Anxiety Sensitivity: Its Relationship to Functional Status in Patients with Chronic Pain

Anxiety sensitivity (AS) is the fear of anxiety-related bodily sensations based on the belief that they are harmful. The purpose of this study was to examine how AS contributes to functional status in chronic pain populations. This study examined the relationship between functional status and AS, demographic, work-related, and pain-related variables in 88 chronic pain patients. Dependent measures of functional status were the SF-36 scales for physical functioning, mental health, vitality, and social functioning. Variables were entered into regression analyses according to category. Significant variables were included in subsequent regressions. AS significantly contributed to lower levels of vitality and poorer social functioning, and was the only variable to significantly contribute to poorer psychological functioning. These results suggest that AS plays an important role in several aspects of functioning in chronic pain patients, and therefore may be a useful concept to be included in pain assessment batteries.     

Determinants of levels and changes of physical functioning in chronically ill persons: results from the GLOBE Study

STUDY OBJECTIVE: Declines in physical functioning are a common result of chronic illness, but relatively little is known about factors not directly related to severity of disease that influence the occurrence of disability among chronically ill persons. The aim of this study was to assess the effect of a large number of potential determinants (sociodemographic factors, health related behaviour, structural living conditions, and psychosocial factors). DESIGN: Longitudinal study of levels and changes of physical functioning among persons suffering from four chronic diseases (asthma/chronic obstructive pulmonary disease (COPD), heart disease, diabetes, chronic low back pain). In 1991, persons suffering from one or more of these diseases were identified in a general population survey. Self reported disabilities, using a subset of the OECD disability indicator, were measured six times between 1991 and 1997. These data were analysed using generalised estimating equations, relating determinants measured in 1991 to disability between 1991 and 1997, and controlling for a number of potential confounders (age, gender, year of measurement, and type and severity of chronic disease). SETTING: Region of Eindhoven (south eastern Netherlands). PARTICIPANTS: 1784 persons with asthma/COPD, heart disease, diabetes mellitus and/or low back pain. MAIN RESULTS: In a "repeated prevalence" model, statistically significant (p<0.05) and strong associations were found between most of the determinants and the prevalence of disabilities. In a "longitudinal change" model, statistically significant (p<0.05) predictors of unfavourable changes in physical functioning were low income and excessive alcohol consumption, while we also found indications for effects of marital status, degree of urbanisation, smoking, and external locus of control. CONCLUSIONS: Other factors than characteristics of the underlying disease have an important influence on levels and changes of physical functioning among chronically ill persons. Reduction of the prevalence of disabilities in the population not only depends on medical interventions, but may also require social interventions, health education, and psychological interventions among chronically ill persons.     

Community‐Based Provision for Young Deaf Children Aged from Birth to Five Years

A single case study was done on a low functioning, non‐verbal, autistic child, which looked at whether the concept of emotion could be taught successfully. Over a six‐month period four emotions were gradually introduced through the use of visual cues taught within an existing home based behavioural intervention programme. These emotions were happy, angry, sad and surprised and were taught using photographs of known people. The participant was tested using novel photographs of familiar and unfamiliar people, which looked at whether he could demonstrate a learnt concept to the novel photographs. The results showed that the four emotions had been learnt and were able to be successfully generalised to the novel photographs.     

Can Emotions be Taught to a Low Functioning Autistic Child?

A single case study was done on a low functioning, non-verbal, autistic child, which looked at whether the concept of emotion could be taught successfully. Over a six-month period four emotions were gradually introduced through the use of visual cues taught within an existing home based behavioural intervention programme. These emotions were happy, angry, sad and surprised and were taught using photographs of known people. The participant was tested using novel photographs of familiar and unfamiliar people, which looked at whether he could demonstrate a learnt concept to the novel photographs. The results showed that the four emotions had been learnt and were able to be successfully generalised to the novel photographs.     

Adverse Childhood Experiences,Family Functioning,and Resilience in Military Families: A Pattern‐Based Approach

Linkages between adverse childhood experiences and long‐term consequences in servicemen and servicewomen were examined in relation to family‐level resiliency processes predicted to mitigate this link. Using a pattern‐based, multi‐informant approach, resilience was explored through a systemic lens in relation to family‐level processes. Latent family profiles were identified using diverse dimensions of family functioning guided by the circumplex model. Data were collected from parents and their adolescents, age 11 to 18, living in the continental United States (N = 273 military families). Variations in adverse childhood experiences among servicemembers and their partners were related to heterogeneous family functioning typologies (profiles). One adaptive family functioning typology illustrated that a select group of families with higher levels of early adverse experiences evinced adaptive functioning outcomes in multiple domains in adulthood. Implications for examining individual resilience via a family‐level process and applications to educational and clinical contexts are discussed in relation to military and nonmilitary families.     

What Factors Contribute to the Resilience of African-American Children Within Kinship Care?

Research about African-American children who overcome adversity to adapt successfully within kinship care is virtually nonexistent. To address this knowledge gap, we studied the caregivers of 30 African-American children residing in kinship care homes to determine why some children succeed in their placements while others do not. In this qualitative investigation, we interviewed the kinship caregivers of resilient and nonresilient children. Resilient children generally resided in families characterized by more structure, clear boundaries, and well-defined roles. Kinship caregivers indicated that the support they received from extended family was helpful and promoted positive child outcomes.     

