Social science & medicine. Part E, Medical psychology最新文献

In menopause research there is an ongoing debate over the question of which symptoms are experienced by a woman during menopause. The confusion stems from a failure by researchers to deal with a series of methodological issues. First, multiple and highly diverse symptom lists have been used yielding very different results. Second, claims have been made regarding the presence or absence of psychological distress at menopause, but the measures of psychological morbidity used have been inadequate. Finally, scant attention has been paid to the probable bias which has arisen from the impact of cultural factors on symptom perception and reporting. Each of these points is discussed in relation to previous research and to the approach taken in a pilot study conducted in Manitoba, Canada.

The Avoidance of Rejection Scales (of self, by others and of others) were specifically developed to assist the psychometric documentation of choice of an avoidance versus confrontation strategy to the issue of rejection. Three kinds of rejection were examined concurrently with respect to the use of 7 chemical agents related to health and social behavior: tobacco, alcoholic beverages, tranquilizers, medication, stimulants, soft drugs (such as marijuana), and hard drugs (such as heroin). Results of analysis based on a sample of 300 individuals revealed that Low scorers (confronters) reported less use of chemical agents in 15 of the 18 cases wherein a posteriori comparisons among High, Medium and Low Scorer Groups indicated statistically significant differences. Some indication of curvilinearity was indicated in 5 of the statistically significant comparisons. In addition, the strongest linearity between the Rejection Scales and the use of Chemical Agents appeared in the following descending order: Of Others, Of Self and By Others. These results suggest a value to awareness strategies, though not in all cases.

An attempt was made to see whether physician order-giving comprised a major area of conflict with nurses. A group of physicians and nurses at a metropolitan hospital in Los Angeles was asked to use the semantic differential to assign meanings to two hypothetical situations wherein a physician tried to influence a nurse and a patient, respectively. Results indicate that, for each of the methods of influence for which their mean scores were significantly different, either the direction of meaning was the same for both groups, or the nurses—as influencees or observers of M.D. influence—had only a ‘slight’ response to the method. The conclusion is that physician power-usage—in the institution studied—is not an apparent source of conflict with nurses.

A 4-category classification of research on elements of provider-patient interaction that appear related to compliance behavior is presented. The first category describes research on pedagogical techniques employed by practitioners to inform patients in detail of the patient behaviors prescribed to deal with the medical problem. This category contains studies of both correlational and experimental design that support the hypothesis that greater provider explicitness regarding needed patient behaviors is associated with better patient follow-through. The second category of research deals with studies that indicate an association between extensive clinician-patient sharing of expectations about appropriate behaviors in the dyad and good patient compliance. In this category, research has not yet proceeded beyond correlational and descriptive research designs to experimental design. The third category contains studies that reveal links between the patient's assumption of responsibility for his own therapy and compliance. In this division the supporting research is both correlational and experimental. The final category contains research linking positive and supportive tone of the clinician-patient interaction with good patient adherence. Research design in this category has not yet reached the experimental level of development.

The concepts and results of research in each category are quite promising. Randomize trials of methods of intervention derived from each category seem called for, though favorable results in different settings, with different combinations of treatments are by no means yet assured.

Personality differences between sick and rarely sick individuals were measured. There was no difference between these groups in amount or type of life change experienced indicating that the population as a whole was very stable and homogeneous. There were significant differences of frustration and satisfaction. Satisfaction appeared to be linearly related to health status: as satisfaction decreased, frequency of illness increased. Finally, differences in worrying indicated that the rarely sick people seldom worried or felt “uptight”, while sick individuals reported feeling chronically “uptight” and worried. These findings are discussed in terms of the stability of the population, the relationship of psychological and physiological symptoms of illness, and the personality profile of a rarely sick individual.

205 newly delivered mothers at the two Local Maternity Centres in Ile-Ife, Oyo State, Nigeria were contacted after delivery to assess their levels of awareness on importance of breast-milk to infants, things forbidden during lactation and sources of information on breastfeeding were collected individually by interview schedule. The levels of awareness on importance of breast-milk to infants by ages and parity of mothers were significant at P < 0.01 and P < 0.05 respectively. However, number of years in school by levels of awareness were found to be insignificant P > 0.05. 88.3% of the mothers regarded sexual intercourse during the entire lactation as taboo primarily for the fear the infant might suck fathers' sperm in the breast which might eventually cause diarrhoea. 70.7% of the mothers credited their major source of advice on breastfeeding to the nurses. The implications of these findings for health workers in developing countries are stressed.