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HEALTH PSYCHOLOGY AND AIDS
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PSYCHOSOCIAL FACTORS AND HIV INFECTION: INFLUENCES ON CLINICAL EVOLUTION AND ON THE IMMUNE SITUATION
BERTINI, Mario. Università di Roma "La Sapienza", Roma, Italia.
We report the results of a series of studies on the topic, some terminated, some in progress.
After a number of initial interviews with subjects at different stages of HIV infection, showing how the quality of their lives was heavily influenced by prychological conditions, we began a longitudinal, multicentric, study on a cohort of 201 Ss., all asymptomatic or LAS at the time of examination, in order to verify whether initially measured prychosocial features coultd have an influence on course of disease. We can presently report data regarding follow-up at 6 and 12 months for all Ss., who were at that point staged as Unchanged or Fully Symptomatic (Group IV c.d.c.). Symptomatic Ss. showed, on initial measures: higher scores on a Denial/Repression measure; lower scores on a social Support measure; lower scores on a Good Relationship with Father measure; higher scores on a Psychological Distress Factor. Some of these results were obtained in interaction with initial CD4+lymphocytes concentrations.
The two groups, Unchanged and symptomatic, showed no significant differences on other independent variables such as: level of instruction, Objetive Social Support, route of transmission of infection, time elapsed from diagnosis.
We are presentily carrying out two other projects, in a specifically psychoimmunologic domain: one, trying to relate mood states, as assessed by Profile of Mood States and by a short interview scored through the Gottschalk method, with the immune situation, both across subjetc and within each subject (longitudinally, 6 measurements); the other, trying to assess immune modifications surrounding the moment of diagnosis, in relationship with stable personality features. Both projects are intended to highlight the importance of psychological support in the different phases of HIV infection.
Detailed results of the first study, and those available of the other two, will be presented at the Congress.
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QUELVES DETÉRMINANTS SOCIO-COGNITIFS DE LA PREVENTION CONTRE LE SIDA.
TOUZARD, Hubert and LUSWING, Dominique; Université René DESCARTES, París, France.
PEREZ-DIAZ, Fernando; CNRS. París, France.
Une enquete nationale concernant les comportements sexuels des adultes de 18 a 69 ans a ete entreprise en France en 1992. L'une des problematiques adoptees par l'equipe des chercheurs ACSF tente de faire la lumiere sur les determinants socio-cognitifs des conduites de prevention. Les variables prises en compte sont cognitives (locus of control, orientation temporelle predominante, attitude envers l'avenir, perception du risque pour soi,du cout de la prevention, representation de l'amour),affectives (sentiment amoureux pour le partenaire)et des variables comportementales (pratiques de prevention ou a risque). Les analyses portent sur un echantillon de personnes a risques objectifs (par ex.multipartenariat ou pratiques homosexuelles pour les hommes,drogue par piqure...N=1140). Des analyses de regression multiple, lineaires ou logistiques, tentent de mettre en evidence quelles sont les variables les plus liées aux conduites de prise de risque. Les résultats montrent le caractere central de la variable "evaluation du cout de la prévention pour soi". Les variables les plus liées aux conduites de prise de risque sont: une perception du cout eleve de l'usage du preservatif,la perception d'un risque personnel plus eleve que celui des proches,le sentiment d'etre amoureux de son partenaire et l'adhesion a la conception selon laquelle amour et fidelite ne sont pas lies.
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CROYANCES DU SIDA: LE BROUILLARD DE LA RÉALITÉ.
GOUVEIA, María; CLÁUDIO, Victor and ROBALO, Patricia; Instituto Superior Psicologia Aplicada, Lisboa, Portugal.
Dans ce travail nous recherchons évaluer la relation entre les representations sociales et les comportements des individus devant SIDA et séropositivité.
Nous avons utilisée une population de 300 etudiants universitaires.
Dans la évaluation expérimental nous avons utilisée un questionnaire de auto-remplissage qui aborde différents situation relationées avec la sexualité auto et hetero-concernantes, et aussi les relations personelles. Nous avons encore utilisée un questionnaire non structurée (avec des questions ouvertes et libre association de paroles).
Les individus en situations hetero-concernantes son plus critiques, et en consequence ils ont des atitudes et comportements plus adéquats, qui contrastent avec les situations auto-concernantes. Dans ces cas les individus présentent des résultats qui conduisent a une majeur dévalorisation des formes de transmission de la maladie, assument de cette façon, des comportements qui ménent a une mineur protection.
Les resultats montrent que, les representations sur MALADIE et les representations sur SIDA, ont en commun, que toutes les deux sont saisies comme exogènes et externes a eux. Pourtant, les representations sociales sur SIDA apartient a champs sémantiques différents des celuis de MALADIE.
