Negative Personal Experiences Research Articles

Immunizing health care workers against influenza: A glimpse into the challenges with voluntary programs and considerations for mandatory policies

Vaccination of health care workers (HCWs) is an important patient safety initiative. It prevents influenza infection among patients and reduces staff illness and absenteeism. Despite these benefits, HCW influenza immunization uptake is low. Therefore, strategies to achieve high immunization coverage in HCWs, barriers to uptake, and perceptions of mandatory influenza immunization policies were discussed in key informant interviews with influenza immunization program planners. We conducted telephone interviews with 23 influenza immunization program planners from 21 organizations (7 acute care hospitals, 6 continuing care facilities, and 8 public health organizations) across Canada. We used content analysis to identify themes from the interviews. Participants used a variety of promotional and educational activities, and many vaccine delivery approaches, to support HCW immunization programs. Barriers to achieving high coverage in HCWs included misconceptions about the safety and effectiveness of the influenza vaccine, negative personal experiences associated with the vaccine, and antivaccine sentiments. Participants mentioned mandatory influenza immunizations as a solution to low coverage. However, they identified challenges with this approach such as obtaining support from stakeholders, enforcement, and limiting personal autonomy. Participants believed immunization coverage in health care organizations will continue to be suboptimal using existing program strategies. Although participants discussed mandatory immunization as a way to improve uptake, potential obstacles will need to be addressed for this to be implemented successfully.

Personal experience and reputation interact in human decisions to help reciprocally

There is ample evidence that human cooperative behaviour towards other individuals is often conditioned on information about previous interactions. This information derives both from personal experience (direct reciprocity) and from experience of others (i.e. reputation; indirect reciprocity). Direct and indirect reciprocity have been studied separately, but humans often have access to both types of information. Here, we experimentally investigate information use in a repeated helping game. When acting as donor, subjects can condition their decisions to help recipients with both types of information at a small cost to access such information. We find that information from direct interactions weighs more heavily in decisions to help, and participants tend to react less forgivingly to negative personal experience than to negative reputation. Moreover, effects of personal experience and reputation interact in decisions to help. If a recipient's reputation is positive, the personal experience of the donor has a weak effect on the decision to help, and vice versa. Yet if the two types of information indicate conflicting signatures of helpfulness, most decisions to help follow personal experience. To understand the roles of direct and indirect reciprocity in human cooperation, they should be studied in concert, not in isolation.

Evaluation of Weight Loss Failure, Medical Outcomes, and Personal Experiences after Roux-en-Y Gastric Bypass: A Critical Analysis

Background. Roux-en-Y gastric bypass (RYGB) is considered an effective and well-tolerated surgical procedure. In this retrospective study, we critically assessed efficacy and negative personal experiences (NPEs) after RYGB with a self-administered questionnaire (SAQ). Methods. This questionnaire study included 404 patients who had undergone RYGB. Analysis was performed using data from medical records, referral letters, and SAQs at an average of 33 months after procedure. We evaluated the occurrence of hypertension, CPEP use and type 2 diabetes mellitus (T2DM), the amount of excess weight loss, degree of satisfaction and negative personal experiences (NPEs) related to the procedure, and adherence to a dedicated life style program and (non)attendance to followup. consults after surgery. Results. 42.3% of all SAQs were evaluable for analysis. T2DM remained similar, while hypertension and continuous positive airway pressure (CPAP) use decreased significantly; excess weight loss of ≥40% was reported in 69% and of <40% in 19%, a significant improvement. Absolute weight gain was reported in 10.5%, fatigue in 44.4%, dysphagia in 11.6%, and other NPEs in 7.6%. Dissatisfaction over weight loss was reported in 9.4%. Mean number of follow-up visits was 9.6 per respondent, while nonattendance of any follow-up visit consults occurred in 1.8%. Conclusions. The use of post-RYGB SAQs provided evaluable data in 42.3%. Treatment failure after RYGB appears to be relevant, encouraging the use of SAQ studies in large cohorts.

