Prevalence and predictors of posttraumatic stress disorder in patients with acute myocardial infarction

OBJECTIVE: We estimated the prevalence of posttraumatic stress disorder (PTSD) and identified predictors of self-rated PTSD symptoms in patients post-myocardial infarction (MI). METHODS: We recruited 400 patients (mean age 60 +/- 12 years, 79% were men) with a previous acute index MI who were referred to a tertiary cardiology clinic. PTSD was assessed by the Clinician-administered PTSD Scale, and self-rated severity of PTSD symptom levels were assessed by the Posttraumatic Diagnostic Scale. RESULTS: Of the 190 patients who completed the Posttraumatic Diagnostic Scale, 34 met the cutoff for clinically significant PTSD symptomatology and 32 agreed to be interviewed. Among these patients, the Clinician-administered PTSD Scale interview yielded a prevalence of full and subsyndromal PTSD of 9.5% (95% confidence interval 7.4-11.6). Retrospectively rated feelings of helplessness (beta = .47, P < .001) and pain intensity during MI (beta = .15, P = .019) independently predicted PTSD symptom level. CONCLUSIONS: Approximately 10% of patients post-MI had full or subsyndromal PTSD. Subjective perception of MI predicted self-rated PTSD symptom level.

Clinical diagnosis of posttraumatic stress disorder after myocardial infarction

BACKGROUND: Clinician-rated large-scale studies estimating the prevalence of posttraumatic stress disorder (PTSD) related to myocardial infarction (MI) and identifying predictors of clinical PTSD are currently lacking. HYPOTHESES: We hypothesized that PTSD is prevalent in post-MI patients and that the subjective experience of the MI determines PTSD status. METHODS: We approached 951 post-MI patients with a questionnaire screening for PTSD symptoms related to their MI. Those responding and meeting a cutoff of PTSD symptom levels were invited to participate in a structured clinical interview to diagnose PTSD following Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Fear of dying, feelings of helplessness, and severity of pain perceived during the MI were also assessed by visual analog scales. RESULTS: The screening questionnaire was completed by 394 patients, whereby 77 met the cutoff for the interview (8 patients declined the interview). Forty of 394 patients (10.2%) had clinical PTSD (subsyndromal and syndromal forms combined). Younger age (OR 0.95, 95% CI 0.91-0.99), greater fear of dying (OR 2.77, 95% CI 1.28-5.97), and more intense feelings of helplessness (OR 2.97, 95% CI 1.42-6.21) were independent predictors of PTSD status. Perceived pain intensity during MI, sex, type of index MI, left ventricular ejection fraction, number of coronary occlusions, and highest level of total creatinine kinase were not significant predictors. CONCLUSIONS: Clinical PTSD is prevalent in post-MI patients. Demographic and particularly psychological variables related to the subjective experience of the event were stronger predictors of PTSD status than were objective measures of MI severity.

Social Work as Laboratory for Normative Professionalisation

In most Western countries, the professional status of social workers is instable and insecure. Of course, most Western countries are themselves instable, ridden with feelings of insecurity and in search of reassurance and promises of control. But social work hardly lends itself as a projection screen for visions of professional control and efficiency in the face of insecurity. On the contrary: within the present cultural and political climate, social work connotes primarily with unpopular social problems, with people unable to cope adequately with the competitiveness and the rate of change of post-industrial societies, that is to say: it connotes more with dependency and helplessness then with autonomy and control. Moreover, whereas public discourse in most Western country is dominated by a neo-liberal perspective and the intricate network of economic, managerial, consumerist and military metaphors connected with it, social work still carries with it a legacy of 'progressive politics' increasingly labeled as outdated and inadequate. Although the values of solidarity and social justice connected with this 'progressive heritage' certainly have not faded away completely, the loudest and most popular voices on the level of public discourse keep underscoring the necessity to adapt to the 'realities' of present-day postindustrial societies and their dependence on economic growth, technological innovation and the dynamics of an ever more competitive world-market. This 'unavoidable' adaptation involves both the 'modernization' and progressive diminishment of 'costly' welfare-state arrangements and a radical reorientation of social work as a profession. Instead of furthering the dependency of clients in the name of solidarity, social workers should stimulate them to face their own responsibilities and help them to function more adequately in a world where individual autonomy and economic progress are dominant values. This shift has far-reaching consequences for the organization of the work itself. Efficiency and transparency are the new code words, professional autonomy is dramatically limited and interventions of social workers are increasingly bound to 'objective' standards of success and cost-effectiveness.

