Feelings Of Hopelessness Research Articles

A Comparative study of Level of Depression among Adolescents

Depression is an emotional state marked by emotional symptoms (e.g. depressed mood), Motivational symptoms (e.g. loss of interest or pleasure), cognitive problems (e.g. negative thoughts, feeling of hopelessness) and somatic (loss of energy, sleep disturbances). Methodology: The present study was conducted on adolescents, the description of the sampling procedure is given below, and as far as design of present investigation is concerned it is comparative in nature. Purposive random sampling technique was used. The sample of present research comprises of n=100 further more sample was divided into 50 males and 50 females adolescents, the age range of the adolescents was 13 to 15 years. Result and Discussion: As far as findings are concerned we will find that, findings in present investigation are in conformity the previous findings.

Origins of Phantom Limb Pain.

Phantom limb pain (PLP) is a chronic neuropathic pain occurring in 45-85% of patients who undergo major amputations of the upper and lower extremities. Chronic pain is physically and mentally debilitating, affecting an individual's potential for self-care and the performance of daily living activities essential for personal and economic independence. In addition, chronic pain may lead to depression and feelings of hopelessness. A National Center for Biotechnology Information study found that in the USA alone, the annual cost of dealing with neuropathic pain is more than $600 billion, with an estimated 20 million people in the USA suffering this condition. PLP manifest predominantly during two time frames post-amputation: during days to a month and again at around 1year. In most patients, the frequency and intensity of the chronic neuropathic pain diminish over time, but severe pain persists in about 5-10% of patients. The development and maintenance of neuropathic pain is attributed to extremity amputations causing changes in peripheral axon properties and neuronal circuitry in both the peripheral and central nervous systems: peripheral axons, dorsal root ganglia, the spinal cord, and the cortex. However, it is not clear how the changes in neuronal properties in these different locations affect neuropathic pain. Is pain initiated by one set of post-amputation changes while the pain is maintained by another set of changes? If one set of amputation-induced changes, such as those of peripheral axons, are reverted to normal, is the chronic pain reduced or eliminated, while reversing another set of neuronal changes and neuronal circuits to normal do not reduce or eliminate the pain? Or, must all the amputation-induced changes be reverted to normal for pain to be eliminated? While this review examines the mechanisms underlying the induction or maintenance of PLP, it is beyond its scope to examine the mechanisms that may permanently reduce or eliminate neuropathic pain. This paper is the first of two reviews in this journal and deals with the causes of chronic PLP development and maintenance, while the second review examines potential mechanisms that may be responsible for promoting the capacity to coping with PLP by reducing or eliminating it.

Coping with Phantom Limb Pain.

Phantom limb pain is a chronic neuropathic pain that develops in 45-85% of patients who undergo major amputations of the upper and lower extremities and appears predominantly during two time frames following an amputation: the first month and later about 1year. Although in most patients the frequency and intensity of pain diminish over time, severe pain persists in about 5-10%. It has been proposed that factors in both the peripheral and central nervous systems play major roles in triggering the development and maintenance of pain associated with extremity amputations. Chronic pain is physically and mentally debilitating, affecting an individual's capacity for self-care, but also diminishing an individual's daily capacity for personal and economic independence. In addition, the pain may lead to depression and feelings of hopelessness. A National Center for Biotechnology Information study found that in the USA alone, the annual cost of dealing with neuropathic pain is more than $600 billion, with an estimated 20 million people in the USA suffering from this condition. Although the pain can be reduced by antiepileptic drugs and analgesics, they are frequently ineffective or their side effects preclude their use. The optimal approach for eliminating neuropathic pain and improving individuals' quality of life is the development of novel techniques that permanently prevent the development and maintenance of neuropathic pain, or that eliminate the pain once it has developed. What is still required is understanding when and where an effective novel technique must be applied, such as onto the nerve stump of the transected peripheral axons, dorsal root ganglion neurons, spinal cord, or cortex to induce the desired influences. This review, the second of two in this journal volume, examines the techniques that may be capable of reducing or eliminating chronic neuropathic pain once it has developed. Such an understanding will improve amputees' quality of life by blocking the mechanisms that trigger and/or maintain PLP and chronic neuropathic pain.

