How do stressors lead to burnout? The mediating role of motivation.

We extend existing stressor-strain theoretical models by including intrinsic motivation as a mediator between well-established job stressors and burnout. Though the link between situational stressors and burnout is well established, little is known about mechanisms behind this relationship. With a sample of 284 self-employed individuals, we examined motivation as a mediator to explain why situational factors impact 3 dimensions of burnout: emotional exhaustion, cynicism, and inefficacy. Motivation is an explanatory mechanism that drives human behavior and thought, and thus may have an impact on important well-being outcomes. As expected, intrinsic motivation was a full mediator for the effect of perceived fit on the inefficacy dimension of burnout. Unexpectedly, neither perceived fit nor motivation was related to the other 2 dimensions of burnout, and role ambiguity had only a direct effect on the inefficacy dimension; it was also unrelated to exhaustion and cynicism. We discuss implications of these findings for researchers as well as for practitioners. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transgender HIV prevention: a qualitative needs assessment

Although clinical experience and preliminary research suggest that some transgender people are at significant risk for HIV, this stigmatized group has so far been largely ignored in HIV prevention. As part of the development of HIV prevention education targeting the transgender population, focus groups of selected transgender individuals assessed their HIV risks and prevention needs. Data were gathered in the following four areas: (1) the impact of HIV/AIDS on transgender persons; (2) risk factors; (3) information and services needed; and (4) recruitment strategies. Findings indicated that HIV/AIDS compounds stigmatization related to transgender identity, interferes with sexual experimentation during the transgender 'coming out' process, and may interfere with obtaining sex reassignment. Identified transgender-specific risk factors include: sexual identity conflict, shame and isolation, secrecy, search for affirmation, compulsive sexual behaviour, prostitution, and sharing needles while injecting hormones. Community involvement, peer education and affirmation of transgender identity were stressed as integral components of a successful intervention. Education of health professionals about transgender identity and sexuality and support groups for transgender people with HIV/AIDS are urgently needed.     

Effects of social support and relapse prevention training as adjuncts to a televised smoking-cessation intervention.

Smokers registering for a televised cessation program who also expressed interest in joining a support group and who had a nonsmoking buddy were randomly assigned to 3 conditions: no-contact control, discussion, and social support. All Ss received a self-help manual and were encouraged to watch the daily TV program. Ss in the discussion and support conditions were scheduled to attend 3 group meetings (one with a buddy). Social support Ss and buddies received training in support and relapse prevention. A 4th analysis group was composed of Ss who failed to attend any of the scheduled meetings (no shows). There were strong group effects at the end of treatment. Abstinence rates were highest in the social support group, followed, in order, by the discussion group, no-shows, and no-contact controls. The social support group improved outcome by increasing both the level of support and program material use (reading the manual and watching TV). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The contribution of predisposing and situational risk factors to serious fall injuries

OBJECTIVES: The objectives were to identify situational risk factors associated with suffering a serious fall injury and to determine whether, and to what extent, predisposing and situational risk factors contributed independently to risk of suffering a serious fall injury. DESIGN: Nested cohort study. SETTING: General community. PARTICIPANTS: 568 members of a representative sample of community-living persons 72 years of age or older who fell during a median follow-up of 36 months. MEASUREMENTS: Candidate predisposing factors, identified during a baseline face-to-face home assessment, were the demographic, cognitive, medical, and physical performance measures associated with an increased risk of serious injury among fallers in a previous analysis of the cohort. Acute host, behavioral, and environmental factors present at the time of the participants' first reported fall constituted potential situational risk factors. The primary outcome was occurrence of a serious fall injury, defined as a fracture, joint dislocation, or head injury resulting in loss of consciousness and hospitalization, during the first fall recorded during follow-up. RESULTS: Sixty-nine subjects (12%) suffered a serious injury during their first reported fall. No acute host factor was associated with increased risk of injury. The environmental and activity factors associated independently with serious injury in multivariate analysis included falling on stairs (adjusted relative risk 2.0; 95% confidence intervals 1.1-3.5), during displacing activity (1.8; 1.0-3.0), and from at least body height (2.1; 1.0-4.7). The independent predisposing factors included female gender (2.1; 1.0-4.4), low body mass index (1.8; 1.2-2.9), and cognitive impairment (2.8; 1.7-4.7). Although 12% of first falls resulted in a serious injury overall, this percentage ranged from 0% to 36% as the number of predisposing risk factors increased from zero to three and from 5% to 40% as the number of situational risk factors increased from zero to three. Further, for any given number of predisposing risk factors, the percentage of fallers suffering a serious injury increased with the number of situational risk factors. CONCLUSIONS: Several environmental and behavioral factors contributed to the risk of serious fall injury; this contribution was independent of the effect of chronic predisposing risk factors. Preventive programs that address both predisposing and situational risk factors may result in the greatest injury reduction. These findings support previously recommended multicomponent intervention programs that combine medical, rehabilitative, and environmental components.     