Sentimientos morales en la relación de cuidado enfermeras(os) - personas que viven con VIH/SIDA

Living with the Human Immunodeficiency Virus and the Acquired Immunodeficiency Syndrome usually becomes a negative personal experience, which translates into pain and suffering. This means a real challenge for the nursing care, which is based on a human interaction which complexity depends on the dialog and bilateral interaction between the nurse and the patient, and implies a reflection of moral kind, in all that it involves values, feelings and moral justifications; that in the practice have frequently been overlooked. This article intends to show a theoretical framework based on empirical research that allows exploring and understanding, the moral feelings that guide the relation nurse- person, who live with HIV / AIDS. In this way, it is necessary to resource to theoretical concepts of the moral philosophy of nursing.

Stories of parents and self: Relations to adolescent attachment.

How individuals construct narratives involving attachment figures (e.g., parents) should reflect their representation of those individuals as either comforting or unsupportive (Bowlby, 1969). Similarly, how individuals talk about parents' childhood experiences may also reflect their attachment representation. Sixty-five 13- to 16-year-old middle-class, diverse adolescents narrated 2 stories each from mother's and father's childhood, and 2 positive and negative personal experiences, all coded for coherence and emotions. As a measure of attachment, adolescents completed the Attachment Script Assessment, coded for attachment security (H. S. Waters & Rodrigues-Doolabh, 2001). Pearson's correlations indicate secure adolescents told coherent and emotionally expressive narratives about mothers' childhood but not fathers'; narratives about mothers' experiences appear important for adolescents' attachment. Secure adolescents also told thematically coherent negative but not positive personal narratives. Thus, secure adolescents do not tell all narratives coherently and emotionally; in this study, the relation between narratives and attachment is specific to intergenerational narratives.

Negative and positive life experiences in patients with psoriatic arthritis

Recent data suggest that childhood and adulthood stressors may play a significant role in the development of an autoimmune disease. The present study explores the relationship between psoriatic arthritis (PsA) and positive and negative life events during childhood and adulthood in psoriatic patients. Forty-five patients with psoriatic arthritis and 101 controls (patients with skin conditions considered to be "non-psychosomatic") were enrolled in the study. All participants completed a specific questionnaire measuring traumatic life experiences [Traumatic Antecedents Questionnaire (TAQ)]. The TAQ assesses positive personal experiences (competence and safety) and negative personal experiences (neglect, separation, secrets, emotional, physical and sexual abuse, trauma witnessing, other traumas and exposure to alcohol/drugs) from early childhood to adulthood. The patients with psoriatic arthritis exhibited lower mean scores of total positive experiences during late childhood (latency) as compared to the control group. Negative experiences during four developmental periods appeared more frequently in patients with psoriatic arthritis than in the controls. The most frequently reported negative experiences were neglect, emotional abuse, physical abuse, sexual abuse, alcohol/drug abuse and other traumas. The present findings add evidence to the relationship between retrospectively reported childhood experiences and psoriatic arthritis. Furthermore, a high amount of reported emotional and physical abuse occurs in patients with psoriatic arthritis during latency and adolescence.

Cultural differences in emotion regulation during self-reflection on negative personal experiences

Reflecting on negative personal experiences has implications for mood that may vary as a function of specific domains (e.g., achievement vs. interpersonal) and cultural orientation (e.g., interdependence vs. independence). This study investigated cultural differences in the social-cognitive and affective processes undertaken as Easterners and Westerners reflected on negative interpersonal and performance experiences. One hundred Asian Americans and 92 European-American college students were randomly assigned to one of three conditions: interpersonal rejection, achievement failure, or a control condition. Results revealed that Asian Americans experienced greater distress than European Americans after self-reflecting over a failed interpersonal experience, suggesting cultural sensitivity in the relational domain. Consistent with theoretical predictions, analysis of the social cognitive and affective processes that participants engaged in during self-reflection provided some evidence that self-enhancement may buffer distress for European Americans, while emotion suppression may be adaptive for Asian Americans.

