Effectiveness of a Multi-Component Smoking Cessation Support Programme (McSCSP) for Patients with Severe Mental Disorders: Study Design

Only a few studies have examined the efficacy and safety of smoking cessation programmes in patients with mental disorders. The aim of this paper is to describe in detail the methodology used in the study as well as the Multi-component Smoking Cessation Support Programme in terms of pharmacological treatments and psychological interventions. An open-label 9-month follow-up study was conducted in Spain. A total of 82 clinically stable outpatients with schizophrenia, schizoaffective or bipolar disorder were enrolled. Treatment consisted of a programme specifically developed by the research team for individuals with severe mental disorders. The programme consisted of two phases: (1) weekly individual motivational therapy for 4-12 weeks, and (2) a 12-week active treatment phase. During this phase, at each study visit patients received a one- or two-week supply of medication (transdermal nicotine patches, varenicline or bupropion) with instructions on how to take it, in addition to group psychotherapy for smoking cessation. Evaluations were performed: (1) at the time of enrolment in the study, (2) during the 12-week active treatment phase of the study (weekly for the first 4 weeks and then biweekly), and (3) after the end of this phase (two follow-up assessments at weeks 12 and 24). Evaluations included: (1) smoking history, (2) substance use, (3) psychopathology, (4) adverse events, and (5) laboratory tests. The importance of this study lies in addressing a topical issue often ignored by psychiatrists: the unacceptably high rates of tobacco use in patients with severe mental disorders.

As turbinadas e os pigmaleões: implantes mamários de silicone e a beleza construída

Esta dissertação trata da construção dos valores acerca do corpo que transforma aspectos estéticos em problemas de saúde física. Com base na pressuposição do compromisso de aliviar o sofrimento o cirurgião plástico busca, dentro do campo da saúde, justificativas para sua atuação. Por outro lado, na aspiração por modelos de beleza socialmente prestigiados há também a procura pela transformação pessoal com a construção e afirmação de papéis sociais, o que contribui para a maior aceitação das intervenções cirúrgicas com finalidade estética. Seguindo tendências estéticas sempre em mutação, observa-se, na atualidade, uma grande demanda por cirurgia plástica para colocação de implantes de silicone com objetivo de aumento mamário. Tomando como recorte a utilização de tais implantes, buscou-se analisar a construção médica e social da beleza e compreender como a procura e a prática da cirurgia plástica estão ligadas a valores controversamente aceitos ou criticados na sociedade contemporânea.

Prevalência do medo de quedas em idosos e sua associação com fatores clínicos,funcionais e psicossociais: Estudo FIBRA-RJ

Introdução: Com o expressivo aumento da população idosa, as quedas são eventos comuns e levam a desfechos adversos à saúde. As consequências do medo de quedas podem ser tão incapacitantes como as quedas. Objetivo: O presente estudo teve como objetivo estimar a prevalência do medo de quedas em idosos e sua associação com fatores clínicos, funcionais e psicossociais. Métodos: Utilizaram-se os dados do Estudo FIBRA-RJ, que avaliou clientes de uma operadora de saúde, residentes na Zona Norte do município do Rio de Janeiro. A seleção desta amostra foi realizada através de amostragem aleatória inversa, de acordo com estratos de faixa etária e sexo do cadastro oferecido pela operadora. As entrevistas foram realizadas face a face no domicilio. O medo de quedas, variável dependente, foi avaliado através da FES-I-BR. As seguintes variáveis clínicas, funcionais e psicossociais foram avaliadas como variáveis independentes: histórico de quedas, fratura pós-queda, número de comorbidades, número de medicamentos, internação no último ano, uso de dispositivo de auxílio à marcha, dependência funcional nas atividades básicas e instrumentais de vida diária, dificuldade visual e auditiva, força de preensão palmar, velocidade de marcha, autopercepção de saúde, sintomas depressivos, alteração cognitiva, morar só, apoio social instrumental e nível de atividade. As associações foram avaliadas através de regressão logística. Resultados: Dentre os 742 idosos avaliados, 51,9% apresentaram medo de quedas, sendo esta prevalência maior no sexo feminino e nos mais idosos. Na análise logística multivariada, houve associação com histórico de 1 ou 2 quedas (OR=2,18; IC95%1,42-3,36), 3 ou mais quedas (OR=2,72; IC95% 1,10-6,70), usar 7 ou mais medicamentos (OR=1,70; IC95%1,04-2,80), dificuldade auditiva (OR=1,66; IC95% 1,10-2,49), ter dependência funcional nas atividades de vida diária (AVDs) (OR=1,73; IC95%1,07-2,79), velocidade de marcha diminuída (OR=1,64; IC95%1,04-2,58), autopercepção de saúde regular (OR=1,89; IC95%1,30-2,74) e ruim/muito ruim (OR=4,92; IC95%1,49-16,27) e sintomas depressivos (OR=1,68; IC95%1,07-2,63). Conclusão: Os resultados obtidos mostram a prevalência elevada de medo de quedas. Destaca-se a necessidade de avaliação desta condição nos idosos. Identificar os fatores associados é útil para desenvolver estratégias efetivas de intervenção dos possíveis fatores modificáveis.

