Psychosocial Area Research Articles

Psychiatric symptomatology and health‐related quality of life in children and adolescents with alopecia areata

There is a very limited amount of data available regarding the relationship between alopecia areata (AA) and psychiatric morbidity and quality of life (QoL) in children and adolescents. The aim of this study was to determine the psychiatric state and health-related quality of life (HRQL) of children and adolescents with AA, as well as their relationships with clinical parameters. The sample consisted of 74 children with AA aged 8-18years. Questionnaires were used to evaluate the psychiatric status and HRQL of the patients. The study and control groups were divided into child and adolescent groups to exclude the effect of puberty on psychological condition. In the child group, patients had higher state anxiety and trait anxiety scores; they also had lower parent-rated psychosocial and total area HRQL scores than the controls did. In addition, the depression score was prone to show a positive relationship with having AA in the children. In the adolescent group, however, only the state anxiety score had a significant association with AA. All of the parent-rated HRQL scores were also prone to being lower compared with controls in this age group. Regarding determinants of HRQL, prolonged disease duration and later disease onset had positive effects, whereas severity of scalp involvement, trait anxiety and depression had negative effects, for the sample as a whole. Alopecia areata is associated with poor psychiatric status and QoL, especially in childhood. The impact of the disease on QoL occurs through both clinical and psychiatric parameters.

Developing a Psycho-Oncology Program in Cancer Settings. Experiences from Southern Europe: the models of Ferrara and Lisbon

Following the indications and recommendations of associations, institutions, and councils around the world, psycho-oncology should have a mandatory function in programs within the health system, with particular references to oncology. The steps in the development of psycho-oncology services and/or units; their functions in terms of clinical, educational, and research activities; the standards that should be respected; and the organizational characteristics are discussed. With regards to this, the experience of Southern Europe and countries, specifi - cally the models developed in Ferrara, Italy and Lisbon, Portugal, are presented. The objective of psycho-oncology, namely that no cancer health is possible without taking into consideration mental health, and, consequently, it is not possible to provide cancer care without a specific investment in the psychosocial area, represents the challenge for the health system.

Couple dynamics and coping with diabetes

Couple dynamics and coping with diabetes

A menina que se constituiu no contexto do tráfico: o estudo psicossocial forense e o resgate da função paterna

Neste artigo discutimos a questão da complementaridade entre a Psicologia e o Direito. O texto tem seu centro no estudo psicossocial forense de um pedido de guarda de um pai sobre sua filha e envolve ligação com o tráfico de drogas. Este estudo oportuniza o resgate do valor da Justiça como um momento propício para que significados ocultos dos conflitos familiares sejam esclarecidos. A questão é como o Setor Psicossocial pode garantir o melhor interesse da criança? Apontamos a concepção de pai de família, como aquele que tem um lugar e uma responsabilidade social. A Justiça clama por este pai.

Illness Experience of People with Chronic Hepatitis B in Korea

The purpose of this study was to explore the experiences of people with chronic hepatitis B (CHB) in Korea. The specific aim was to identify major problems that people with CHB face and strategies that they are dealing with. A grounded theory method was utilized. The data were collected by individual in-depth interviews from 12 CHB patients from one of the major hospitals in Korea. After constant comparative analysis, a core category emerged as "illness management with self-reliance and will." Seven major strategies that were identified in dealing with the illness were maintaining receptive and positive attitudes; restraining excessive work and greed; searching for information; controlling illness information; adhering to practices for not spreading the viral disease; abstaining from alcohol and smoking and maintaining healthy eating habits; nd using alternative therapies. The outcomes that result from employing these strategies were identified as burden, depression and helplessness, stress for maintaining compliance, and dispirited interpersonal relationships. The results of this study suggest that most people with CHB in Korea have problems in psychosocial area. Thus health professionals need to provide not only informational support but also emotional one to improve quality of life of the people with CHB.

Risk factors for lower health‐related QoL after allogeneic stem cell transplantation in children

To explore risk factors affecting HrQoL, we analyzed data from patients (n = 51) at least three yr beyond SCT and their parents (n = 41), who responded to the SCHQ, to a subjective symptom inventory and to a sense of coherence instrument, in parallel with a physician-rated scoring of late effects. Children with leukemia rated a lower HrQoL than children with non-malignant disease only in subscale RE, limitations in role socially because of the emotional difficulties (p < 0.05) but had more severe late effects (p < 0.05). Parents of children with leukemia rated their children's HrQoL overall lower in both the psychosocial area and physical area (p < 0.01) and the child's condition also had a greater impact on parents' emotional situation (p < 0.05), compared with parents of children with non-malignant diagnosis. The psychosocial HrQoL was more affected in recipients of an unrelated than of a sibling graft, according to both child (p < 0.01) and parent (p < 0.05). In the multiple regression analysis, however, late effects remained the only independent factor, contributing to low parental psychosocial (p < 0.05) and physical (p < 0.001) HrQoL ratings, while leukemia, unrelated donor and TBI did not. To conclude, parent-reported HrQoL was lower in SCT patients with leukemia, mainly due to a higher impact of late effects in this group.

