Enquiring about traumatic experiences in psychosis: A comparison of case notes and self-report questionnaires

Purpose: Studies have found an association between a history of trauma and the presence of psychotic symptoms. Despite the research evidence it appears to be the case that many clinicians are not routinely asking about traumatic experiences. This study aims to ascertain the level of agreement between rates of self-reported trauma and that which is recorded in case notes.

Methods: The study population was drawn from all individuals with a confirmed diagnosis of psychosis, residing within a defined catchment area. Rates of childhood trauma, lifetime trauma and trauma related to the Troubles in Northern Ireland recorded in participants’ case notes were compared to their responses on self-report questionnaires: THQ, CTQ and TREQ.

Results: Relatively high levels of trauma were reported by participants on the self-report measures that were administered. The rates of trauma recorded in case note records were similar to that found in other studies. Also in line with other research were poor levels of agreement between self-report and case note data.

Conclusion: High levels of lifetime, childhood and trauma related to the Troubles in Northern Ireland were found when the individuals in the sample were directly assessed for the purposes of this study. In contrast much lower rates were recorded in patient notes on routine clinical assessment. The results suggest that clinicians do not routinely enquire about trauma histories with this population and as a result, case notes underestimate trauma prevalence.

Family relationships and learning experiences in anxious vs. non-anxious families: Are there differences ?

L'objectif principal de ce travail était d'explorer les relations parent-enfant et les processus d'apprentissage familiaux associés aux troubles anxieux. A cet effet, des familles ayant un membre anxieux (la mère ou l'enfant) ont été comparées avec des familles n'ayant aucun membre anxieux. Dans une première étude, l'observation de l'interaction mère-enfant, pendant une situation standardisée de jeu, a révélé que les mères présentant un trouble panique étaient plus susceptibles de se montrer verbalement contrôlantes, critiques et moins sensibles aux besoins de l'enfant, que les mères qui ne présentaient pas de trouble panique. Une deuxième étude a examiné les perceptions des différents membres de la famille quant aux relations au sein de la famille et a indiqué que, par comparaison aux adolescents non-anxieux, les adolescents anxieux étaient plus enclins à éprouver un sentiment d'autonomie individuelle diminué par rapport à leurs parents. Finalement, une troisième étude s'est intéressée à déterminer l'impact d'expériences d'apprentissage moins directes dans l'étiologie de l'anxiété. Les résultats ont indiqué que les mères présentant un trouble panique étaient plus enclines à s'engager dans des comportements qui maintiennent la panique et à impliquer leurs enfants dans ces comportements, que les mères ne présentant pas de trouble panique. En se basant sur des recherches antérieures qui ont établi une relation entre le contrôle parental, la perception de contrôle chez l'enfant et les troubles anxieux, le présent travail non seulement confirme ce lien mais propose également un modèle pour résumer l'état actuel des connaissances concernant les processus familiaux et le développement des troubles anxieux. Deux routes ont été suggérées par lesquelles l'anxiété pourrait être transmise de manière intergénérationnelle. Chacune de ces routes attribue un rôle important à la perception de contrôle chez l'enfant. L'idée est que lorsque les enfants présentent une prédisposition à interpréter le comportement de leurs parents comme hors de leur contrôle, ils seraient plus enclins à développer de l'anxiété. A ce titre, la perception du contrôle représenterait un tampon entre le comportement de contrôle/surprotection des parents et le trouble anxieux chez l'enfant. - The principal objective of the present work was to explore parent-child relationships and family learning processes associated with anxiety disorders. To this purpose, families with and without an anxious family member (mother or child) were compared. In a first study, observation of mother-child interaction, during a standard play situation, revealed that mothers with panic disorder were more likely to display verbal control and criticism, and less likely to display sensitivity toward their children than mothers without panic disorder. A second study examined family members' perceptions of family relationships and indicated that compared to non-anxious adolescents, anxious adolescents were more prone to experience a diminished sense of individual autonomy in relation to their parents. Finally a third study was interested in determining the effect of less direct learning experiences in the aetiology of anxiety. Results indicated that mothers with panic disorder were more likely to engage in panic-maintaining behaviour and to involve their children in this behaviour than mothers without panic disorder. Based on previous research showing a relationship between parental control, children's perception of control, and anxiety disorders, the present work not only further adds evidence to support this link but also proposes a model summarizing the current knowledge concerning family processes and the development of anxiety disorders. Two pathways have been suggested through which anxiety may be intergenerationally transmitted. Both pathways assign an important role to children's perception of control. The idea is that whenever children have a predisposition towards interpreting their parents' behaviour as beyond of their control, they may be more prone to develop anxiety. As such, perceived control may represent a buffer between parental overcontrolling/overprotective behaviours and childhood anxiety disorder.

