RESUMEN
BACKGROUND: The ability to return to work (RTW) is a significant quality of life indicator for many working aged cancer survivors. In the void of available support, many are left to independently navigate the RTW process which includes such important considerations as disclosure or concealment of diagnosis with concomitant sequellae. OBJECTIVE: This article reviews participants' variable approaches to concealment, disclosure, or even an open educative stance as well as the associated benefits and limitations. METHODS: Photovoice methods combined with interviewing. RESULTS: While most participants disclosed their diagnosis and many extolled the benefits of an open, educative stance, there were drawbacks experienced. Similarly, those who concealed their diagnosis also experienced benefits and challenges. CONCLUSIONS: In the current void of appropriate cancer rehabilitation supports, cancer survivors must independently negotiate their RTW process. Although most participants openly disclosed their diagnosis and associated limitations, a few concealed or camouflaged. There are benefits and limitations to both approaches of which survivors should be made aware at the outset as such will shape their RTW experience. Multidisciplinary rehabilitation support services would best guide survivors' management of the myriad of factors that will impact their work reintegration.
Asunto(s)
Neoplasias/diagnóstico , Sobrevivientes/psicología , Revelación de la Verdad , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Neoplasias/psicología , Privacidad/psicología , Reinserción al TrabajoRESUMEN
PURPOSE: Work is an important quality of life indicator for many cancer survivors. There is, however, a lack of appropriate support to help survivors with work integration. As a result, many survivors are forced to independently navigate their return to work, experiencing unnecessary pitfalls in the process. As a preliminary step toward addressing this current gap in survivorship support, we explored the work integration experiences of 20 cancer survivors, 10 women and 10 men. METHODS: Photovoice methods were combined with two individual interviews per participant. Participant-produced photographs and interview transcripts were analyzed to identify key themes. RESULTS: Both commonalities and gender-differentiated motivations underlying work integration emerged. Female and male participants both demonstrated and discussed differentiated manners of coping. Men expressed a propensity for productivity and active engagements over talking used predominantly by women. CONCLUSION: Appreciation of men's proclivity for productivity and activity suggests that a gender-tailored approach to rehabilitation may enhance male survivors' participation and the utility of rehabilitation efforts.
Asunto(s)
Neoplasias/rehabilitación , Reinserción al Trabajo/psicología , Adaptación Psicológica , Adulto , Femenino , Identidad de Género , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/mortalidad , Fotograbar , Calidad de Vida , Sobrevivientes/psicologíaRESUMEN
OBJECTIVES: To examine interobserver reliability of the Acute Physiologic and Chronic Health Evaluation (APACHE) II score and identify major causes of variability in data collection. DESIGN: Descriptive, comparative analysis. SETTING: Nine intensive care units in two teaching and six community hospitals SUBJECTS: A random sample of 342 patient records selected from a network database. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Data were reabstracted and compared with the original records. Individual physiologic points derived from the APACHE II scoring system (instead of the actual physiologic values) were compared using the kappa statistic. Paired measurements of the continuous variables were compared using the interclass correlation coefficient and Bland-Altman plots. Excellent agreement was found in most demographic, admission, and discharge data. The system failure requiring intensive care unit admission was consistently identified by both data collectors in 88% of cases, but only 66% agreed on the exact admitting diagnosis. For APACHE II score components, the kappa statistic ranged from 0.315 for the Glasgow Coma Scale point to 0.976 for the age point. Significant disagreement regarding the probability of death derived from the APACHE II model was evident in some patient records. Overall agreement among groups of patients regarding the APACHE II score was good, however, with no significant difference in the mean score (20.2 vs. 20.1; p = .758). The predicted mortality from the reabstracted data was 30%, similar to the 27% predicted mortality from the original data (p = .380). CONCLUSION: Reliability of data collection varied widely in different components of the APACHE II probability-of-death model. Significant discrepancies in some components suggested a lack of explicit definitions and timing for consistent data collection between institutions or between data collectors. Nonetheless, variability resulting from data collection appears to be randomly distributed, so that comparisons of group means are valid.
