The Russian Federation's recently adopted family medicine as a specialty, but with little or no training in psychosocial and behavioral issues, unlike many training programs in other countries. The purpose of this qualitative study was to explore the perceptions and experiences of Russian primary care physicians regarding the practice of behavioral medicine and psychosocial methods. Semi-structured in-depth interviews were conducted with ten Russian family physicians. Examination of key words, phrases, and concepts used by the physicians revealed five themes that physicians related to their incorporation of psychosocial/behavioral medicine methods: (1) factors limiting the practice of behavioral medicine (inadequate training; cultural barriers); (2) demand for behavioral medicine services; (3) patient-doctor issues related to behavioral medicine (e.g., communication); (4) physician's role strain; and (5) intuition and experience. These findings suggest that Russia's new family physicians would benefit from residency and post-graduate curricula in behavioral sciences, tailored to their unique needs.

This study served as an initial evaluation of integrated psychology services within a clinic designed to serve uninsured patients with complex medical concerns and high utilization histories at the Medical College of Virginia in Richmond, Virginia. The current study evaluates patient outcomes, and more specifically, it further quantifies and describes the role that psychologists play in the primary care setting and their impact on utilization of medical care and in improved health outcomes. Additionally, the study evaluates psychologists’ success at treating mental and behavioral health conditions within the primary care model. The present study demonstrates that patients with complex medical and mental health needs can be effectively managed and treated in an integrated ambulatory care clinic. Care within this clinic resulted in significant improvements in depression, anxiety, HbA1c, cholesterol, and blood pressure. The findings suggested possible improvements in behavioral health outcomes such as insomnia as well, but more structured follow-up data are needed in future research to explore this relationship. Additionally it is possible that reductions in BMI may be significant if followed over a longer period of time. Utilization outcomes were more mixed, and contrary to the expectation that integrated services and improvements in health would be related to decreased utilization. Given the shift in health outcomes over the follow-up period, it is possible that early increases in utilization at the six-month mark, may shift to reductions in utilization and cost if the window of observation is expanded.

This study examined measures of disease specific quality of life (DSQOL), coping, and benefit finding for differences between ethnic groups in a diverse sample of men treated for localized prostate cancer. The relationship between DSQOL and benefit finding was also evaluated, along with the relationship between coping and benefit finding. Ethnicity was evaluated as a possible moderator of the relationship between DSQOL and benefit finding, and coping was examined as a possible mediator. Results demonstrated that while minority men did show decrements in urinary function, sexual function scores were similar between groups. Furthermore, minority men reported higher levels of benefit finding as well as more frequent use of active and passive coping strategies. DSQOL was not associated with benefit finding, and the relationship was not moderated by ethnicity or mediated by coping. However, benefit finding was associated with ethnic minority status, religious group identification and less yearly income. Both active and passive coping composites were also related to benefit finding. These findings contribute to current literature on factors related to benefit finding in prostate cancer survivors. Limitations of the current study, as well as future directions are explored in the discussion.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2005. / Härtill 4 uppsatser.