Valence and agency influence striatal response to feedback in patients with major depressive disorder

BACKGROUND: Reduced sensitivity to positive feedback is common in patients with major depressive disorder (MDD). However, findings regarding negative feedback are ambiguous, with both exaggerated and blunted responses being reported. The ventral striatum (VS) plays a major role in processing valenced feedback, and previous imaging studies have shown that the locus of controls (self agency v. external agency) over the outcome influences VS response to feedback. We investigated whether attributing the outcome to one's own action or to an external agent influences feedback processing in patients with MDD. We hypothesized that depressed participants would be less sensitive to the feedback attribution reflected by an altered VS response to self-attributed gains and losses. METHODS: Using functional MRI and a motion prediction task, we investigated the neural responses to self-attributed (SA) and externally attributed (EA) monetary gains and losses in unmedicated patients with MDD and healthy controls. RESULTS: We included 21 patients and 25 controls in our study. Consistent with our prediction, healthy controls showed a VS response influenced by feedback valence and attribution, whereas in depressed patients striatal activity was modulated by valence but was insensitive to attribution. This attribution insensitivity led to an altered ventral putamen response for SA - EA losses in patients with MDD compared with healthy controls. LIMITATIONS: Depressed patients with comorbid anxiety disorder were included. CONCLUSION: These results suggest an altered assignment of motivational salience to SA losses in patients with MDD. Altered striatal response to SA negative events may reinforce the belief of not being in control of negative outcomes contributing to a cycle of learned helplessness.

Association of Trait Resilience With Peritraumatic and Posttraumatic Stress in Patients With Myocardial Infarction.

OBJECTIVE Acute myocardial infarction (MI) is a life-threatening condition, leading to immediate fear and distress in many patients. Approximately 18% of patients develop posttraumatic stress disorder in the aftermath of MI. Trait resilience has shown to be a protective factor for the development of posttraumatic stress disorder. However, whether this buffering effect has already an impact on peritraumatic distress and applies to patients with MI is elusive. METHODS We investigated 98 consecutive patients with acute MI within 48 hours after having reached stable circulatory conditions and 3 months thereafter. Peritraumatic distress was assessed retrospectively with three single-item questions about pain, fear, and helplessness during MI. All patients completed the Posttraumatic Diagnostic Scale (PDS) and the Resilience Scale to self-rate posttraumatic stress and trait resilience. RESULTS Multivariate models adjusting for sociodemographic and medical factors showed that trait resilience was not associated with peritraumatic distress, but significantly so with posttraumatic stress. Patients with greater trait resilience showed lower PDS scores (b = -0.06, p < .001). There was no significant relationship between peritraumatic distress scores and PDS scores; resilience did not emerge as a moderator of this relationship. CONCLUSIONS The findings suggest that trait resilience does not buffer the perception of acute MI as stressful per se but may enhance better coping with the traumatic experience in the longer term, thus preventing the development of MI-associated posttraumatic stress. Trait resilience may play an important role in posttraumatic stress symptoms triggered by medical diseases such as acute MI.