Offline: Sweden seeks a renaissance in global health

We gather in the atrium of the Royal Swedish Academy of Sciences, founded in 1739, surrounded by statues of Carl Linnaeus and portraits of the great (male) heroes of science (Newton, Galileo, Brahe). Reflecting on the pride and responsibility that Swedish scientists feel for their stewardship of the Nobels, some recalled with fond nostalgia the great lost years of Swedish influence in global health. The amplification of Sweden's presence in health stemmed from the nation's distinctive values, innovative research, policy translation, and strong activism. That was back in the 1970s and 1980s. But for reasons unexplained and unexamined, Sweden slowly disengaged from the global health community. The Swedish International Development Cooperation Agency (SIDA) has continued to play an important part in promoting attention to health systems, maternal and child health, and sexual and reproductive health and rights. There are still pockets of research excellence, such as Stig Wall's international epidemiological research centre at Umeå University. We mourn and miss Hans Rosling. A rather too quiet Ambassador for Global Health goes about his business. To add insult to injury, as Sweden lost its voice, so Norway gained their's. But thanks to the vision of two individuals, Peter Friberg and Göran Tomson, this trajectory of decline is about to change. With the support of the Bill & Melinda Gates Foundation, last week saw the launch of SIGHT—the Swedish Institute for Global Health Transformation. SIGHT's vision is “to contribute to health and wellbeing globally for all, with a particular focus on vulnerable groups, including women and children”. An international faculty was assembled to offer ideas for SIGHT's future work. The list of suggestions was long: from adolescent health to pandemic preparedness, universal health coverage to the biosphere. But the challenge facing SIGHT's ambitious, and small, team is to identify a niche in global health that complements Sweden's strengths. One strength is the country's values. Sweden's concern for equity, gender, environment, and peace, together with its history of political neutrality and civil society advocacy, provides the firm foundation for a radical reframing of global health in an era of sustainable development. And the moment for radicalism is supremely urgent. During one working dinner, news broke that President Trump was withdrawing America from the Paris Climate Agreement. He was fulfilling a campaign pledge. It is easy to be angry at Trump's decision. I am. Many are. But we should be wiser. He is riding on a feeling of voter rage against elites. Global health is a classic elite. A vote for Trump, a vote for Brexit, was a vote, at least partly, against us. For here is a truth we prefer to overlook. Global health represents an uneasy paradox. It stands for two contrary ideas that exist in perpetual opposition. The idea of “health” suggests the lived experiences of a particular person at a particular time and place. The idea of “global” is, by contrast, ethereal, distant, everywhere, and at the same time nowhere. For us to protect and strengthen the notion of global health, we must constantly strive to root it in the lives of those who make up authentic and identifiable communities and societies. Abstract inquiry and advocacy will justifiably earn us contempt. Moreover, there is no single global health. Your global health is different from mine because our experiences, perceptions, and understanding of the world are different. What is Sweden's experience, perception, and understanding? It is the fourth best nation in terms of health-care access and quality. The third best in progress towards the health-related SDGs. The second best for innovation. And Sweden enjoys flourishing artistic creativity (it recently won the Palme d'Or for Ruben Östlund's film, The Square). But Swedes have fears too. They are living in the aftermath of a terrorist attack, which took place in Stockholm on April 7 with the loss of five lives. The rapid rise of the far-right Sweden Democrats—a party Prime Minister Stefan Löfven calls “neofascist”—is eroding the country's historically liberal political culture. The Green Party has seen its support collapse. One Green Party leader has pointed to feelings of hopelessness in Swedish society. The global context for Sweden's anxieties is not propitious. Democracy is in recession, and the world is a less peaceful place. But these trends and inclinations are all arguments in favour of SIGHT. To discover solutions to our most dangerous challenges demands disruptive thinking, interdisciplinary inquiry, collective action—and new institutions that will confront lazy orthodoxies.

