No description available.

Shaken Baby Syndrome (SBS) is a potentially lethal form of child abuse. Primary prevention efforts have been targeted towards educating the general population, especially pregnant women and new parents, about the dangers of shaking. It is hypothesized that there are identifiable perinatal risk fadors for children that make them more at risk for injury from SBS than other forms of Abusive Head Trauma (AHT). All hospitalized children with suspected AHT (n=206) over a 14-year period who were referred to a multidisciplinary child protection center, were identified. The records of 24 children were not included in the study because they were not available for review, the child did not have a primary head injury, or the child was adopted and birth records were not available. Nonaccidental injury was confirmed in 116 of the remaining children. These included 72 (62%) children fitting SBS criteria, and 44 (38%) children identified as having other AHT. Case analysis included review of hospital and multidisciplinary child protection center records. The SBS and AHT groups were compared to separate perinatal risk fadors that might assist in identifying children at increased risk for SBS. Results of the analysis demonstrated that there was no significant difference between groups evident in the perinatal history. These preliminary findings support the follOWing conclusion that in contrast to many published reports, the perinatal information on the child did not provide significant pre-injury risk identifiers. It was concluded that changes in early educational programs and media campaigns are needed to reduce the sequalae of head trauma in infants and children. Programs must focus on AHT in general, rather than only SBS.

Coping strategies and causal attributions have been shown to be related to recovery and adjustment following illness. Certain coping strategies and causal attributions, such as avoidant coping and other blame have been found to be related to higher levels of distress while others, like behavioural self blame and attention coping have been shown to be related to lower distress. There have however, been few longitudinal studies of the process. The study described here examined coping strategies, causal attributions and levels of distress over a period of 1 year in 91 patients following a first myocardial infarction (MI). Coping strategies (measured by the COPE), causal attributions (measured by open ended questions and a check-list) and distress (measured by the HAD a measure of anxiety and depression with minimal somatic symptoms), were measured within 2 weeks of discharge and at 2, 6 and 12 months post MI. The main findings of the study showed that both coping strategies and causal attributions changed over time. Patients were most likely to use attention coping strategies early following the illness onset but more avoidant and religious coping later on. Patients made fewer attributions as time passed and the most commonly reported causal attributions were stress and smoking. Results further revealed that both coping strategies and causal attributions were either concurrently related to and/or predictive of levels of distress. Avoidant coping was related to higher distress at all assessment times. Furthermore, both characterological self blame and other blame were found to be concurrently related to higher distress, with characterological self blame also being predictive of subsequent higher distress. These findings have implications for care and rehabilitation of cardiac patients as they imply that certain causal attributions and coping strategies might be problematic as regards post MI distress. This points towards the importance of examining and if necessary, altering certain causal attributions and coping strategies in order for the patient to gain the best possible recovery.

Endometriosis or the "career woman's disease" is a puzzling disease affecting women in their reproductive years. Research on endometriosis has focussed on aspects such as the personality characteristics of sufferers and its correlation with infertility (Venter, 1980). As yet, the experiential world of endometriosis sufferers and the relationships which are influenced by their disease have received little attention (Weinstein, 1987). Furthermore, endometriosis is construed as a physical disorder which is medically diagnosed and medically treated. As such, the epistemology surrounding the term "endometriosis" is an adherent to a largely non-contextual, non-systemic and intrinsically mechanistic biomedical model (Bogdan, 1984; Schwartz, 1982). By using an ecosystemic epistemology, this dissertation will attempt to describe the unique experiential world of the afflicted woman in terms of her coping strategies in dealing with endometriosis and to formulate a description of the interactional patterns between herself and significant others directly influenced by her disease. / Psychology / M.A. (Clinical Psychology)

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The purposes of this study were: (a) to identify which of four competing theories best accounted for self help as a learned outcome of chronic illness experience, and (b) to generate a Self Help Model that could be used to explicate self help as a learned response to chronic illness. The concepts of severity of chronic illness, intimate dependency reinforcers, self induced dependency reinforcers, cue outcome independence reinforcers, enabling skill, self help and life quality were specified in a causal format that allowed a competitive test of four different theories. The theories tested were instrumental passivity theory, self induced dependency theory, an adaptation of learned helplessness theory and learned resourcefulness theory. The study utilized a causal modeling design to assess a five stage model. A judgment sample of 786 individuals having a diagnosis of arthritis or an arthritis related condition were mailed questionnaires. Two hundred seventy-eight subjects responded, a 36 percent return rate. Seven scales using a visual analogue response format indexed the theoretical concepts. Reliability and validity estimates were conducted to assess psychometric properties of the instruments. Model parameters were estimated using multiple regression statistical techniques. Residual analysis was conducted to estimate violations of the causal model and statistical assumptions. Factors from one theory, the learned resourcefulness theory, emerged as more credible than factors from any single other theory. However, the data did evidence factors from other theories that were significant. Self induced sick role reinforcers and cue outcome independence reinforcers were found to slightly reduce perception of enabling skill (B = -.31 and B = -.12, respectively; R² = .11). Intimate dependency reinforcers and cue outcome independence reinforcers were found to slightly reduce perception of self help (B = -.34 and B = -.24, respectively; R² = .19). These factors helped to identify environmental and intra-person contingencies that led to reduction in self help. The learned resourcefulness factor, enabling skill, demonstrated the mediating skills that worked to enhance self help (B = .44; R² = .29). The Self Help Model generated to explicate self help as a learned response to chronic illness explained 50 percent of the variance in perceived self help. Self help had a direct positive impact on life quality (B = .61; R² = .46). By knowing the factors influencing a patient’s self help response to chronic illness experience, the nurse is better able to plan more effective self help promoting interventions for individuals, or groups of patients. Nurses who promote a self help response in those having a chronic illness could improve their life quality.

