农村脑血管病患者和照顾者的需求及其影响因素

目的 探讨农村脑血管病患者和照顾者的需求及其影响因素.方法 本研究采用由世界卒中组织设计的针对卒中患者及其照顾者的网上调查问卷,并根据中国国情进行修改.对住院的农村脑血管病患者及其照顾者的一般情况、心理支持、卒中相关知识、诊疗及护理、社会支持及功能恢复需求方面进行问卷调查.结果 共514例卒中患者及其照顾者(514名)完成问卷调查.93.0％的患者对心理支持方面有需求,其次是临床诊疗及护理(84.8％)、卒中知识(74.7％)、社会支持及功能恢复(53.5％);95.1％的照顾者对心理支持方面有需求,其次是卒中知识(89.9％)、临床诊疗及护理(84.0％)、社会支持及功能恢复(66.3％).照顾者在卒中知识、社会支持及功能恢复需求方面程度高于患者(P均＜0.05).多元线性回归分析显示,年龄、性别、文化程度、美国国立卫生研究院卒中量表评分、距首次卒中发病时间是脑血管病患者及其照顾者需求的影响因素.结论 脑血管病患者及其照顾者的许多需求未得到满足,特别是心理需求.应根据脑血管病患者及其照顾者的不同需求提供区域性和个体化的服务,增强群众的卒中防治意识,并不断完善农村卫生服务体系的建设.     

The burden of the ‘RA RA’ positive: survivors’ and hospice patients’ reflections on maintaining a positive attitude to serious illness

Goals This article seeks to make a contribution to fostering work on the neglected area of research about how individuals maintain a positive outlook during their confrontation with serious illness. Insights are presented from both haematology survivors and hospice patients about the factors that hinder and facilitate their capacity to be positive.Patients and methods Open-ended interviews with 14 hospice patients and 12 haematology survivors on their construction of meaning in the face of serious illness were audio-recorded, transcribed verbatim and thematically analysed. The findings on the topic of maintaining a positive outlook are presented in this article.Main results Although the participants affirmed the value of a positive perspective on their illness experience, they were critical of unwanted pressure from others to be positive: a phenomenon they called the RA RA positive. Such pressure interfered with the natural process of continually having to re-negotiate a positive outlook through exploring the fullness of feeling, both positive and negative. The participants indicated that at times of relapse or worsening physical condition they had to cycle through a process of despair/negativity and re-adjustment before they were able to find the positive. The process could not be rushed and required freedom from an imposed pressure to be positive.Conclusions The essential message is that a positive outlook cannot be imposed but requires a nurturing orientation that allows the expression of a full range of feelings in a supportive environment.     

Trauma and Personality Correlates in Long Term Pediatric Cancer Survivors

To explore the relationship between PTSD and trauma-spectrum symptoms, including personality and functional correlates, in long term pediatric cancer survivors (N = 40), we assessed these constructs with a structured interview for PTSD, a clinical interview, and self-report questionnaires. Thirty-five out of 40 participants (88%) currently met at least one trauma symptom at a functionally significant level. These survivors demonstrate high levels of restraint and low levels of distress, representative of a repressive adaptive style. After more than 5 years since treatment completion, the relatively high levels of current trauma-spectrum symptoms may reflect the long-term deleterious impact of childhood cancer.     

Truth and reconciliation: a psycholegal perspective

The South African Truth and Reconciliation Commission ('TRC') represents one model of dealing with human rights abuses at a national level. Such abuses, and the subsequent attempts to come to terms with them, can cause mental disorders and psychological pain. Consequently, mental health and mental health practitioners ('practitioners') will play an important role in the process of bodies such as the TRC. The aim of this article is to examine the TRC process from a psycholegal perspective and to recommend which aspects thereof can be improved in the future. For example, the use of terminology such as 'victim' and 'perpetrator' during the process may have influenced how participants were perceived and treated. Likewise, the emphasis on collective, rather than individual interests, restricted the role of survivors and amnesty seekers in the TRC process. This reduced the effectiveness of the TRC in bringing about reconciliation at an individual and a national level, and limited the TRC's potential as a therapeutic agent. Nevertheless, there were claims that the TRC process healed people. It is argued that the process in itself usually did not lead to healing. Instead, the TRC process highlighted great mental health needs, which were not adequately met. The article discusses the factors that make it difficult to meet mental health needs in countries where human rights abuses have taken place. The article then considers strategies to meet these needs and emphasizes how important it is that those who render mental health services are competent and seen to be credible by the consumers of such services. Finally, the article addresses the need for research in this field to be co-ordinated and professionally responsible.     