As relações estabelecidas entre a terapia Reiki e o bem estar subjetivo mediadas pelas representações sociais

O objetivo do presente estudo é analisar o impacto da terapia Reiki no bem estar subjetivo e suas representações sociais em uma universidade pública do Rio de Janeiro. Trata-se de uma pesquisa quanti-qualitativa, com abordagem experimental, apoiado na Teoria de Representações Sociais. O grupo estudado foi composto de 60 sujeitos que não tiverem acesso à terapia anteriormente entrevistados antes e depois de três sessões de Reiki. Os dados foram coletados através de quatro instrumentos: questionário de identificação dos sujeitos, questionário de representação social do Reiki, questionário de evocação livre e escala de Bem estar Subjetivo. A análise dos dados foi realizada com estatística descritiva e inferencial com o software SPSS 19, análise estrutural e análise de conteúdo das representações sociais, a partir do software EVOC. Os sujeitos participantes são do sexo feminino (88,33%); nível superior (76,66%); discentes de ensino superior e médio e enfermeiros (48,34%); está empregado (56,67%); renda pessoal inferior a R$ 1.000,00 (41,67%); solteiro (61,67%); vive sozinho (68,33%); tem companheiro fixo (68,33%); sem doença (58,33%); uso de terapia não convencional (63,33%); tem religião (88,33%) e religião católica (33,33%) e evangélica (21,67%). Quanto às representações sociais, a busca do Reiki antes e depois do experimento revelou duas categorias com maior frequência, que são: equilíbrio da saúde mental, antes (35,44%) e depois (50,65%) e equilíbrio da saúde física, antes (16,46%) e depois (27,27%). Quanto à estrutura representacional do Reiki, o possível núcleo central dos dois grupos analisados foi composto pelas palavras energia, relaxamento e tranquilidade, configurando-se como uma dimensão funcional e positiva do Reiki e não apresentando variação da representação antes e depois da realização da terapia. O estudo experimental apresentou como resultados: No experimento I: diferença estatisticamente significante na dimensão afeto positivo, com escore maior no grupo de sujeitos que recebeu a terapia Reiki comparado aos que não receberam. No experimento II: diferença estatisticamente significante na dimensão afeto negativo, com escore maior no grupo de sujeitos que recebeu informação do Reiki associado à religiosidade comparado àqueles que receberam outros tipos de informação. E no experimento III: na dimensão afeto positivo, observou-se que todos os escores se elevaram, apontando para um efeito generalizado e inespecífico da realização do Reiki e da informação sobre o afeto positivo, exceto no que se refere à informação de espiritualidade que apresentou inversão das médias. No afeto negativo observou-se que todos os escores diminuíram, apontando para um efeito generalizado e inespecífico da realização do Reiki.Na dimensão cognitiva as médias dos escores antes e depois das manipulações experimentais praticamente não se alteraram. Conclui-se que a terapia Reiki favoreceu na manutenção do equilíbrio energético dos usuários, através de relaxamento, tranquilidade e sentimentos positivos, proporcionando, assim, efeitos psicológicos saudáveis, nutrindo e fortificando o campo energético dos usuários que participaram do estudo.