Effects of psychosocial and situational variables on substance abuse among homeless adults.

Finding direct and indirect influences of salient psychosocial and situational variables on problem substance use among homeless people is important in designing evidence-based, effective, and relevant interventions for this special population. A stress-coping paradigm in conjunction with situational items specialized for homeless people was used to explore predictive relationships in a sample of homeless adults (N = 664) among (a) psychosocial variables of self-esteem, social support, positive and negative coping, and emotional distress, (b) situational variables of homelessness history and quality of recent housing, and (c) outcomes of alcohol use, injection drug use (IDU), and non-IDU. Lower self-esteem predicted greater emotional distress, lower positive coping, greater negative coping, and more alcohol use. Social support predicted less emotional distress and more positive coping. Chronic homelessness predicted more emotional distress, less positive coping, greater alcohol use, and IDU. Poor housing was associated with more alcohol use and IDU. Substance abuse interventions among the homeless should have a dual focus that includes attention to psychological issues and negative coping patterns while also addressing situational, environmental factors, including encouraging provision of permanent supportive housing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrity of emotional and motivational states during the prodromal, first-episode, and chronic phases of schizophrenia.

Emotional and motivational dysfunction is fundamental to schizophrenia, and yet, the nature and scope of associated deficits are not well understood. This study assessed the integrity of emotional responding from the perspective of its underlying motivational systems during different phases of schizophrenia. Evaluative, somatic, and autonomic responses were measured during viewing of pictures categorized by emotional content, including threat, mutilation, contamination, illness, pollution, mild erotica, families, food, and nature. Participants were 13 patients at ultra high risk or prodromal for psychosis, 40 first-episode schizophrenia patients, 37 chronic schizophrenia patients, and 74 healthy comparison subjects. Irrespective of phase of illness, schizophrenia patients showed a robust and normal pattern of response across multiple systems, with differential engagement of the defensive and appetitive systems as a function of the motivational significance assigned to specific emotional contexts. Although the integrity of core motivational states also appeared to be intact in prodromal patients, a less consistent pattern of response was observed. As continuing efforts are made to identify emotional and motivational abnormalities in schizophrenia, identified deficits will likely be independent of a fundamental dysfunction in basic emotion and motivation response systems and involve integration with higher order processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-focused attention and emotional reactivity: The role of culture.

Research conducted with European Americans suggests that attention to the individual self intensifies emotional reactivity. We propose, however, that cultural models of the self determine which aspect of the self (individual vs. relational), when attended to, intensifies emotional reactivity. In 3 studies, we predicted and observed that attention to individual aspects of the self was associated with levels of emotional reactivity that were greater in individuals from European American contexts (which promote an independent model of the self) than in individuals from Asian American contexts (which promote an interdependent model of the self). In contrast, attention to relational aspects of the self was associated with levels of emotional reactivity that were similar or greater in individuals from Asian American than in individuals from European American contexts. These findings highlight the importance of considering cultural and situational factors when examining links between the self and emotion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Burnout among school psychologists: An exploratory investigation into its nature, extent, and correlates.