The nature and consequences of topic avoidance in Chinese and Taiwanese close relationships

Two studies examined topic avoidance in Chinese and Taiwanese opposite-sex friendships and romantic relationships. Five areas of topic avoidance emerged through analytic induction and cluster analysis: negative appraisal, relational issues, sexual issues, politics, and personal experience. Partner protection, negative relational impact, and self inefficacy emerged as the most common reasons for avoidance. Results revealed that friends, relative to romantic partners, engaged in higher levels of topic avoidance. Taiwanese participants, moreover, avoided discussing politics to a greater extent than did mainland Chinese participants. Lacking closeness was the main reason behind avoidance of political discussion. Topic avoidance was also linked to relationship quality, as relational satisfaction negatively predicted relational issue avoidance and topic avoidance breadth (i.e. the number of topics regularly avoided in the relationship). The authors explain these and other findings based on Chinese cultural codes and historically-embedded concepts that shape interpersonal interaction.

There Is Lack of Evidence that Succinylcholine Should Be Avoided in Patients on Statin Therapy

Northwestern University, Feinberg School of Medicine, Chicago, Illinois. g-jr@northwestern.eduTo the Editor: I read with great concern the recent editorial from Dr. Lee, the title of which provided a very strong message to the readers of ANESTHESIOLOGY: “Succinylcholine Should Be Avoided in Patients on Statin Therapy.”1The editorial was in reference to the article by Turan et al. from the Department of Outcomes Research at the Anesthesiology Institute at Cleveland Clinic in Cleveland, Ohio.2The Cleveland Clinic authors performed a well designed study and were correct when they concluded that despite statistically significant results, the difference on plasma myoglobin concentration attributed to the use of succinylcholine in patients taking statins was likely to be small and probably of limited clinical consequences.Lee based the strong and conclusive title of his editorial on a hypothesis that the negative finding of Turan et al. 's study was probably due to the fact that subjects at high risk for the development of high myoglobin plasma concentrations were excluded from the protocol, and that the inclusion of those subjects would have led to different results. He specifically mentioned the elderly population as a particularly vulnerable group because of its limited functional reserve. Although only another well designed study will be able to answer this question, I hypothesize that, if pursued, the study will find similar results as the one found by Turan et al. Elderly patients are probably less prone to a possible combined effect of statin and succinylcholine, simply because they have less muscle mass. If this clinical effect in fact existed, we would been observing a pandemic of perioperative renal failure caused by myoglobinuria during the past several years, since statins are prescribed frequently for the elderly population undergoing surgical procedures in the United States,3and succinylcholine has not been contra-indicated in the same population. In contrast, postoperative myoglobinuria leading to kidney injury is not a common clinical entity, being only reported in few case reports that attributed inappropriate patient positioning as a possible cause.4Scientific writing techniques teach us that certain parts of manuscripts are particularly powerful in conveying the manuscript's message, and the title is definitely one of them. This fact has led certain peer-reviewed journals to restrict the use of conclusive titles by authors in order to limit the influence of the author's conclusion on readers' conclusions. I personally believe that conclusive titles are important and should be allowed to point out important study results based on scientific evidence, but this was not the case in Lee's editorial.If readers are mislead by the title of Lee's editorial, it could lead to a change in practice that may increase the use of high doses of rocuronium in substitution for succinylcholine, and certainly could create a favorable clinical setting for the widespread use of sugammadex. Despite early favorable safety studies, sugammadex lacks the several decades of clinical experience of succinylcholine, which were crucial to understand the safety profile of succinylcholine. This change in practice would substantially increase the market for sugammadex because of the high prevalence of statin use among surgical patients. I understand that Lee has demonstrated in a well designed, industry-sponsored study the beneficial reversal effects of sugammadex on rocuronium-induced neuromuscular block, compared with spontaneous succinylcholine,5and therefore he might have a negative personal experience with succinylcholine. This was further confirmed by Lee's suggestion that succinylcholine should be removed from the anesthesia practice: “After all, many inexpensive anesthesia drugs have been removed from anesthesia practice, why not succinylcholine?” Again, another strong statement, supported by not enough evidence. It is unknown if patients are willing to pay the cost of sugammadex in cases where high doses of rocuronium are used instead of succinylcholine. It is also unknown the effects high doses of rocuronium can have on operating room utilization costs in countries were sugammadex is still not available, such as the United States. Also important to note is that succinylcholine postoperative myalgias can be reduced by a number of low-cost interventions, such as the perioperative use of another cheap drug, lidocaine.6Succinylcholine has been used for several decades by anesthesiologists. Although it has well established contraindications, such as in patients with a history of malignant hyperthermia and spine cord injury, it is also a cheap and highly efficacious drug with clear indications for its use by anesthesiologists. Based on the current literature, there is no evidence that succinylcholine should be avoided in patients receiving statins. There is evidence after Turan et al. 's study that succinylcholine is likely safe for otherwise healthy patients taking statins.