Emergency department crowding: prioritising quantified crowding measures using a Delphi study.

AimsEmergency department (ED) crowding has been associated with a number of negative health outcomes, including unnecessary deaths, increased waiting times and a decrease in care quality. Despite the seriousness of this issue, there is little agreement on appropriate crowding measures to assess crowding effects on ED operations. The objective of this study was to prioritise a list of quantified crowding measures that would assess the current state of a department.MethodsA three round Delphi study was conducted via email and an Internet based survey tool. The panel consisted of 40 professionals who had exposure to and expertise in crowding. Participants submitted quantified crowding measures which, through three rounds, were evaluated and ranked to assess participant agreement for inclusion.ResultsThe panel identified 27 measures of which eight (29.6%) reached consensus at the end of the study. These measures comprised: (1) ability of ambulances to offload; (2) patients who leave without being seen or treated; (3) time until triage; (4) ED occupancy rate; (5) patients' total length of stay in the ED; (6) time to see a physician; (7) ED boarding time; and (8) number of patients boarding in the ED.ConclusionsThis study resulted in the identification of eight quantified crowding measures, which present a comprehensive view of how crowding is affecting ED operations, and highlighted areas of concern. These quantified measures have the potential to make a considerable contribution to decision making by ED management and to provide a basis for learning across different departments.

Climate resilience of schools: a case study

Social and political concerns are frequently reflected in the design of school buildings, often in turn leading to the development of technical innovations. One example is a recurrent concern about the physical health of the nation, which has at several points over the last century prompted new design approaches to natural light and ventilation. The most critical concern of the current era is the global, rather than the indoor, environment. The resultant political focus on mitigating climate change has resulted in new regulations, and in turn considerable technical changes in building design and construction. The vanguard of this movement has again been in school buildings, set the highest targets for reducing operational carbon by the previous Government. The current austerity measures have moved the focus to the refurbishment and retrofit of existing buildings, in order to bring them up to the exacting new standards. Meanwhile there is little doubt that climate change is happening already, and that the impacts will be considerable. Climate scientists have increasing confidence in their predictions for the future; if today’s buildings are to be resilient to these changes, building designers will need to understand and design for the predicted climates in order to continue to provide comfortable and healthy spaces through the lifetimes of the buildings. This paper describes the decision processes, and the planned design measures, for adapting an existing school for future climates. The project is at St Faith’s School in Cambridge, and focuses on three separate buildings: a large Victorian block built as a substantial domestic dwelling in 1885, a smaller single storey 1970s block with a new extension, and an as-yet unbuilt single storey block designed to passivhaus principles and using environmentally friendly materials. The implications of climate change have been considered for the three particular issues of comfort, construction, and water, as set out in the report on Design for Future Climate: opportunities for adaptation in the built environment (Gething, 2010). The adaptation designs aim to ensure each of the three very different buildings remains fit for purpose throughout the 21st century, continuing to provide a healthy environment for the children. A forth issue, the reduction of carbon and the mitigation of other negative environmental impacts of the construction work, is also a fundamental aim for the school and the project team. Detailed modelling of both the operational and embodied energy and carbon of the design options is therefore being carried out, in order that the whole life carbon costs of the adaptation design options may be minimised. The project has been funded by the Technology Strategy Board as part of the Design for Future Climates programme; the interdisciplinary team includes the designers working on the current school building projects and the school bursar, supported by researchers from the University of Cambridge Centre for Sustainable Development. It is hoped that lessons from the design process, as well as the solutions themselves, will be transferable to other buildings in similar climatic regions.

