A picture paints a thousand words: Heart drawings reflect acute distress and illness perception and predict posttraumatic stress symptoms after acute myocardial infarction

The aim of this study was to examine whether heart drawings of patients with acute myocardial infarction reflect acute distress symptoms and negative illness beliefs and predict posttraumatic stress symptoms 3 months post-myocardial infarction. In total, 84 patients aged over 18 years drew pictures of their heart. The larger the area drawn as damaged, the greater were the levels of acute distress (r = 0.36; p < 0.05), negative illness perceptions (r = 0.42, p < 0.05), and posttraumatic stress symptoms (r = 0.54, p < 0.01). Pain drawings may offer a tool to identify maladaptive cognitions and thus patients at risk of posttraumatic stress disorder.

The inter-relationship between depressive, anxiety and stress symptoms in fathers during the antenatal period

Objective: The aim of this study was to examine whether depressive symptoms predict anxiety and stress or whether anxiety and stress precede depressive symptoms in fathers during the antenatal period. Background: The findings of previous studies suggest that there is an association between paternal depression, anxiety and stress during the antenatal period. However, the temporal inter-relationship between these variables has yet to be investigated. Method: Data were collected from 150 expectant couples at approximately 18, 25 and 33 weeks’ gestation. Results: After accounting for the relative stability of depression, anxiety and stress over time, for men higher levels of anxiety earlier in pregnancy predicted higher levels of depression and stress in middle pregnancy, which predicted higher depression during late pregnancy. A similar relationship remained after partialling out the effects of partner’s depression, perceived social support and sleep quality. Further analyses also revealed significant differences in the manifestation of distress symptoms between men and women, but not between first-time and non-first-time fathers. Conclusion: Our findings indicated a possible inter-relationship between depression, anxiety and stress for men antenatally. Our findings also showed that men who reported elevated depression, anxiety and stress earlier in the antenatal period also reported elevated symptomology at later time points. Finally, the current findings revealed that antenatal paternal stress may play a key role in the development of depression and anxiety later in pregnancy. Therefore, it may be important to screen for early levels of antenatal stress in men, as well as depression and anxiety.

Distress symptomatology in men during their partner's pregnancy

This thesis explored predictors of elevated distress symptoms in men during their partner’s pregnancy. Results demonstrated that depression, anxiety and stress (distress symptoms) in men have a bi-directional relationship with one another across their partner’s pregnancy, and that distress symptoms are predictive of that measure across the antenatal period.

Socioeconomic Status, Occupational Factors and Lifestyle as Predictors of Hospitalisation for Back Disorders

The aim of this dissertation was to examine the determinants of severe back disorders leading to hospital admission in Finland. First, back-related hospitalisations were considered from the perspective of socioeconomic status, occupation, and industry. Secondly, the significance of psychosocial factors at work, sleep disturbances, and such lifestyle factors as smoking and overweight was studied as predictors of hospitalisation due to back disorders. Two sets of data were used: 1) the population-based data comprised all occupationally active Finns aged 25-64, and included hospitalisations due to back disorders in 1996 and 2) a cohort of employees followed up from 1973 to 2000 having been hospitalised due to back disorders. The results of the population-based study showed that people in physically strenuous industries and occupations, such as agriculture and manufacturing, were at an increased risk of being hospitalised for back disorders. The lowest hospitalisation rates were found in sedentary occupations. Occupational class and the level of formal education were independently associated with hospitalisation for back disorders. This stratification was fairly consistent across age-groups and genders. Men had a slightly higher risk of becoming hospitalised compared with women, and the risk increased with age among both genders. The results of the prospective cohort study showed that psychosocial factors at work such as low job control and low supervisor support predicted subsequent hospitalisation for back disorders even when adjustments were made for occupational class and physical workload history. However, psychosocial factors did not predict hospital admissions due to intervertebral disc disorders; only admissions due to other back disorders. Smoking and overweight predicted, instead, only hospitalisation for intervertebral disc disorders. These results suggest that the etiological factors of disc disorders and other back disorders differ from each other. The study concerning the association of sleep disturbances and other distress symptoms with hospitalisation for back disorders revealed that sleep disturbances predicted subsequent hospitalisation for all back disorders after adjustment for chronic back disorders and recurrent back symptoms at baseline, as well as for work-related load and lifestyle factors. Other distress symptoms were not predictive of hospitalisation.