(P100) Burnout Among Trainees in Radiation Oncology: Determining the Root of the Problem

More than 30% of U.S. radiation oncology residents experience burnout during residency. For some residents, these sentiments are accompanied by dissatisfaction with the residency program and feelings of hopelessness. Determining demographic factors and aspects of residency associated with burnout allows for implementation of strategies to prevent or alleviate burnout and improve program satisfaction among residents. A nationwide survey, including the Maslach Burnout Index (MBI)-Human Services Survey, was sent to all U.S. radiation oncology program directors and coordinators as published by the Association of Residents in Radiation Oncology. The survey included demographic-, resident-, and program-specific questions. Univariate binomial models examined the relationship between various residency-specific and resident-specific characteristics and two endpoints: 1) high burnout levels (as identified on the MBI Emotional Exhaustion and Depersonalization subscales) and 2) likelihood the resident would choose the same radiation oncology program again. Variables with a p <0.10 were included in multivariable models. There was a statistically significant inverse association with adequate work-life balance (OR 0.37; 95% CI: 0.17-0.83) and burnout. Female gender (OR 3.39; 95% CI: 1.32-9.52), marriage (OR 2.27; 95% CI 1.02-5.20), work-personal life balance (OR 4.24; 95% CI: 1.75-10.7), residents’ opinions about whether the program served patient needs (OR: 2.93; 95% CI: 1.11-7.91), and residents opinions about whether the program was invested in the resident’s educational success (OR: 5.23; 95% CI: 2.12- 13.4) were each associated with the likelihood of choosing the same radiation oncology program again. On univariate and multivariate regressions, factors directly examining time at work were not significantly associated with choosing the same radiation oncology program or burnout. Increasing educational opportunities and maintaining adequate work-life balance may lead to an increase in residency program satisfaction. Ensuring an adequate work-life balance in the residency program may reduce burnout and its associated negative outcomes.

Depression among cancer patients–A reality where therapeutic nihilism cannot be accepted

IntroductionCancer is a life-threatening disease, characterized by a great deal of uncertainty and unpredictability. Thus, several stressors and emotional upheavals pervade the everyday life of cancer patients and can lead to the development of depression.ObjectivesTo review the recent research related to depression in cancer patients.MethodsLiterature review based on PubMed/MEDLINE, using the keywords “cancer” and “depression”.ResultsIt is estimated that 20–25% of cancer patients meet the criteria for major depressive syndrome at some point in their illness. Depression is associated with a negative impact on treatment adhesion, cancer progression and quality of life, besides increasing suicide risk. However, it is often unrecognized and untreated. Importantly, the mistaken belief that depressive symptoms are expected in this group, the overlap between the neurovegetative symptoms of depression, the somatic symptoms of cancer and its treatment, as well as the effects of comorbid diseases make the diagnosis of major depression so complex in these patients. Some of the most helpful diagnostic indicators are feelings of hopelessness, worthlessness, excessive guilt, loss of self-esteem, and wishes to die. The several risk factors for the development of depression in cancer patients can be divided into four broad categories, namely cancer-related factors, cancer treatment-related factors, psychiatric history, and social factors. Effective management of depression consists in a combination of psychotherapy and psychopharmacology.ConclusionDepression in cancer patients has serious consequences, however appropriate psychiatric intervention can do it over. Thus, its early recognition and appropriate management is imperative.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Outcomes of involuntary hospital admission. Satisfaction with treatment and the effect of involuntary admissions on patients

IntroductionInvoluntary hospitalization in those presumed to be mentally ill has been a common practice. Although some patients are hospitalized for aggression, two-thirds of the patients are hospitalized because of the threat they pose to themselves. Although these patients require risk assessment and evaluation for possible presence of mental illness, the question is how much these patients will benefit from involuntary admission and what the long-term outcome would be.MethodAll patients admitted involuntary to the psychiatric ward in Kingston, Canada, and psychiatrists involved in their care were interviewed to see whether they think the involuntary admission was helpful. All patients were asked to fill-out MacArthur AES to assess their satisfaction with hospitalization.ResultsAlthough psychiatrists frequently reported that the admission was justified, only 29 out of 81 patients reported being explained to why they had been admitted involuntarily. Also, there was a significant difference in AES scores between those who were and were not given an explanation for admission. In addition, psychiatrists more often reported that the involuntary admission worsened the therapeutic relationship which was significantly associated with involuntary admission that was not explained to patients.DiscussionThe results of our study shows that patients admitted involuntarily often feel disappointed with staff and mental health system. It could lead to feeling of hopelessness, frustration and low self-esteem. If explained, some patients who present with risk to self might accept voluntary admissions, that will improve therapeutic alliance with psychiatrists and increase satisfaction from hospitalization. Result of this study could improve the decision making process for involuntary admissions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychotic and obsessive symptoms: A case report