军队医学科技人员身心健康与影响因素的研究

To study the relationship between mental-physical health and coping behavior,job stress and job motivation in medical laboratory scientists and technicians. A cross-section survey was conducted,using the anxiety rating scale(SAS), depression rating scale(SDS), coping behavior rating scale,self-rating subhealth scale,self-rating stress scale,and self-rating job motivation scale among 289 medical laboratory scientists and technicians with analysis of ANOVA and Regression. The study was carried out in three steps:step1 is to analyze the general situation of the mental-physical health.Step 2 is to analyze the features of the main influencial facotors.Step 3 is to study the influence of the relative factors on mental-physical health.The following are the results: 1.The anxiety and depression scores of the medical researchers and technicians were 30±6 and 37±8 respectively,both significantly lower than those of the national norm（34±6 and 42±11 respectively,both P<0.01）,which are of significant difference. The depression score of the associate chief technician was 42±7, significantly higher than those of the medical researchers and technicians with any other professional titles (all P<0.05）, and the anxiety score of the associate chief technicians was 32±7, significantly higher than that of the research fellows（28±4, P<0.05），with no significant difference to the score of the medical researchers and technicians with other professional titles. The depression score,anxiety score and the subhealth score of the age group of 36～49 were 39±9,31±7 and 32±9 respectively, both higher than that of the age group of 20～35 （36±8,29±6 and 29±7 respectively,both P<0.05）,while there is much diference among other age groups. And the subhealth status has nothing to do with marital status,education background and professional titles. 2.The coping behaviors,job stress and motivation of the military medical laboratory scientists and technicians. 1）Coping behaviors:The seeking help score of the associate chief technicians was 2.8±0.5,not significantly different from that of the associate research fellows（2.8±0.5）,but significantly lower than those of the medical researchers and technicians with other professional titles(all P<0.01),and whose self-blame score was higher than that of the research fellows,which is of significant difference.The self-blame score and the imagination score of the associate research fellows were 2.0±0.5 and 2.4±0.5 respectively, significantly higher than that of the research fellows(1.6±0.4, 2.1±0.4,both P<0.01). The seeking help score of the females was 3.1±0.5, significantly higher than that of the males(2.9±0.5, both P<0.01),and the solving problem score was 3.4±0.6,significantly lower than the male(3.6±0.7, both P<0.01).There is no any significant difference in coping behaviors among researchers and technicians of different marital status,education background and age groups. 2)Job stress: The score of job stress of the age group of 35~49 and 50~60 were 23±8 and 25±6 respectively,significantly higher than that of the 20~35(21±7,both P<0.05). There is no any significant difference in job stress among researchers and technicians of different marital status,gender,professional titles and education background. 3)The score of meeting personal desire for reputation and interests of the males was 19.6±5.4，significantly higher than that of the females(18.4±5.0, both P<0.05), while there is no significant difference in job motivation among researchers and technicians of different titles,education,age and marital status. 3.The relationship of the mental-physical health of the military medical laboratory scientists and technicians with their coping behaviors,job stress and motivations 1) Coping behaviors:Regression analysis showed that, the best predictors of subhealth were anxiety,depression and escaping (β=-0.40,β=0.23, β=0.14, both P<0.01).the best predictors of anxiety and depression were active coping behaviors and negative coping behaviors (β=-0.40,β=0.40, both P<0.01).The moderate(rational) coping behaviors is the best predictor only of anxiety and of significant difference. 2)job stress : Regression analysis demonstrated that anxiety,depression,job stress 2 and job stress 4 are the best predictor for subhealth;job stress 12 is the best retro-predictor for depression; job stress 3 and 8 are the best predictor for depression;and job stress 2 and 9 are the best predictor for anxiety ,which are of significant difference. 3)Motivation:Regression analysis demonstrated that depression is the best predictor for subhealth while motivation itself doesn't predict subhealth;with respect to the specific contents of motivation,"probing unknown rules and making contributions to the human society "is the best retro-predictor for depression and has nothing to do with anxiety prediction. 4) The combined influences of coping behaviors,job stress and motivations: Regression analysis showed that, the best predictors for subhealth were anxiety,depression and job stress(β=0.41,β=0.24, β=0.19, both P<0.01).the best predictors for anxiety and depression were active coping behaviors and negative coping behaviors (β=-0.40,β=0.40, both P<0.01).The moderate(rational) coping behaviors is the best predictor only for anxiety and of significant difference. CONCLUSIONS: Regression analysis showed that the best predictors for anxiety and depression were active coping behaviors and negative coping behaviors, the best predictors for subhealth were anxiety,depression and job stress.Coping behaviors, job stress and motivations have significant influences on the mental-physical health of the military medical researchers and and technicians. Among them,coping behavior is the most important factor while job stress and motivation follow. Seeking help more often,less self-blame ,imagination and job stress could help release the anxiety, depression and improve the subhealth of the medical researchers and technicians. The findings of this study indicate we should address the physical and mental health of the military laboratory researchers and technicians.

