Social support as a mediator of optimism and distress in breast cancer survivors.

Breast cancer patients can experience emotional distress as a result of diagnosis and treatment. Higher levels of optimism and social support are associated with less emotional distress in cancer patients. This 12-month prospective study followed 69 women who had completed treatment for Stages 0-11 breast cancer. At 3-month intervals, participants completed measures of mood disturbance, optimism, and social support. As hypothesized, affective social support mediated the relationship between optimism and distress in early-stage breast cancer survivors at baseline and 6 months but not at 1 year. In contrast, confidant social support did not mediate the optimism-distress relationship at any time point. Clinical and research implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The evolution of adjustment issues in HIV/AIDS

The issues of emotional adjustment to AIDS have been inextricably linked to medical advances in fundamental knowledge about the human immunodeficiency virus and its potential therapies. In 1987 patients were struggling with the advantages and disadvantages "to do or not to do AZT (zidovudine)," whereas the choices imposed by combination therapies and the protease inhibitors in 1997 are fundamentally different and are occurring in an evolving context created by a number of striking medical advances, expanding populations, the availability of environmental support, and changing public sentiments. As the psychiatric treatment of HIV-positive individuals shifts increasingly from "AIDS specialists" to the wider therapeutic community, it is important that the therapist who has had relatively little experience with this population not assume that contemporary issues and concerns of the seropositive patient, or the patient with AIDS, are essentially those discussed widely in the earlier years of the epidemic. Patients living with this virus for a number of years have traveled a long and arduous journey and will experience more empathy from a therapist who has some knowledge of that path. Awareness of the evolution of emotional adjustment, counseling, and ethical issues of AIDS should amplify the general fund of knowledge required for good clinical management of the person living with AIDS.     

Despite some PR fallout, proponents say MD walkouts increase awareness and may improve health care

This fall Ontario braced for possible strikes by public servants and teachers. A year earlier, the province's physicians were preparing their own job action. Walkouts by physicians, which have not been uncommon since the introduction of medicare, create two camps. In one are physicians who say legal job actions are ethical and often improve health care for patients. In the other are some doctors and ethicists who question whether doctors have an ethical right to withdraw services, even if it is legal to do so. Nicole Baer interviewed members of both camps.     

Pharmacological distribution diagrams: a tool for de novo drug design

BACKGROUND: There is no empirical data available on attitudes concerning AIDS and habits towards HIV infected patients of physicians in general or private practice. In this study results of a self-evaluation are presented. METHODS: 178 physicians working with out-patients in different medical fields were randomly selected for a cross sectional study and interviewed using a standardised questionnaire. RESULTS: 89% think that they are sufficiently informed about AIDS (in the USA 20%). They regarded the risk of infection to be lower than the Anglo-American physicians. They believed there is a lack of interchange of information between colleagues regarding the degree of infectiousness of referred patients. A third of the physicians fear that other patients will go elsewhere if they find out that their physician is treating AIDS patients. 54% would hold special clinic sessions for HIV-patients outside the normal schedule for practice times. 89% believed that HIV patients were partly to blame for their illness. CONCLUSIONS: Although the physicians recognise the problem of HIV-infection, they partly deny the real necessities and facts. A reason for this could be the emotions underlying the general attitude to everything pertaining to HIV-disease. Attitudes to HIV-disease and the dealing with it in daily practice must be considered on the basis of individual emotional motives.     

Establishing the doctor-patient relationship: science, art, or competence?

Establishing and sustaining strong doctor-patient relationships is an important aim in clinical practice, since it is through these relationships that the effectiveness of our work as healers is mediated. In recent years, a research literature emerging from the application of social science to medicine is beginning to highlight certain specific physician behaviors, especially those involved in doctor-patient communication, as actions of considerable importance to both physicians and patients. Successful physicians will further understand that our patients and their families also have high expectations for additional behaviors of physicians, particularly those recognized in the popular culture as professional, respectful of patients' circumstances, and supportive of patients' efforts. To the extent that physicians make an explicit effort to understand and appreciate the "life-world" of patients, and even to modify medical recommendations in order to maximize the meaningfulness and goodness-of-fit of these recommendations, the "art" of medicine also becomes an essential part of routine clinical practice. In the final analysis, new science, art, and behavioral competence are all required for strengthening doctor-patient relationships.     

Valence focus and self-esteem lability: Reacting to hedonic cues in the social environment.