Beteendemedicin är ett paraplybegrepp där den fysioterapeutiska tillämpningen i praktik kan se ut på många olika sätt. Hur fysioterapeuter tillämpar beteendemedicin i praktiken och hur det avspeglas i den individanpassade behandlingsplanen råder det oklarheter kring. Syftet med denna studie var att undersöka fem fysioterapeuters upplevelser och erfarenheter av tillämpning av beteendemedicin inom sina respektive verksamheter i Uppsala län. Studien var av kvalitativ design. Enskilda semistrukturerade intervjuer avfem fysioterapeuter inom olika verksamheter utfördes. Databearbetning genomfördes i form av en kvalitativ innehållsanalys. Deltagarna tillämpade flertalet olika tekniker inom beteendemedicin. De upplevde även att det finns utmaningar som att det är tidskrävande, att patienten inte förstår konceptet och att teorin är lättare än tillämpningen i praktik. Alla deltagare var överens om att det finns en nytta med beteendemedicinsk tillämpning, som att bli en bättre fysioterapeut, att det ger vinst i långa loppet samt att teorin fyller en viktig funktion för praktisk tillämpning. Det föreföll sig som att fysioterapeuterna tillämpar beteendemedicin på ett annat sätt än vad de lärt sig från den teoretiska utbildningen. Fyra huvudkategorier identifierades under databearbetningen; Olika tekniker inom beteendemedicin, Utmaningar med att arbeta beteendemedicinskt, Förståelse av nyttan med beteendemedicin, Blivit en “tyst” kunskap. Deltagarna upplevde att beteendemedicin fyller en viktig funktion i den individualiserade behandlingsplanen för patienten, men upplevde även många utmaningar. Trots utmaningarna så var deltagarna överens om att beteendemedicin är ett vinnande behandlingskoncept inom fysioterapi. Detta examensarbete kan bidra till utvecklingsmöjligheter för grundutbildningen i fysioterapi. / Behavioral medicine is an umbrella concept where the physiotherapeutic application in practice can differ in many ways. There are uncertainties about how physiotherapists apply it in practice and how this is reflected in the individualized treatment plan. The aim of this study was to investigate five physiotherapists' experiences of applying behavioral medicine in clinical practice within each of their workplaces in Uppsala. This study is of a qualitative design. Individual semi-structured interviews offive physiotherapists were performed. Data processing was carried out in the form of a qualitative content analysis. The participants applied several different behavioral medicine techniques. They also experienced challenges; it is time consuming, the patient does not understand the concept and the theory is easier than the application in practice. All participants agreed that there are benefits to behavioral medicine application; becoming a better physiotherapist, it provides benefits in the long run and the theory fulfills an important function for practical application. It seemed that the physiotherapists apply behavioral medicine in a different way than what they have learned. Four main categories were identified; Different techniques in behavioral medicine, Challenges when working with behavioral medicine, Understanding the benefits of behavioral medicine, Has become a “silent” knowledge. The participants experienced that behavioral medicine fulfills an important function in individualized treatment plans for patients, but they also experienced many challenges. Despite the challenges, the participants agreed that behavioral medicine is a winning concept in physiotherapy. This degree project can contribute to development opportunities for the undergraduate education in physiotherapy.

Abstract available in the Annals of Behavioral Medicine.

Individuals who suffer from severe dementia require assistance when performing activities of daily living. The highly important person transfer situation is influenced by complex, intertwined biopsychosocial factors that are related to the expression of personal, environmental and behavioral variables, which can interfere with the performance of dementia-care dyads' transfer situations. The overall aim of this study was to leverage a behavioral medicine perspective in physiotherapy to explore, intervene in, and develop an assessment scale for problematic person transfer situations including persons with dementia and the interaction with the caregiver in these transfer situations. Interviews were performed with ten caregivers who were recruited to two focus groups and worked in a special care unit for persons with dementia; interviewees described their experiences pursuant to assisting persons with dementia in transfer situations (I). Literature review and video recordings elicited 93 possible items for the new scale. Expert opinions and item-content validity index reduced the number of items to 17 that spanned two areas. Eight items related to the actions of persons with dementias, whereas nine related to caregiver actions. The feasibility testing of the scale in eight person transfer situations showed that the scale was ready for inter- and intra-rated reliability testing (II). Inter- and intra- rater reliability was good (III). In two single-case experimental design studies, the new scale was shown to contribute to a substantial gathering of data on behaviors in care dyads' person transfer situations (IV). In summary, the results of the thesis show that person transfer situations in dementia special care units are influenced by different biopsychosocial factors and that the new assessment scale can support decision-making about treatment strategies. These findings are important in promoting evidence-based behavior change strategies that can facilitate both sets of individuals—i.e., both persons with dementia and caregivers—in transfer situations. The results highlight important research issues that merit attention in future studies.