Back to School, Back to Normal? Exploring the Lived Experiences of Childhood Cancer Survivors and their Families Throughout the School Re-Entry Process

This study investigated parent and child perspectives of childhood cancer survivors' return to school. Four specific areas were examined including cognitive and academic concerns, social issues, perceived support, and the impact on siblings. Participants consisted of parents and childhood cancer survivors who were recruited through a regional parent support group. Data was collected during a focus group and interviews. Using a descriptive content analysis, results indicated that participants generally received the necessary resources, however issues such as consistency and having to advocate in order to attain these resources served as barriers for the families.

Maltreatment and family dysfunction in childhood and the subsequent adjustment of children and adults

The adjustment problems associated with sexual abuse, physical abuse, psychological maltreatment, neglect, and witnessing family violence during childhood were examined in three studies. Study 1 demonstrated significant overlap between maltreatment types in parent reports (N = 50) of maltreatment experiences of their child aged 5–12 years. Parental sexual punitiveness, traditionality, family adaptability and family cohesion significantly predicted scores on 4 maltreatment scales and children's externalizing behavior problems. Level of maltreatment predicted internalizing, externalizing, and sexual behavior problems. In Study 2, significant overlap was found between adults' retrospective reports (N = 138) of all 5 types of maltreating behaviors. Parental sexual punitiveness, traditionality, family adaptability, and family cohesion during childhood predicted the level of maltreatment and current psychopathology. Although child maltreatment scores predicted psychopathology, childhood family variables were better predictors of adjustment. Study 3 demonstrated that child maltreatment scores predicted positive aspects of adult adaptive functioning (N = 95).

General anaesthesia or conscious sedation for painful procedures in childhood cancer: the family's perspective

Background: Until recently, midazolam sedation was routinely used in our institution for bone marrow aspirates and lumbar punctures in children with cancer. It has been perceived by many doctors and nurses as being well tolerated by children and their families.

Aim: To compare the efficacy of inhalational general anaesthesia and midazolam sedation for these procedures.

Methods: A total of 96 children with neoplastic disorders, who received either inhalational general anaesthesia with sevoflurane, nitrous oxide, and oxygen (GA) or sedation with oral or nasal midazolam (SED) as part of their routine preparation for procedures were studied. The experiences of these childen were examined during their current procedure and during their first ever procedure. Main outcome measures were the degree of physical restraint used on the child, and the levels of distress and pain experienced by the child during the current procedure and during the first procedure. The family‘s preference for future procedures was also determined.

Results: During 102 procedures under GA, restraint was needed on four occasions (4%) when the anaesthetic mask was first applied, minimal pain was reported, and children were reported as distressed about 25% of the time. During 80 SED procedures, restraint was required in 94%, firm restraint was required in 66%, the child could not be restrained in 14%, median pain score was 6 (scale 0 (no pain) to 6 (maximum pain)), and 90% of the parents reported distress in their child. Ninety per cent of families wanted GA for future procedures. Many families reported dissatisfaction with the sedation regime and raised concerns about the restraint used on their child.

Conclusions: This general anaesthetic regime minimised the need for restraint and was associated with low levels of pain and distress. The sedation regime, by contrast, was much less effective. There was a significant disparity between the perceptions of health professionals and those of families with respect to how children coped with painful procedures.

Self-reported attenuated psychotic-like experiences in help-seeking adolescents and their association with age, functioning and psychopathology