Dificuldades sentidas pelos cuidadores informais de Pessoas Idosos

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de licenciada em Serviço Social

Vitamin D status and requirements during pregnancy and lactation

Vitamin D deficiency during pregnancy, lactation, and early infancy has been widely reported. Current understanding of vitamin D metabolism during pregnancy and lactation is incomplete, and to date, experimental data to support vitamin D requirements for these life stages are scarce. There is a shortage of nationally representative data and appropriate reference ranges for serum 25-hydroxyvitamin D (25OHD) during pregnancy, lactation and infancy, including in umbilical cord blood. This thesis described concentrations of total 25OHD and individual metabolites including 25OHD3, 25OHD2, and 3-epi-25OHD3 at 15 weeks’ gestation in a large seasonally balanced pregnancy cohort study (n 1768), carried out in Cork, Ireland (52oN). The prevalence of low 25OHD concentrations in pregnant women was higher than published reports in other Caucasian women, and was highest among non-users of vitamin D-containing supplements during winter. A longitudinal pregnancy study was included which suggested gestational stages had an impact on the total serum 25OHD concentration. This thesis incorporated a randomized controlled trial carried out among 100 women across 3 intervention groups using 20 μg/day of vitamin D3 with or without 500 mg calcium, or placebo, over 12-weeks of lactation to investigate the vitamin D requirement for lactating mothers and the vitamin D content of human milk. A daily intake of 25 μg/day was suggested to meet the requirement of lactating women to maintain a 25OHD levels above 50 nmol/L in 97.5% of the population at 52oN all year around. However, vitamin D content in human milk did not increase in response to supplementation. Serum 25OHD concentration has been used as a predictor of a number of health outcomes. This thesis reported large differences in serum 25OHD concentrations using different methods in 86 umbilical cord samples. The need for international standardization of serum 25OHD measurements was re-emphasized in this thesis.

At what price? A cost-effectiveness analysis comparing trial of labour after previous caesarean versus elective repeat caesarean delivery

Background: Elective repeat caesarean delivery (ERCD) rates have been increasing worldwide, thus prompting obstetric discourse on the risks and benefits for the mother and infant. Yet, these increasing rates also have major economic implications for the health care system. Given the dearth of information on the cost-effectiveness related to mode of delivery, the aim of this paper was to perform an economic evaluation on the costs and short-term maternal health consequences associated with a trial of labour after one previous caesarean delivery compared with ERCD for low risk women in Ireland.Methods: Using a decision analytic model, a cost-effectiveness analysis (CEA) was performed where the measure of health gain was quality-adjusted life years (QALYs) over a six-week time horizon. A review of international literature was conducted to derive representative estimates of adverse maternal health outcomes following a trial of labour after caesarean (TOLAC) and ERCD. Delivery/procedure costs derived from primary data collection and combined both "bottom-up" and "top-down" costing estimations.Results: Maternal morbidities emerged in twice as many cases in the TOLAC group than the ERCD group. However, a TOLAC was found to be the most-effective method of delivery because it was substantially less expensive than ERCD ((sic)1,835.06 versus (sic)4,039.87 per women, respectively), and QALYs were modestly higher (0.84 versus 0.70). Our findings were supported by probabilistic sensitivity analysis.Conclusions: Clinicians need to be well informed of the benefits and risks of TOLAC among low risk women. Ideally, clinician-patient discourse would address differences in length of hospital stay and postpartum recovery time. While it is premature advocate a policy of TOLAC across maternity units, the results of the study prompt further analysis and repeat iterations, encouraging future studies to synthesis previous research and new and relevant evidence under a single comprehensive decision model.