Decreased sound tolerance (DST) conditions, including misophonia and hyperacusis, are emerging clinical conditions in behavioral medicine. Misophonia involves an extreme emotional response (often anger, disgust, or annoyance) to specific sounds (such as people chewing, swallowing, tapping their foot on the floor, etc.), while hyperacusis is defined by high sensitivity to sounds below normal sound sensitivity thresholds. Although research on these DST conditions is increasing, clearly defined prevalence rates, associations with other mental health conditions, and development of assessment tools that can identify and differentiate DST symptoms are needed. Research and clinical reports also suggest that DST problems are more likely to occur in individuals affected by tinnitus, and that drawing upon a bio-psychosocial conceptualization of tinnitus and other behavioral medicine conditions may be useful in understanding and treating DST conditions. This cross-sectional survey study was administered to college student (N=451) and community adult (N=375) samples and investigated DST prevalence rates, clinical correlates, and risk factors and mechanisms of action for misophonia and hyperacusis. In addition, the study developed and validated a new scale to identify misophonia and hyperacusis type sound sensitivity. Nearly 35% of individuals surveyed reported some degree of general auditory sensitivity, with 15-63% endorsing misophonia symptoms, and 17-26% endorsing hyperacusis symptoms, with rates depending on assessment method. Moderate to strong correlations were found between DST conditions and other mental and physical health conditions, including obsessive compulsive disorder, autism-spectrum traits, anxiety, depression, social phobia, medical conditions, and somatic and neurobehavioral symptoms. Mediation models revealed that the process by which misophonia symptoms become clinically significant and functionally impairing is partially mediated by amplification of bodily sensations and anxiety sensitivity. Risk factors for functional impairment related to misophonia symptoms were identified in moderation analyses and included neuroticism, synesthesia, and sensory sensitivity. An assessment instrument, the DST-10, and its subscales the Loudness Sensitivity Scale and Human Sounds Scale, was subjected to exploratory and confirmatory factor analysis and initial evidence for construct validity was demonstrated. This study was the first to assess hyperacusis, misophonia, and tinnitus rates in large general population samples and provides initial support for conceptualizing DST problems as behavioral medicine conditions.

Bakgrund: Skada på det mediala kollateralligamentet (MCL) är en av de vanligast förekommande knäskadorna och drabbar främst yngre idrottande personer. En av fysioterapeutens roller i rehabiliteringen är att se till människans helhet där biomedicinska, psykiska och sociala aspekter ingår, detta för att patienten ska få ett bra omhändertagande. Syfte: Att undersöka hur fysioterapeuter beskriver sitt arbete med rehabilitering av patienter med MCL-skador. Metod: En kvalitativ intervjustudie med deskriptiv design utfördes. Data insamlad från sex intervjuer av fysioterapeuter bearbetades med hjälp av en induktiv ansats i en kvalitativ innehållsanalys. Ett ändamålsenligt bekvämlighetsurval användes vid valet av intervjupersoner. Resultat/slutsats: Studiens resultat mynnade ut i fyra kategorier med två underkategorier inom varje. Kategoriernas namn var ”Identifierar behov av och arbetar med att ge patienterna stöd”, ”Anpassar rehabilitering efter patientens träningsmöjligheter och olika aktiviteter”, ”Arbetar med att minska rädsla, oro och öka tillit till knät hos patienterna” och ”Arbetar med patienternas motivation”. Det visade sig i studiens resultat att hänsyn togs av intervjupersonerna till såväl biomedicinska som psykosociala faktorer i sitt arbete med denna patientgrupp. / Background: Injury to the Medial Collateral Ligament (MCL) are one of the most common knee injuries and mainly affect younger athletes. One of the physiotherapists' roles in rehabilitation is to look at the whole of the human being, which includes biomedical, psychological and social aspects, in order to ensure a good medical care. Purpose: To investigate how physiotherapists describe their work with rehabilitation of patients with MCL injuries. Method: The design of the study was a qualitative interview study, with an inductive approach. Data collected from six interviews of physiotherapists was analysed using a qualitative content analysis. An appropriate convenience sample was used in the selection of interviewees. Result / conclusion: The study's results consisted of four categories with two subcategories within each. The names of the categories were "Identifying need of and work with supporting biopsychosocial factors", "Adapting rehabilitation to the patient's possibilities regarding training and various activities", "Working with reducing fear, worry and increasing the patient’s confidence regarding their knees" and "Working with the patients' motivation". It was shown in the results that consideration was taken by the interviewees regarding the patient’s biomedical and psychosocial factors.