Joint Manipulation Curricula: The Story Continues

In this issue of the Journal of Physical Therapy Education, Neena K. Sharma, PT1 PhD1 CMPT, and Carla H. Sabus, PT, PhD, along with Tamara S. Struessel, PT, DPT, OCS, MTC, et al, have provided readers with interesting data that continues the story related to thrust joint manipulation curricula. Ioint manipulation provides a specific example for discussions related to a broader challenge facing physical therapist academicians: ensuring that classroom knowledge and skills are being transitioned to the clinical setting. It is doubtful that any single intervention has been studied more than joint manipulation related to physical therapist professional education. The original paper titled Manipulative therapy in physical therapy was published in 1973, l with follow-up curricula benchmark studies published in 1988,2 1997,3 and 2004.4 Besides describing to what degree and how this content area was being integrated into the curriculum, these benchmark studies identified potential barriers to students developing competence. There is no longer any question as to whether joint manipulation is an entry-level skill. The Commission on Accreditation in Physical Therapy Education's (CAPTE) Evaluative Criteria for Accreditation of Education Programs for the Preparation of Physical Therapists lists Manual Therapy (including Mobilization/Manipulation Thrust and Nonthrust Techniques under Curricular Content.5 Despite this, student competence and the transition from classroom to clinic is not guaranteed. In fact, faculty surveyed in 2004 stated that the most beneficial way for students to further develop joint manipulation skills was increased emphasis during clinical affiliations.4 This led to an investigation of joint manipulation clinical education opportunities for physical therapist students.6 Results published in 20066 revealed that approximately 70% of surveyed clinical instructors (CIs) did not teach students joint manipulation. The reasons provided included the following: (1) the belief that joint manipulation was not an entry-level skill, (2) CIs lack of expertise, (3) professional liability concerns, (4) the belief that students were not academically prepared, and (5) the belief that joint manipulation techniques were not appropriate for the clinic's patient population. A follow-up study revealed that for some CIs' previous negative personal experiences with joint manipulation as a patient or student led to their decision to not teach students this skill.7 The gap in the literature at this point was the student perspective related to use of joint manipulation as an intervention. Although student utilization of joint manipulation techniques was first described by Flynn, Wainner, and Fritz8 in 2006, the emphasis was on utilization rates, the timing of joint manipulation utilization (initial visit, interim, or discharge session), patient outcomes, and reported adverse events (none were reported). There was no mention of encountered barriers.8 The following articles by Sharma and Sabus,9 and Struessel et al10 provide us with the missing link: student insight on the topic of joint manipulation. Sharma and Sabus9 surveyed students completing clinical internships in outpatient orthopedic clinics, noting that almost 90% agreed or strongly agreed that they were academically prepared to use joint manipulation techniques. Despite this level of confidence, 50% performed joint manipulation during the internships. The most oft-cited reason for not using joint manipulation during the internship was the belief that the technique was not appropriate for the clinic's patient population, followed by a lack of CI joint manipulation training. Consistent with the previous survey of CIs,6 Sharmus and Sabus found a correlation between CI utilization (or lack of) of joint manipulation and student utilization.9 The primary limitation of this study was the sample of students being from one physical therapy program. …

Recovery From Heroin Or Alcohol Dependence: A Qualitative Account of the Recovery Experience in Glasgow

