Research report MMed 10 December 2018 / Background: Burnout is a response to prolonged stress and consists of three elements: Emotional Exhaustion (EE); Depersonalisation (DP); and Personal Accomplishment (PA). Existence of burnout under doctors is often not acknowledged but has major consequences for personal and professional life. Only limited research done regarding prevalence of burnout amongst registrars in South Africa. Objectives: To describe the prevalence of burnout, and asses for relationships between burnout and socio-demographic factors. Methods: A cross-sectional descriptive, internet survey was conducted. Respondents were registrars within the departments of the School of Clinical Medicine at the University of the Witwatersrand. To measure burnout the Mashlach Burnout Inventory (MBI) was used. Relationships were assessed by independent samples t-test and ANOVA. Results: Of the 585 successfully delivered questionnaires, 201 registrars started the survey (response rate of 34%). 170 questionnaires were analysed. The mean age of the respondents was 33 years, the male to female ratio was 1:1.8. The average score for EE was 3,5 (SD1.2), for DP 2.7 (SD1.1) and for PA 4.1 (SD1.1). The overall level of burnout was 84%. None of the respondents scored low over all categories. No significant association between socio-demographics and MBI dimensions was found. Conclusion: The prevalence levels found in this study was higher than found in national and international literature. Extremely high levels of DP were found. This is worrisome as DP affects professionalism and engagement of doctors. In keeping with international literature no associations were found with socio-demographic factors and burnout, suggesting the cause of burnout should truly be sought out in the work environment. Efforts to improve autonomy in the workspace, development opportunities and promoting peer collaboration, are needed to prevent of burnout. / E.K. 2019

by Chen Wei-Qing. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (p. 143-158). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

Thesis (Ph.D.). / Written for the Dept. of Epidemiology, Biostatistics and Occupational Health. Title from title page of PDF (viewed 2009/06/10). Includes bibliographical references.

Thesis (Ph. D.)--University of Missouri--Columbia, 1999. / Typescript. Vita. Includes bibliographical references (leaves 104-110). Also available on the Internet.

The purpose of this study was to identify variables that facilitate lay caregivers in maintaining dependent elders in the home setting. Specifically, this study: (1) tested a deduced theory designed to explain home maintenance of a dependent elder; (2) examined the relationship between the following variables: Seriousness of an Elder's Illness, Caregiver Overload, Quality of Care, Learning State, Caregivers Maintenance Ability, Acceptance of the Maintenance Role and the Caregiver's Perception of Power; and (3) evaluated the reliability and validity of the instruments that measured the proposed variables. A descriptive correlational design with causal modeling methodology was used to assess a five stage theory. The convenience sample was comprised of 70 English speaking caregivers providing a minimum of five hours of direct care to a dependent elder in the home setting. Reliability and validity of the instruments used to evaluate the theoretical concepts were assessed by Cronbach's alpha, factor analysis and predictive model testing. Multiple regression statistics were used to evaluate the theory and residual analysis was used to assess violations of statistical and causal modeling assumptions. The findings supported two of the predicted relationships: Seriousness of Illness had a direct and positive relationship with Caregiver Overload (B =.60, R² =.35) and Learning State had a direct and positive influence on Acceptance of the Maintenance Role (B =.36, R² =.18). As the disabilities of the dependent elder became more acute, the caregivers' feelings of being overloaded with the burden of the caregiving responsibilities increased. However, when the caregivers had a positive perception of their abilities to implement prescribed health care instruction as well as felt positively about their caregiving role (Learning State), they spent a greater amount of time giving direct care to the dependent elder (Acceptance of Maintenance Role). Identification of learning needs as they relate to the caregivers' ability to understand and implement health care instruction as well as feel positively about their role, can assist nurses in developing appropriate teaching interventions. The expected outcome of these interventions is direct care provided by the caregiver to the dependent elder.

The issue of occupational stress in nurses is significant because it has been associated with absenteeism, burnout and turnover among nurses. This study was an attempt to illuminate the occupational stress experience of workers in general with a focus upon nurses as subjects. Consequently, this research evaluated multiple contributory components to this stress process. Further, consideration of the fit between this stress-coping-depression model and General Systems Theory was another major focus of this study. The independent variables of daily hassles, occupational stress, primary stress appraisal, coping strategies, social support, repression and extraversion were measured in an attempt to determine their combined and singular influence upon the dependent variable of professional depression. These variables were measured by means of a paper-and-pencil self-report inventory of questionnaires mailed to a random sample of six hundred registered nurses in the state of Arizona. Analyses of returned questionnaires consisted of regression analyses of a causal model of the above noted variables. The findings indicate that emotion-focused coping strategies, especially escape avoidance and distancing strategies, demonstrated the most consistently significant effect upon depression for the total sample as well as for all of the demographic subgroups. The next most significant variable measured in this study was that of social support. This variable demonstrated an inverse relationship to depression and thereby appears to provide protection from depression when an individual is exposed to external stressors. External stressors, especially the daily hassles subscales of work, and time pressures, were also significantly related to increased depression in most of the analyses. Occupational stress, on the other hand, as measured revealed a statistically significant relationship to depression for only two subsamples of the study population, charge nurse/clinical specialists and nurses who had worked in nursing longer than 20 years. In regard to stress appraisal, the aspects of threat and stressfulness both revealed significant relationships. The appraisal of threat was significantly related to depression while stressfulness revealed influences upon both external stressors of daily hassles and occupational stress as well as upon depression.