Santé reproductive et santé mentale des femmes qui ont subi la violence sexuelle en temps de conflit armé : cas de la République Démocratique du Congo

Problématique : Depuis bientôt deux décennies, la République Démocratique du Congo (RDC) est le territoire d’un conflit armé qui, selon l’International Rescue Commite, aurait occasionné plus de 3 millions de décès et autant de déplacés internes. Plusieurs rapports font également cas des nombreux actes de violence sexuelle (les viols, les mutilations, l’esclavage, l’exploitation sexuelle, etc.) commis envers les filles, les femmes et dans une moindre ampleur les hommes. S’il existe un consensus sur le côté barbare des actes de violence sexuelle liés aux conflits armés, rares sont les études qui ont évalué leurs conséquences sur la santé reproductive des survivantes surtout en termes d’issues telles que les fistules, les douleurs pelviennes chroniques (DPC), le désir de rapports sexuels, le désir d’enfant et le désir d’interruption de la grossesse issue de tels actes. Par ailleurs, même si la santé mentale des populations en zones de conflit représente un sujet d’intérêt, l’impact spécifique de la violence sexuelle liée au conflit sur la santé mentale des survivantes a été peu étudié. De plus, ces travaux s’intéressent aux effets de la violence sexuelle liée au conflit sur la santé mentale et sur la santé reproductive séparément et ce, sans évaluer les relations qui peuvent exister entre ces deux dimensions qui, pourtant, s’influencent mutuellement. Aussi, l’impact social de la violence sexuelle liée au conflit, ainsi que la contribution des normes socioculturelles aux difficultés que rencontrent les survivantes, a été peu étudié. Pourtant, l’impact social de la violence sexuelle liée au conflit peut permettre de mieux comprendre comment l’expérience d’un tel acte peut affecter la santé mentale. Enfin, aucune étude n’a évalué les effets de la violence sexuelle liée au conflit en la comparant à la violence sexuelle non liée au conflit (VSNLC). Pourtant, il est reconnu qu’à de nombreux égards, la violence sexuelle liée au conflit est bien différente de la VSNLC puisqu’elle est perpétrée avec l’intention de créer le maximum d’effets adverses pour la victime et sa communauté. Objectifs : Les objectifs poursuivis dans cette thèse visent à : 1) évaluer les effets de la violence sexuelle liée au conflit sur la santé reproductive; 2) évaluer les effets de la violence sexuelle liée au conflit sur la santé mentale en termes de sévérité des symptômes de stress posttraumatique (PTSD), de sévérité des symptômes de détresse psychologique et de probabilité de souffrir de troubles mentaux communs (TMC); 3) évaluer la contribution des troubles physiques de santé reproductive, en particulier les fistules et les douleurs pelviennes chroniques (DPC), aux effets de la violence sexuelle liée au conflit sur la santé mentale; 4) évaluer la contribution de l’état de santé mentale aux effets de la violence sexuelle liée au conflit sur le désir de rapports sexuels et le désir d’enfant; et 5) étudier l’impact de la violence sexuelle liée au conflit sur le plan social ainsi que la contribution des normes socioculturelles à ses effets adverses et la façon dont ces effets pourraient à leur tour influencer la santé des femmes et leur relation avec l’enfant issu de l’acte de violence sexuelle subi. Méthodologie : Un devis mixte de nature convergente a permis de collecter des données quantitatives auprès de l’ensemble des participantes (étude transversale) et des données qualitatives sur un nombre plus restreint de femmes (étude phénoménologique). Une étude transversale populationnelle a été conduite entre juillet et août 2012 auprès de 320 femmes âgées de 15 à 45 ans habitant quatre (4) quartiers de la ville de Goma située dans la province du Nord-Kivu en RDC. Les femmes ont été recrutées à travers des annonces faites par les responsables des programmes d’alphabétisation et de résolution de conflits implantés dans les différents quartiers par le Collectif Alpha Ujuvi, une ONG locale. Les issues de santé reproductive évaluées sont : les fistules, les DPC, le désir de rapports sexuels, le désir d’enfant et le désir d’interruption