Conceptions of wellness among the Yup'ik of the Yukon-Kuskokwim Delta: the vitality of social and natural connection

Focus group research was conducted to examine indigenous conceptions of wellness among the Yup'ik Eskimos of southwestern Alaska. The dialogue on wellness emphasized the importance of living a traditional lifestyle, seeking creative solutions to manage drastic cultural change, and fostering connection within the communities and the native landscape. These themes mesh well with existing characterizations of Alaska Native experiences and worldviews, and reflect substantial links between enculturation, acculturation and health. The data underscores the importance of comprehending local conceptions of wellness in order to effectively work toward promoting optimal health. This paper represents part of an ongoing dialogue in which researchers and native communities co-direct the investigation into healthy ways of being in the world.     

Effectiveness of sampling-exposure procedures on facilities utilization by psychiatric hard-core chronic patients

Sampling-exposure procedures patterned on those of Ayllon and Azrin (1968 a, b) were systematically introduced, alternating with regular pass procedures, in an attempt to increase use of off unit facilities and services by residents of milieu and social-learning treatment units. Social-learning unit residents (for whom passes cost tokens) remained unaffected by the experimental conditions for 22-week duration of the study, using services at a frequency consistently and significantly below that of milieu unit residents (for whom passes were “free”). However, milieu unit residents' utilization was dramatically increased by the sampling-exposure procedures, generalized to alternating announce-only procedures, and continued at a significantly higher level at a final extended baseline.     

Psychological differences between binge and chronic methamphetamine using gay and bisexual men

Methamphetamine use among gay and bisexual men in New York City continues to pervade the psychological and physical well being of those who engage in its use. While the behavioral and contextual factors associated with methamphetamine use have been examined, there is a paucity of literature examining the psychological and psychosocial correlates associated with varying levels of addiction to the substance. We assessed these correlates among 49 methamphetamine-using gay and bisexual men in New York City. Findings suggest that "Chronic" users report higher levels of avoidant coping and are more likely to use methamphetamine to avoid unpleasant emotions, to avoid physical pain, and to engage in pleasant times with others than those who are "Binge" users. While previous research demonstrates the value of treatment approaches that consider the synergy of mental health, drug use, and sexual-risk taking, our findings suggest the importance of identifying the frequency and current progression of methamphetamine use when addressing the psychological meanings it has for the individual user.     

Psychological Distress in U.S. Women Who Have Experienced False-Positive Mammograms

Background In the United States, approximately 10.7% of all screening mammograms lead to a false-positive result, but the overall impact of false-positives on psychological well-being is poorly understood.Materials and methods Data were analyzed from the 2000 U.S. National Health Interview Survey (NHIS), the most recent national survey that included a cancer control module. Study subjects were 9,755 women who ever had a mammogram, of which 1,450 had experienced a false-positive result. Psychological distress was assessed using the validated K6 questionnaire and logistic regression was used to discern any association with previous false-positive mammograms.Results In a multivariate analysis, women who had indicated a previous false-positive mammogram were more likely to report feeling sad (OR = 1.18, 95% CI, 1.03–1.35), restless (OR = 1.23, 95% CI, 1.08–1.40), worthless (OR = 1.27, 95% CI, 1.04–1.54), and finding that everything was an effort (OR = 1.27, 95% CI, 1.10–1.47). These women were also more likely to have seen a mental health professional in the 12 months preceding the survey (OR = 1.28, 95% CI, 1.03–1.58) and had a higher composite score on all items of the K6 scale (P < 0.0001), a reflection of increased psychological distress. Analyses by age and race revealed that, among women who had experienced false-positives, younger women were more likely to feel that everything was an effort, and blacks were more likely to feel restless.Conclusion In a random sampling of the U.S. population, women who had previously experienced false-positive mammograms were more likely to report symptoms of anxiety and depression.The opinions and assertions contained in this article represent the private views of the authors and should not be construed as reflecting the official views of the U.S. Departments of the Army, Navy, or Defense, or the Agency for Healthcare Research and Quality, or the Department of Health and Human Services     

Health-related quality of life in breast cancer: A cross-cultural survey of German, Japanese, and South Korean patients

Purpose The aim of this study was to evaluate health-related quality of life (HRQOL) in breast cancer patients across countries, and to cross-culturally examine the impact of psychosocial factors on HRQOL.Patients and methods A total of 413 women with breast cancer from Germany (n=195), Japan (n=112), and Korea (n=106) completed a survey assessing HRQOL and HRQOL-related factors. HRQOL was measured using the Short-Form Health Survey (SF-8). Measures of psychological distress (Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised), coping (Dealing with Illness Inventory-German Revised), and social support (Illness-Specific Social Support Scale-German Revised) were included.Results The effect of the factor country on physical QOL was seen to be significant, but small (P=0.049, ES=0.018). The scales of General Health (P=0.023), Vitality (P=0.004), and Role Emotional (P=0.003) differed across countries, with the South Korean patients having lower scores compared to the German and Japanese patients. The nature of the impact of psychosocial factors on HRQOL did not differ greatly across countries except with regard to avoidance, however, the degree to which these factors influence HRQOL did differ greatly. Overall, depression, depressive coping, and problematic support showed a strong detrimental effect on the HRQOL of breast cancer patients.Conclusions Results from this study suggest that strategies which target an improvement of HRQOL in cancer patients should also consider the patients’ cultural and healthcare system contexts. Interventions are needed to improve detrimental psychosocial factors.     