MRI scan-related emotional distress leads to motion artefact and scan incompletion. A number of intervention studies therefore targeted to reduce anxiety. However, there is little research specifically on the development and evaluation of theory- and evidence-based psychological preparation for MRI. This research was aimed at developing and evaluating a theory- and evidence-based psychological preparation for patients undergoing MRI scanning through three empirical studies which involved 193 outpatients. Study 1: a predictive study investigated the effects of illness perceptions, MRI self-efficacy and emotional distress on scan behavioural and emotional outcomes, Study 2: a randomised controlled trial investigated the effects of a psychological preparation integrating self-efficacy enhancement and information provision techniques on scan behaviour, MRI self-efficacy and scan emotional outcomes. Study 3 aimed to: generate the items of MRI-SEQ, pre-test the measure, investigate the reliability and validity and reassess them in a replication study. Participants completed prescan and post-scan questionnaires. Scan behaviour was recorded by the radiographer. Analyses were conducted using correlation, multiple regression, logistic regression and Guttman Scaling. MRI self-efficacy significantly predicted scan behaviour and contributed to scan emotional outcomes. The developed psychological preparation had a significant effect increasing the likelihood of successful scan completion. It also significantly predicted MRI self-efficacy, and scan emotional outcomes. The intervention was also found to be acceptable and feasible for delivery to MRI outpatients. MRI-SEQ was found to have excellent internal consistency, good content validity, good predictive and criterion validity and was strongly associated with conceptually related measures. Self-efficacy is a major predictor for MRI scan outcomes. The psychological preparation intervention integrating self-efficacy enhancement and information provision was successful in improving MRI scan completion and may have potential for implementation in routine services. The MRI-SEQ possesses good psychometric quality is predictive of MRI outcomes and has potential as a screening tool in the MRI centre.

A Research Report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements of the PhD degree. Johannesburg 2014 / The current study investigates the relationship between stressful life events, personality profile, dissociative experiences, attachment styles and the types of crimes committed among 100 mentally ill offenders and 100 criminal offenders in the South African context. It is motivated by the fact that there are no studies in South Africa comparing forensic patients and criminal offenders and the various factors that may lead to criminal behaviour, and how these may present in terms of the type and/or nature of offences committed. Instead, there is a growing emphasis on observation of patients and assessments for fitness and competence to stand trial with very little focus on understanding the mentally ill offenders and criminal offenders. This study aims to improve the understanding and knowledge with regards to the presentation of each of these groups under study and also to investigate possible differences in the types of crimes committed. It aims to assess possible correlations between the variables of the study (stressful life events, personality profiles, dissociative experiences, attachment styles and the types of crimes). It further aims to inform future treatment interventions in the forensic setting and to offer possible prevention models for the community setting. The study hypothesises that there are no differences between the mentally ill offenders and criminal offenders with regards to stressful life events, personality profile, dissociative experiences, attachment styles and the types of crimes committed. Ethical clearance was obtained from the Committee for Research on Human Subjects of the University of Witwatersrand‟s medical school. The sample size of this study consists of 200 participants (156 males and 54 females). Convenience sampling was used, where 100 mentally ill offenders admitted at the Sterkfontein Psychiatric Hospital and 100 criminal offenders, incarcerated at the Johannesburg Correctional Services in the Johannesburg area at the time of data collection, were involved in the study. The mentally ill offenders from Sterkfontein Psychiatric Hospital were interviewed at the hospital and the criminal offenders from Correctional Services were interviewed in their respective prisons without the presence of a prison guard. Participants‟ ages ranged from 18 years to 60 years. Those people who were not willing to participate were not included in the study. The Biographical details questionnaire, Social Readjustment Rating Scale (SRRS), Stressful Life Events Screening Questionnaire (SLESQ), Multiphasic Minnesota Personality Inventory – II (MMPI-II), Dissociative Experience Scale (DES) and Attachment Styles Questionnaire (ASQ) were administered to the participants of the study as a means of gathering information regarding the variables under study. The types of crimes and diagnoses were obtained from the records. The study attempted to ascertain whether there were any associations, and whether predictions could be made for possible future assessments and treatment strategies. It is a quasi-experimental design with “diagnosis” as the between-participants factor. Independent variables of the study were the type of offender, i.e. mentally ill/clinical/forensic patient offender and criminal offenders, as well as the types of crimes, i.e. violent or non-violent crime. The dependent variables were stressful life events. These variables were measured in terms of low risk to illness, moderate risk and high risk to illness; personality profile; dissociative experiences, measured as either low levels or high levels of dissociation and attachment styles (secure, fearful avoidant, ambivalent and preoccupied attachment styles). The confounding variables were substance abuse, medication and comorbid diagnoses. Descriptive statistics and the discriminant function analysis were performed. Box M was also performed to test the null hypothesis that the covariance matrices did not differ between groups formed by the dependent variables. The Chi Square test for independence was also used to determine whether associations existed between two nominally categorical variables. The results of the study indicated that there were only four female participants in the clinical offender group. A high number of research participants were single in both the criminal (72%) and clinical (80%) offender groups. Furthermore, the majority of the participants in the study were Black, where 93% in the criminal offender group and 75% in the clinical offender group. 65% of the participants in the criminal offender group and 85% in the clinical offender group had no tertiary education. There was evidence that clinical offenders tended to commit more violent crimes (83%), while criminal offenders committed more non-violent (61%) and “other” crimes (21%). 91% of criminal offenders reported homelessness compared to clinical offenders (22%). The Dissociative Experience Scale was statistically significant, suggesting that dissociative experiences were a strong determinant of whether one is deemed a criminal or clinical offender. High levels of stress were correlated with higher incidents of criminal behaviour. In contrast to the literature review, past childhood trauma was not statistically significant in the current study. Clinical offenders reported more psychological problems. When ANOVA‟s were performed, psychological difficulties such as depression, anger, antisocial practices, low self-esteem, psychasthenia and family problems were statistically significant, suggesting that these variables were strong determinants for the likelihood of criminal offending. Dismissive and Fearful attachment styles were statistically significant. In conclusion, dissociative experiences, social re-adjustment, psychological pathology and both dismissive and fearful attachment styles were strong determinants of offending behaviour.

