Factors associated with the wish to hasten death : a study of patients with terminal illness

Background. There is considerable debate regarding the clinical issues surrounding the wish to hasten death (WTHD) in the terminally ill. The clinical factors contributing to the WTHD need further investigation among the terminally ill in order to enhance understanding of the clinical assessment and treatment needs that underlie this problem. A more detailed understanding may assist with the development of appropriate therapeutic interventions. Method. A sample of terminally ill cancer patients (N=256) recruited from an in-patient hospice unit, home palliative care service and a general hospital palliative care consulting service from Brisbane Australia between 1998–2001 completed a questionnaire assessing psychological (depression and anxiety), social (family relationship, social support, level of burden on others) and the impact of physical symptoms. The association between these factors and the WTHD was investigated. Results. A high WTHD was reported by 14% of patients. A discriminant function analysis revealed that the following variables were associated with a high WTHD (P<0·001): higher levels of depressive symptoms, being admitted to an in-patient hospice setting, a greater perception of being a burden on others, lower family cohesion, lower levels of social support, higher levels of anxiety and greater impact of physical symptoms. Conclusions. Psychological and social factors are related to a WTHD among terminally ill cancer patients. Greater attention needs to be paid to the assessment of psychological and social issues in order to provide appropriate therapeutic interventions for terminally ill patients.

Teacher praise and feedback and students’ perceptions of the classroom environment

The relationships between teacher praise and feedback, and students’ perceptions of the classroom environment were investigated in six rural elementary schools (n 5 747). The Teacher Feedback Scale and My Classroom Scale were developed as part of this study and used to collect the data. Structural equation modelling was used to test a hypothesised model. The results indicated that negative teacher feedback and effort feedback were both related to students’ relationships with their teachers, while ability feedback was associated with perceptions of the classroom environment. Praise was not related to classroom environment or teacher–student relationships. Significant age and gender differences were found. Additionally, differences were found between students who were satisfied with their classroom and those who were dissatisfied. Satisfied students received more general praise, general ability feedback, effort feedback and less negative teacher feedback when compared to dissatisfied students. Research studies have emphasised the influence of signicicant adults (teachers and parents) on students’ personal development (Porlier et al., 1999) and the importance of significant others’ verbal statements when directed at children (Burnett, 1996a). The relationships between negative and positive statements made by teachers, parents, peers and siblings and children’s self-talk have been investigated (Burnett, 1996a) and positive statements (praise) have been found to be more beneficial than verbal criticism (Burnett, 1999). The quality of life in the classroom in recent times has been considered of great importance to students (Thorp et al., 1994) and this is recognised by Baker (1999) who reported a relationship between students’ satisfaction with the learning environment, and differential teacher feedback and praise. This study investigated the relationships between teacher praise and feedback, and how students perceived their classroom and their relationship with their teacher.

Elementary students, creativity, and technology

This article reports on the impact on student personal creativity of a longitudinal study that had as its major goal the creation of a unique intervention program for elementary students. The intervention was based on the National Profile and Statement (Curriculum Corporation, 1994a, 1994b) for the curriculum area of technology. The intervention program comprised thematically based units of work that integrated all eight Australian Key Learning Areas (KLA). A pretest/posttest control group design investigation (Campbell & Stanley, 1963) was undertaken with 580 students from 7 schools and 24 class groups that were randomly divided into 3 treatment groups. One group (10 classes) formed the control group. Another 7 classes received the year-long intervention program, while the remaining 7 classes received the intervention, but with the added seamless integration of their available classroom computer technologies. The effect of the intervention on the personal creativity characteristics of the students involved in the study was assessed using the Creativity Checklist, an instrument that was developed during the study. The results suggest that the purposeful integration of computer technology with the intervention program positively affects the personal creativity characteristics of students.

A database ATP simulated waveforms of shunt reactor switching cases with vacuum breakers on motor circuits

This paper presents a database ATP (Alternative Transient Program) simulated waveforms for shunt reactor switching cases with vacuum breakers in motor circuits following interruption of the starting current. The targeted objective is to provide multiple reignition simulated data for diagnostic and prognostic algorithms development, but also to help ATP users with practical study cases and component data compilation for shunt reactor switching. This method can be easily applied with different data for the different dielectric curves of circuit-breakers and networks. This paper presents design details, discusses some of the available cases and the advantages of such simulated data.

Suicidal ideation, suicide attempts, and HIV infection

A cross-sectional study was performed to investigate the prevalence and predictors of suicidal ideation and past suicide attempt in an Australian sample of human imumunodeficiency virus (HIV)-positive and HIV-negative homosexual and bisexual men. Sixty-five HIV-negative and 164 HIV-positive men participated. A suicidal ideation score was derived from using five items selected from the Beck Depression Inventory and the General Health Questionnaire (28-item version). Lifetime and current prevalence rates of psychiatric disorder were evaluated with the Diagnostic Interview Schedule Version-III-R. The HIV-positive (Centers for Disease Control and Prevention [CDC] Stage IV) men (n=85) had significantly higher total suicidal ideation scores than the asymptomatic HIV-positive men (CDC Stage II/III) (n=79) and the HIV-negative men. High rates of past suicide attempt were detected in the HIV-negative (29%) and HIV-positive men (21%). Factors associated with suicidal ideation included being HIV-positive, the presence of current psychiatric disorder, higher neuroticism scores, external locus of control, and current unemployment. In the HIV-positive group analyzed separately, higher suicidal ideation was discriminated by the adjustment to HIV diagnosis (greater hopelessness and lower fighting spirit), disease factors (greater number of current acquired immunodeficiency syndrome [AIDS]-related conditions), and background variables (neuroticism). Significant predictors of a past attempted suicide were a positive lifetime history of psychiatric disorder (particularly depression diagnoses), a lifetime history of injection drug use, and a family history of suicide attempts. The findings indicate increased levels of suicidal ideation in symptomatic HIV-positive men and highlight the role that multiple psychosocial factors associated with suicidal ideation and attempted suicide play in this population.