A 28-year-old patient who began three months of symptoms of low mood, apathy and anhedonia. The patient in this last month had accepted a job but the first day had left by “feeling incapable”. He asked for specialized help. He was diagnosed with severe depressive episode and antidepressant treatment. Some weeks of patient treatment did not improve. He began to voice greater feelings of hopelessness and ideas of active death secondary to his process. He was admitted a partial hospitalization for further control and evaluation. In his evolution, visual hallucinations and a mild delusional ideation of unstructured surveillance and injury were observed. The patient verbalized with little repercussion these sensoperceptive alterations. Neuroleptic treatment was given but we could not manage high doses because of poor tolerance and side effects of treatment. The symptomatology did not improve and the patient's anguish increased. In the moments of greater distress, the patient performed superficial cuts on his forearms that he criticized. During the following months, symptoms of an obsessive type were observed, which had already pre-entered but had been reactivated. He began to perform rituals of verification with important repercussion.DiscussionIn the scientific literature the relationship between psychosis and obsession has been studied on many occasions, without reaching firm conclusions. In 2004, Poyurosvsky postulated the possible diagnosis of a subgroup called “schizo-obsessive” that included both disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Assessing suicide risk with the Clinical Interview for Psychotic Disorders (CIPD): Preliminary reliability and validity of the Suicide Risk Scale for Psychosis (SRS-P)

BackgroundSuicide risk is an important variable to consider both in assessment and throughout the therapeutic process in psychotic disorders. The SRS-P is an 18-item scale computed from the patient and clinician-rated scores obtained in the CIPD. The scale comprises lifetime assessment of depressed mood, anhedonia and its current interference and severity, current and past feelings of hopelessness, suicidal ideation, ‘voices’ about suicide, and suicide-related behaviors.AimsTo assess reliability and convergent validity of the SRS-P in a sample of participants with psychosis.MethodsThe sample comprised 22 participants (68.2% male), single (72.7%), between 19 and 47 years old (M = 31.05; SD = 7.088), with 4–17 years of education (M = 11.77; SD = 3.176), employed (50%). The most prevalent diagnosis was schizophrenia (68.2%) and the participants had a mean of 1.90 hospitalizations (SD = 2.548). The mean age of illness onset was 23.57 years (SD = 5.555). The participants were assessed with the CIPD, Depression, Anxiety and Stress Scales-21, Forms of Self-Criticism and Reassurance Scale, Self-Compassion Scale, Other as Shamer Scale and the Empowerment with Psychotic Symptoms Scales.ResultsThe SRS-P has shown good reliability (α = .87) and validity in relation to depressive symptoms (r = .67; P = .001), anxiety (r = .74; P &lt; .001), stress (r = .59; P = .004), inadequate self (r = .43; P = .046), hated self (r = .54; P = .009), reassured self (r = –.65; P = .001), self-compassion (r = –.63; P = .002), shame (r = .46; P = .033) and empowerment regarding positive symptoms (r = –.54; P = .015).ConclusionsThe SRS-P presented adequate reliability and convergent-divergent validity. Further studies are planned in order to test the factorial structure of the scale and confirm the presented results in a larger sample.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Life hardships and its relationship with Suicide Probability among University Students: أحداث الحياة الشاقة لدى طلبة جامعة الملك سعود وعلاقتها باحتمالية الانتحار

This study aimed to identify the major Events of Life hardships among King Saud university students, and its relationship with Suicide Probability. The study was based on Social Survey Methodology with a Simple Random Sampling Method, and used both measures of Suicide Probability and life hardships. It was applied to 377 students enrolled in the first year’s joint study at King Saud University in Riyadh for the academic year 1437- 1438. The results showed that the average rate of the sample members that agreed that they suffered from life hardships is 17.75% , While the average rate of the sample members who didn’t agree with suffering from any life hardships is 82.25%. The results also showed that the responses' total average of the sample members, on all scales, was 2.02 with verbal estimate (Sometimes). As for the dimensions of the scale, the first rank was negative self- evaluation with an average of 2.45, then the hopelessness with an average of 2.19, with verbal estimate (Sometimes). While the suicide perception dimension had an average of 1.74, and the dimension of hostility had an average of 1.71, with verbal estimate (rarely). The results also revealed that there is no statistically significant relationship at the level 0.05 between the sample members' responses on the bound total of Life hardships and responses on the bound total of the Suicide Probability, as well as the dimensions: (feeling of hopelessness, negative self- esteem, hostility), while there is a statistically significant relationship between responses on the Life hardships scale and the perception of suicide dimension. In the view of the findings, lots of recommendations is given to improve the student services to reduce the hardships which is facing the college student.

