Why doctors choose small towns: A developmental model of rural physician recruitment and retention

Shortages of health care professionals have plagued rural areas of the USA for more than a century. Programs to alleviate them have met with limited success. These programs generally focus on factors that affect recruitment and retention, with the supposition that poor recruitment drives most shortages. The strongest known influence on rural physician recruitment is a “rural upbringing,” but little is known about how this childhood experience promotes a return to rural areas, or how non-rural physicians choose rural practice without such an upbringing. Less is known about how rural upbringing affects retention. Through twenty-two in-depth, semi-structured interviews with both rural- and urban-raised physicians in northeastern California and northwestern Nevada, this study investigates practice location choice over the life course, describing a progression of events and experiences important to rural practice choice and retention in both groups.     

Measurement and predictors of resilience among community-dwelling older women

Background

Resilience, the ability to adapt positively to adversity, may be an important factor in successful aging. However, the assessment and correlates of resilience in elderly individuals have not received adequate attention.

Method

A total of 1395 community-dwelling women over age 60 who were participants at the San Diego Clinical Center of the Women’s Health Initiative completed the Connor-Davidson Resilience Scale (CD-RISC), along with other scales pertinent to successful cognitive aging. Internal consistency and predictors of the CD-RISC were examined, as well as the consistency of its factor structure with published reports.

Results

The mean age of the cohort was 73 (7.2) years and 14% were Hispanic, 76% were non-Hispanic white, and nearly all had completed a high school education (98%). The mean total score on the CD-RISC was 75.7 (sd = 13.0). This scale showed high internal consistency (Cronbach’s alpha = 0.92). Exploratory factor analysis yielded four factors (somewhat different from those previously reported among younger adults) that reflected items involving: (1) personal control and goal orientation, (2) adaptation and tolerance for negative affect, (3) leadership and trust in instincts, and (4) spiritual coping. The strongest predictors of CD-RISC scores in this study were higher emotional well-being, optimism, self-rated successful aging, social engagement, and fewer cognitive complaints.

Conclusions

Our study suggests that the CD-RISC is an internally consistent scale for assessing resilience among older women, and that greater resilience as assessed by the CD-RISC related positively to key components of successful aging.     

临床护士心理应激对职业倦怠的影响:一个链式中介模型

目的 探讨领悟社会支持与心理弹性在临床护士心理应激与职业倦怠间的中介作用。方法 使用领悟社会支持量表、心理弹性量表、心理应激自评量表、职业倦怠量表对1 052名临床护士进行调查。结果 心理应激与心理弹性、领悟社会支持呈显著负相关,与职业倦怠呈显著正相关(r=-0.38,P<0.01;r=-0.41,P<0.01;r=0.66,P<0.01);心理弹性、领悟社会支持与职业倦怠呈显著负相关(r=-0.62,P<0.01; r=-0.60,P<0.01);领悟社会支持与心理弹性呈显著正相关(r=0.60,P<0.01)。领悟社会支持—心理弹性在临床护士心理应激与职业倦怠间具有链式中介作用,间接效应值为0.12,间接效应占总效应比值为15.2%。结论 心理应激既可以直接预测临床护士的职业倦怠,又可以分别通过领悟社会支持、心理弹性的中介作用,以及领悟社会支持—心理弹性的链式中介作用间接预测临床护士的职业倦怠。     

Diminished cortisol responses to psychosocial stress associated with lifetime adverse events a study among healthy young subjects

BACKGROUND: Animal and human studies have found that prior stressful events can result in an altered reactivity in the HPA axis. The aim of the present study was to investigate the role of adverse events in childhood on cortisol reactivity to psychosocial stress in young healthy subjects (n=80). METHODS: Salivary cortisol levels were measured before, during and after exposure to a psychosocial stress task in healthy men and women with high (n=33) and low (n=47) exposure to adverse childhood events. RESULTS: A significant blunted cortisol response was found in individuals with a history of adverse events compared to individuals with no adverse life events, with no differences in baseline cortisol levels. This finding appeared to be primarily driven by men. The groups did not differ on any other physiological or subjective stress measure, including heart rate, blood pressure, and subjective tension. CONCLUSIONS: These findings suggest that, at least in healthy young males, adverse childhood events are associated with changes in HPA-axis functioning. Longitudinal studies are needed to investigate whether the blunted cortisol response is a risk factor in the etiology of psychiatric disorders or rather reflects resiliency with regard to the development of psychopathology.     