Self-management education for cystic fibrosis

Background: Self-management education may help patients with cystic fibrosis and their families to choose, monitor and adjust treatment requirements for their illness, and also to manage the effects of illness on their lives. Although self-management education interventions have been developed for cystic fibrosis, no previous systematic review of the evidence of effectiveness of these interventions has been conducted. Objectives: To assess the effects of self-management education interventions on improving health outcomes for patients with cystic fibrosis and their caregivers. Search methods: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register (date of the last search: 22 August 2013). We also searched databases through EBSCO (CINAHL; Psychological and Behavioural Sciences Collection; PsychInfo; SocINDEX) and Elsevier (Embase) and handsearched relevant journals and conference proceedings (date of the last searches: 01 February 2014 ). Selection criteria: Randomised controlled trials, quasi-randomised controlled trials or controlled clinical trials comparing different types of self-management education for cystic fibrosis or comparing self-management education with standard care or no intervention. Data collection and analysis: Two authors assessed trial eligibility and risk of bias. Three authors extracted data. Main results: Four trials (involving a total of 269 participants) were included. The participants were children with cystic fibrosis and their parents or caregivers in three trials and adults with cystic fibrosis in one trial. The trials compared four different self-management education interventions versus standard treatment: (1) a training programme for managing cystic fibrosis in general; (2) education specific to aerosol and airway clearance treatments; (3) disease-specific nutrition education; and (4) general and disease-specific nutrition education. Training children to manage cystic fibrosis in general had no statistically significant effects on weight after six to eight weeks, mean difference -7.74 lb (i.e. 3.51 kg) (95% confidence interval -35.18 to 19.70). General and disease-specific nutrition education for adults had no statistically significant effects on: pulmonary function (forced expiratory volume at one second), mean difference -5.00 % (95% confidence interval -18.10 to 8.10) at six months and mean difference -5.50 % (95% confidence interval -18.46 to 7.46) at 12 months; or weight, mean difference - 0.70 kg (95% confidence interval -6.58 to 5.18) at six months and mean difference -0.70 kg (95% confidence interval -6.62 to 5.22) at 12 months; or dietary fat intake scores, mean difference 1.60 (85% confidence interval -2.90 to 6.10) at six months and mean difference 0.20 (95% confidence interval -4.08 to 4.48) at 12 months. There is some limited evidence to suggest that self-management education may improve knowledge in patients with cystic fibrosis but not in parents or caregivers. There is also some limited evidence to suggest that self-management education may result in positively changing a small number of behaviours in both patients and caregivers. Authors' conclusions: The available evidence from this review is of insufficient quantity and quality to draw any firm conclusions about the effects of self-management education for cystic fibrosis. Further trials are needed to investigate the effects of self-management education on a range of clinical and behavioural outcomes in children, adolescents and adults with cystic fibrosis and their caregivers.

Aging African American Women and the Impact of Positive Psychological Factors on Quality of Life