OBJECTIVE Self-rated attenuated psychotic-like experiences (APLEs) are increasingly used to screen for ultra-high-risk (UHR) across all ages. However, self-rated psychotic-like experiences (PLEs), in particular perception-related ones, were more frequent in children and adolescents, in which they possessed less clinical significance. We therefore explored the prevalence of different factors of APLEs in help-seeking adolescents, and their relationship with age, functioning and psychopathology METHOD As a part of the "Liberiamo il Futuro" project, help-seeking adolescents (N=171; 11-18years, 53% male) were screened with the 92-item Prodromal Questionnaire (PQ-92). A factor analysis was performed on the PQ-92 positive items (i.e., APLEs) to identify different APLE-factors. These were assessed for their association with age, functioning and psychopathology using regression analyses. RESULTS APLEs were very common in help-seeking adolescents, and formed four factors: "Conceptual Disorganization and Suspiciousness", "Perceptual Abnormalities", "Bizarre Experiences", and "Magical Ideation". Associations with age and functioning but not psychopathology were found for "Perceptual Abnormalities" that was significantly more severe in 11-12-year-olds, while "Conceptual Disorganization and Suspiciousness" was significantly related to psychopathology. CONCLUSION In line with findings on PLEs, prevalence and clinical significance of APLEs, especially perception-related ones, might depend on age and thus neurodevelopmental stage, and may fall within the normal spectrum of experience during childhood. This should be considered when screening for UHR status in younger age groups

Sexual abuse in childhood and sexual dysfunction in adulthood: An Australian population-based study

This study examined self-reported adult sexual functioning in individuals reporting a history of childhood sexual abuse (CSA) in a representative sample of the Australian population. A sample of 1793 persons, aged 18-59 years, were randomly selected from the electoral roll for Australian states and territories in April 2000. Respondents were interviewed about their health status and sexual experiences, including unwanted sexual experiences before the age of 16 years. More than one-third of women and approximately one-sixth of men reported a history of CSA. Women were more likely than men to report both non-penetrative and penetrative experiences of CSA. For both sexes, there was a significant association between CSA and symptoms of sexual dysfunction. In assessing the specific nature of the relationship between sexual abuse and sexual dysfunction, statistically significant associations were, in general, evident for women only. CSA was not associated with the level of physical or emotional satisfaction respondents experienced with their sexual activity. The total number of lifetime sexual partners was significantly and positively associated with CSA for females, but not for males; however, the number of sexual partners in the last year was not related to CSA. CSA in the Australian population is common and contributes to significant impairment in the sexual functioning of adults, especially women. These consequences appear not to extend to the other areas of sexual activity considered in this study.

The Lifelong Impacts of Adverse Experiences in the Early Years: Final Report

This report is an outcome of a half-day workshop that was held at The Lantern in St. John's on June 1st, 2016. “The Lifelong Impact of Adverse Experiences in the Early Years” brought together about 150 people who are in some way involved with the issue of adverse childhood experiences – that is, chronic neglect or abuse in the early years that is likely to have a negative impact over the entire course of a person’s life. A list of the attendees is provided in appendix, and it shows the wide variety of perspectives represented at the session, including that of clinicians, social workers, health care professionals, academic researchers, teachers, policy advisors and persons with lived experience.

Experiences in Passively Detecting Session Hijacking Attacks in IEEE 802.11 Networks

Current IEEE 802.11 wireless networks are vulnerable to session hijacking attacks as the existing standards fail to address the lack of authentication of management frames and network card addresses, and rely on loosely coupled state machines. Even the new WLAN security standard - IEEE 802.11i does not address these issues. In our previous work, we proposed two new techniques for improving detection of session hijacking attacks that are passive, computationally inexpensive, reliable, and have minimal impact on network performance. These techniques utilise unspoofable characteristics from the MAC protocol and the physical layer to enhance confidence in the intrusion detection process. This paper extends our earlier work and explores usability, robustness and accuracy of these intrusion detection techniques by applying them to eight distinct test scenarios. A correlation engine has also been introduced to maintain the false positives and false negatives at a manageable level. We also explore the process of selecting optimum thresholds for both detection techniques. For the purposes of our experiments, Snort-Wireless open source wireless intrusion detection system was extended to implement these new techniques and the correlation engine. Absence of any false negatives and low number of false positives in all eight test scenarios successfully demonstrated the effectiveness of the correlation engine and the accuracy of the detection techniques.