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LES DÉFIS DE LA PRATIQUE QUÉBÉCOISE EN PSYCHOLOGIE DANS L'INTERVENTION "SIDA"
RITCHOT, Pierre and SAURIOL, Pierrette, Veurs un Mieux-Vivre Enr., Montreal, Canada.
Dans cet atelier, les conférenciers interrogeront l'intervention psycho-sociale québécoise traditionnelle en faisant ressortir l'importance du soutien psychologique dans le travail psychothérapeutique auprès des personnes vivant avec le vih/sida. Ils expliqueront comment le travail sur le «vih» force la reconstruction individuelle éclatée par les multiples histoires antécédentes à l'infection et consacrée par le diagnostic. À la lumière de vignettes thérapeutiques, les conférenciers étayeront leurs observations cliniques en suggérant des pistes d'intervention et de réflexion pour le suivi de certaines clientèles spécifiques. Enfin, ils tenteront de démontrer les aspects transférentiels et contransférentiels suscités dans l'intervention psychologique qui précipitant l'angoisse chez le psychologue et provoquant un rite de déni ou de prise en charge supplémentaire aux besoins de la personne aidée.
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AN ANALYSIS OF THEORETICAL MODELS FOR HIV/AIDS EDUCATION.
DOCKRELL, W.; University of Newcastle,
DOCKRELL, J.; University of London, London, United Kingdom.
In the course of a study of sexual behaviour and HIV a number of theoretical models focusing on health related behaviour were evaluated. One hundred and five individuals were interviewed and completed a questionnaire. The in-depth semistructured interview dealt with issues surrounding knowledge about AIDS/HIV and its transmission; attitudes to HIV and sexual behaviour; range of sexual behaviour; problems in sexual relations and in negotiating safer sex practices. The questionnaire collected information about sexual history and recent sexual behaviour.
Our results indicated that the factors which influenced safer sex needed to be considered at a range of levels. No single belief or knowledge state determined behaviour. Multi-dimensional models offered greater explanatory power but failed because they focused on individual knowledge states, appealed to rationality and did not include wider social, interpersonal or cultural factors. Our study indicates that models of health behaviour must include an understanding of sociai factors. Not only is the behaviour itself influenced by the social nature of the activity but so are individual perceptions, modifying factors and the likelihood of taking further action.
A dynamic model is proposed which integrates personal and social behaviours and addresses the interface between the different levels.
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HEALTH BEHAVIOUR GOAL MODEL AND EXERCISE BEHAVIOUR.
GEBHARDT, W. A. and MAES, S.;
The Health Behaviour Goal Model (Maes & Gebhardt, in prep.), is a theoretical framework, based on social cognitive theories, that can be applied in the field of healt behaviour modification. Main characteristics of the model are that it (1) incorporates the personal goal structure of the individual, (2) focuses on individual emotional and health costs as well as benefits of chaning behaviour and (3) encompasses all phases of behaviour change. We applied the model to the area of exercise adoption and maintenance. A questionnaire on exercise behaviour, consisting of atatements based on the principal constructs of the model, was developed andadministered to a sample of 800 nurses and order lies, working in nursing homes. Results from this study will be presented and their implications for the applicability of the model will be discussed.
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APPLICATIONS OF ADOLESCENT OPTIMISM BIAS AND RISK TAKING.
HAINES, Mary M. and SOAMES JOB, R.F.; Sydney University, Sydney, Australia.
Optimism bias is the systemic error of believing that good things are more likely to occur to oneself than to one's peers and that bad things are less likely to occur. Optimistically biased appraisals have been implicated in feelings of personal invulnerability, risk taking behaviour and neglect of health precautions. This is especially relevant to adolescents who are effected by the detrimental consequences of risk taking such as road injury, drug addiction and AIDS. The causes and nature of optimism bias were examined in three studies on a mixed sex sample of adolescents. The major findings have methodological, theoretical and applied implications. First, optimism bias occurred in adolescents and the optimism bias scale is stable over time. Second, experience, perceived control and egocentrism, variables established as correlates in adult samples, correlated appropriately with optimism bias. Third, females experimentally manipulated to have high self-esteem had greater optimism bias on negative events. Males manipulated to have low self-esteem had lower optimism bias on negative events. Methodologically, the optimism bias scale is a reliable tool for further research with adolescents. Theoretically, the effects of self-esteem may provide a partial account of optimism bias. Based on the experimental treatment, the manipulation of optimism bias (for example by changing self-esteem in relation to specific behaviours) could lead to decreased adolescent risk taking behaviour.
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SMOKING PREVENTION: A DUTCH REPLICATION OF THE WISCONSIN SMOKING PREVENTION STUDY.
CHATROU, Marlène; University of Leiden, Leiden, The Netherlands.