Avaliação das habilidades cognitivas, da comunicação e neuromotoras de crianças com risco de alterações do desenvolvimento

O objetivo deste estudo foi avaliar habilidades neuropsicomotoras e funcionais de crianças que apresentaram, no primeiro ano de vida, história clínica de risco para alterações do desenvolvimento, quanto às áreas motora, cognitiva, lingüística e psicossocial. Foram avaliadas 60 crianças, classificadas em dois grupos: o Grupo Experimental (GI), composto por 30 crianças com idade cronológica variando de zero a dois anos e onze meses, ambos os sexos, tendo história de intercorrências peri, pré e pós-natal e/ou atraso neuropsicomotor; o Grupo Controle (GII), formado por 30 crianças sem história de alterações do desenvolvimento, pareadas quanto ao sexo e idade. Os resultados indicaram que, na comparação entre grupos, (GI e GII), GI apresentou diferença estatisticamente significante nas áreas motora, de linguagem e cognitiva. Na análise da comparação entre áreas, as de maior prejuízo foram a da linguagem e motora, seguido da cognitiva. A área psicossocial foi a menos comprometida e na comparação entre grupos os escores não foram estatisticamente significantes. Isto demonstra a influência dos fatores de risco no processo de desenvolvimento e a importância do acompanhamento precoce às crianças que apresentam histórico de intercorrências.

The Climacteric Symptoms and Quality of Life in Climacteric Women according to Hormone Replacement Therapy

The purpose of this study is to find the difference of the climacteric symptoms and quality of life according to hormone replacement therapy (HRT) in climacteric women. The research design was a descriptive survey with questionaries. A convenience sample of 181 climacteric women aged 45-65 who had climacteric symptoms were selected in Kwangju city, Korea. Sixty-six climacteric women among those subjects were receiving HRT at K university hospital in Kwangju city. Data were collected by the interview with questionaries from Feb 3. 1999 to March 25, 1999. Climacteric symptoms were measured using scores developed by Neugarten(1965) and modified by Park(1989), and the quality of life scale related to climacteric symptoms developed by Hildtich(1996) and modified Kim(1998). Data were analyzed by z 2-test, t-test, ANOVA and Pearson's correlation procedures, using SAS/win PC+. The results were as follows 1. No statistically significant differences were found between the receiving HRT group and not receiving HRT group in demographic, obstetrical and health related characteristics.2. There were no significant difference on the climacteric symptoms between the group of women receiving HRT (score 2.4) and the group of women who were not (score 2.6) except psychological area (t=2.407, p=0.017).3. The quality of life of the group of women receiving HRT was significantly higher than that the group of women who were not (t=2.151, p=.032).4. The quality of life of the group of women receiving HRT were high scores There were significantly high of the quality of life in the vaso-motor change area (t=2.634, p=0.009), psycho-social change area (t=3.239, p=0.001), and physical change area (t=2.031, p=0,043) in the group of receiving HRT compared to not receiving HRT group.5. The variables showed significantly differences on the degree of climacteric symptoms of the group of women not receiving HRT were the subjective health state (t=15.81, p=0.000), age (t=7.50, p=0.007), feeling of menopause (t=30.88, p=0,000) and climacteric periods (t=8.66, p=0.003), and receiving HRT were number of para (t=3.95, p=0.050) and feeling of menopause (t=3.94, p=0.050).6. The variables showed significantly difference on the quality of life of the group of women not receiving HRT were the subjective health state (t=4.14, p=0.044) and feeling of menopause (t=10.86, p=0.001).7. There were significantly positive correlations between the climacteric symptoms and the quality of life in climacteric women (r=0.512, p=0.000).

Effects of the implementation of the Resident Assessment Instrument on gaps between perceived needs and nursing care supply for nursing home residents in the Netherlands

This study evaluated the effects of the implementation of the Resident Assessment Instrument (RAI) on gaps perceived between residents’ needs and nursing care received in Dutch nursing homes. In a controlled group design residents were interviewed before and after the implementation. Most gaps were perceived in the psycho-social area rather than physical or needs with aids and facilities. In general, perceived gaps decreased more strongly in the experimental group. The results give an indication that assessment using RAI leads to a better meeting of the residents’ perceived needs. More research is needed to investigate the quality of the assessment using RAI in more detail.