INTRODUÇÃO: A dermatite atópica (DA) é uma doença inflamatória crônica, comum, da pele que afeta a vida das crianças. No tratamento desta doença tem-se, cada vez mais, demonstrado a importância e a necessidade de desenvolver ações educacionais/ terapêuticos, multidisciplinares focadas em informações sobre o manejo da doença para os pacientes desenvolverem um melhor curso da doença e, consequentemente, melhor prognóstico. OBJETIVOS: Este estudo tem como objetivo apresentar os resultados de um jogo educativo/terapêutico, especialmente desenvolvido, para crianças dos 7 aos 12 anos de idade, com intenção de possibilitar o acesso a informações e aumentar a adesão ao tratamento de pacientes jovens com dermatite atópica de uma forma lúdica e eficiente. MÉTODOS: O jogo foi estruturado em cinco grandes grupos para emular as situações vividas pelas crianças: família, escola, consultório médico, amigos e sentimentos. O planejamento foi realizado a partir de um script anterior, que foi contextualizado em situações de jogo, através dele procurou-se adaptar o conteúdo e argumentos, narrativa, procurando associar o jogo, as intenções pedagógicas, características cognitivas das crianças dessa faixa etária, bem como a desejada abordagem psicológica para lidar com a doença. O jogo estava disponível através do formato swf2 permitindo usar em casa ou no escritório do médico. Para testar o jogo foi feito um estudo experimental "antes-depois", incluindo crianças de 7-12 anos de idade, com dermatite atópica. Trinta e três crianças brincavam individualmente. O desfecho analisado foi o grau de conhecimento e habilidades de gerenciamento de sintomas da dermatite atópica após o uso do jogo por 30 dias, avaliado por um questionário de conhecimentos sobre a doença. Todas as crianças e seus pais expressaram suas opiniões sobre o jogo através de um outro questionário de opinião. A coleta de dados foi realizada no período entre 2009 e 2010, e a análise foi realizada utilizando SPSS 17,0 entre 2010 e 2011. RESULTADOS: As trinta e três crianças utilizaram o jogo uma vez e responderam ao questionário antes de jogar, e, deste total, 15 responderam ao questionário pela segunda vez. Verificou-se que as crianças que usaram o jogo aumentaram seu conhecimento sobre a doença em 5 pontos (questionário sobre DA), IC 95%: 3,5-6,1. CONCLUSÃO: A ampliação do uso do território virtual, tais como os jogos e internet, podem desenvolver novas oportunidades para tratamento médico e psicológico permitindo a projeção de sentimentos, desejos, frustrações e outras manifestações de usuários, sejam eles crianças ou adultos jovens, e permitir a aquisição de informações sobre o manejo da doença de uma forma lúdica e agradável para pacientesjovens. / INTRODUCTION: Atopic dermatitis (AD) is a common chronic inflammatory skin disease that affects children’s life. The treatment of AD has increasingly shown the importance and need to develop educational/therapeutic, multidisciplinary actions focused on information about the management of the disease for the patients to have a better disease course and prognosis. OBJECTIVES: This study aims to present the results of an educational/therapeutic game for children from 7 to 12 years old, developed to disseminate information and increase adherence to treatment of young patients with atopic dermatitis in a playful and efficient way. METHODS: The game was structured into five major groups to emulate the situations experienced by children: family, school, doctor’s office, friends and feelings. The planning was carried out from a previous script which was contextualized in game situations, through a script that sought to adapt the content and narrative arguments, seeking to associate game play, pedagogical intentions, cognitive characteristics of children in this age group as well as the desired psychological approach for coping with the disease, in that situation. The game was available through the swf2 format enabling to use either at home or at the doctor’s office. To test the game was made an experimental “before-after” study, including 7-12 years- old children with atopic dermatitis. Thirty three children played individually. The analyzed outcome was the degree of knowledge and management abilities of atopic dermatitis symptoms after using the game for thirty days, verified by a questionnaire of knowledge about the disease. All children and their parents expressed their opinions about the game through an opinion questionnaire. Data collection was performed in the period between 2009 and 2010, and the analysis was performed using SPSS 17.0 between 2010 and 2011. RESULTS: A total of 33 children used the game once and answered the questionnaire before playing, and, from this total, 15 answered the questionnaire for a second time. It was found that children who used the game increased their knowledge about the disease in 5 points (questionnaire on AD), 95% CI: 3.5 to 6.1. CONCLUSION: The expanded use of virtual territories, such as the games and the internet, to develop new opportunities for medical and psychological treatment enable the projection of feelings, desires, frustrations and other manifestations of users, whether they are children or young adults, and enable the acquisition of information on the disease management in a playful and enjoyable way for young patients.