Narratives from caregivers of children surviving the terrorist attack in Beslan: issues of health, culture, and resilience

Acts of terrorism have an extremely negative impact on the mental health of children and families. The school siege in Beslan, Russia, in 2004, represents a particularly traumatizing event as it was directed specifically at children and involved the entire community. This qualitative study aims to: (a) examine caregiver reactions to the terrorist attack in Beslan as reported 3 months after the traumatic event; (b) determine the extent to which indigenous cultural values and religious belief systems play a role in Beslan's caregivers' reactions to such event; and (c) identify variables that may function as sources of resilience to caregivers. A convenience sample of 17 primary caregivers from Beslan with at least one child who survived the school siege were asked to participate in semi-structured interviews. Narratives generated from the interviews were qualitatively analyzed using a thematic approach; nine major themes were identified. Caregivers' concerns centered on children's physical and psychological well-being, the reorganization of family life, and the disruption of community ties. Cultural values of pride, heroism, courage, and revenge emerged as relevant aspects shaping caregivers' reactions to the traumatic event. Possible sources of resilience included the willingness to return to normality, social support, and the reaffirmation of positive, culturally shared values in face of the perceived threat of future terrorist attacks. Findings are discussed in terms of their theoretical implications on the effects of trauma on children and families as well as interventions with highly traumatized populations in diverse cultural settings.     

Building psychosocial assets and wellbeing among adolescent girls: A randomized controlled trial

We conducted a randomized controlled trial of a 5-month resilience-based program (Girls First Resilience Curriculum or RC) among 2308 rural adolescent girls at 57 government schools in Bihar, India. Local women with at least a 10th grade education served as group facilitators. Girls receiving RC improved more (vs. controls) on emotional resilience, self-efficacy, social-emotional assets, psychological wellbeing, and social wellbeing. Effects were not detected on depression. There was a small, statistically significant negative effect on anxiety (though not likely clinically significant). Results suggest psychosocial assets and wellbeing can be improved for girls in high-poverty, rural schools through a brief school-day program. To our knowledge, this is one of the largest developing country trials of a resilience-based school-day curriculum for adolescents.     

Inoculation stress hypothesis of environmental enrichment

One hallmark of psychiatric conditions is the vast continuum of individual differences in susceptibility vs. resilience resulting from the interaction of genetic and environmental factors. The environmental enrichment paradigm is an animal model that is useful for studying a range of psychiatric conditions, including protective phenotypes in addiction and depression models. The major question is how environmental enrichment, a non-drug and non-surgical manipulation, can produce such robust individual differences in such a wide range of behaviors. This paper draws from a variety of published sources to outline a coherent hypothesis of inoculation stress as a factor producing the protective enrichment phenotypes. The basic tenet suggests that chronic mild stress from living in a complex environment and interacting non-aggressively with conspecifics can inoculate enriched rats against subsequent stressors and/or drugs of abuse. This paper reviews the enrichment phenotypes, mulls the fundamental nature of environmental enrichment vs. isolation, discusses the most appropriate control for environmental enrichment, and challenges the idea that cortisol/corticosterone equals stress. The intent of the inoculation stress hypothesis of environmental enrichment is to provide a scaffold with which to build testable hypotheses for the elucidation of the molecular mechanisms underlying these protective phenotypes and thus provide new therapeutic targets to treat psychiatric/neurological conditions.     

抑郁症患者心理弹性、防御机制与抑郁的相关性分析

目的:探索抑郁症患者心理弹性、防御机制对抑郁的影响。方法:选取山西省某三级甲等医院精神科门诊、住院部符合ICD-10抑郁障碍诊断标准的61例抑郁症患者,采用汉密尔顿抑郁量表(HAMD)、防御机制自评量表(DSQ)、心理弹性量表(CD-RISC)进行问卷调查。结果:1心理弹性中的乐观性与抑郁显著负相关(r=-0.29,P0.05),不成熟型防御机制、中间型防御机制与抑郁之间呈正相关(r=0.32,0.31;P0.05),不成熟型防御机制与心理弹性得分呈显著负相关(r=-0.37,P0.01);2在心理弹性中的乐观性对于抑郁程度的预测中,不成熟的防御机制起完全中介效应,中介效应占总效应的比例为37.5%。结论:心理弹性中的乐观性是抑郁的重要保护因子,而不良的防御机制是影响抑郁的内部因素,并且心理弹性中的乐观性对于抑郁程度的预测是通过不成熟防御机制实现的。     

医学生心理弹性与应对方式的相关性及其影响因素

目的:了解医学生心理弹性与应对方式的相关性及其影响因素,为降低医学生心理压力,制定心理弹性干预措施提供科学依据。方法:采用方便抽样方法,对640名医学生采用一般情况问卷、Conner-Davidson心理弹性量表中文版及简易应对方式量表进行问卷调查。结果:640名医学生心理弹性总均分(61.70±12.44)分,显著低于普通成人总均分(65.4±13.9)分,差异具有统计学意义(t=-7.542,P0.01)。相关分析显示,医学生心理弹性总分与积极应对显著正相关(r=0.538,P0.01),与消极应对呈负相关(r=-0.096,P0.05)。进一步回归分析显示,积极应对方式、消极应对方式、担任学生干部及家庭月收入是影响医学生心理弹性的重要因素。结论:医学生心理弹性水平较低,采取积极应对方式、担任学生干部及家庭经济状况好的医学生心理弹性水平更高。