de la grossesse issue d’un acte de violence sexuelle. Les variables de santé mentale d’intérêt sont : la sévérité des symptômes de détresse psychologique, la sévérité des symptômes de PTSD et la probabilité de souffrir de TMC. Pour les analyses, l’exposition a été définie en trois (3) catégories selon l’expérience passée de violence sexuelle : les femmes qui ont vécu des actes de violence sexuelle liée au conflit, celles qui ont vécu des actes de VSNLC et celles qui ont déclaré n’avoir jamais subi d’acte de violence sexuelle au cours de leur vie. Les variables de confusion potentielles mesurées sont : l’âge, le statut matrimonial, le nombre d’enfants, le niveau d’éducation le plus élevé atteint et l’occupation professionnelle. Les mesures d’associations ont été évaluées à l’aide de modèles de régressions logistiques et linéaires simples et multiples. Des tests d’interaction multiplicative et des analyses stratifiées ont été également conduits pour évaluer l’effet potentiellement modificateur de quelques variables (âge, statut matrimonial, nombre d’enfants) sur la relation entre la violence sexuelle et les variables de santé reproductive ou de santé mentale. Ces tests ont également été utilisés pour évaluer la contribution d’une variable de santé reproductive ou de santé mentale aux effets de la violence sexuelle sur l’autre dimension de la santé d’intérêt dans cette étude. Une étude phénoménologique a été conduite dans le même intervalle de temps auprès de 12 femmes ayant participé à la partie quantitative de l’étude qui ont vécu la violence sexuelle liée au conflit et ont eu un enfant issu d’une agression sexuelle. Les sujets explorés incluent : la perception de l’acte de violence sexuelle liée au conflit vécu et de la vie quotidienne par les victimes; la perception de l’acte de violence sexuelle liée au conflit par la famille et l’entourage et leurs réactions après l’agression; la perception de la grossesse issue de l’acte de violence sexuelle par la victime; la perception de l’enfant issu de la violence sexuelle liée au conflit par la victime ainsi que son entourage; les conséquences sociales de l’expérience de violence sexuelle liée au conflit et les besoins des victimes pour leur réhabilitation. Une analyse thématique avec un codage ouvert a permis de ressortir les thèmes clés des récits des participantes. Par la suite, l’approche de théorisation ancrée a été utilisée pour induire un cadre décrivant l’impact social de l’expérience de la violence sexuelle liée au conflit et les facteurs y contribuant. Résultats : Le premier article de cette thèse montre que, comparées aux femmes qui n’ont jamais vécu un acte de violence sexuelle, celles qui ont vécu la violence sexuelle liée au conflit ont une probabilité plus élevée d’avoir une fistule (OR=11.1, IC 95% [3.1-39.3]), des DPC (OR=5.1, IC 95% [2.4-10.9]), de rapporter une absence de désir de rapports sexuels (OR=3.5, IC 95% [1.7-6.9]) et une absence de désir d’enfant (OR=3.5, IC 95% [1.6-7.8]). Comparées aux mêmes femmes, celles qui ont vécu la VSNLC ont plus de probabilité de souffrir de DPC (OR=2.3, IC 95% [0.95-5.8]) et de rapporter une absence de désir d’enfant (OR=2.7, IC 95% [1.1-6.5]). Comparées aux femmes qui ont vécu la VSNLC, celles qui ont vécu la violence sexuelle liée au conflit ont également une probabilité plus élevée d’avoir une fistule (OR=9.5, IC 95% [1.6-56.4]), des DPC (OR=2.2, IC 95% [0.8-5.7]) et de rapporter une absence de désir de rapports sexuels (OR=2.5, IC 95% [1.1-6.1]). En ce qui concerne les grossesses issues des viols, comparées aux femmes qui ont vécu la VSNLC, celles qui ont vécu la violence sexuelle liée au conflit sont plus nombreuses à souhaiter avorter (55% vs 25% pour celles qui ont vécu la VSNLC). Elles sont également plus nombreuses à déclarer qu’elles auraient avorté si les soins appropriés étaient accessibles (39% vs 21% pour celles qui ont vécu la VSNLC). Le second article montre qu’en comparaison aux femmes qui n’ont jamais subi de violence sexuelle, celles qui ont vécu la violence sexuelle liée au conflit présentent des symptômes de détresse psychologique (moyennes de score respectives 8.6 et 12.6, p<0.0001) et des symptômes de PTSD (moyennes de