Asunto(s)
APACHE , Unidades de Cuidados Intensivos/estadística & datos numéricos , Variaciones Dependientes del Observador , Medición de Riesgo , Escala de Coma de Glasgow , Mortalidad Hospitalaria , Hospitales Comunitarios/estadística & datos numéricos , Hospitales de Enseñanza/estadística & datos numéricos , Humanos , Ontario , Reproducibilidad de los ResultadosRESUMEN
This study examined the associations between two factors of depressive experience (dependency and self-criticism) and satisfaction in adult romantic relationships. The Depressive Experiences Questionnaire, along with measures of attachment and relationship satisfaction, were administered to 107 men and 140 women attending local community colleges. Self-criticism was associated with global relationship distress and sexual dissatisfaction. In a combined regression equation, measures of self-criticism, attachment security, and attachment activation all contributed to predicting general relationship distress. Only scores on self-criticism predicted sexual dissatisfaction. The relationship dissatisfaction reported by those with high scores on self-criticism appears to be a relational aspect of the "destructiveness of perfectionism" described by Blatt.
Asunto(s)
Cortejo , Depresión/psicología , Relaciones Interpersonales , Adolescente , Adulto , Femenino , Humanos , Masculino , Análisis de RegresiónRESUMEN
Community college students in the United States (151 men, 217 women) described their current or most recent intimate relationship on questionnaires derived from the Structural Analysis of Social Behavior (Benjamin & Friedrich, 1991). Attachment organization was assessed by categories (secure, avoidant, or ambivalent) and by dimensions (Attachment Security x Level of Activation). Respondents with avoidant or ambivalent attachment described more hostility in their relationships than secure participants did. Avoidant participants described themselves as less submissive. Respondents with low attachment security and high attachment activation were especially likely to describe more hostile patterns of interaction. Those with greater attachment security also described more interdependence in the relationship. No interaction effects of attachment with amount of experience in close relationships were found.
Asunto(s)
Relaciones Interpersonales , Apego a Objetos , Desarrollo de la Personalidad , Conducta Social , Adolescente , Adulto , Femenino , Hostilidad , Humanos , Masculino , Inventario de PersonalidadRESUMEN
The MMPI and MMPI-2 were compared as predictors of psychiatric diagnosis in 100 male and 100 female outpatients who completed the test items in a single session. Test profiles and the clinical diagnosis were grouped into five categories (normal, neurotic, character disordered, psychotic, and other). The MMPI and MMPI-2 code types were in the same category in 75% of the cases. Both the MMPI and MMPI-2 had a 39% agreement rate with category of clinical diagnosis (p < .0001). Discriminant function analyses based on Scales L, F, K, 1, 2, 3, 4, 6, 7, 8, and 9 accounted for significant variance in diagnostic group, (p < .02), and two functions correctly classified 49% and 50% of the cases for the MMPI and MMPI-2, respectively. The rate of correct classification for normals was more than 70%. The rate of correct classification for psychotics was 55% for the MMPI and 30% for the MMPI-2. For both the MMPI and MMPI-2, it appears important not to rely on test findings alone as a basis for diagnostic decisions.
Asunto(s)
Atención Ambulatoria , MMPI/normas , Trastornos Mentales/diagnóstico , Adulto , Comorbilidad , Femenino , Humanos , MMPI/estadística & datos numéricos , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/epidemiologíaRESUMEN
OBJECTIVE: To assess the psychosocial implications of growing up with and living with socially noticeable strabismus. DESIGN: Self-report mailed questionnaire and the Hopkins Symptom Checklist. SETTING: Patients with strabismus who were seen at the University of California, Davis, Medical Center, Department of Ophthalmology, from 1976 to 1989. PARTICIPANTS: Forty-three female and male subjects aged 15 years or older who had a history of childhood strabismus that was uncorrected or incompletely corrected past the age of 13 years. INTERVENTION: None. MAIN OUTCOME MEASURES: Participants' responses to our survey and to the Hopkins Symptom Checklist. RESULTS: Strabismus had a negative impact on many aspects of our subjects' lives. They report difficulty with self-image, securing employment, interpersonal relationships, school, work, and sports. Furthermore, difficulties encountered did not go away after childhood, rather, the problems encountered by our subjects intensified in the teenage and adult years. Subjects demonstrated generalized higher levels of distress on the Hopkins Symptom Checklist than age- and sex-matched controls (P < .01). CONCLUSIONS: Psychosocial difficulties relating to socially noticeable strabismus are not just a problem for school-children but also for teenagers and adults. Correction of strabismus in the older teenager or adult may offer them improvement in psychosocial functioning, a benefit not previously reported in the literature.