Carmen Wing Han Chan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1997. / Includes bibliographical references (leaves 98-107). / Questionnaire also in Chinese. / Chapter One： --- Introduction --- p.8 / Chinese Perspectives --- p.9 / Chapter Two: --- Literature Review --- p.12 / The Impact of Cancer on the Family --- p.12 / The Effect of Caregiver Stress on the Family --- p.15 / Caregiver Tasks --- p.22 / Chapter - --- Physical and Comforting Care --- p.24 / Chapter - --- Being available --- p.26 / Chapter - --- Uncertainty --- p.28 / Chapter - --- Finances --- p.31 / Chapter - --- Existential Concerns and Meaning of Cancer --- p.32 / Chapter - --- Supportive Services and Family Resources --- p.34 / Chapter - --- Altered Role and Lifestyle --- p.37 / Stress Symptoms --- p.39 / Chapter - --- Physical Symptoms --- p.40 / Chapter - --- Psychological Symptoms --- p.42 / Summary --- p.44 / Chapter Three： --- Methodology --- p.46 / Aim of the Study --- p.46 / Research Objectives --- p.46 / Design --- p.47 / Sample --- p.48 / Instruments --- p.49 / Chapter - --- Patient's Demographic Information --- p.50 / Chapter - --- Caregiver's Demographic Information --- p.50 / Chapter - --- Caregiver Tasks --- p.50 / Chapter - --- Stress Symptoms --- p.52 / Translation of Instruments --- p.53 / Data Collection Procedure --- p.54 / Ethical Consideration --- p.55 / Data Analysis --- p.56 / Chapter Four: --- Results --- p.58 / Caregivers' Characteristics --- p.58 / Patients' Characteristics --- p.59 / Caregiver Tasks --- p.60 / Stress Symptoms --- p.62 / Correlation among Stress Symptoms and Caregiver Tasks --- p.64 / Chapter - --- The Stress Symptoms Scale and its Sub-Scales --- p.64 / Chapter - --- The Caregiver Tasks Scale and its Sub-Scale --- p.64 / Chapter - --- Stress Symptoms and Caregiver Tasks --- p.65 / "Caregivers' Age, Education Level, Patients' Age, and Study Variables" --- p.66 / Chapter - --- "Caregivers' Age, Education Level and Caregiver Tasks" --- p.66 / Chapter - --- "Caregivers' Age, Education Level, and Stress Symptoms" --- p.66 / Chapter - --- "Patients' Age, Caregiver Tasks, and Stress Symptoms" --- p.67 / Other Caregivers' Demographic Variables and Study Variables --- p.67 / Other Patients' Demographic Variables and Study Variables --- p.68 / Chapter Five： --- Discussion --- p.70 / Introduction --- p.70 / Caregiver Tasks --- p.70 / Stress Symptoms --- p.76 / Relationship between Caregiver Tasks and Stress Symptoms --- p.79 / Caregivers' Demographic Characteristics and Study Variables --- p.81 / Patients' Demographic Characteristics and Study Variables --- p.86 / Limitations --- p.88 / Chapter - --- Cross-sectional Design --- p.88 / Chapter - --- Sample --- p.90 / Chapter - --- Instruments --- p.91 / Chapter - --- Translation --- p.91 / Recommendations for Future Research --- p.92 / Conclusion --- p.96 / REFERENCES --- p.98 / Appendix / Chapter I. --- Informed Consent Form --- p.108 / Chapter II. --- Characteristics of Patient --- p.109 / Chapter III. --- Narrative for Consent --- p.110 / Chapter IV. --- Caregiver's Profile --- p.111 / Chapter V. --- Caregiver Tasks --- p.112 / Chapter VI. --- Stress Symptoms --- p.115 / Chapter VII. --- Translated copies of Instrument --- p.117