Individuals differ in the extent to which they emphasize feelings of pleasure or displeasure in their verbal reports of emotional experience, termed valence focus (VF). Two event-contingent, experience-sampling studies examined the relationship between VF and sensitivity to pleasant and unpleasant social cues. It was predicted, and found, that individuals with greater VF (i.e., who emphasized feelings of pleasure/displeasure in reports of emotional experience) demonstrated greater self-esteem lability (i.e., larger changes in self-esteem) to pleasant and unpleasant information contained in social interactions than did those lower in VF. These effects held even after statistically controlling for possible confounding variables (neuroticism, affect intensity). Implications for understanding the psychological impact of valenced interpersonal events are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physicians disciplined for sex-related offenses

CONTEXT: Physicians who abuse their patients sexually cause immense harm, and, therefore, the discipline of physicians who commit any sex-related offenses is an important public health issue that should be examined. OBJECTIVES: To determine the frequency and severity of discipline against physicians who commit sex-related offenses and to describe the characteristics of these physicians. DESIGN AND SETTING: Analysis of sex-related orders from a national database of disciplinary orders taken by state medical boards and federal agencies. SUBJECTS: A total of 761 physicians disciplined for sex-related offenses from 1981 through 1996. MAIN OUTCOME MEASURES: Rate and severity of discipline over time for sex-related offenses and specialty, age, and board certification status of disciplined physicians. RESULTS: The number of physicians disciplined per year for sex-related offenses increased from 42 in 1989 to 147 in 1996, and the proportion of all disciplinary orders that were sex related increased from 2.1% in 1989 to 4.4% in 1996 (P<.001 for trend). Discipline for sex-related offenses was significantly more severe (P<.001) than for non-sex-related offenses, with 71.9% of sex-related orders involving revocation, surrender, or suspension of medical license. Of 761 physicians disciplined, the offenses committed by 567 (75%) involved patients, including sexual intercourse, rape, sexual molestation, and sexual favors for drugs. As of March 1997, 216 physicians (39.9%) disciplined for sex-related offenses between 1981 and 1994 were licensed to practice. Compared with all physicians, physicians disciplined for sex-related offenses were more likely to practice in the specialties of psychiatry, child psychiatry, obstetrics and gynecology, and family and general practice (all P<.001) than in other specialties and were older than the national physician population, but were no different in terms of board certification status. CONCLUSIONS: Discipline against physicians for sex-related offenses is increasing over time and is relatively severe, although few physicians are disciplined for sexual offenses each year. In addition, a substantial proportion of physicians disciplined for these offenses are allowed to either continue to practice or return to practice.     

Physician-assisted suicide. Finding common ground

In Washington state, practicing physicians have been forced to confront the emotional, complex issue of physician-assisted suicide sooner than physicians elsewhere in the US. The Washington State Medical Association has struggled at length with the issue and ultimately delineated a policy on safeguards for physician-assisted suicide. The Washington experience may prove instructive to other professional physician organizations even before the US Supreme Court rules on the issue.     

Don't hide your happiness! Positive emotion dissociation, social connectedness, and psychological functioning.

It is now clear that positive emotion leads to enhanced psychological functioning. What is less clear, however, is just why this is so. Drawing on a social-functional perspective, we argue that positive emotional behavior that accurately signals to others the individual's internal state will enhance social connectedness. Positive emotional behavior that does not accurately signal a person's experience—such as a smile that is not felt—may impede social connectedness and, in turn, psychological functioning. This perspective suggests that (a) the degree to which experience and behavior are dissociated during positive emotional episodes, over and above level of positive behavior, should predict worse psychological functioning and (b) the effect of dissociation should be mediated by social connectedness. To test these hypotheses, we conducted a short-term prospective longitudinal study, with a baseline assessment of depressive symptoms and well-being at Time 1. Six months later, at Time 2, we used a novel within-individual laboratory paradigm to measure the degree to which positive emotional behavior was dissociated from (vs. coherent with) a participant's positive emotional experience. We also assessed level of positive behavior and experience. Then, another 6 months later, we assessed social connectedness as a mediator and depressive symptoms and well-being as outcomes at Time 3. Even when controlling for baseline functioning and for level of positive emotion behavior and experience, we found that greater positive experience–behavior dissociation at Time 2 predicted higher levels of depressive symptoms and lower levels of well-being at Time 3. As predicted, these associations were mediated by social connectedness. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Maintaining good morale in old age

Traditional aging studies have seen life's later years as a time of inevitable biological and social decline. Psychological decline might also be expected, but this is not true for most older people, according to epidemiologic studies. Thus, we must ask: Why is aging not as emotionally threatening as might be expected? Why do some older people do better than others? How should medicine address these issues? It is only possible to understand the successful emotional aging of most elders if the customary diathesis-stress model is supplemented by a developmental perspective. Expectations as well as capacities diminish with aging. This means that subjective health appears more tightly linked with morale than objective health. Some older people experience recurrence of mental disorders (for example, major depression) first present earlier in life. Others experience new disorders such as minor depression in response to biological or social losses. As geriatric medicine comes to increasingly focus on chronic disease, attention to morale is an important strategy for maximizing quality of life. Physicians will need improved skills in the detection and treatment of problems in morale if they are to provide optimum care for their older patients.     

Physicians' liking for their patients: More evidence for the role of affect in medical care.