Asunto(s)
Estrabismo/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Autoimagen , Conducta Social , Encuestas y CuestionariosRESUMEN
Two hundred (N = 200) outpatients completed MMPI (W.G. Dahlstrom, Walsh, & L.G. Dahlstrom, 1989) and MMPI-2 (Butcher, W.G. Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) items at one time, permitting comparison of alternate forms. The concordance rate for elevated codetypes was 58%; for 2-point codetypes independent of elevation, it was also 58%. Only 50% of the men compared to 66% of the women showed concordance between forms. Of the 200 cases, 72 (36%) had codetypes that were both elevated and "well defined." The concordance rate among these 71 cases was 72%. Comparison of mean raw scores for the validity and clinical scales showed a small difference for MMPI versus MMPI-2 (Form) on Scales 2 and 5, small differences for Gender on Scales 1, 2, and 3, and no Gender by Form interactions. There were significant MMPI versus MMPI-2 differences for T-scores on all scales, and there were significant Gender by Form interactions for T-scores on all scales except Scale L, Scale K, and Scale 6 (excluding Scale 5). Comparison of mean T-scores (excluding Scale 5) showed no significant differences for Gender on the 12 scales. In spite of significant mean differences, correlational analyses show correlations above .96 for the raw scores and T-scores for each gender, indicating that rank ordering of cases is maintained between forms. These results are discussed in terms of the issues for use of the MMPI-2 compared to the MMPI.
Asunto(s)
Atención Ambulatoria , MMPI/estadística & datos numéricos , Trastornos Mentales/diagnóstico , Adulto , Femenino , Humanos , MMPI/normas , Masculino , Trastornos Mentales/clasificación , Escalas de Valoración Psiquiátrica , Psicometría , Reproducibilidad de los Resultados , Factores Sexuales , Terminología como AsuntoRESUMEN
The influence of certain personality characteristics (tendency to depressive experiences, personal boundary preferences) on psychotherapist reaction to patients with borderline personality disorder was assessed by semantic differential ratings in an analogue study. Vignettes presented one of two patients enacting the Rewarding and Withdrawing object relations unit in two separate therapy sessions. Therapists higher on anaclitic depressive and fusion tendencies evaluated themselves less positively than other therapists (p less than .01) in the Withdrawing condition. They evaluated the patient less positively regardless of condition (p less than .05). High boundary therapists evaluated patients more positively (p less than .05) in the Withdrawing condition. They evaluated themselves more positively regardless of condition (p less than .05) and showed less tendency to devalue self and patient with the lower functioning borderline patient.
Asunto(s)
Actitud del Personal de Salud , Trastorno de Personalidad Limítrofe/terapia , Personalidad , Psicoterapia , Autoimagen , Adulto , Trastorno de Personalidad Limítrofe/diagnóstico , Trastorno Depresivo/diagnóstico , Femenino , Humanos , Relaciones Interpersonales , Masculino , Apego a Objetos , Inventario de Personalidad , Relaciones Profesional-Paciente , Diferencial Semántico , Encuestas y Cuestionarios , Conducta VerbalRESUMEN
Psychotherapists' reactions to patients with borderline personality disorder were assessed by semantic differential ratings in an analogue study. Vignettes presented one of two patients who enacted the Rewarding and Withdrawing object relations units in two separate therapy sessions. In response to the Rewarding object relations unit therapists evaluated themselves more positively and perceived themselves as more active and more potent than in response to the Withdrawing object relations unit (p less than .01). They also evaluated the patients more positively and perceived them as less active (p less than .01). These patterns were modified by some order effects and some differences in response to the two vignettes, which represented a lower and higher functioning borderline patient.
Asunto(s)
Actitud del Personal de Salud , Trastorno de Personalidad Limítrofe/terapia , Personalidad , Relaciones Profesional-Paciente , Psicoterapia , Autoimagen , Adulto , Femenino , Humanos , Masculino , Apego a Objetos , Inventario de Personalidad , Diferencial Semántico , Transferencia Psicológica , Conducta VerbalRESUMEN
Male and female college students (N = 106) in the developmental stage of transition to young adulthood (mean age = 19.9 yr.) were asked to imagine themselves at midlife in three life settings: work, personal relationships/family, and leisure. For each setting they described themselves on the instrumental and expressive scales of the Personal Attributes Questionnaire and on scales of agentic and communal competencies. Subjects anticipated more instrumental traits, more agentic competency, and less communal competency in work settings than in personal relationships, with no differences between men and women. Gender and setting interacted for expressiveness: women anticipated more expressive traits than men in personal relationships, with no difference in the other settings. The anticipated traits and competencies of these subjects were related more to setting than to gender. This may reflect a shift in the definition of sex-role boundaries in American culture.