El mundo del trabajo vitivinícola en Mendoza (Argentina) durante la modernización capitalista, 1880-1914

Este artículo traza un breve panorama del proceso de desarrollo de la vitivinicultura capitalista en Mendoza y luego, utilizando diversas fuentes primarias y secundarias, determina la composición del mercado de trabajo vitivinícola y su evolución cuantitativa y cualitativa. La introducción de equipamiento técnico de avanzada obligó a la capacitación de la mano de obra con mejoras en los ingresos de los asalariados. Este mercado se complejizó con el tiempo y aparecieron múltiples jerarquías, desde el peón al enólogo o director técnico de las bodegas, pasando por los contratistas de viñas o los capataces. Muchos trabajadores ascendieron socialmente y se convirtieron en empresarios, en itinerarios que respondieron a diversas estrategias rastreables en las fuentes. Finalmente, las condiciones laborales que tuvieron los trabajadores muestran la precariedad en la que se desenvolvían y la indefensión en la que estaban inmersos por la ausencia de colectivos gremiales que asumieran la representación del trabajo frente al capital.

El mundo del trabajo vitivinícola en Mendoza (Argentina) durante la modernización capitalista, 1880-1914

Este artículo traza un breve panorama del proceso de desarrollo de la vitivinicultura capitalista en Mendoza y luego, utilizando diversas fuentes primarias y secundarias, determina la composición del mercado de trabajo vitivinícola y su evolución cuantitativa y cualitativa. La introducción de equipamiento técnico de avanzada obligó a la capacitación de la mano de obra con mejoras en los ingresos de los asalariados. Este mercado se complejizó con el tiempo y aparecieron múltiples jerarquías, desde el peón al enólogo o director técnico de las bodegas, pasando por los contratistas de viñas o los capataces. Muchos trabajadores ascendieron socialmente y se convirtieron en empresarios, en itinerarios que respondieron a diversas estrategias rastreables en las fuentes. Finalmente, las condiciones laborales que tuvieron los trabajadores muestran la precariedad en la que se desenvolvían y la indefensión en la que estaban inmersos por la ausencia de colectivos gremiales que asumieran la representación del trabajo frente al capital.

El mundo del trabajo vitivinícola en Mendoza (Argentina) durante la modernización capitalista, 1880-1914

Este artículo traza un breve panorama del proceso de desarrollo de la vitivinicultura capitalista en Mendoza y luego, utilizando diversas fuentes primarias y secundarias, determina la composición del mercado de trabajo vitivinícola y su evolución cuantitativa y cualitativa. La introducción de equipamiento técnico de avanzada obligó a la capacitación de la mano de obra con mejoras en los ingresos de los asalariados. Este mercado se complejizó con el tiempo y aparecieron múltiples jerarquías, desde el peón al enólogo o director técnico de las bodegas, pasando por los contratistas de viñas o los capataces. Muchos trabajadores ascendieron socialmente y se convirtieron en empresarios, en itinerarios que respondieron a diversas estrategias rastreables en las fuentes. Finalmente, las condiciones laborales que tuvieron los trabajadores muestran la precariedad en la que se desenvolvían y la indefensión en la que estaban inmersos por la ausencia de colectivos gremiales que asumieran la representación del trabajo frente al capital.

Germany in the Russian-Ukrainian conflict: a political or a humanitarian mission? OSW Commentary No. 163, 2015-02-18

Since the beginning of the Russian-Ukrainian conflict, profound changes in Germany’s thinking about Russia, its political elite and foreign policy, can be observed. The trust most German politicians had in their former strategic partner has now lessened. At the same time, Germany has been particularly involved in the process of resolving the conflict, which was demonstrated by the intensive diplomatic actions it undertook. When these failed, Chancellor Angela Merkel did not hesitate to force through the introduction and maintenance of economic sanctions. At the same time, however, this evolution in Germany’s thinking about Russia has not translated into any change in the two basic assumptions of the German attitude towards a possible solution to the conflict. First, Germany supports the concept of ‘strategic patience’ in politics in the context of Russia’s aggression. Second, it is convinced that Europe is fated to cooperate with the Russian Federation, and Europe’s welfare and security are only possible with Russia as a partner in cooperation, not against it or without it. Therefore, in the immediate future no radical change in Germany’s policy as pursued so far should be expected. This provokes questions concerning not only the effectiveness of Berlin’s current actions, but also – in a broader sense – Germany’s ability to negotiate and achieve real, political solutions to the Russian-Ukrainian conflict, reaching beyond (another) ceasefire. The Minsk agreements of 12 February can be considered a success worthy of a humanitarian mission carried out in the hope of reducing the number of casualties. However, the political mission undertaken by Chancellor Merkel and Foreign Minister Steinmeier aimed at “ensuring Europe’s security order”[1] has so far resulted in the sense of helplessness and frustration which have recently dominated Germany’s policy towards Russia[2].