心理干预对消化性溃疡患者防御方式与应对方式的影响

目的探讨心理干预对消化性溃疡疗效的影响。方法正常人与消化性溃疡患者各100名,进行防御方式、简易应对方式、症状自评量表、艾森克人格问卷评定,对评定结果进行比较。再将消化性溃疡患者分为药物组与合并心理干预组,在心理干预2个月前后分别进行量表评定,对评定结果进行比较。结果消化性溃疡患者与正常人对照组在躯体化、抑郁、焦虑、积极应对、消极应对方面的分值分别为(1.62±0.43)分,(1.18±0.09)分,(1.37±0.36)分,(1.82±0.53)分,(1.35±0.59)分和(1.46±0.40)分,(1.14±0.03)分,(1.30±0.40)分,(1.89±0.45)分,(1.18±0.43)分,差异有显著性(P<0.05),在EPQ方面P、N因子分值分别为(5.73±2.43)分,(13.41±3.62)分和(4.55±3.25)分,(11.15±3.70)分差异有显著性(P<0.05)。消化性溃疡干预组与单用药物组在心理干预后,在成熟防御方式、积极应对、消极应对方面因子分别为(4.35±2.18)分,(1.91±0.55)分,(1.19±0.44)分和(4.23±3.01)分,(1.83±0.49)分,(1.14±0.52)分,差异有显著性(P<0.05)。结论心理干预可改善消化性溃疡患者心理卫生状况及防御方式和应对方式,对改善患者的预后其积极作用。     

Economic implications of method of delivery

OBJECTIVE: This study was undertaken to examine the costs of hospital care associated with different methods of delivery. STUDY DESIGN: An 18-year population-based cohort study (1985-2002) using the Nova Scotia Atlee Perinatal Database compared outcomes in nulliparous women at term undergoing spontaneous or induced labor for planned vaginal delivery, or undergoing cesarean delivery without labor. Costs that were assessed included physician fees, nursing hours in the labor and delivery, postpartum and neonatal intensive care units, epidural use, induction of labor agents, and consumables. RESULTS: A total of 27,614 pregnancies satisfied inclusion and exclusion criteria, 5233 of which had labor induced. A comparison of mean costs per mother/infant pair demonstrated that cesarean delivery in labor ($2137) was increased compared with spontaneous vaginal delivery ($1340, P=.01), assisted vaginal delivery ($1594, P=.01), and cesarean delivery without labor ($1532, P=.01). The cost of delivery after induction of labor ($1715) was increased compared with spontaneous onset of labor ($1474, P<.001). CONCLUSION: Cesarean delivery in labor occurs more frequently with labor induction and is associated with increased costs compared with other methods of delivery.     

Reducing problem behaviors in the severely and profoundly retarded

A 21-week pilot project was conducted in a large state institution for the mentally retarded applying behavior modification principles for reducing disruptive and hostile behavior. Fourteen males served as experimental subjects. They were housed on a “closed” ward and exhibited a high frequency rate of physical and verbal aggression as well as some psychotic-like behavior. The pilot project demonstrated that brief time-out periods combined with systematic positive reinforcement for acceptable behaviors resulted in the eliminationof both extremely aggressive and psychotic-like behaviors.     

A comparison of covert sensitization and “nonspecific” treatment in the modification of smoking behavior

Forty-nine volunteer participants in a study to reduce cigarette smoking, were randomly assigned to one of five experimental conditions: covert sensitization, attention-placebo, self-control, monitoring control, or no-contact control. Subjects in the first three conditions received six individual contacts over a 2-week treatment period. Subjects in all three of these “treatment” conditions significantly decreased smoking behavior. There were no significant differences between these groups at the end of treatment or at follow-up. Although smoking rates increased during follow-up, subjects were still smoking significantly fewer cigarettes than baseline at the end of 6 months.     

Residual effects of hypnotics

Ten normal subjects were tested on a large battery of physiological and psychological tests 12 h after a hypnotic dose of butobarbitone sodium (100 or 200 mg) or nitrazepam (5 or 10 mg) and compared with a placebo. The subjects received all five treatments in a balanced design. The tests used included self-ratings, the electroencephalogram, the auditory electroencephalographic evoked response, reaction time, tapping, card-sorting and the digit symbol substitution test. Both drugs were effective hypnotics according to the ratings but butobarbitone had more subjective hangover the following morning. The electroencephalogram showed significant changes after both drugs but the evoked response was affected most by 10 mg nitrazepam. The psychological tests showed some dose-related impairment after both drugs. Bioassay statistics suggested that with respect to these residual effects the relative potency of nitrazepam to butobarbitone was 271.