Post-traumatic stress disorder in response to HIV infection

This study investigated the psychological impact of HIV infection through assessment of posttraumatic stress disorder in response to HIV infection. Sixty-one HIV-positive homosexual/bisexual men were assessed for posttraumatic stress disorder in response to HIV infection (PTSD-HIV) using a modified PTSD module of the DIS-III-R. Thirty percent met criteria for a syndrome of posttraumatic stress disorder in response to HIV diagnosis (PTSD-HIV). In over one-third of the PTSD cases, the disorder had an onset greater than 6 months after initial HIV infection diagnosis. PTSD-HIV was associated with other psychiatric diagnoses, particularly the development of first episodes of major depression after HIV infection diagnosis. PTSD-HIV was significantly associated with a pre-HIV history of PTSD from other causes, and other pre-HIV psychiatric disorders and neuroticism scores, indicating a similarity with findings in studies of PTSD from other causes. The findings from this preliminary study suggest that a PTSD response to HIV diagnosis has clinical validity and requires further investigation in this population and other medically ill groups. The results support the inclusion of the diagnosis of life-threatening illness as a traumatic incident that may lead to a posttraumatic stress disorder, which is consistent with the DSM-IV criteria.

Older patients request more information : a survey of use of written patient education materials in general practice

Objectives: To determine GPs' reported use of written education materials with older patients and older patients' reported receipt of these materials. To determine GPs' and older patients' perceptions of written materials.---------- Method: Using self-report questionnaires, two populations were surveyed; a randomised sample of 50 GPs (29 males and 21 females) practising in Brisbane's southern suburbs and a convenience sample of 188 older community-dwelling people (aged over 64 years).----------- Results: All GPs reported using written materials with patients, although 28% had not given any to the Last 10 patients. This increased to 46% when patients were older. Twenty percent of patients wanted more written information from their GP, while some GPs believed that older patients preferred verbal information and gave out written information only when they perceived patient interest. All GPs reported giving written materials at the time of consultation and over two thirds discussed the content with patients. Just over 50% of patients reported receiving written information from GPs in the Last six months and only hall of these again discussed it directly with their GP. Overall, patients were more positive than GPs about the value of written education materials.---------- Conclusions: Older patients' desire for written information may be better met if they are more assertive in requesting this of GPs and GPs may better serve their patients' needs if they make written information more readily available to them. Better access to materials and more financial incentives to give them out might also increase GPs' use of written materials.

Increase in particle number emissions from motor vehicles due to interruption of steady traffic flow

We assess the increase in particle number emissions from motor vehicles driving at steady speed when forced to stop and accelerate from rest. Considering the example of a signalized pedestrian crossing on a two-way single-lane urban road, we use a complex line source method to calculate the total emissions produced by a specific number and mix of light petrol cars and diesel passenger buses and show that the total emissions during a red light is significantly higher than during the time when the light remains green. Replacing two cars with one bus increased the emissions by over an order of magnitude. Considering these large differences, we conclude that the importance attached to particle number emissions in traffic management policies be reassessed in the future.

The relationship between closeness to significant others and self-esteem

One hundred and forty-three children (61 boys and 82 girls) between 8 and 12 years of age participated in a study which focused on closeness to significant others and its relationship with self-esteem. A closeness rating scale was developed to determine quantitatively how close children feel to their mother, father, two closest peers, and current teacher. Marsh's (1990) eight general self-concept items from the Self-Description Questionnaire 1 (SDQI), together with eight items from Burnett's (1994) Self-scale, were administered to the children, who ranged in age from 8 to 12 years, to measure their self-esteem. Closeness to mother was found to correlate most significantly with a child's self-esteem, while closeness to teacher was related more strongly to self-esteem for girls than for boys.

Concepts of normal bereavement

This study used a 25-item questionnaire to examine the perceptions of 128 people with a close interest in bereavement and its literature. The study is part of a project to identify key aspects and the bereavement process. Subjects were asked to rate their perceptions of key bereavement phenomena with regards their frequency in the acute and later stages of bereavement. Descriptive results are presented and discussed, and a profile of phenomena perceived to be common to both stages is outlined.

Self-concept or self-esteem

Confusion exists with regard to the substantive difference between self-concept and self-esteem. In an endeavour to cast some light on this confusion two studies were conducted with 1193 preadolescents using modified versions of two commonly used instruments designed to measure self-concept and self-esteem. Exploratory factor analysis indicated that both these instruments measure specific facets of the same construct, namely self.-concept. General or global self-concept proved to be a difficult construct to measure in preadolescent students.