Examined correlates of physicians' liking for their patients among 17 internists at an HMO and 530 of their patients (aged 70+ yrs). Analyses were conducted for the entire sample as well as for individual physicians, whose results were combined by meta-analysis. Both kinds of analysis showed that patients were more liked when they were in better health (based on psychometric measures of social, emotional, functional, and overall self-rated health) and when they were more satisfied with their care. In addition, male patients were liked more than female patients, and physicians who were female and less experienced liked their patients more. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age differences in social preferences among Taiwanese and mainland Chinese: The role of perceived time.

Socioemotional selectivity theory holds that as people recognize the inevitable constraint of time imposed by mortality, their social goals change, motivating them to limit social contacts to those with whom they are emotionally close. This theory was tested among Taiwanese and Mainland Chinese. As predicted, results showed that older adults (aged 60–90 years) in both cultures were more likely than younger adults (aged 18–30 years) to prefer familiar social partners who were most likely to provide emotionally close social interactions. Mainland Chinese, who as a group have shorter actuarial life expectancy, were more likely to prefer familiar social partners than were Taiwanese. These age and cultural differences were eliminated when differences in perceived time were statistically controlled for. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Examples of foreign countries

In France we are not well aware of the health of people in situation of poverty: they have not resources enough to care of oneself, not knowing the services of social welfare, and not identified by these services. 1) Some studies in Great Britain and in U.S. have followed up some deprived groups with health index on a long duration: life expectancy at birth, number of stillbirths in the group, low birth weight, casualty during childhood, violent deaths among teen agers and young men. Disparities between rich and poor are dramatic, unskilled men have a mortality three times that of professional men; advantage is given to people who had had some education and a steady family home during childhood, compared with those who have not. 2) In France investigations have been more accurate on the health of deprived individuals: where are they taken care of, who cures them for which diseases? According to the results, they are not abandoned. Places for reception and care are many, the public institutions welcome them even without social security guarantee, almost a hundred non profit associations may help them: these discreet institutions are poorly known even by the public administration.     

A transitional living environment for persons with brain injuries: staff and client perceptions

As part of the Iron Overload, Public Health and Genetics conference, sponsored by the Centers for Disease Control and Prevention in March 1997, a working group was convened to consider strategies to increase early case detection of hemochromatosis. This group emphasized that the primary public health goal should be to diagnose hemochromatosis before symptoms appear. To reach this goal, education and action need to be targeted to physicians and other health care workers, laboratorians, administrators, payers, and the public. Strategies to disseminate updated information and increase early case detection were prioritized according to expected effectiveness. Strategies targeting physicians are 1) to identify national and local physician-leaders and 2) to educate physicians about hemochromatosis in basic, graduate specialty, and continuing medical education. Strategies aimed at the health system are 1) to encourage laboratories to provide the transferrin saturation test as part of routine laboratory panels and 2) to work with policymakers and payers to allow reimbursement for case detection. Finally, public education is recommended to increase lay support for the early diagnosis of hemochromatosis. Attempts to educate the public should be aimed first at persons who receive diagnoses of hemochromatosis in order to ensure that they are properly treated and then at asymptomatic persons who could be screened as part of health appraisals. Although identifying physician-leaders and educating physicians are the highest priorities, physicians should not be targeted at the exclusion of payers and the public. Simultaneous efforts to reach all groups in appropriate ways should be initiated to provide the interest and infrastructure necessary to decrease morbidity and mortality from hemochromatosis.     

How house officers cope with their mistakes

We examined how house officers coped with serious medical mistakes to gain insight into how medical educators should handle these situations. An anonymous questionnaire was mailed to 254 house officers in internal medicine asking them to describe their most important mistake and their response to it; 45% (N = 114) reported a mistake and completed the questionnaire. House officers experienced considerable emotional distress in response to their mistakes and used a variety of strategies to cope. In multivariate analysis, those who coped by accepting responsibility were more likely to make constructive changes in practice, but to experience more emotional distress. House officers who coped by escape-avoidance were more likely to report defensive changes in practice. For house officers who have made a mistake, we suggest that medical educators provide specific advice about preventing a recurrence of the mistake, provide emotional support, and help them understand that distress is an expected concomitant of learning from the experience.     

Context matters: The benefits and costs of expressing positive emotion among survivors of childhood sexual abuse.

Positive emotions promote adjustment to aversive life events. However, evolutionary theory and empirical research on trauma disclosure suggest that in the context of stigmatized events, expressing positive emotions might incur social costs. To test this thesis, the authors coded genuine (Duchenne) smiling and laughter and also non-Duchenne smiling from videotapes of late-adolescent and young adult women, approximately half with documented histories of childhood sexual abuse (CSA), as they described the most distressing event of their lives. Consistent with previous studies, genuine positive emotional expression was generally associated with better social adjustment two years later. However, as anticipated, CSA survivors who expressed positive emotion in the context of describing a past CSA experience had poorer long-term social adjustment, whereas CSA survivors who expressed positive emotion while describing a nonabuse experience had improved social adjustment. These findings suggest that the benefits of positive emotional expression may often be context specific. (PsycINFO Database Record (c) 2010 APA, all rights reserved)