Europe as International Actor: Maximizing Nation-State Sovereignty. CES Germany & Europe Working Papers, No. 06.3, 1996

The continually increasing literature on foreign- and security-policy dimensions of the European Union (EU) has provided no remedy for the widespread helplessness in gaining a purchase on Europe as an international actor. The basic hindrance to understanding this policy comes from an all-too-literal interpretation of the acronym involved: the CFSP is understood as a total or partial replacement of the nation-states' foreign and security policy. This article aims to point the way to a new understanding of the CFSP in which this policy is not based on the integration of nation­ state foreign and security policy. I suggest that the proper way to grasp the phenomenon of the CFSP is to describe it as an international regime whose goal is to administer links between economic integration and foreign- and security­ policy cooperation in the sense of maximizing the sovereignty of member states. This requires, on the one hand, the prevention of "spillovers" from the economic area that could interfere with the foreign- and security-policy indepen­ dence of member states. On the other hand, it demands applying the EU's economic potential to reinforce the foreign- and security-policy range of member states. Due to the logic of this policy, CFSP priorities and fields of ac­ tion differ profoundly from those of a national foreign and security policy. Expectations on the evolution of the CFSP must be aware of these basic characteristics of this policy.

The shadow of Chornobyl. Ukraine thirty years after the disaster. OSW COMMENTARY NUMBER 210/22.04.2016

Thirty years after the Chornobyl nuclear power plant disaster, its aftermath and consequences are still a permanent element of the economic, environmental and social situation of Ukraine, Belarus and some regions of Russia. Ukraine, to which the scope of this text is limited, experienced the most severe shock because, among other factors, the plant where the accident took place was located just 100 km away from Kyiv. Its consequences have affected the course of political developments in the country, and have become part of the newly-shaped national identity of independent Ukraine. The country bore the huge cost of the clean-up effort but did not give up on nuclear energy, and today nuclear power plants generate more than half of its electricity. The system of social benefits for people recognised as disaster survivors, which was put in place by the Soviet government, has become a huge burden on the country’s budget; if implemented fully, it would account for more than 10% of total public spending, and is therefore being implemented to only a partial extent. This system has reinforced the Ukrainian people’s sense of helplessness and dependence on the state. The disaster has also become part of the ‘victim nation’ blueprint of the Ukrainian national myth, which it has further solidified. The technological and environmental consequences of the disaster, and hence also its economic costs, will persist for centuries, while the social consequences will dissipate as the affected generation passes away. In any case, Chornobyl will remain an important part of the life of the Ukrainian state and society.

Social Rights in Post-Revolutionary Tunisia: Is a Consensus-driven Policy Still on The table? EUSpring Policy Brief/Citizenship Review No. 17, June 2016

The immolation of street vendor Mohamed Bouazizi and the demonstrations that followed in December 2010 triggered the Tunisian revolution. But there were more deep-seated issues at stake: unemployment, poverty and exclusion, coupled with a deep sense of injustice, humiliation and helplessness of the peripheries to influence the political centre. Five years after the revolution, the social and economic problems are still persistent and arguably worse. Many people believe Tunisians are facing a distorted revolution; political progress has not coincided with reforms leading to welfare.