score respectives 2.2 et 2.6, p<0.0001) plus sévères et ont plus de probabilité d’être dépistées comme un cas de TMC (30% vs 76%, p<0.0001). De plus, comparées aux femmes qui ont vécu la VSNLC, celles qui ont vécu la violence sexuelle liée au conflit présentent des symptômes de détresse psychologique (moyennes de score respectives 10.1 et 12.6, p<0.0001) et des symptômes de PTSD (moyennes de score respectives 2.2 et 2.6, p<0.0001) plus sévères et ont plus de probabilité d’être dépistées comme un cas de TMC (48% vs 76%, p<0.001). Les valeurs minimales et maximales de score de sévérité de symptômes de détresse psychologique sont de 0/12 pour les femmes qui n’ont jamais vécu de violence sexuelle, 4/19 pour celles qui ont vécu la VSNLC et de 5/18 pour celles qui ont vécu la violence sexuelle liée au confit. En ce qui concerne la sévérité des symptômes de PTSD, les scores minimal et maximal sont respectivement de 0.36/3.22, 0.41/3.41 et 0.95/3.45. Le fait d’avoir développé une fistule ou de souffrir de DPC après l’agression sexuelle augmente la force des associations entre la violence sexuelle et la santé mentale. Les femmes qui ont subi la violence sexuelle liée au conflit et qui ont souffert de fistules présentent des symptômes de détresse psychologique et de PTSD plus sévères comparées aux femmes qui ont subi la violence sexuelle liée au conflit mais n’ont pas de fistules. Les résultats sont similaires pour les femmes qui ont subi la violence sexuelle liée au conflit et qui souffrent de DPC. Des résultats complémentaires suggèrent que le statut matrimonial modifie l’effet de la violence sexuelle sur la sévérité des symptômes de détresse psychologique, les femmes divorcées/séparées et les veuves étant celles qui ont les moyennes de score les plus élevées (respectivement 11.3 et 12.1 vs 9.26 et 9.49 pour les célibataires et les mariées). Par ailleurs, la sévérité des symptômes de détresse psychologique modifie l’association entre la violence sexuelle liée au conflit et le désir d’enfant. Le troisième article montre que, sur le plan social, l’expérience de violence sexuelle liée au conflit entraine également de lourdes conséquences. Toutes celles qui ont vécu ce type d’acte décrivent leur vie de survivante et de mère d’un enfant issu d’une agression sexuelle comme difficile, oppressive, faite de peines et de soucis et sans valeur. Plusieurs facteurs influencent la description que les victimes de violence sexuelle liée au conflit font de leur vie quotidienne, et ils sont tous reliés aux normes socioculturelles qui font de la femme une citoyenne de seconde zone, ne font aucune différence entre un viol et un adultère, condamnent les victimes de violence sexuelle plutôt que leurs agresseurs, rejettent et stigmatisent les victimes de tels actes ainsi que l’enfant qui en est issu. En réponse au rejet et au manque de considération, les femmes victimes de violence sexuelle liée au conflit ont tendance à s’isoler pour éviter les insultes et à garder le silence sur leur agression. En plus, les réactions de leur entourage/communauté ont tendance à leur faire revivre l’agression sexuelle subie, autant d’éléments qui nuisent davantage à leur réhabilitation. D’autres résultats démontrent que les enfants issus d’actes de violence sexuelle liée au conflit sont également rejetés par leur communauté, leur famille adoptive ainsi que le conjoint de leur mère, ce qui affecte davantage les survivantes. Avec leurs mères, les relations développées varient entre le rejet, la résignation et l’affection. Néanmoins, ces relations sont plus souvent tendues probablement à cause de la stigmatisation de la communauté. Conclusion: La violence sexuelle liée au conflit a des effets adverses sur la santé reproductive, la santé mentale mais également sur le plan social. Ces trois dimensions sont loin d’être isolées puisque cette étude a permis de démontrer qu’elles s’influencent mutuellement. Ceci suggère que la prise en charge des victimes de violence sexuelle liée au conflit ne doit pas se concentrer sur un aspect ou un autre de la santé mais prendre en compte l’ensemble des dimensions de la femme pour offrir une aide holistique, plus adaptée et qui sera plus efficace à long terme.