Studied 139 school psychologists who completed a survey that included the Maslach Burnout Inventory, a stress inventory, demographic questions, and questions designed to assess their job satisfaction, ideal caseloads, and intent to leave the profession. The results suggested that symptoms of burnout occur frequently among Ss, particularly feelings of emotional exhaustion and reduced personal accomplishment. Demographic factors related modestly to burnout, whereas job-related stressors (lack of resources, interpersonal conflict, crisis cases) related more substantially to burnout. Burnout was also related to Ss' perceptions of their caseloads, overall job satisfaction, supervision satisfaction, and the desire to leave the profession. Also, Ss reported using burnout coping methods that may not adequately address its antecedents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Afferent mechanism of cortical myoclonus studied by proprioception-related SEPs

This questionnaire study examined perceived sources of stress and satisfaction at work among 121 mental health staff members. Five factors were derived from principal component analysis of sources of work stress items (stress from: role, poor support, clients, future, and overload), and accounted for 70% of the total variance. Four factors were derived from the items related to sources of job satisfaction (satisfaction from: career, working with people, management, and money), accounting for 68% of the variance. The associations of these factors with sociodemographic and job characteristics were examined, and they were entered as explanatory variables into regression models predicting mental health, burnout, and job satisfaction. Stress from "overload" was associated with being based outside an in-patient ward, and with emotional exhaustion and worse mental health. Stress related to the "future" was associated with not being white. Stress from "clients" was associated with the "depersonalization" component of burnout. Higher job satisfaction was associated with "management" and "working with people" as sources of satisfaction, whereas emotional exhaustion and poorer mental health were associated with less "career" satisfaction.     

Teaching Rwandan families to care for people with AIDS at home

AIDS causes disabling symptoms during its chronic and terminal phases. Families throughout the world, whether related to the patient by blood or affection, provide most of the personal care for him or her at home during these phases. Whether the family has access to advanced medical care or not, they can be taught simple comfort measures and nursing care skills that will improve the well-being of the patient. In Rwanda, a small country in east-central Africa, Red Cross volunteers were trained to teach these skills. The volunteers then returned to their villages to help local families. Six months later, 24 of these families were interviewed about the impact of the volunteers' visits. Families indicated they had benefited from being taught the caregiving skills. They also appreciated the emotional support attendant to the volunteers' visits. In summary, the training course enabled volunteers both to enhance family nursing care skills and to provide emotional support to families caring for people with AIDS at home. This training can also be used by volunteers to assist families caring for members ill with other endemic chronic infectious diseases.     

Academic and emotional functioning in early adolescence: longitudinal relations, patterns, and prediction by experience in middle school

Adopting a motivational perspective on adolescent development, these two companion studies examined the longitudinal relations between early adolescents' school motivation (competence beliefs and values), achievement, emotional functioning (depressive symptoms and anger), and middle school perceptions using both variable- and person-centered analytic techniques. Data were collected from 1041 adolescents and their parents at the beginning of seventh and the end of eight grade in middle school. Controlling for demographic factors, regression analyses in Study 1 showed reciprocal relations between school motivation and positive emotional functioning over time. Furthermore, adolescents' perceptions of the middle school learning environment (support for competence and autonomy, quality of relationships with teachers) predicted their eighth grade motivation, achievement, and emotional functioning after accounting for demographic and prior adjustment measures. Cluster analyses in Study 2 revealed several different patterns of school functioning and emotional functioning during seventh grade that were stable over 2 years and that were predictably related to adolescents' reports of their middle school environment. Discussion focuses on the developmental significance of schooling for multiple adjustment outcomes during adolescence.     

Pharmacological profiles of a novel non-peptide angiotensin II type I receptor antagonist HR720 in vitro and in vivo

The relationship, in 539 individuals infected with the human immunodeficiency virus (HIV), between two prognostic markers, the CD4 count and beta-2-microglobulin (B2M), and the development of the acquired immunodeficiency syndrome (AIDS) and death was investigated. Cox proportional hazards models were used to determine the risk of AIDS or death. In a multivariate model which adjusted for demographic factors and treatment, the most recent measurements of B2M (relative hazard (RH) 1.37 per g/l higher) and CD4 count (RH 2.17 per log-unit lower) were both significantly associated with the development of AIDS. Similarly, in a multivariate model which additionally adjusted for the development of AIDS as a time dependent covariate, there was a strong relationship with risk of death for the most recent measurements of B2M (RH 1.34 per g/l higher), and CD4 lymphocyte count (RH 1.91 per log-unit lower). A difference in the level of B2M could be used among patients with similar CD4 counts as an indicator of increased risk of progression to AIDS or death. Using the most recent values of these markers provides a better estimate of the risk of AIDS or death, compared to the more common method of analysis, where baseline values of the markers are used.     