Predictors of suicide in the patient population admitted to a locked-door psychiatric acute ward

ObjectiveNo prior study appears to have focused on predictors of suicide in the general patient population admitted to psychiatric acute wards. We used a case-control design to investigate the association between suicide risk factors assessed systematically at admission to a locked-door psychiatric acute ward in Norway and subsequent death by suicide.MethodFrom 2008 to 2013, patients were routinely assessed for suicide risk upon admission to the acute ward with a 17-item check list based on recommendations from the Norwegian Directorate of Health and Social Affairs. Among 1976 patients admitted to the ward, 40 patients, 22 men and 18 women, completed suicide within December 2014.ResultsCompared to a matched control group (n = 120), after correction for multiple tests, suicide completers scored significantly higher on two items on the check list: presence of suicidal thoughts and wishing to be dead. An additional four items were significant in non-corrected tests: previous suicide attempts, continuity of suicidal thoughts, having a suicide plan, and feelings of hopelessness, indifference, and/or aggression. A brief scale based on these six items was the only variable associated with suicide in multivariate regression analysis, but its predictive value was poor.ConclusionSuicide specific ideations may be the most central risk markers for suicide in the general patient population admitted to psychiatric acute wards. However, a low predictive value may question the utility of assessing suicide risk.

Depression, anxiety, hopelessness and quality of life in users of cocaine/crack in outpatient treatment.

To identify symptoms of anxiety, depression, and feelings of hopelessness in patients in outpatient treatment for substance dependency and to test for correlations with various aspects of their quality of life. A cross-sectional study of a sample of 25 men in recuperation from substance dependency, selected by convenience. We assessed symptoms of depression (Beck Depression Inventory-II), anxiety (Beck Anxiety Inventory), hopelessness (Beck Hopelessness Scale), and quality of life (World Health Organization Quality of Life instrument-Abbreviated version [WHOQOL-Bref]), and also analyzed sociodemographic profile, substance abuse, and family history. Categorical variables were expressed as frequencies and percentages and quantitative variables as means and standard deviations or as medians and interquartile ranges. We also analyzed Spearman correlations to a 5% significance level. The study revealed prevalence rates of 32% for depression, 24% for anxiety, and 12% for hopelessness, at a moderate/severe level. Correlations between Beck scales and WHOQOL-Bref were significant; but impacts differed in the four areas evaluated. Overall, we observe global negative impacts on subjects' lives, affecting their psychiatric symptoms and quality of life and their relationships and occupational factors to a similar degree. The results show that the lower the scores on these scales, the better the quality of life in some areas, indicating that there is a negative correlation between psychiatric symptoms and quality of life.

Paul Kammerer and Alban Berg: Rivals in Song

Between 1904 and 1911, two young Viennese composers—Alban Berg and Paul Kammerer—engaged in a competition for the attention of Helene Nahowska, a rising young singer. Kammerer, later famed as a biologist, composed songs for her beginning in 1904, and the two soon fell in love. Eight of Kammerer’s songs were published by Simrock in Berlin in 1906, and the texts that he chose, including Helene’s own poetry, refer obliquely to their relationship. In that same year Kammerer broke off their connection and married another woman. Shortly afterwards, Alban Berg vied for Helene’s attention, and his songs from 1907 to 1909 increasingly used texts that were addressed to Helene, often expressing feelings of hopelessness and despair reminiscent of Tristan’s passion for Isolde. Although Kammerer continued to have contact with Helene, Berg gradually won her over, and they were married in 1911.

Subgenual Anterior Cingulate–Medial Orbitofrontal Functional Connectivity in Medication-Resistant Major Depression: A Neurobiological Marker for Accelerated Intermittent Theta Burst Stimulation Treatment?