While it is increasingly recognized that recovery from dependent use of heroin or alcohol is possible, little is known about the long-term process of recovery. A study in Glasgow, Scotland used interviews and self-completed questionnaires to investigate the recovery journeys of former problematic users of heroin or alcohol. Qualitative data showed that recovery was understood as including but transcending freedom from dependence, and that most participants saw their own recovery as an ongoing process rather than a time-limited milestone. Motivating factors were usually negative personal experiences—with former heroin users more likely to cite “the lifestyle” and former alcohol users their behavior and health problems - and more positively around issues of personal identity. Social factors were often cited as key in sustaining recovery, especially peer support. An understanding of the views and perceptions of those who have experienced recovery from dependent use of alcohol or heroin can help to develop and improve recovery services and support.

User fees for public health care services in Hungary: Expectations, experience, and acceptability from the perspectives of different stakeholders

Objective The introduction of user fees for health care services is a new phenomenon in Central-Eastern European Countries. In Hungary, user fees were first introduced in 2007, but abolished one year later after a referendum. The aim of our study is to describe the experiences and expectations of health system stakeholders in Hungary related to user fees as well as their approval of such fees. Method For our analysis we use both qualitative and quantitative data from focus-group discussions with health care consumers and physicians, and in-depth interviews with policy makers and health insurance representatives. Results Our findings suggest that the reasons behind the unpopularity of user fees might be (a) the rejection of the objectives of user fees defined by the government, (b) negative personal experiences with user fees, and (c) the general mistrust of the Hungarian population when it comes to the utilization of public resources. Conclusion Successful policy implementation of user fees requires social consensus on the policy objectives, also there should be real improvements in health care provision noticeable for consumers, to assure the fees acceptance.

Toward a positive psychology of coping with anticipated events.

Many people appear to be quite resilient to significant stress suggesting that they may possess an orientation to events and life that is resistant to such threats. We propose that one significant aspect of this orientation is tendency to view adversities as something that can happen to anyone and is reflected in tendency of people entering uncertain contexts to prepare by imagining a range of possible outcomes, both desired and undesired. This preparatory work facilitates immediate implementation of effective problem solving and support seeking strategies should desired outcome seem in doubt. We refer to this orientation as realistic orientation and review evidence suggesting that such an orientation is associated with realistic ? but not unrealistic ? optimism and smooth adaptation to adversity. Keywords: proactive coping, realistic orientation, optimism Research on psychological dimensions of human stress has been rooted historically in clinical psychology, where, understandably, concern has been with alleviating distress and faciUtating adaptation (SeUgman & Csikzszentmihalyi, 2000). Presented with clients suffering from debilitating grief, depression, anxiety, chronic pain, and a variety of other distressing conditions with psychological aspects, psychologists' attention focused on ways to understand stress and coping, and how they might help alleviate distress they saw in their clients. Psychologists' attempts to understand what it means to adapt were therefore based on experiences of those who were seeking help. As has been noted, such an understanding may lead to a view of coping and adjustment that does not apply outside of help-seeking or clinical domain (e.g., Taylor & Brown, 1988). As research turned to understanding how people who do not seek treatment adjust to adversity and grow, a positive psychology of human adaptation was born. Positive psychology represents a branch of psychological science concerned with understanding development of well-being, virtue, and resilience. Our perspective is that well-being, virtue, and resilience are achieved by complex strivings that are not attributable merely to being optimistic, focusing on positive, and expressing positive emotions. Rather, well-being, virtue and resilience come by a variety of means, some of which include thoughtful reflection on a wide range of positive and negative personal experiences (past and present), by pursuing intrinsically meaningful and challenging goals, and by developing a realistic understanding of oneself (one's abiUties, strengths, weaknesses) and context or environment in which one finds oneself (Colvin & Block, 1994). This is not to say that optimism, focusing on positive, and expressing positive emotions are not involved in development of well-being, virtue, and r?sinent outcomes, but rather that they do not tell whole story. Thusly, our notion of positive psychology does not ignore or downplay negative thoughts, negative emotions, or doubts. Indeed, a number of studies suggest that active processing or contemplation of negative and threatening information plays an important role in health, well-being, and personal growth (e.g., Davis & Morgan, 2008; Niederhoffer & Pennebaker, 2009; Larsen, Hemenover, Norris, & Cacioppo, 2003). The focus of much of our work concerns processes by which everyday people appraise and respond to particular meanings engendered in major stressful events and situations (e.g., Davis & Morgan, 2008; Davis, Nolen-Hoeksema, & Larson, 1998; Davis, Wohl, & Verberg, 2007; Davis, Wortman, Lehman, & Silver, 2000). The death of one's spouse, for instance, carries many meanings (the loss of a soulmate, loss of shared memories, perhaps a loss of faith or hope, shattering of dreams), and each one of these meanings represents an issue that may need to be addressed in coping with the loss. …