Chronic disease, the chronic patient and his family. Psychosocial impact of diabetes mellitus

Concerning a revision about the mutual influence between the diabetes, the diabetic and his family, the author reviews the literature about the psychosocial area of the Family Physician content's work. It is also confirmed the high prevalency of the chronic disease and the importance of the family ecosystem, not only as support but also as problem to the bearing person of such type of disease. Studies of chronic disease indicate that family dysfunction is associated with poor health outcomes. The areas which more and better have been studied in this scope are reviewed. Thus, having as backdrop the diabetes management, the family's diabetic influence in general is reviewed, as well as the parental attitudes, the family organization and the family life events. Finally, the health care team role is reviewed and particulary the role of the family physician in the management of this type of patients. It is pointed out, as example of the Family Medicine specific contribution, the improving cooperation with medical treatment from the diabetic.

Is fibromyalgia equivalent to major depression?

s from C-L Forum Agenesis of the corpus callosum (ACC) is an infrequent malformation of the central (nervous system that appears to be closely linked with failure to develop local limbic structures, both derived embryogenetically from the same formation (Lamina terminalis) and frequently reported in association with other malformations of the nervous system. From a fp the psychosis appeared at a mean age of 15. These features were observed in 18 of the 31 individuals older than 15. As the 33 others were younger, their clinical evolution is as yet unknown. Ten of 18 had a partial or total ACC; its presence or absence was unrelated to the clinical course. We suggest that the psychotic syndrome could be due to limbic malformations associated with the commissural defect and that its onset at adolescence or early adulthood supports the Weinberger hypothesis of a congenital brain lesion clinically silent until the critical period of vulnerability brought on by adolescence. Is Fibromyalgia Equivalent to Major Depression? Douglas H. Finestone East Carolina School of Medicine, Greenville, NC This pilot study sought to determine if fibromyalgia patients suffer from major depression. Fibromyalgia is a chronic, nonarticular rheumatic syndrome characterized by generalized aches or stiffness, and accompanied by specific anatomical sites of tenderness. Fibromyalgia patients frequently complain of fatigue, diminished concentration, and poor sleep. We studied 15 inpatients with incapacitating fibromyalgia for evidence of major depression. The mean patient age was 42, 87% were female, 93% were white, and 80% were married. Two-factor Hollingshead SES ratings averaged 3.5. Twenty-seven percent of patients had a DSM-III diagnosis of major depression; two other patients (13%) had a past history of major depression. SCL-90-R depression subscale scores were significantly elevated in 40% of patients; MMPI depression subscale scores were greater than 70 in 53% of patients. Twenty percent of patients had Carroll Depression Scale scores consistent with severe depression. All lab data were obtained after at least a 2-week drug washout period. Overnight polysomnograms displayed at least moderate evidence of major depression in 20% of patients. Four of 10 patients (40%) for whom 3 and 9 p.m. samples were drawn had a positive DST. Mean platelet (‘H)-imipramine receptor density (Bh,.,,) in 11 patients (1091.74) did not differ significantly from 11 ageand sex-matched normal control subjects (1043.00), but did differ significantly (p less than 0.01) from 11 ageand sex-matched patients with DSM-III major depression (554.89). Our preliminary findings support the clinical impression that depressive symptoms are common in fibromyalgia patients. Our results do not support fibromyalgia to be equivalent to major depression. Psychological Prognostic Factors in Patients with Acute Lymphoblastic Leukemia: Long-Term Follow-up N. Fisman, M.T. Santarelli, S. Pavlovsky, G. Garay GATLA (Grupo Argentina de Tratamiento de la Leucemia Aguda) Psychosocial Area, city, state, country The objective of this study was to ascertain whether acute lymphoblastic leukemia patients (ALL PTS) with good psychological prognosis (GPP) achieved a longer survival (SV) period than those with poor psychological prognosis (WI’), and if there is any relation between organic and psychological prognosis features. Ninety-five MS belonging to six consecutive ALL GATLA treatment protocols were psychologically evaluated through individual and family interview and projective techniques administered during induction period, without knowing the medical prognosis (MI’). Items scored were ego strength, defense pattern, preferential area of expression of conflicts, diseases suffered, disease and death throughout life, changes and losses. Total items were 14; each positive was scored 1 and each negative was scored 2. Fifty-four PTS scored 5 20 as PPP. The probability of complete remission (CR), event-free survival (EFS), and SV at 150 months is as follows:

A Mid-Career Perspective of Mental Health Practice

The mental health practice area in occupational therapy has contracted during the 1980s. The practice area has been strongly affected by changing social values, reimbursement requirements and demographic trends. This paper offers a perspective on the realities, challenges and benefits of a career in mental health occupational therapy. The paper may be used by educators and supervisors in discussing the psychosocial dysfunction practice area with students.