Antidepressant treatment and emotional processing: can we dissociate the roles of serotonin and noradrenaline?

The ability to match individual patients to tailored treatments has the potential to greatly improve outcomes for individuals suffering from major depression. In particular, while the vast majority of antidepressant treatments affect either serotonin or noradrenaline or a combination of these two neurotransmitters, it is not known whether there are particular patients or symptom profiles which respond preferentially to the potentiation of serotonin over noradrenaline or vice versa. Experimental medicine models suggest that the primary mode of action of these treatments may be to remediate negative biases in emotional processing. Such models may provide a useful framework for interrogating the specific actions of antidepressants. Here, we therefore review evidence from studies examining the effects of drugs which potentiate serotonin, noradrenaline or a combination of both neurotransmitters on emotional processing. These results suggest that antidepressants targeting serotonin and noradrenaline may have some specific actions on emotion and reward processing which could be used to improve tailoring of treatment or to understand the effects of dual-reuptake inhibition. Specifically, serotonin may be particularly important in alleviating distress symptoms, while noradrenaline may be especially relevant to anhedonia. The data reviewed here also suggest that noradrenergic-based treatments may have earlier effects on emotional memory that those which affect serotonin.

A meta-analytic clarification of the relationship between posttraumatic growth and symptoms of posttraumatic distress disorder

Traumatic experiences can have a powerful impact on individuals and communities but the relationship between perceptions of beneficial and pathological outcomes are not known. Therefore, this meta-analysis examined both the strength and the linearity of the relationship between symptoms of posttraumatic stress disorder (PTSD) and perceptions of posttraumatic growth (PTG) as well as identifying the potential moderating roles of trauma type and age. Literature searches of all languages were conducted using the ProQuest, Wiley Interscience, ScienceDirect, Informaworld and Web of Science databases. Linear and quadratic (curvilinear) rs as well as βs were analysed. Forty-two studies (N=11, 469) that examined both PTG and symptoms of PTSD were included in meta-analytic calculations. The combined studies yielded a significant linear relationship between PTG and PTSD symptoms (r=.315, CI = 0.299, 0.331), but also a significantly stronger (as tested by Fisher’s transformation) curvilinear relationship (r=.372, CI = 0.353, 0.391). The strength and linearity of these relationships differed according to trauma type and age. The results remind those working with traumatised people that positive and negative post-trauma outcomes can co-occur. A focus only on PTSD symptoms only may limit or slow recovery and mask the potential for growth.

A shared care model pilot for palliative home care in a rural area:Impact on symptoms, distress, and place of death

Context: Shared care models integrating family physician services with interdisciplinary palliative care specialist teams are critical to improve access to quality palliative home care and address multiple domains of end-of-life issues and needs. Objectives: To examine the impact of a shared care pilot program on the primary outcomes of symptom severity and emotional distress (patient and family separately) over time and, secondarily, the concordance between patient preferences and place of death. Methods: An inception cohort of patients (n = 95) with advanced, progressive disease, expected to die within six months, were recruited from three rural family physician group practices (21 physicians) and followed prospectively until death or pilot end. Serial measurement of symptoms, emotional distress (patient and family), and preferences for place of death was performed, with analysis of changes in distress outcomes assessed using t-tests and general linear models. Results: Symptoms trended toward improvement, with a significant reduction in anxiety from baseline to 14 days noted. Symptom and emotional distress were maintained below high severity (7-10), and a high rate of home death compared with population norms was observed. Conclusion: Future controlled studies are needed to examine outcomes for shared care models with comparison groups. Shared care models build on family physician capacity and as such are promising in the development of palliative home care programs to improve access to quality palliative home care and foster health system integration. © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Somatic symptoms, hypochondriasis and psychological distress: a study of somatisation in Australian general practice

Objective: To measure the prevalence of somatisation (multiple somatic symptoms and hypochondriasis) among Australian general practice attendees, its recognition by general practitioners, and its relationship with symptoms of depression and anxiety. Design, setting and participants: Self-reported questionnaires completed by 10 507 consecutive patients aged ≥18 years attending 340 GPs enrolled in a 6-hour national mental health program of continuing professional development who accepted invitations to participate; audit form completed by GPs for each patient during the period March 2004 to December 2006. Main outcome measures: Somatic symptom severity (measured with the 15-item Patient Health Questionnaire [PHQ-15]); hypochondriasis (measured with the Whiteley Index [Whiteley-7]; depression and anxiety (measured by the Kessler Psychological Distress scale [K10]); prevalence of “somatisers” (defined by medium to severe somatic symptom severity and hypochondriasis); GP recognition of somatisation (determined by their responses on audit forms to questions on whether patient’s complaints were most likely to have a physical or psychological explanation). Results: 18.5% of patients were classified as somatisers and 9.5% as probable cases of depression or anxiety. While 29.6% of somatisers had high anxiety or depression scores, 57.9% of people with anxiety or depression were also somatisers. Sex and age asserted significant but weak effects on psychometric scores. GPs identified somatic complaints as “mostly explained by a psychological disturbance” in 25.1% of somatisers. Conclusions: Somatisation is common in general practice, and more prevalent than depression or anxiety. While a minority of somatisers have significant anxiety and depression, most patients with depression and anxiety have a significant degree of somatisation. Recognition of depression and anxiety can be hindered by a somatic presentation and attribution. On the other hand, managing somatisation does not just involve recognising depression and anxiety, but also dealing with the health anxieties that underpin hypochondriasis.