Les effets de l’écriture expressive sur la santé physique et psychologique des rédacteurs : un bilan, des perspectives de recherches

This review is organized in three sections in order to evaluate if expressive writing (namely, to report emotions and deep thoughts concerning positive or negative personal experiences) has a beneficial impact on the physical and psychological well-being of writers. Part 1 reviews studies that showed a beneficial influence of expressive writing. Part 2 is devoted to the examination of the theories for explaining the processes of emotional and cognitive regulation at work during writing disclosure (Disinhibition theory, Cognitive-processing theory, Self-regulation theory, Exposure theory). Findings of several meta-analyses designed to probe the power and validity of results and models are presented. The necessity of a better understanding of the processes by which expressive writing can transform emotional state and intrusive thoughts among writers is examined within the framework of concepts of cognitive psychology involved in writing productions. It is now crucial to use the knowledge of the cognitive approach of written productions for identifying the cognitive-emotional operations that are involved in disclosures and their dependency upon attentional resources of working memory.

Exploring contraceptive knowledge and use among women experiencing induced abortion in the Greater Accra Region, Ghana.

Using a qualitative research methodology, twenty-four semi-structured interviews were conducted with women with induced abortion experiences at Korle Bu and Tema Hospitals in the Greater Accra Region, Ghana. Results suggest that these women tended not to have knowledge of contraceptive methods prior to the abortion, while others were informed but failed to use for a variety of reasons ranging from rumours of side effects to personal negative experiences with modem contraceptive methods. A few women also stated contraceptive failure as a reason for their unintended pregnancies that were later aborted. Peer and reproductive health education must be reinforced in communities in the Greater Accra Region to curb adolescents engaging in early sex and should challenge the existing rumours associated with contraception in Ghana. In addition, family planning services in terms of appropriate methods with no side effects must be made available to women in the reproductive ages.

Reflections and Legal Analysis of the Relationship between “Religious Government and Human Rights” from the Perspective of Grand Ayatullāh Muntazirī

AbstractThis article discusses the book "Religious Government and Human Rights" (Hukūmat-i dīn-i wa huqūq-i insān) by the Shiite Grand Ayatullāh Husayn 'Alī Muntazirī (1922-2009). In this work, he explicitly tackles central issues of religious government and discusses its incongruity with human rights. He advocates the recognition of human rights along general lines, and positions himself firmly against absolutist Islamic rule, thereby undermining the concept of religious authority currently prevalent in the Islamic Republic. Muntazirī justifies these moves by applying the traditional method of jurisprudence (usūl al-fiqh), calls for re-arranging the system of how sections of the law are structured and even for the possibility of adding entirely new articles. Iğtihād for him is the renewal of jurisprudence in accordance with the Zeitgeist, with changing social conditions and with scientific discoveries. Jurisprudence, in contrast to revelation, is the work of man and can therefore be questioned and adapted in the light of the principles of reason ('aql). Muntazirī calls for a fresh review of jurisprudence based on the liberal human rights of our time. He also stresses the permanent and universal character of these natural and fundamental rights, which apply in all situations and under all conditions despite cultural and religious differences. For Muntazirī, these fundamental rights are deduced from the very essence of man's existence (insāniyat-i insān), which constitutes their only legitimate source. The roots for Muntazirī's oppositional and critical stance towards the Islamic Republic and its despotic system of rule lie first and foremost in his negative personal experiences with the system. Gradually, these gave way to a critical and more liberal concept of religion and political authority in his thought.