Asunto(s)
Envejecimiento/psicología , Identidad de Género , Desarrollo de la Personalidad , Adolescente , Adulto , Femenino , Humanos , Imaginación , Masculino , Persona de Mediana Edad , Medio SocialRESUMEN
Coping strategies of bulimic women in intimate and nonintimate stressful situations were assessed using the Ways of Coping Questionnaire. Compared to a group of 30 women who exercised frequently, the 28 bulimic women felt a greater sense of threat and made greater use of escape-avoidant coping in both types of situations although the groups did not appraise the situations differently. Findings were discussed in terms of behavioral and interactional explanations of symptom maintenance in bulimia.
Asunto(s)
Adaptación Psicológica , Peso Corporal , Bulimia/psicología , Relaciones Interpersonales , Estrés Psicológico/complicaciones , Adulto , Imagen Corporal , Femenino , Humanos , Control Interno-Externo , Inventario de PersonalidadRESUMEN
Patients with keratoconus frequently are described as having peculiar personality characteristics, despite the lack of controlled studies in the ophthalmologic or psychiatric literature. We studied 109 subjects, using a standardized personality inventory (the Millon Clinical Multiaxial Inventory) that measures 20 personality scales-both normal and pathologic. Subjects were divided into three age-matched groups: (1) patients with keratoconus, (2) patients with other chronic eye diseases, and (3) normal controls. Results indicated that although chronic eye disease, including keratoconus, did have an impact on personality functioning in young and middle-aged adults, no specific complex of personality characteristics attributable to keratoconus could be identified. Patients with keratoconus differed from normal controls in much the same way as did patients with other chronic eye diseases, being less conforming and more passive-aggressive, paranoid, and hypomanic. They tended to more disorganized patterns of thinking and scored higher on substance abuse indicators. The influence of keratoconus on personality may be a function of the timing and nature of its onset in the context of the patient's psychosocial development.
Asunto(s)
Oftalmopatías/psicología , Queratocono/psicología , Personalidad , Adolescente , Adulto , Enfermedad Crónica/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Inventario de Personalidad , Relaciones Médico-PacienteRESUMEN
The effects of leader gender and degree of authority on work activity and group-as-a-whole defensive processes were examined in two Tavistock-model group relations conferences. The small groups in each conference had two leaders with different degrees of explicit authority, a consultant and associate consultant. In one conference, males were designated as consultants and females as associate consultants. In the second conference these role assignments were reversed. Segments of group interaction following leaders' interventions were scored for primary group activity (dependency, fight/flight, pairing or work) and individual member work. High authority leaders elicited more fight/flight than leaders with secondary authority, who in turn evoked more pairing. High authority female leaders tended to evoke more fight/flight activity than the males paired with them. Groups periodically responded with dependency regardless of leader gender or authority position. Group-as-a-whole work occurred infrequently. Individual work occurred, with no significant difference in frequency, in response to all leaders and in the midst of each group-as-a-whole defensive process.
Asunto(s)
Identidad de Género , Procesos de Grupo , Identificación Psicológica , Predominio Social , Trabajo , Autoritarismo , Mecanismos de Defensa , Dependencia Psicológica , Femenino , Humanos , MasculinoRESUMEN
The present study represents a replication and extension of a recent investigation of the patterns of stresses in psychotherapeutic work. A sample of 227 licensed psychologists who were practicing in Northern California were administered two Likert-type rating scales, which were expanded versions of questionnaires originally developed by Farber and Heifitz (1981). Factor analysis of the data revealed that the stressful aspects of therapeutic work include maintaining the therapeutic relationship, scheduling difficulties, professional doubt, work overinvolvement, and feeling personally depleted. In addition, stressful patient behaviors were found to cluster into five distinct categories: Expressions of negative affect, resistances, psychopathological symptoms, suicidal threats, and passive-aggressive behaviors. Demonstration of the empirical generalizability of the factor structure and of the relative importance of stressful therapeutic events argues for the usefulness of the extended versions of The Therapeutic Stresses and Stressful Patient Behaviors rating scales.