Breast self-examination in long-term breast cancer survivors

Introduction  For many breast cancer survivors, continued surveillance will be necessary to increase the possibility of finding a new diagnosis in an early stage. One such surveillance approach, breast self-examination, has not been studied specifically in breast cancer survivors. The current study was designed to assess the practice of BSE in a sample of long-term breast cancer survivors, and to examine the personal, emotional, cognitive, and health-care provider factors that may contribute to its performance. Methods  Three hundred forty-five breast cancer survivors (34% response rate, 345/1,001) diagnosed with in situ-stage II breast cancer between 1997–2004 at a community hospital provided answers to a mailed, self-report questionnaire. Results  Seventy-six percent of respondents reported that they had performed a BSE in the last 30-days. Forty percent reported performing BSE once/month, 39% more than once/month, and 21% less than once/month since their diagnosis. Most of the women (90%) reported that a doctor or nurse told them to perform a BSE once/month since their diagnosis, although only 69% had actually been shown how to perform a BSE. Consistently, the perception of increased barriers to BSE performance was associated with performance of BSE less than once/month (OR = 1.4, 95% CI 1.2, 1.6; OR = 0.8, 95% CI 0.8, 0.9). In addition, depending on the model, age (OR = 1.1, 95% CI 1.0, 1.2), perceived effectiveness of cancer treatments (OR = 0.7, 95% CI 0.5, 0.9), and perceived benefits of BSE (OR = 0.8, 95% CI 0.7, 0.9) also was associated with differences in BSE performance. Conclusion  The current study suggests that breast cancer survivors between 4 and 11 years from diagnosis practice BSE, although their perception of the barriers to conducting BSE influences the frequency of this behavior. Further examination is needed to understand why some survivors perceive greater barriers to BSE performance than others. Also needed is a prospective examination of BSE performance using behavioral measures in relation to self-report. Implications for cancer survivors  Increased attention should be paid to this particular screening behavior performed by a majority of breast cancer survivors by both researchers and health-care providers alike. Whether survivors perform the behavior correctly and the impact it has on their emotional and cognitive well-being should be further explored. Supported in part by R25T CA87972     

Consistency of near-death experience accounts over two decades: Are reports embellished over time?

AIM: "Near-death experiences," commonly reported after clinical death and resuscitation, may require intervention and, if reliable, may elucidate altered brain functioning under extreme stress. It has been speculated that accounts of near-death experiences are exaggerated over the years. The objective of this study was to test the reliability over two decades of accounts of near-death experiences. METHODS: Seventy-two patients with near-death experience who had completed the NDE scale in the 1980s (63% of the original cohort still alive) completed the scale a second time, without reference to the original scale administration. The primary outcome was differences in NDE scale scores on the two administrations. The secondary outcome was the statistical association between differences in scores and years elapsed between the two administrations. RESULTS: Mean scores did not change significantly on the total NDE scale, its 4 factors, or its 16 items. Correlation coefficients between scores on the two administrations were significant at P<0.001 for the total NDE scale, for its 4 factors, and for its 16 items. Correlation coefficients between score changes and time elapsed between the two administrations were not significant for the total NDE scale, for its 4 factors, or for its 16 items. CONCLUSION: Contrary to expectation, accounts of near-death experiences, and particularly reports of their positive affect, were not embellished over a period of almost two decades. These data support the reliability of near-death experience accounts.     

A population-based study of prevalence of complementary methods use by cancer survivors: a report from the American Cancer Society's studies of cancer survivors

BACKGROUND: The use of complementary methods (CMs) is widespread and increasing in the United States. Most literature on CM use among cancer survivors focuses on the treatment period, whereas only a few studies address use further along the cancer continuum. METHODS: This study analyzed the prevalence and the medical and demographic associations of CM use among cancer survivors surveyed 10 to 24 months after diagnosis. The study's sample-4139 survivors of 1 of 10 adult cancers-was selected from stratified random samples provided by statewide cancer registries and surveyed by mail and telephone. Three logistic regression models examined associations between medical and demographic factors and CM use among survivors of sex-specific and non-sex-specific cancers. RESULTS: Of the 19 CMs included in the survey, the CMs most frequently reported were prayer/spiritual practice (61.4%), relaxation (44.3%), faith/spiritual healing (42.4%), nutritional supplements/vitamins (40.1%), meditation (15%), religious counseling (11.3%), massage (11.2%), and support groups (9.7%). Among these 19 CMs, the least prevalent were hypnosis (0.4%), biofeedback therapy (1.0%), and acupuncture/acupressure (1.2%). Survivors more likely to use CMs were female, younger, white, higher income, and more educated. CONCLUSIONS: This study provides information regarding prevalence and medical-demographic determinants of CM use reported by a large, population-based sample of survivors of 10 cancers surveyed 10 to 24 months after diagnosis. These findings may be used by clinicians and researchers to inform their decisions regarding which CMs to address in practice and research.