Symptoms and distress in children with advanced cancer: prospective patient-reported outcomes from the PediQUEST Study

PURPOSE: Thousands of children are living with advanced cancer; yet patient-reported outcomes (PROs) have rarely been used to describe their experiences. We aimed to describe symptom distress in 104 children age 2 years or older with advanced cancer enrolled onto the Pediatric Quality of Life and Evaluation of Symptoms Technology (PediQUEST) Study (multisite clinical trial evaluating an electronic PRO system).

METHODS: Symptom data were collected using age- and respondent-adapted versions of the PediQUEST Memorial Symptom Assessment Scale (PQ-MSAS) at most once per week. Clinical and treatment data were obtained from medical records. Individual symptom scores were dichotomized into high/low distress. Determinants of PQ-MSAS scores were explored using linear mixed-effects models.

RESULTS: During 9 months of follow-up, PQ-MSAS was administered 920 times: 459 times in teens (99% self-report), 249 times in children ages 7 to 12 years (96% child/parent report), and 212 times in those ages 2 to 6 years (parent reports). Common symptoms included pain (48%), fatigue (46%), drowsiness (39%), and irritability (37%); most scores indicated high distress. Among the 73 PQ-MSAS surveys administered in the last 12 weeks of life, pain was highly prevalent (62%; 58% with high distress). Being female, having a brain tumor, experiencing recent disease progression, and receiving moderate- or high-intensity cancer-directed therapy in the prior 10 days were associated with worse PQ-MSAS scores. In the final 12 weeks of life, receiving mild cancer-directed therapy was associated with improved psychological PQ-MSAS scores.

CONCLUSION: Children with advanced cancer experience high symptom distress. Strategies to promote intensive symptom management are indicated, especially with disease progression or administration of intensive treatments.

A patient-reported outcome measure to identify occurrence and distress of post-surgery symptoms of WOMen with vulvAr Neoplasia (WOMAN-PRO) - a cross sectional study.

OBJECTIVE The aim of the study was to describe the (a) symptom experience of women with vulvar intraepithelial neoplasia and vulvar cancer (vulvar neoplasia) during the first week after hospital discharge, and (b) associations between age, type of disease, stage of disease, the extent of surgical treatment and symptom experience. METHODS This cross-sectional study was conducted in eight hospitals in Germany and Switzerland (Clinical Trial ID: NCT01300663). Symptom experience after surgical treatment in women with vulvar neoplasia was measured with our newly developed WOMAN-PRO instrument. Outpatients (n=65) rated 31 items. We used descriptive statistics and regression analysis. RESULTS The average number of symptoms reported per patient was 20.2 (SD 5.77) with a range of 5 to 31 symptoms. The three most prevalent wound-related symptoms were 'swelling' (n=56), 'drainage' (n=54) and 'pain' (n=52). The three most prevalent difficulties in daily life were 'sitting' (n=63), 'wearing clothes' (n=56) and 'carrying out my daily activities' (n=51). 'Tiredness' (n=62), 'insecurity' (n=54) and 'feeling that my body has changed' (n=50) were the three most prevalent psychosocial symptoms/issues. The most distressing symptoms were 'sitting' (Mean 2.03, SD 0.88), 'open spot (e.g. opening of skin or suture)' (Mean 1.91, SD 0.93), and 'carrying out my daily activities' (Mean 1.86, SD 0.87), which were on average reported as 'quite a bit' distressing. Negative associations were found between psychosocial symptom experience and age. CONCLUSIONS WOMAN-PRO data showed a high symptom prevalence and distress, call for a comprehensive symptom assessment, and may allow identification of relevant areas in symptom management.