AUSÊNCIA PATERNA E SUAS REPERCUSSÕES SOBRE O DESENVOLVIMENTO INFANTIL

O presente estudo teve por objetivos a) investigar as repercussões da ausência paterna sobre o desenvolvimento da criança; b) descrever o conteúdo intrapsíquico de crianças com pais presentes e de crianças com pais ausentes no lar. Para tanto foram estudados três casos de crianças em idade escolar que freqüentavam uma instituição não governamental da cidade de Santos e utilizou-se dos instrumentos entrevista semi-estruturada com as mães e Procedimento de Desenho-Estória com Tema com as crianças. A aplicação foi feita nos seguintes termos, pediu-se ao participante que desenhasse uma criança e, em seguida que contasse uma estória sobre o desenho. Após, foi solicitado à criança que desenhasse o pai dessa criança e que contasse uma estória sobre esse mesmo desenho. Optamos também por aplicar o Teste das Matrizes Coloridas de Raven - Escala Especial com as crianças. Embora cada caso tivesse revelado suas peculiaridades, os resultados mostraram indicativos de distúrbios da identidade sexual, desamparo, insegurança, tendências depressivas, além de associação entre a ausência paterna, déficit cognitivo e/ou inibição intelectual. Foi também observado em um dos casos, dificuldades da mãe em permitir que o pai paternasse . Concluiu-se que a ausência paterna foi percebida pela criança não somente como a falta da pessoa do pai no lar, mas sim por sua omissão; somando-se ao fato de que a internalização da figura paterna não pareceu determinada pelo laço biológico, mas sim pela possibilidade de oferecimento à criança de identificação e afeto. Entendeu-se com esse estudo que o desenvolvimento psíquico saudável pode ser facilitado pela introjeção das boas figuras materno/paternas pela criança. Sendo assim, estudos dedicados ao tema da paternidade são tão importantes de serem explorados na atualidade quanto o foram aqueles destinados à maternidade ao longo da história da psicologia do desenvolvimento e da psicanálise. (AU)

Attributions, cognitions, and coping styles:teleworkers' reactions to work-related problems

Based on the attributional reformulation of learned helplessness theory (Abramson, Seligman, & Teasdale, 1978) and Lazarus and Launier's (1978) primary-secondary appraisal theory of stress, the present study sought to examine teleworkers' reactions to their work-related problems. The role of attributions about the sources, and cognitions about the consesquences, of these problems in promoting positive adaptation was addressed. In particular, it was predicted that teleworkers who made optimistic attributions and cognitions would be more likely to employ problem-focused coping strategies and, as a result, report more positive psychological and job-related outcomes. Based on a survey sample of 192 teleworkers, the results indicated that a tendency to engage in self-blame was related to the use of emotion-focused coping strategies. In turn, there was evidence linking emotion-focused coping strategies to negative outcomes and problem-focused coping strategies to positive outcomes. The results are discussed in relation to attributional approaches to stress which highlight the importance of cognitions about the consequences of negative events. Finally, implications for the training of teleworkers are presented.

Europa i świat zachodni:szkodliwe dla gospodarki niedostrzegane lub lekceważone zjawiska

The paper presents an abbreviated version of the second part of the report on problems of Europe, prepared by a team of teachers at the University of Information Technology and Management in Rzeszow, Poland. We stress therein that the hotly debated problems of the Eurozone and the global financial crisis and its aftermath are, at best, medium-term ones, while real issues Europe faces are of the long-term nature and result from policies pursued for decades. Their consequences are also long-term – and increasingly harmful. Our diagnosis is as follows. Long-term problems related to the increasing burden of the welfare state and its side effects, like the slowing economic growth rate, are not subject to serious policy debates. It applies to both traditional elites from parties belonging to the moderate political spectrum, and to anti-elites on both extremes. Both elites and anti-elites reject the reality as a starting point to developing corrective policy measures. Our economic analysis has revealed that incentives to create wealth in old Western countries have been weakening for a long time. Yet, without deep cuts in public (especially welfare) expenditures and accompanying institutional reforms, economic performance of European (and generally Western) economies is going to worsen over time. The chances of continued stagnation in the next 5–10 years are very high. Finally, we look at the socio-psychological behavioral framework of the ever-expanding welfare state. We point at the phenomenon of the learned helplessness which appears as a result of the people’s lacking perception of linkages between their actions and economic results of these actions. We interpret it as a consequence of the welfare state. It further weakens the prospects for successful reforms and the resultant avoidance of the long-term stagnation.