BackgroundAccelerated repetitive transcranial magnetic stimulation paradigms have been shown to result in fast decreases in depressive symptoms and suicidal ideation. Although the subgenual anterior cingulate cortex (sgACC) region has been put forward as a possible biological marker, so far, no studies evaluated the clinical effects of accelerated intermittent theta burst stimulation (aiTBS) on sgACC functional connectivity (FC). MethodsFifty patients with treatment-resistant depression were enrolled in this registered randomized double-blind sham-controlled crossover aiTBS treatment study. All received 20 iTBS sessions applied to the left dorsolateral prefrontal cortex (5 daily sessions spread over 4 days). Forty-four complete resting-state functional magnetic resonance imaging scans were collected. Baseline resting-state functional magnetic resonance imaging scans were compared with a matched healthy control group. Besides depression severity, all patients were also assessed with the Scale for Suicide Ideation and the Beck Hopelessness Scale. ResultsOur main resting-state functional magnetic resonance imaging findings indicate that a positive sgACC FC correlation with the medial orbitofrontal cortex could distinguish aiTBS responders from nonresponders at baseline. Beneficial aiTBS treatment strengthened sgACC–medial orbitofrontal cortex FC patterns. Moreover, this increased FC pattern was associated with a decrease in feelings of hopelessness. ConclusionsClinical response to aiTBS treatment is not only characterized by stronger FC patterns between the sgACC and the medial orbitofrontal cortex, but it is also associated with decreases in hopelessness. Our observations provide a possible neurobiological explanation why accelerated repetitive transcranial magnetic stimulation paradigms may result in prompt attenuation of negative thinking in depressed patients.

District nurses’ experiences of caring for leg ulcers in accordance with clinical guidelines: a grounded theory study

ABSTRACTThis qualitative study used the grounded theory method to investigate district nurses’ experiences of caring for leg ulcers in accordance with clinical guidelines at seven primary health care centres in Stockholm, Sweden. Group interviews were conducted with 30 nurses. The results describe how district nurses strive to stay on track in order to follow clinical guidelines and remain motivated despite prolonged wound treatment and feelings of hopelessness. Three main obstacles to following the guidelines were found. District nurses used compensating strategies so the obstacles would not lead to negative consequences. If the compensating strategies were insufficient, perceived prolonged wound treatment and feelings of hopelessness could result. District nurses then used motivating strategies to overcome these feelings of hopelessness. Sometimes, despite the motivating strategies, treatment in accordance with guidelines could not be achieved. With some patients, district nurses had to compromise and follow the guidelines as far as possible.

Closing the Gap: Improving Access to Mental Health Care Through Enhanced Training in Residency.

“Daniel,” a previously healthy teenager, complained of chest pain at his annual well child visit. His doctor, a second-year pediatric resident, quickly and confidently evaluated Daniel for cardiac or pulmonary causes of chest pain. She recognized that his pain was associated with anxiety and provided Daniel with a referral to a clinical psychologist. After several counseling sessions, his symptoms improved and the two agreed he no longer required therapy. But when Daniel returned to primary care several months later, his depression screen was positive. He had been having frequent panic attacks on the subway, difficulty concentrating at school, and feelings of hopelessness. The pediatric resident caring for him realized he needed additional mental health treatment, but she was unable to persuade him to seek care with a psychologist or psychiatrist. He was firm in his refusal to see a specialist, leaving his resident provider unsure what to do next. Her skills and expertise were not sufficient to deliver initial therapies for depression and anxiety, nor was she able to coordinate follow-up with a mental health specialist. Daniel’s situation is not uncommon; although 1 in 5 children in the United States experiences a severe mental health disorder, nearly 80% of children with mental health disorders do not receive mental health care.1,2 Daniel’s reluctance to see a psychologist or psychiatrist may have stemmed from denial that his symptoms signaled a mental health condition, lack of comfort with a specialist provider, or the stigma associated with mental … Address correspondence to Gauri Raval, MD, MPH, Department of Pediatrics, University of Virginia School of Medicine, P.O. Box 800386, Charlottesville, VA 22908. E-mail: raval{at}virginia.edu

Experiences of mobility for people living with rheumatoid arthritis who are receiving biologic drug therapy: implications for podiatry services