Personal narratives, well-being, and gender in adolescence

Relations between narratives, especially the inclusion of internal state language within narratives, and well-being have been found in adults. However, research with adolescents has been sparse and the findings inconsistent. We examined gender differences in adolescents’ personal autobiographical narratives as well as relations between internal state language and emotional well-being. Mirroring previous research with different age groups, we found that females narrate both positive and negative personal experiences in more emotional ways than do males. Also, adolescent females include more cognitive processing words indicative of self-reflection than do adolescent males. Adolescent males who told personal narratives richer in internal state language displayed higher levels of well-being, but there were no relations between internal state language in personal narratives and well-being for adolescent females. These results are interpreted in terms of gender differences in emotional processing and understanding. Directions for future research are discussed.

Childhood and adulthood traumatic experiences in patients with psoriasis

It is well known that several psychiatric disorders may be related to childhood psychological trauma. Recent studies have associated childhood exposure to trauma to some skin diseases. Our study aimed at exploring whether psoriasis is related to the reported positive and negative traumatic life events in different age intervals beginning from early childhood to adulthood. Furthermore, we investigated differences between psoriatics with early and late onset according to traumatic experiences in different age intervals. Also, we investigated the possible correlation of traumatic experiences with the disease severity. One hundred patients with psoriasis and 101 controls (patients with skin conditions considered to be "non-psychosomatic") were enrolled in the study. All participants completed a specific questionnaire measuring traumatic life experiences (Traumatic Antecedents Questionnaire, TAQ). The TAQ assesses positive personal experiences (competence and safety) and negative personal experiences (neglect, separation, secrets, emotional, physical and sexual abuse, trauma witnessing, other traumas and exposure to alcohol/drugs) from early childhood to adulthood. The severity of psoriasis was estimated according to the Psoriasis Area and Severity Index (PASI), a standardized measuring instrument. The amount of positive experiences did not differ significantly among groups, except for safety scores that were higher in controls compared with both psoriatic groups (early and late onset). On the other side, negative traumatic experiences appeared more frequently in patients with psoriasis during all developmental periods. We found no correlation between severity of psoriasis and traumatic experiences. The present study demonstrates an increased history of childhood and adulthood negative traumatic experiences in patients with psoriasis compared to the control group. Our findings suggest a relationship between retrospectively reported negative traumatic experiences and psoriasis.

A Qualitative Analysis of Decision-Making for Total Knee Replacement in Patients With Osteoarthritis

Variation in the utilization of total knee arthroplasty (TKA) for patients with osteoarthritis has been well documented. Conceivably, patient preferences may play a major role in these differences; however, this has not been adequately assessed. The purpose of this study was to conduct a qualitative analysis of decision-making factors influencing preferences for TKA in patients with knee osteoarthritis. We conducted 6 focus groups of patients with knee osteoarthritis from diverse ethnic backgrounds attending primary care clinics affiliated to the largest private outpatient institution in Houston, TX. All groups were lead by race-concordant facilitators. The group discussions were centered on factors considered to be important in the decision-making for TKA. Thematic analysis was conducted, using a grounded theory approach aided by qualitative software. Several themes emerged from the groups' discussions. Positive and negative personal experiences played a major role in decision-making. Generally, participants had good expectations about improved function and quality of life, but a number of fears were identified, the most prevalent being fear of a lengthy recovery, followed by fear of complications and of anesthesia. Additional emerging themes included trust in surgeon, financial concerns, and worries about general health. The attitudes and beliefs of patients with knee osteoarthritis about TKA are largely based on personal experiences, expectations, and fears, and they are largely influenced by their close social environment. These findings emphasize the need for open doctor-patient communication around individual experiences to achieve satisfactory shared decision-making for TKA.

Health, Emotion and the Body

Health, Emotion and the Body