A prospective study of positive psychological well-being and coronary heart disease.

Objective: Research suggests that positive psychological well-being is associated with cardiovascular health. However, much of this research uses elderly samples and has not determined the pathways by which psychological well-being influences cardiovascular disease or whether effects are similar for men and women. This study investigates the association between two aspects of well-being (emotional vitality and optimism) and coronary heart disease (CHD) in a sample of middle-aged men and women, and considers potential mediating factors. Method: Between 1991 and 1994, well-being and coronary risk factors were assessed among 7,942 individuals without a prior cardiovascular event from the Whitehall II cohort. Incident CHD (fatal CHD, first nonfatal myocardial infarction, or first definite angina) was tracked during 5 person-years of follow-up. Results: Positive psychological well-being was associated with reduced risk of CHD with an apparent threshold effect. Relative to people with the lowest levels of well-being, those with the highest levels had minimally adjusted hazard ratios of 0.74, 95% confidence interval [0.55, 0.98] for emotional vitality and 0.73, 95% confidence interval [0.54, 0.99] for optimism. Moreover, the association was strong for both genders and was only weakly attenuated when accounting for ill-being. Neither health-related behaviors nor biological factors explained these associations. Conclusions: Positive psychological well-being was associated with a modest, but consistent reduced risk of incident CHD. The relationship was comparable for men and women, and was maintained after controlling for cardiovascular risk factors and ill-being. Additional research is needed to identify underlying mechanisms and investigate whether interventions to increase well-being may enhance cardiovascular health. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Me against myself: Motivational conflicts and emotional development in adulthood.

Two studies investigated adult age differences in the frequency and emotional consequences of motivational conflicts (i.e., feeling that one wants to or should do something else in a given situation). Study 1 compared younger and older adults. Study 2 included a more age-heterogeneous sample ranging from 20 to 70 years. Data were obtained using diary and experience-sampling methods. Multilevel regression showed that motivational conflict was associated with lower emotional well-being. With age, the frequency of motivational conflict decreased, while emotional well-being increased. Importantly, the age-related decrease in motivational conflicts partly accounted for the age-related increase in emotional well-being. Findings were consistent across studies and robust after the authors controlled for age differences in a number of control variables including time use. The authors conclude that an age-related decrease in motivational conflicts in daily life may be among the factors underlying the positive development of emotional well-being into older adulthood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Regulatory control and adults' stress-related responses to daily life events.

In this study, the authors examined the relations of regulatory control to adults' daily stress-related responses. A physiological index of regulatory control (vagal tone) and daily response of stress and coping were obtained from 92 college students. The results of the study generally confirmed the prediction that individuals who are high in regulatory control were relatively unlikely to experience high levels of negative emotional arousal in response to stressors, but this relation held only for moderate- to high-intensity stressors. Moreover, under conditions of moderate to high stress, highly regulated individuals were likely to cope constructively with the stressor. Mediational analyses suggested that the relation of regulatory control to constructive coping was partially mediated by negative emotional arousal. The results support the conclusion that individual differences in regulatory control interact with situational factors in influencing the prediction of stress-related responses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotion and motivation I: Defensive and appetitive reactions in picture processing.