Complex Interactions Between Tutor Performance,Tutorial Group Productivity and the Effectiveness of PBL Units as Perceived by Students

Aim: Tutor performance and tutorial group productivity interact with each other in a complex manner. The aim of this study was to investigate how tutor performance, tutorial group productivity and the effectiveness of a PBL unit interact with each other. Three hypotheses were tested: (1) Does the tutor performance score differ across different levels of group productivity? (2) Does the group productivity score differ across different levels of tutor performance? and (3) Is the learning effectiveness score of a PBL unit related to tutor performance and group productivity? Method: Students rated the tutor performance, the tutorial group productivity and the effectiveness of the PBL unit. In total 287 unique tutors were involved and were categorized as having a relatively low, average or relatively high score on tutor performance. This was also done for the group productivity score. For each combination, average effectiveness score were computed. Furthermore, partial correlation coefficients were computed. Results: The results demonstrated that the average tutor performance score was higher if the productivity score was higher (hypothesis 1). The results also demonstrated that the average productivity score was higher if the tutor performance score was higher (hypothesis 2). Furthermore it was found that the effectiveness score was higher if the productivity score was higher. The effectiveness score was also higher if the tutor score was higher. The results furthermore demonstrated that the correlation coefficient between tutor performance and effectiveness of the PBL unit is 0.01 (n.s.) if the correlation between the two variables was controlled for group productivity (was 0.36). In addition, the correlation coefficient between group productivity and effectiveness became 0.39 if the correlation between these two variables was controlled for tutor performance (was 0.51) (hypothesis 3). Conclusion: It is concluded that tutor performance differs across different levels of group productivity and that the group productivity score differs across different levels of tutor performance. In addition, it is concluded that both group productivity and the tutor’s performance have an impact on the effectiveness of a PBL unit, although the correlation between group productivity and effectiveness is higher than the correlation between tutor performance and effectiveness. This finding illustrates the importance of the group’s productivity in PBL and the tutor’s importance and implies that schools should put more efforts in improving tutorial group functioning as well as in improving a tutor’s performance.     

Understanding carers’ lived experience of stigma: the voice of families with a child on the autism spectrum

Existing research suggests that there are several unique challenges associated with caring for a child on the autism spectrum. Despite a growing evidence base regarding autism spectrum disorders and their increasing prevalence, children on the autism spectrum and their families continue to perceive stigmatisation from various sources throughout the community. These perceptions of stigma can profoundly impact the quality of life of these children and their carers alike. This exploratory study sought to investigate carers’ perceptions of stigma in caring for a child with high functioning autism. Fifteen carers from Sydney and the South Coast regions of New South Wales, Australia, participated in semi‐structured interviews regarding their caring experiences and any perceived encounters with stigma. Four domains of stigmatising experiences were identified: (i) lack of knowledge, (ii) judgement, (iii) rejection and (iv) lack of support. These domains were each reported to exist in four main contexts: (i) school, (ii) public, (iii) family and (iv) friends. These domains and contexts established a framework which provided a detailed account of how and where carers felt stigmatised, including the suggestion of a stigmatising pathway through the four domains. The main contexts in which stigma was perceived also appeared to be related, with those carers who experienced stigma in one context being more likely to report similar experiences in other contexts. Any attempts to empower carers in the face of stigmatisation should therefore consider each of these domains, the pathway that connects them and the relationship between different social contexts. Through identifying this pathway, supportive services can be acutely aware of how carers may perceive potentially stigmatising experiences and therefore provide appropriate interventions or support for the relevant stage of the pathway.     

The effect of retirement on cognitive functioning

Cognitive impairment has emerged as a major driver of disability in old age, with profound effects on individual well-being and decision making at older ages. In the light of policies aimed at postponing retirement ages, an important question is whether continued labour supply helps to maintain high levels of cognition at older ages. We use data of older men from the US Health and Retirement Study to estimate the effect of continued labour market participation at older ages on later-life cognition. As retirement itself is likely to depend on cognitive functioning and may thus be endogenous, we use offers of early retirement windows as instruments for retirement in econometric models for later-life cognitive functioning. These offers of early retirement are legally required to be nondiscriminatory and thus, inter alia, unrelated to cognitive functioning. At the same time, these offers of early retirement options are significant predictors of retirement. Although the simple ordinary least squares estimates show a negative relationship between retirement duration and various measures of cognitive functioning, instrumental variable estimates suggest that these associations may not be causal effects. Specifically, we find no clear relationship between retirement duration and later-life cognition for white-collar workers and, if anything, a positive relationship for blue-collar workers.     

Evaluation of healing by gentle touch

OBJECTIVES: To evaluate the effectiveness and safety of healing by gentle touch in clients attending The Centre for Complementary Care (CCC) in Eskdale, Cumbria. STUDY DESIGN: An evaluation of data collected by questionnaire over 6 years. METHODS: All clients attending the CCC between 1995 and 2001 were invited to participate in this study, and data were collected from 300 subjects with a wide range of ailments who received four treatment sessions within 6 weeks. Exclusion criteria were: recent treatment at the CCC; failure to complete four treatment sessions; and age under 16 years. Outcome measures included comparison of pre- and post-treatment levels of physical (pain, disability, immobility, sleep disturbances, reliance upon medication, daily activities) and psychological (stress, panic, fear, anger, relaxation, coping, depression/anxiety) functioning; these were assessed using a questionnaire with visual analogue scales for subjective rating of symptoms and the EuroQoL (EQ-5D), a generic state-of-health measure. RESULTS: Wilcoxon signed ranks tests showed statistically significant improvements in both psychological and physical functioning, particularly in stress reduction (median stress levels fell by four points), pain relief (median pain ratings fell by two points), increased ability to cope (median improvement of three points) and increased general health ratings (median improvement of 20 points) between study entry and end of treatment (P < 0.0004 for all these symptoms). The most substantial improvements were seen in those with the most severe symptoms at study entry. No adverse effects of treatment were documented. CONCLUSIONS: This audit of treatment outcomes provides evidence consistent with the hypothesis that healing, as provided at the CCC, was associated with improved psychological and physical functioning in the majority of subjects, and is worthy of further evaluation.