Towards ubiquitous city : concept, planning, and experiences in the Republic of Korea

Information and communication technologies (ICTs) had occupied their position on knowledge management and are now evolving towards the era of self-intelligence (Klosterman, 2001). In the 21st century ICTs for urban development and planning are imperative to improve the quality of life and place. This includes the management of traffic, waste, electricity, sewerage and water quality, monitoring fire and crime, conserving renewable resources, and coordinating urban policies and programs for urban planners, civil engineers, and government officers and administrators. The handling of tasks in the field of urban management often requires complex, interdisciplinary knowledge as well as profound technical information. Most of the information has been compiled during the last few years in the form of manuals, reports, databases, and programs. However frequently, the existence of these information and services are either not known or they are not readily available to the people who need them. To provide urban administrators and the public with comprehensive information and services, various ICTs are being developed. In early 1990s Mark Weiser (1993) proposed Ubiquitous Computing project at the Xerox Palo Alto Research Centre in the US. He provides a vision of a built environment which digital networks link individual residents not only to other people but also to goods and services whenever and wherever they need (Mitchell, 1999). Since then the Republic of Korea (ROK) has been continuously developed national strategies for knowledge based urban development (KBUD) through the agenda of Cyber Korea, E-Korea and U-Korea. Among abovementioned agendas particularly the U-Korea agenda aims the convergence of ICTs and urban space for a prosperous urban and economic development. U-Korea strategies create a series of U-cities based on ubiquitous computing and ICTs by a means of providing ubiquitous city (U-city) infrastructure and services in urban space. The goals of U-city development is not only boosting the national economy but also creating value in knowledge based communities. It provides opportunity for both the central and local governments collaborate to U-city project, optimize information utilization, and minimize regional disparities. This chapter introduces the Korean-led U-city concept, planning, design schemes and management policies and discusses the implications of U-city concept in planning for KBUD.

'Getting a job' : Aborignal Women's issues and experiences in the health sector

Indigenous participation in employment has long been seen as an indicator of Indigenous economic participation in Australia. Researchers have linked participation in employment to improved health outcomes, increased education levels and greater self-esteem. There has been a dramatic increase in the number of Indigenous workforce policies and employment strategies as employers and industries attempt to employ more Aboriginal and Torres Strait Islander people. Coupled with this has been a push to employ more Indigenous people in specific sectors to address the multiple layers of disadvantage experienced by Indigenous people, for example, the health sector. This paper draws on interview discussions with Aboriginal women in Rockhampton, Central Queensland, along with findings from the research of others to offer a greater understanding of the mixed benefits of increased Indigenous employment. What is demonstrated is that the nature of Indigenous employment is complex and not as simple as ‘just getting a job’.

The role of relational capabilities in developing the capacity for supply chain innovation

The purpose of this paper is to gain a better understanding of the types of relational capabilities supply chain participants develop to enable ongoing supply chain innovation capacity building that produces improved business outcomes. This is exploratory research using qualitative data gathered by using five interviews, with the Australian road freight industry as the context. Two key relational capabilities and the improvement of four key business outcomes were identified as being present in the interaction of freight transport service providers with members of their supply chain. The data also demonstrates that by entering into competence building relationships with customers and suppliers firms can build capabilities that will increase their capacity for supply chain innovation. Even in short term arm’s length relationships firms can acquire improved skills behaviours and practices that enhance their operation effectiveness and the efficiency of the supply chain relationships.

A grounded theory study of nursing students’ experiences in the off-campus clinical setting

Poor workplace relations are an issue of concern in many workplaces and this phenomenon is not restricted to the nursing profession. The issue of workplace violence in nursing is well documented and there are an increasing number of studies which have investigated the notion of horizontal violence amongst graduate nurses. The impact that poor workplace relations has on the development of a professional identity by nursing students in the off-campus clinical setting is significant in light of the current global shortage of nurses. There is a dearth of knowledge in understanding how Australian undergraduate nursing students experience the off-campus clinical setting and subsequently develop a professional identity as a nurse. Therefore the aim of this study was to discover and describe the phenomena in order to develop a substantive theory that explains the experiences of the undergraduate nursing students in a regional setting. Constructivist grounded theory methods were utilised in the conduct of the study. A sample of 29 participants was recruited permitting the formulation of a substantive theory regarding the development of a professional identity in nursing students. This substantive theory contributes knowledge relevant to the undergraduate nursing students, nurse educators, nursing workforce planners, and the tertiary educational institutions offering nursing. This is achieved through discovering, describing and explaining the phenomenon of ‘anxiety’ which the nursing students experience as a result of the interrelationship and interactions of tradition bearing, staff and student performance. These interactions intersect to form expectations of where the student fits within the hierarchy of the facility and the nursing profession in general. An understanding of the issues associated with tradition bearing, staff performance, and student performance and the impact that the interaction of these conditions has upon the student’s developing professional identity as a nurse is necessary to allow for the implementation of corrective strategies.