Although a vast literature attests to the belief that psychosocial disturbance is an important component of functional gastrointestinal disorders (FGID), the relation of life stress, psychological distress and personality to the development of these disorders is poorly understood. The broad objective of this thesis is to provide data on relations between psychosocial factors and FGID, especially irritable bowel syndrome (IBS) and functional dyspepsia (FD), in representative outpatient samples. Issues not previously addressed are examined in a series of studies. The first two studies are concerned with relations between psychosocial factors, extraintestinal (somatic) symptoms and the number and type of FGID syndromes present at consultation and, in IBS patients, the prospective relation of psychosocial factors to changes in symptom intensity over 16 months. The last three studies relate psychosocial factors to gastrointestinal (GI) transit, motor, and sensory function in FGID, abnormalities in these parameters representing the putative origin of symptoms in FGID. In total, 350 patients participated, representing a 95% participation rate. Important features of the methodology include the use of a recently standardised symptom-based classification system for FGID, an objective and reliable interview-based life stress instrument (The Life Events and Difficulties Schedule), and sophisticated and sensitive technologies to assess GI transit, motor and sensory function. Novel measures, which conceptually take into account the chronic, fluctuating and recurrent course of IBS and FD syndromes, and the tendency of these syndromes to coexist, are also included. Thus, measures of symptom outcome assess the number of syndromes present, while the symptom intensity variable reflects the severity and frequency of both FD and IBS symptoms, if both are present. Similarly, with respect to altered transit, and motor and sensory function, physiological outcome variables reflect not only the presence of an abnormality but the number of regions affected, and the type and number of abnormalities present. Cross-sectional findings showed for the first time that psychosocial disturbance is associated with FGID symptomatology in a quantitative manner, that chronic life stress threat is central to this process and this stress-related process is a prominent feature of a particular group of syndromes (ie IBS/FD) defined primarily by the presence of pain and discomfort. A combination of psychological, social and biological factors combined to predict the number of FGID syndromes present at entry into the study. Prominent among them was an angry, reactive and anxious (neurotic) personality, chronic life stress threat, increased coping, poor emotional support and increased age. In addition to a greater number of FD/IBS syndromes, individuals with an anger-reactive response style had experienced more intense pain and discomfort, and displayed more complete sensorimotor disturbance. Longitudinal data demonstrated (also for the first time) the strength, consistency and unequivocal direction of the relation of chronic threat to symptom intensity over time. Almost all of the within subject variance in symptom intensity levels (assessed on 3 occasions over a 16 month period) was explained by the severity of chronic threat during the previous 6 months or more. For 76% of IBS patients, the presence vs the absence of one or more highly threatening chronic stressors predicted with considerable precision, the long-term clinical outcome. Thus, no patient exposed to even one such stressor improved clinically (ie by at least 50%) over the follow-up period, while in contrast, all patients who improved clinically did so in the absence of such a stressor. For 24% of patients, however, failure to improve clinically could not be explained by any psychological, social (including life stress) or demographic factor included in this study. Key risk indicators of a poor outcome at 16 months were identified - chronic life stress threat, the severity of baseline GI symptomatology, and female gender. Life stress is important because it alone determined the magnitude and direction of change in symptom intensity over time, while the severity of baseline GI symptomatology revealed the extent of improvement required to achieve a recovery, and female gender predicted the presence of a larger number of FD/IBS syndromes in women long-term. Widespread hypomotility, which was almost exclusive to women in this study, represents one factor that may inhibit improvement (or rate of improvement) for women over time. Finally, these findings have identified a psychophysiological subgroup, with underlying psychosocial, motor (and perhaps also sensory) dysfunctions that are more specific for women than men, and which does not seem to be distinctive of any particular FGID subgroup.