations scale. Implications for further research are noted.

Helping Behavior↗
PubMed2005

Differences in helping whites and blacks: a meta-analysis.

The amount of help given to Blacks versus Whites is often assumed to reflect underlying levels of racism (or lack thereof). This meta-analysis assessed discrimination against Blacks in helping studies. The overall effect size for the 48 hypothesis tests did not show universal discrimination against Blacks (d = .03, p = .103). However, consistent with the predictions of aversive racism, discrimination against Blacks was more likely when participants could rationalize decisions not to help with reasons having nothing to do with race. Specifically, when helping was lengthier, riskier, more difficult, more effortful, and when potential helpers were further away from targets, less help was given to Blacks than to Whites. Interestingly, discrimination against Blacks was shown when there were higher levels of emergency. This suggests that discrimination may occur when the ability to control prejudicial responding is inhibited, or when the arousal of the emergency is misattributed to intergroup anxiety.

Black People↗
PubMed2005

Application of powder rheometer to determine powder flow properties and lubrication efficiency of pharmaceutical particulate systems.

The objective of this study was to understand the behavior of particulate systems under different conditions of shear dynamics before and after granulation and to investigate the efficiency of powder lubrication. Three drug powders, metronidazole, colloidal bismuth citrate, and tetracycline hydrochloride, were chosen as model drugs representing noncohesive and cohesive powder systems. Each powder was individually granulated with microcrystalline cellulose and 5%PVP as a binder. One portion from each granulation was lubricated with different levels of magnesium stearate for 5 minutes. The powder characterization was performed on the plain powders, nonlubricated and lubricated granules using powder rheometer equipped with a helical blade rotating and moving under experimentally fixed set of parameters. The profiles of interaction during the force-distance measurements indicate that powder compresses, expands, and shears many times in a test cycle. Test profiles also clearly reveal existence of significant differences between cohesive and noncohesive powders. In all cases lubrication normalized the overall interactive nature of the powder by reducing peaks and valleys as observed from the profiles and reduced the frictional effect. The developed methods are easy to perform and will allow formulation scientists to better understand powder behavior and help in predicting potential impact of processing factors on particulate systems.

Lubrication↗
PubMed2006

Ultrasonic rat vocalizations during the formalin test: a measure of the affective dimension of pain?

The emission of ultrasonic vocalization (USV) by rats submitted to the formalin test has not yet been demonstrated. We performed two experiments to establish the formalin concentration to induce USV and the relationship of USV emission with motor behaviors and the effects of morphine and naloxone on USV during the formalin test. Male Wistar rats were used. In Experiment 1, 3 different groups of rats were subcutaneously injected with 5%, 10%, or 12.5% formalin in 1 of the anterior paws. Experiment 2 was intended to verify the effect of morphine 1, 2.5, or 5 mg/kg on USV during the 12.5% formalin test, whereas other groups of rats received naloxone 2 mg/kg with each one of the morphine doses to verify the specificity of opioid action. USV and motor behaviors were simultaneously measured in 5-min windows for 40 min, and early (0-5 min), interphase (5-20 min), and late (20-40 min) phases of the test were characterized. Vocalization was detected mostly during the interphase of the formalin test, mainly after formalin 12.5%. Morphine suppressed USV in a naloxone-reversible manner. This is a demonstration of USV during the formalin test, allowing the inclusion of an additional nonreflex behavioral measure to help characterize more clinically relevant integrated behavioral patterns in this rat model of pain.

Animals↗