Smoking prevention interventions have been developed from different theoretical viewpoints. The first interventions were based on the idea that providing correct knowledge about the harmful effects of smoking would prevent youngsters from starting to smoke. It became clear very soon, that this was a too simplistic view.
Important elements as self-efficacy, the influence of important others etc. were added to the models, resulting in the application of more extended models as the Health Belief Model and Fishbein & Azjen's Theory of Reasoned Action.
Leventhal's Parallel Response Model was the basis of a smoking prevention intervention which was successfully carried out in the United States of America. In this self-regulating model, a cognitive feedback loop operates simultaneously with an emotional feedback loop. The emotional aspect of starting (not) to smoke is denied in most smoking prevention interventions. In the Netherlands, however, a replication study of Leventhal's intervention showed not the expected positive results. The results of this study are discussed on the basis of a model of smoking behaviour.
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BIOPSYCHOSOCIAL CORRELATES OF CORONARY HEART DISEASE RISK FACTORS
MARUSIC, Andrej and STARC, Radovan. Public Health Institute, Ljubljana, Slovenia.
1. The objectives of the study were:
- to investigate some biological and psychosocial variables on a group of coronary heart disease (CHD) patients and a control group, to discover which, if any, are important risk factors (RF); - next, to discover possible biopsychosocial correlates of CHD RF;
- 48 CHD (40 men and 8 women) patients were compared with 48 controls matched for age and sex on all the important biological RF and following psychosocial variables: the main personality traits (EPQ), coronary-prone psychosocial type, and different coping styles; - the factor analysis provided the biopsychosocial correlates of statistically significant biological and psychosocial RF;
- nearly all standard RF, android obesity type and snoring among biological, and neuroticism (N), psychoticism (P), coronary-prone psychosocial type and emotional coping style among psychosocial variables were statistically more frequent in the CHD group than in the control group; - two of extracted factors are typical biopsychosocial correlates: N with elevated lipoprotein(a), and low HDL with P in android obese smokers;
- some strong correlations between biological and psychosocial RF indicates the existence of biopsychosocial correlates of RF, that could explain different risk behaviour patterns;
- it is not possible to control these behaviour patterns with classical preventive measures; - lowering cholesterol, reducing hypertension and smoking cessation has nothing to do with the factor (pattern) of N and elevated lipoprotein(a); as the latter cannot be changed, psychotherapy could be a possible measure;
- the classical preventive measures could be right for patients with strong second factor (pattern) of low HDL, android obesity and smoking, but because of high P suitablepsychological counselling is necessary.
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SURVEY OF STUDENTS' BELIEFS AND BEHAVIORS RELATED TO BODY IMAGE, FOOD, AND OTHER SUSTANCES
PHILLIPS, Elaine L. Western Michigan University, USA.
A multidisciplinary group (psychologist, physician, nutritionist, substance abuse specialist and wellness educator) developed and administered a 65 question survey to incoming freshmen at a midwestern university in the summer of 1993. Questions pertained to eating behavior, self concept, alcohol and drug use and sexual behavior. The survey was developed by adapting questions from the Center for Disease Control Youth Risk Behavior and the concepts identified in the Eating Disorder Inventory. Sample questions are as follows: I determine the amount I should eat by how full my plate looks rather than by feelings of hunger or full ness; During the past 12 months I have experienced physical violence in my family; During the past 12 months I have seriously considered suicide; I have had vaginal or anal intercourse at least once. Student participation was voluntary and anonynous. 1,320 surveys were usable (at least 80% of the questions were answered.) Data is being analyzed using the Statistical Package for the Social Sciences (SPSS). Initial findings include: 11% reporting family violence; 13% considering suicide; 3.7% report cocaine use. The presentation would discuss survey findings in all areas and encourage replication of the survey in other parts of the world for cross-cultural comparisons.
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RELATIONS ENTRE LES COMPORTEMENTS DE RISQUE, LES FACTEURS DÉPRESSIFS ET LE SUICIDE CHEZ LES JEUNES HOMMES.
RATTÉ, J. Université Laval and BERGERON, J. Université de Montréal, Canada.
Peu de recherches rigoureuses ont porté sur la personnalité des conducteurs à risque (Tsuang et al., 1985). Certaines relations furent trouvées entre les attitudes et les antécédents routiers (Bergeron et Joly, 1987). Les tendances dépressives et suicidaires furent par ailleurs peu étudiées à l'aide de mesures validées, appliquées à de grands groupes. La présente recherche a évalué la personnalité des conducteurs imprudents et fortement accidentés en regard de la tendance au risque, des traits reliés à une prédisposition suicidaire, au suicide conscient et intentionnel, au désespoir et à l'anxiété. Trois groupes expérimentaux furent évalués: 54 bons, 47 intermédiaires et 58 mauvais conducteurs. Tous les sujets, de sexe masculin, ont été recrutés grâce à leur dossier routier provincial. Les résultats montrent que les mauvais conducteurs se distinguent significativement des deux autres groupes, et encore davantage des mauvais conducteurs, au plan de la tendance au risque et de traits propres aux personnes suicidantes; par contre, ils ne s e différencient pas au plan des pensées conscientes de suicide. Les résultats seront discutés en termes des implications au niveau de la prévention et de l'intervention auprès des conducteurs à risque.