Aging African-American women are disproportionately affected by negative health outcomes and mortality. Life stress has strong associations with these health outcomes. The purpose of this research was to understand how aging African American women manage stress. Specifically, the effects of coping, optimism, resilience, and religiousness as it relates to quality of life were examined. This cross-sectional exploratory study used a self-administered questionnaire and examined quality of life in 182 African-American women who were 65 years of age or older living in senior residential centers in Baltimore using convenience sampling. The age range for these women was 65 to 94 years with a mean of 71.8 years (SD = 5.6). The majority (53.1%) of participants completed high school, with 23 percent (N = 42) obtaining college degrees and 19 percent (N = 35) holding advanced degrees. Nearly 58 percent of participants were widowed and 81 percent were retired. In addition to demographics, the questionnaire included the following reliable and valid survey instruments: The Brief Cope Scale (Carver, Scheier, & Weintraub, 1989), Optimism Questionnaire (Scheier, Carver, & Bridges, 1994), Resilience Survey (Wagnild & Young, 1987), Religiousness Assessment (Koenig, 1997), and Quality of Life Questionnaire (Cummins, 1996). Results revealed that the positive psychological factors examined were positively associated with and significant predictors of quality of life. The bivariate correlations indicated that of the six coping dimensions measured in this study, planning (r=.68) was the most positively associated with quality of life. Optimism (r=.33), resilience (=.48), and religiousness (r=.30) were also significantly correlated with quality of life. In the linear regression model, again the coping dimension of planning was the best predictor of quality of life (beta = .75, p <.001). Optimism (beta = .31, p <.001), resilience (beta = .34, p, .001) and religiousness (beta = .17, p <.01) were also significant predictors of quality of life. It appears as if positive psychology plays an important role in improving quality of life among aging African-American women.

Patient-provider communication, self-reported medication adherence, and race in a postmyocardial infarction population.

OBJECTIVES: Our objectives were to: 1) describe patient-reported communication with their provider and explore differences in perceptions of racially diverse adherent versus nonadherent patients; and 2) examine whether the association between unanswered questions and patient-reported medication nonadherence varied as a function of patients' race. METHODS: We conducted a cross-sectional analysis of baseline in-person survey data from a trial designed to improve postmyocardial infarction management of cardiovascular disease risk factors. RESULTS: Overall, 298 patients (74%) reported never leaving their doctor's office with unanswered questions. Among those who were adherent and nonadherent with their medications, 183 (79%) and 115 (67%) patients, respectively, never left their doctor's office with unanswered questions. In multivariable logistic regression, although the simple effects of the interaction term were different for patients of nonminority race (odds ratio [OR]: 2.16; 95% confidence interval [CI]: 1.19-3.92) and those of minority race (OR: 1.19; 95% CI: 0.54-2.66), the overall interaction effect was not statistically significant (P=0.24). CONCLUSION: The quality of patient-provider communication is critical for cardiovascular disease medication adherence. In this study, however, having unanswered questions did not impact medication adherence differently as a function of patients' race. Nevertheless, there were racial differences in medication adherence that may need to be addressed to ensure optimal adherence and health outcomes. Effort should be made to provide training opportunities for both patients and their providers to ensure strong communication skills and to address potential differences in medication adherence in patients of diverse backgrounds.

Risikowahrnehmung und psychologische Reaktionen in öffentlichen Krisensituationen am Beispiel von Terrorattentaten / Risk perception and psychological reactions in public crisis situations using the example of terror attacks