Asunto(s)
Enfermedades Profesionales/diagnóstico , Psicoterapia , Estrés Psicológico/diagnóstico , Adulto , Anciano , California , Análisis Factorial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Relaciones Profesional-Paciente , Psicología ClínicaRESUMEN
Centralization of a residential mental health treatment program from three small houses to one large facility provided a naturally occurring opportunity to study the effect of organizational size on the perceptions held by clients and staff. Quantitative data were repeatedly collected on their perceptions of themselves, the organization as a whole, and subgroups within the organization during their involvement in both the small and large social contexts. Results of repeated measures analyses of variance provided considerable support for the theoretically derived hypotheses of heightened anxiety, self-impoverishment, more negative views of the psychosocial environment, and greater psychological distance in the large organizational context.
Asunto(s)
Actitud , Centros Comunitarios de Salud Mental/organización & administración , Tamaño de las Instituciones de Salud , Esquizofrenia/terapia , Adulto , Enfermedad Crónica , Humanos , Relaciones Profesional-Paciente , Distancia Psicológica , Psicología del Esquizofrénico , Autoimagen , Medio Social , Estrés Psicológico/complicacionesRESUMEN
A variety of circumstances renders the ileum dysfunctional or necessitates ileal resection. Loss of this tissue is manifested by a group of disorders collectively termed the short-bowel syndrome. Traditionally, individuals who have sustained such functional loss learn to manage their altered bowel in relative isolation from the health care team. Inadequate management can lead to rehospitalization or to chronic systemic imbalances which predispose these individuals to additional disease processes. The purpose of this article is to review the physical consequences of functional loss of the ileum and the essential elements in the assessment and management of individuals who have sustained such losses. This should better prepare nurse practitioners to help these individuals learn how to minimize dysfunction and prevent additional disease.
Asunto(s)
Íleon/fisiopatología , Síndromes de Malabsorción/fisiopatología , Síndrome del Intestino Corto/fisiopatología , Bicarbonatos/metabolismo , Ácidos y Sales Biliares/metabolismo , Cloruros/metabolismo , Humanos , Íleon/fisiología , Absorción Intestinal , Enfermeras Practicantes , Síndrome del Intestino Corto/dietoterapia , Síndrome del Intestino Corto/metabolismo , Vitamina B 12/metabolismoRESUMEN
Thirty-one counselor trainees viewed videotapes of two actors portraying either an easy client (one who expressed intrinsic motivation for help, responded openly to questions and spontaneously elaborated on responses) or a difficult client. Trainees made 11 ratings of client functioning, likely response to treatment, and personal reactions to client. As expected, clients with a difficult interpersonal style were not regarded as more psychologically disturbed, but were rated as having less potential for change and less ego strength. They were rated as less likely to attend the next interview or to complete counseling and less likely to respond well to counseling. They also were less well-liked. Auxiliary analyses indicated that minority counselors (N = 9) appeared more optimistic about the results of counseling, though they anticipated equally much difficulty in working with the clients. A single interaction effect indicated that white counselor trainees saw less potential for change in the difficult vs. easy clients; minority Ss made no such distinction.
Asunto(s)
Actitud del Personal de Salud , Consejo/educación , Relaciones Profesional-Paciente , Adulto , Alcoholismo/terapia , Femenino , Humanos , Masculino , Competencia Profesional , PronósticoRESUMEN
Abused children are believed to develop in a harsh environment with minimal contingency of parental responses to their behavior. Seligman proposed that noncontingent caregiving produces helplessness. In this study, helplessness was assessed by measures of persistence and locus of control and by an experimental manipulation which varied contingency feedback. Compared to matched nonabused peers, abused children showed no less persistence in working for rewards, made equivalent use of contingency information to maintain persistence, and assumed equivalent responsibility for success. However, they took less responsibility for failure. Family learning history may render abused children helpless primarily in avoidance of aversive outcomes.
Asunto(s)
Maltrato a los Niños , Desamparo Adquirido/psicología , Control Interno-Externo , Socialización , Logro , Niño , Retroalimentación , Femenino , Humanos , Inteligencia , Masculino , Motivación , AutoimagenRESUMEN
Special educators and child-care personnel ranked the appropriateness of various psychological treatments for a boy described either as mentally retarded or of normal intelligence and whose behavior was described either as withdrawn or overactive. The predicted IQ level by behavior interaction was found only for drug treatment, which was ranked as relatively more appropriate for the retarded overactive child (p less than .05). Drug treatment and behavior modification were perceived as more appropriate for the overactive child (p less than .01, .05). Play therapy, family therapy, and no treatment were deemed more appropriate for the withdrawn child (p less than .05). Educators favored behavior modification and school consultation more than did child-care personnel (p less than .05).