BackgroundDespite significant advancements in new treatment modalities for rheumatoid arthritis with biological therapies, foot complications remain a disabling and common feature of the disease. In this study the aim was to explore and describe the personal experiences of people with rheumatoid arthritis in receipt of biologic treatments in a bid to understand the impact of this form of medication on their mobility.MethodsAn interpretative phenomenological analysis (IPA) was undertaken to explore in depth the individual experience of rheumatoid disease through personal accounts of the patient journey spanning both ‘before’ and ‘after’ the instigation of biologic therapy. A purposive sampling strategy was adopted and in-depth semi structured interviews used to facilitate rich, detailed interview data exploring the lived experiences of individuals undertaking biological therapy and the changes to mobility experienced as a result. Thematic analysis was employed with an IPA framework to identify key meanings, and report patterns within the data.ResultsFive people with rheumatoid arthritis participated in the study. The mean disease duration was 20.2 years (range: 6 -32) and all were being treated with biologic therapies. Four key themes emerged from the data: 1) Life before biologic treatment, depicted in accounts as a negative experience characterised by painful and disabling symptoms and feelings of hopelessness. 2) Life with biologic treatment, often experienced as a life changing transition, restoring function and mobility and offering renewed hope. 3) Sense of self, in which the impact of rheumatoid disease and the subsequent changes arising from biologic therapy reveal a profound impact on feelings of personal identity both pre and post biologic therapy; an effect of footwear on self-image emerges as a dominant sub theme; 4) Unmet footcare needs were evident in the patient narrative, where the unrelenting if diminished impact of foot pain on mobility was viewed in the context of problematic access to foot health services.ConclusionWhilst the findings from this study mirror those within the existing literature, which report improvements in physical function related to biological therapy, foot problems clearly remained an unremitting feature of life for patients with rheumatoid disease, even when in receipt of biologics.

Cancer and palliative care in Africa.

Cancer and palliative care in Africa.

Self-reported suicidality behavior and attitudes toward suicide among medical and paramedical students

Aims and Objectives: The aim of this study was to evaluate knowledge and attitudes toward suicide and suicidality behavior among medical and paramedical students. Materials and Methods: A cross-sectional study was conducted in a medical college of western India where undergraduate medical (238), physiotherapy (25), and nursing (137) students were enrolled. After taking informed consent, detailed assessment of knowledge, attitude towards suicide using Suicide Opinion Questionnaire and suicidality behavior using mini-international neuropsychiatric interview were done. Data were analyzed using appropriate statistical tests. Results: Ninety-three percent students agreed “people who are at risk can't be easily identified.” Eighty percent students believed “potentially anyone can be a suicide victim.” Acceptability of suicide was highest in nursing students; B.P.T students had highest knowledge regarding suicide. None had active suicidal ideation or planning. Only at a thought level, one-third of total population reported feeling of hopelessness sometime in their life. Sixteen percent, nearly double females ( n = 299) thought sometimes in their life that “it would be better off dead” compared to 8% males ( n = 101). Among three groups, nursing students showed highest suicidality behavior. Conclusions: Attitudes toward suicide and suicidality behavior differ among the groups with significant gender differences. Although acceptability is the highest among nursing students, the group is at higher risk with higher suicidal ideation. Students believe, “people who are at risk can't be easily identified;” hence, further exploration, awareness, and interventions are suggested.

Suicidal Ideation and Hopelessness among Mexican Adolescents Studying In Public and Private Schools: The Role of Family Factors

Background: The transition from childhood to adolescence is associated with suicidal ideation (SI) and feelings of hopelessness. The aim of this study was to investigate the prevalence of SI and hopelessness (and relevant family factors) among adolescents in southern Mexico studying in public and private high schools. Methods: A significant sample of high school students (15-19 years old) was taken in the city of Tuxtla Gutiérrez, the State of Chiapas, Mexico. The Beck scale for SI, the Beck hopelessness inventory, and a survey of family data were applied to adolescents, 364 in public and 240 in private high schools. Results: The teens in public schools showed a higher prevalence of hopelessness (32%) and SI+hopelessness (10%). In both public and private schools, these attitudes were more common among women as well as teens from small (3-4) families and those without a job. Conclusions: The behaviors found among teens of public and private high schools suggest the importance of a lack of family stability and economic solvency in the development of suicidal behavior. The present results may be useful in formulating strategies to prevent suicide.