The reactions to the 9/11 terror attacks were immense in the western population. In the current review, the impact of terror attacks is presented with surveys, clinical interviews, and scientific polls, which were identified in a comprehensive literature search. Results show that the fear of further terror attacks is comparatively overestimated in the population and is associated with numerous psychological consequences and reactions. The overestimation of the probability of further terror attacks is related among other reasons to its unique features and its strong representation in the media. Several independent studies proved that the number of stress symptoms and psychiatric diagnoses is associated with a high risk perception in relation to terror attacks. This was not only the case for victims of terror attacks, but also for people indirectly exposed to the terror attacks. In addition, there is evidence that the number of the stress symptoms correlate with the duration of TV consumption of new findings about terror attempts. Methodologically, there is a critical lack of more in-depth analyses to explain the development of risk perceptions and its influence on mental and physical health. Because of the international importance and cross-cultural differences, an international standardization of research is desirable. [In German] Die Reaktionen auf die Terrorattentate vom 9. September 2001 in New York waren in der westlichen Bevölkerung immens. In der vorliegenden Übersichtsarbeit werden die Auswirkungen von Terrorattentaten durch Einbeziehung bevölkerungsrepräsentativer Untersuchungen, Surveys, klinischer Interviews und Einstellungsbefragungen dargestellt, die über eine deskriptive Literaturrecherche ermittelt wurden. Als Ergebnis des Reviews zeigt sich, dass die Angst vor weiteren Terrorattentaten in der Bevölkerung vergleichsweise hoch und mit zahlreichen psychologischen Folgen und Reaktionen assoziiert ist. Die Einschätzung der Auftretenswahrscheinlichkeit eines Terrorattentats hängt unter anderem mit den besonderen Charakteristika und der hohen medialen Präsenz des Themas zusammen. Die Anzahl der Stresssymptome bis hin zu psychiatrischen Diagnosen erwies sich in mehreren unabhängigen Untersuchungen mit einer hohen Risikowahrnehmung assoziiert. Dies ließ sich nicht nur bei den Opfern von Terrorattentaten, sondern auch bei indirekt Betroffenen zeigen. Darüber hinaus gibt es mehrfache Belege dafür, dass die Anzahl der Stresssymptome mit der Dauer des TV-Konsums über Neuigkeiten zu Terrorattentaten zusammenhing. Als methodische Kritik ist an den gegenwärtigen Untersuchungsszenarien einzuwenden, dass es derzeit keine tiefer gehenden Analysen zur Entwicklung der Risikowahrnehmung und zu ihrem Einfluss auf die Gesundheit gibt. Aufgrund der internationalen Bedeutung des Themas und der interkulturellen Unterschiede im Umgang mit Krisensituationen ist eine internationale Standardisierung von Untersuchungszugängen wünschenswert.

Adult personality inconsistency and problems with parents: uncovering the roots of the false self

Research has established that individuals who tend to vary their personality depending on who they are with, show a variety of signs of psychological maladjustment in comparison to those who do not; they show more negative affect (Baird, Le and Lucas, 2006), lower life satisfaction (Suh, 2002), lower self-esteem (Sheldon et al., 1997), lower role-satisfaction (Donahue et al., 1993), higher rates of depression (Lutz and Ross, 2003), more anxiety (Diehl, Hastings and Stanton, 2001) and poorer physical health (Cross, Gore and Morris, 2003). It has also been shown that personality variability is positively related to the experience of inauthenticity and falsity (Sheldon et al., 1997). Donahue, Roberts, Robins and John (1993) found that personality inconsistency of this type is related to tension within the family. Psychoanalytic theory has also linked the operation of an adult false self to experiences with parents, particularly in early life (Winnicott, 1960). It was hypothesized that personality variability and the adult experience of falsity in social situations would be related to an emotionally unstable relationship with parents. The method to test this comprised a questionnaire-based survey given to a non-clinical population. The final sample comprised 305, with 193 women and 112 men, aged from 19 to 55. The first questionnaire asked participants to rate personality traits, including emotional stability, in three social contexts - with parents, with friends and with work colleagues. The second part involved 3 questions; participants were asked to select in which of the aforementioned three social contexts they felt “most themselves”; in which they were “most authentic” and in which they “put on a front”. It was found, consistent with predictions, that an index of overall personality variability calculated from the personality questionnaire correlated strongly with emotional instability around parents (r = 0.46, p<0.001), while not correlating with emotional instability in either of the other two contexts measured. This suggests a specific link between a person’s relationship with their parents and their overall personality integration. Furthermore, it was found that participants who cited one of the three social contexts (parents, friends, work colleagues) as being one in which they were “more themselves” or “more authentic” had significantly higher ratings of emotional instability with parents than those participants who found that they were equally authentic across settings (F = 9.8, p<0.005). The results suggest a clear link between a person’s relationships with their parents and their adult personality integration. An explanation is that individuals who experience an anxious or ambiguous attachment with their parents in childhood may fear rejection or abandonment in later life, and so habitually adapt their personality to fit in to social contexts as adults, in order to be accepted by others and to minimize the possibility of social rejection. These individuals meanwhile retain an emotionally unstable relationship with their parents in adulthood. This interpretation is speculative but is open to empirical testing. Clinicians should be aware that attachment problems with parents may underlie poor personality integration in adulthood.