Rehabilitation of the breast cancer patient.

No treatment program for breast cancer is complete without arrangements for rehabilitation. This includes consideration of the emotional and psychosocial factors, as well as the physical problems that arise as the result of the treatments. The most important person in planning rehabilitation is the treating physician, but a multidisciplinary team provides optimal results. In recent years, the most dramatic improvements in rehabilitation have been seen in the psychosocial area, but improvements have also been made in restoring the patient to normal physical activity.

Social entropy, enthalpy, exergy and disergy in examples

For the thermodynamic terms entropy, enthalpy and exergy, parallel terms for the psychosocial area of communication are illustrated. The thermodynamic notion energy is paralleled by dynamic information, the molecule by a goal-oriented social individual, exergy by the maximum goal attainment of the individuals who constitute a communication system, enthalpy by the will of action and the associated activity and entropy by the density of communication, the amount of information exchanged and the classification of communication (as devotional, aggressive or destructive). The absolute temperature in thermodynamics is paralleled by the speed with which information is exchanged. The term disergy ( distracting en ergy) is added and illustrated in cases where the communication system is open to outside environment.

Assessing physician/patient perceptions in rheumatoid arthritis. A vital component in patient education

Patient education surveys were completed by 101 patients with rheumatoid arthritis and by 28 rheumatologists to assess and compare patients' reports with physicians' perceptions of patients' needs regarding content, provider, and education program delivery methods. Both groups agreed on the importance of patients' education about arthritis, especially on the topics of medication, physician/patient communication, quackery, and maintaining ambulation. A higher proportion of physicians reported that patient education was needed in psychosocial areas, activities of daily living, sexual concerns, and community resources. Patients sought more education in disease process, diagnostic procedures, and nutrition. Patients rated pharmacists and nutritionists significantly more important as educational sources than did physicians. Both groups reported individual patient/practitioner meetings as the preferred delivery method. Physicians reported group education to be valuable for some psychosocial topics; patients disagreed significantly. Despite considerable consensus, disagreements were evident in the psychosocial area and in the role of allied health professionals. Clarification, understanding, and resolution of these differences should be sought before implementing patient education programs.

The Prevalence of Burnout in Occupational Therapists

Burnout is a stress which may affect an health all health professionals. In this paper its process, causes and characteristics in various health professions are outlined. A survey of burnout in Australian occupational therapists was conducted. The results show that occupational therapists working in the psychosocial area have significantly more burnout on the measure of frequency of feelings of personal accomplishment than do those working in paediatric or physical rehabilitation areas. These feelings are related to specific differences in job characteristics. Implications for prevention of burnout are discussed.

Nurses and social workers in home health care: identifying and resolving turf conflict.

A survey of role perceptions of nurses and social workers employed in home health care in Washington State indicated potential turf conflict in a number of roles involved in home care of elderly patients. Nurses tended to perceive themselves capable of all patient-directed tasks and perceived few professional tasks in home health care as the unique domain of social work. This attitude was in sharp contrast to social workers' perceptions, particularly regarding tasks in the psychosocial area. Strategies for identifying and overcoming professional turf conflict in home health care agencies are discussed.

Obstetric, Neonatal, and Psychosocial Outcome of Pregnant Adolescents

Obstetric, neonatal, and psychosocial outcomes were compared for 82 matched adolescents who had been pregnant, been delivered of an infant, and received health care in three sites in Rochester, New York. There were no major differences in obstetric and neonatal outcome of adolescents and their babies according to health site. Differences in outcome were expected in the psychosocial area where a specialized maternity project (Rochester Adolescent Maternity Project [RAMP]) offered more services. On follow-up two years later, school attendance and reliance on full or partial assistance were similar. Repeated pregnancy and postpartum use of contraception favored RAMP.

Adolescents and the high school system.

This paper studies the social organization of high schools and questions whether the structures of the social systems that have been created meet the developmental needs of adolescents. The need of the schools to change to meet these needs is enhanced because the breakdown of the social networks of society have made schools the only stable psychosocial developmental area for many pupils. Adolescents are considered in their two early stages, early and middle, and the specific needs of these age groups are related to the social organization of the school. In particular, the size of the school, the change in ages of children from school to school, the structure of groups are considered. Necessary changes, if there is to be improvement in teacher-pupil relationships, are discussed.