Emotional reactions are organized by underlying motivational states--defensive and appetitive--that have evolved to promote the survival of individuals and species. Affective responses were measured while participants viewed pictures with varied emotional and neutral content. Consistent with the motivational hypothesis, reports of the strongest emotional arousal, largest skin conductance responses, most pronounced cardiac deceleration, and greatest modulation of the startle reflex occurred when participants viewed pictures depicting threat, violent death, and erotica. Moreover, reflex modulation and conductance change varied with arousal, whereas facial patterns were content specific. The findings suggest that affective responses serve different functions--mobilization for action, attention, and social communication--and reflect the motivational system that is engaged, its intensity of activation, and the specific emotional context. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

HIV/AIDS related knowledge, attitudes, and preventive behavior of pregnant Korean women

OBJECTIVE: To assess HIV-AIDS-related knowledge, attitudes, and preventive behavior of pregnant Korean women before designing patient and public education programs. DESIGN: Pre-experimental cross-sectional survey. POPULATION, SAMPLE, SETTING, YEARS: Convenience sample of 409 women at six prenatal clinics in Seoul, Korea, in 1993. OUTCOME MEASURES: HIV-AIDS-related knowledge, attitudes, and preventive behavior. METHODS: Self-administered questionnaires. FINDINGS: The women described high levels of knowledge about HIV and AIDS risk factors but less knowledge about transmission of the virus, as well as attitudes of rejection toward unrelated people with HIV/AIDS; 16% provided condoms for their husband's use in extramarital sex, the primary risk behavior. CONCLUSIONS: Korean women are at risk for heterosexual transmission of HIV despite knowledge of risk factors. CLINICAL IMPLICATIONS: Korean education programs for women should focus on modes of heterosexual transmission, care of individuals with HIV or AIDS, self-assessment of HIV-AIDS risk, and self protection.     

Thoracic esophageal diverticula. Why is operation necessary?

Human herpesvirus 6 (HHV-6) is a human herpesvirus isolated from patients with various lymphoproliferative disorders and acquired immunodeficiency syndrome (AIDS). The prevalence of HHV-6 infection and its correlation as a cofactor in pathogenicity of HIV infection was investigated in serum samples from 365 healthy volunteers at various age groups, 50 persons at risk for HIV-1 infection, and 90 HIV-1 seropositive individuals. Sera were screened and titrated for antibodies against HHV-6 by a standard indirect immunofluorescence assay on an acetone fixed HHV-6 infected HSB2 cells. The data show high prevalence of HHV-6 in Thailand (71.7%) and the infection is acquired early in life. Prevalence of anti-HHV-6 IgG antibodies was not strikingly different among people at risk for HIV infection, asymptomatic HIV-1 infected cases, and aged-matched controls with low risk for HIV-1 infection. The AIDS cases showed high titers of anti-HHV-6 IgG antibody and high rates for presence of anti-HHV-6 IgM antibody (33.3%) which suggests higher prevalence of HHV-6 infection by either reactivation of an earlier HHV-6 infection or a new primary infection.     

Effects of recruitment strategy on response rates and risk factor profile in two cardiovascular surveys

BACKGROUND: The study was set up to assess the effect of recruitment methods on participation rate, response bias and cardiovascular risk factor estimates. METHODS: Two random samples of men and women in Halifax County aged 25-74 were drawn from the same sampling frame. Their respective sizes were 1007 (NSHHS) and 3036 (MONICA) people. Recruitment by Nova Scotia Heart Health Survey (NSHHS) was through face-to-face contact, whereas the MONICA survey relied on invitation by mail. Outcome measures were response rates at various stages of the recruitment process and the differences in cardiovascular risk factor estimates. RESULTS: Face-to-face recruitment located 51% and mail recruitment located 47% of their respective samples; face-to-face recruitment resulted in fewer individuals who refused to participate in the survey, but also produced fewer who were prepared to provide blood samples in addition to answering questionnaires. By-mail recruits were more likely to have post-secondary education, but did not differ in the proportion of smokers, mean diastolic blood pressure or body mass index, if controlled for education level, gender and age. However, the mean systolic blood pressure was 5.7 mmHg higher and the mean cholesterol level 0.44 mmol/l lower in face-to-face recruits. CONCLUSIONS: Controlling for age, gender and education level eliminates the effect of recruitment bias on most cardiovascular risk factors estimates. The exceptions in our study were systolic blood pressure and cholesterol, where methodological factors may have played a role.