Frequency, severity and distress of dialysis-related symptoms reported by patients on hemodialysis

Purpose. To determine which symptoms are the most reported, occur most frequently, have the greatest severity, and cause the most bother for hemodialysis (HD) patients and to determine if the symptoms experienced differ between the first (HD 1) and second (HD 2) treatments of the week. ^ Design. An observational, comparative design was used to determine participants' HD symptoms experience on HD 1 and HD 2, and the effect of the symptom experience on Quality of Life (QOL). One hundred subjects were recruited from five dialysis centers. ^ Methods. The adapted Dialysis Frequency, Severity and Symptom Burden Index (DFSSBI) and the Medical Outcomes Study Short Form 36 (MOS SF 36) were administered (N = 99) on HD 1 and the DFSSBI again on HD 2. Data were analyzed for significance among symptoms experience test scores in relation to HD 1 and HD 2, QOL, and gender and age. ^ Results. Of 31 symptoms assessed, respondents reported an average of 9.69 symptoms on HD 1 and 7.51 symptoms on HD 2. Overall, more symptoms were reported, and were more frequent, severe and bothersome on HD 1 when the level of metabolic waste is highest. The most reported symptoms included tiredness, dry skin, difficulty falling asleep, itching, numbness/tingling, difficulty staying asleep, decreased interest in sex, and bone/joint pain. Females scored consistently higher than males in the four symptom dimensions. The respondents reported about the same as the population norm (50) on the physical component summary score of the MOS SF 36 and higher than the norm (65.23) on the mental component summary score. ^ Conclusion. The study findings highlighted the fact that hemodialysis patients experience multiple symptoms that can be frequent, severe, and bothersome. Interventions should be developed and tested to reduce symptom burden and improve QOL. ^

Shame, Dissociation, and Complex PTSD Symptoms in Traumatized Psychiatric and Control Groups: Direct and Indirect Associations With Relationship Distress

Objectives: Elevated shame and dissociation are common in dissociative identity disorder (DID) and chronic posttraumatic stress disorder (PTSD) and are part of the constellation of symptoms defined as complex PTSD. Previous work examined the relationship between shame, dissociation, and complex PTSD and whether they are associated with intimate relationship anxiety, relationship depression, and fear of relationships. This study investigated these variables in traumatized clinical samples and a nonclinical community group.

Method: Participants were drawn from the DID (n = 20), conflict-related chronic PTSD (n = 65), and nonclinical (n = 125) populations and completed questionnaires assessing the variables of interest. A model examining the direct impact of shame and dissociation on relationship functioning, and their indirect effect via complex PTSD symptoms, was tested through path analysis.

Results: The DID sample reported significantly higher dissociation, shame, complex PTSD symptom severity, relationship anxiety, relationship depression, and fear of relationships than the other two samples. Support was found for the proposed model, with shame directly affecting relationship anxiety and fear of relationships, and pathological dissociation directly affecting relationship anxiety and relationship depression. The indirect effect of shame and dissociation via complex PTSD symptom severity was evident on all relationship variables.

Conclusion: Shame and pathological dissociation are important for not only the effect they have on the development of other complex PTSD symptoms, but also their direct and indirect effects on distress associated with relationships.

Final report : a software diagnostic tool for evaluating distress mechanisms in bridges exposed to aggressive environments

Durability issues of reinforced concrete construction cost millions of dollars in repair or demolition. Identification of the causes of degradation and a prediction of service life based on experience, judgement and local knowledge has limitations in addressing all the associated issues. The objective of this CRC CI research project is to develop a tool that will assist in the interpretation of the symptoms of degradation of concrete structures, estimate residual capacity and recommend cost effective solutions. This report is a documentation of the research undertaken in connection with this project. The primary focus of this research is centred on the case studies provided by Queensland Department of Main Roads (QDMR) and Brisbane City Council (BCC). These organisations are endowed with the responsibility of managing a huge volume of bridge infrastructure in the state of Queensland, Australia. The main issue to be addressed in managing these structures is the deterioration of bridge stock leading to a reduction in service life. Other issues such as political backlash, public inconvenience, approach land acquisitions are crucial but are not within the scope of this project. It is to be noted that deterioration is accentuated by aggressive environments such as salt water, acidic or sodic soils. Carse, 2005, has noted that the road authorities need to invest their first dollars in understanding their local concretes and optimising the durability performance of structures and then look at potential remedial strategies.