Twenty-two subjects with chronic/recurrent Epstein-Barr Virus (EBV) infection were compared with 22 controls to assess cognitive dysfunction. Subjects were compared on 15 measures of cognitive functioning from the Boston Diagnostic Aphasia Examination, Perceptual Speed, Wechsler Adult Intelligence Scale-Revised, Finger Tapping Test, Stroop Test, Trail-Making Test, Wisconsin Card Sorting Test and Revised Wechsler Memory Scale. They also were compared on measures of depression including the Beck Depression Inventory, Minnesota Multiphasic Personality Inventory (MMPI) depression subscale and SCL-90-Revised depression subscale. Group differences were assessed using discriminant analysis. Only some measures were included in this analysis, i.e. percent retention on Visual Reproduction and Logical Memory subtests of the Revised Wechsler Memory Scale, differential between time scores and between error scores on conditions three and two of the Stroop Test and total number of errors and perseverative errors on the Wisconsin Card Sorting Test. The Beck Depression Inventory was included to statistically remove depression effects from cognitive performances. Remaining measures were administered for exploratory and/or comparative purposes only. Results from discriminant analysis revealed significant group differences on the Beck, but not on any cognitive measure either before or after removal of depression effects. However, direction of group differences on cognitive measures occurred as expected. Also, a post-hoc multivariate analysis of variance revealed significant group differences on MMPI scales 1, 2 and 3 with EBV subjects showing higher elevations. Significant group differences also occurred on MMPI scale 7. Two categories of explanation for results are offered. The first suggests that cognitive deficits were missed due to shortcomings in study design. Remaining hypotheses address the possibility that no cognitive deficits occur with chronic/recurrent EBV infection. Suggestion for why EBV patients complain of cognitive deficits include discussion of hysteroid tendencies and intensification of sensations by a focus on somatic processes. The usefulness of assuming a multifactorial basis for symptoms associated with chronic/recurrent EBV infection, and the importance of abandoning the either/or approach of earlier investigators to hypothesizing about etiology, are discussed.

No description available.

No description available.

Almost everyone experiences an incident, illness, or concern that requires clinical advice or assistance. Most persons obtain the desired care and renew their daily activities. Some people, however, appear to be (medical) problem-prone, wellness-resistant or reinforced by illness sequelae. Individuals who maintained illness behaviors are often called, for example, chronic pain, asthma, or psychiatric patients by caregivers who focus on diagnoses. Some patients may be viewed as primarily chronic, with specific diagnoses considered secondary. Chronicity is here defined as a measure of individual, situation, exposure, and provider interaction outcomes. Independent of disease processes, chronicity-producing interactions often predict inappropriate and atypical medical utilization patterns. The assessment of chronicity, its precursors, and dynamics may identity high risk person, situation, provider, and environment combinations and permit more effective and relevant prevention and treatment strategies. The study patient chronicity, the Pre-Assistance Questionnaire (PAQ) was developed with 320 items on medical, personal, and situational topics. PAQ responses from 60 medical and 40 psychiatric VA outpatients were correlated with three estimators of patient chronicity: PAQ totals (from an empirically-derived key), clinicians' subjective ratings of patients' chronicity, and indices of subjects' 2 year use of VA medical center resources. PAQ totals correlated significantly with 240 items, medical usage with 119, and clinicians' ratings with 100. For replication, a 40 item short form was given to 120 medical and 80 psychiatric outpatients. Thirty-four items correlated significantly with two of the three measures, 26 with all three. The short form demonstrated high reliability (alpha = .91; test-retest reliability = .90; split-half reliability = .89). PAQ totals, chronicity ratings, and use indices showed no significant differences across from administrations although the psychiatric patients scored significantly higher (more chronic) on all measures. The findings support a general chronicity construct and suggest many applications from the screening of potential employees to the development of specific treatment plans matched to particular PAQ patterns. The major message, however, is that public health, medical, psychological, and sociological constructs may be integrated into a comprehensive model of medical utilization patterns that provides views of illness, wellness, and health care delivery and assessment.