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MOTIVATION FOR CESSATION AMONG DIFFERENT TYPES OF CIGARETTE SMOKERS - RESULTS OF A REPRESENTATIVE SURVEY IN AUSTRIA.
SCHOBERBERGER, R. and KUNZE, M.; Institute of Social Medicine of the University of Vienna, Austria.
FAGERSTRÖM, K. O.; Smoking Cessation Clinic, Medical School, University of Lund, Sweden.
Using the Fagerström Test for Nicotine Dependence (FTND) to assess nicotine dependence in a population 6.000 randomly selected Austrians were interviewed. 42 % of men and 27 % of females were found to be smokers. The FTND-score divides the Austrian smokers into three groups - differing in dependence: (a) 36,5 % are nicotine addicted - which means that there are not only psychosocial factors effective to continue smoking but also physiological factors; (b) 30,2 % must be psychosocial dependent because the show nearly no sign of nicotine dependence; (c) and there is a group between, difficult to classify as more psychological or more nicotine addicted. When probands were asked if they ever tried to quit smoking, 44,7 % affirmed this question. But there is a significant difference between psychological and physiological dependent regular smokers. The non-nicotine-addicted had more trials than the nicotine addicted (52,6 % to 40,3 %). Nicotine dependence has also consequences for the short term success of smoking cessation. Psychosocial dependent have significant longer abstinence periods when the try to quit than nicotine dependent smokers. So only 4,0 % of the psychological dependent had no success while 13,7 % of the nicotine dependent had not been successful. On the other hand 40,2 % of the psychological dependent reached abstinence periods of more than 3 months while only 15,0 % of the nicotine addicted can report such a success. Summing up these data about the knowledge of different types of cigarette smokers it seems clear that nicotine dependent smokers need more motivation than other smokers to start cessation.
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CONSTITUTING DYNAMIC PATTERNS OF CHRONIC PAIN BEHAVIOUR - A STUDY OF HOW PLANNING EVERYDAY LIFE ACTIVITIES FORMS A BASIS FOR DEVELOPING PATIENTS' PAIN BEHAVIOUR -.
SÄTTERLUND LARSSON, Ullabeth and PEOLSSON, Michael; Linköping University, Linköping, Sweden.
People suffering from chronic pain often describe how they are forced to adopt different routines to avoid or reduce perceptions of pain from everyday activities. In this way, patients' experiences of pain intervene with their lives. Over the years, patterns of pain behaviour are formed.
This study was carried out at a rehabilitation clinic and is based on six patients' experiences of chronic pain. The aim of the study is to highlight layman descriptions of long-term pain and how patients arrange their everyday life as a consequence of chronic pain. The data for the present study derive from interview interactions with the patients and focus on their utterances in the interviews.
The results show how activities generating pain are verbally expressed and, furthermore, how patients express the consequences of these practices verbally. Moreover, the results show how patients make use of their experiences of pain and, as a consequence, plan their everyday life activities. The results also show that these verbalized patterns of pain behaviour are not static but dynamically formed by, and used in as the patients express, the situated activity in which they are involved.
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HEALTH PSYCHOLOGY IN CHILDREN I
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INTEGRATED APPROACH TO THE DEVELOPMENT OF THE CHILD WITH DOWN SYNDROME. FIRST REPORT FROM AN INTEGRATED WORKING GROUP
BIONDI, G.; PISCITELLI, O. and ALBERTINI, G. Pediatric Hospital "Bambino Gesù", Roma, Italia.
This paper presents the path we followed in a project about a multidisciplinary intervention on a group of 42 children and teen aged affected by down syndrome.
The program involved the Psychosocial Service, Neuro-rehabilitation Service and Department of Science, Faculty of Psychology University of Bologna.
The path was address to evaluate psycho-physical conditions of the children/teens and to produce an integrated intervention about the emotional/relational/teaching life experience of parents of handicapped children.
Up till now we can state the relevance of an integrated medical/rehabilitatve/psycosocial/pedagogic intervention adress to provide a teaching path (supported also by the schools to which these children apply) and a therapeutic path for the handicapped child and his/her family.
Our working group began this project in an experimentally way in 1990, the project is still on the way and we are to have meetings with parents and children every 3 months.
The program foresces, during the meeting day, beside a set of non invasive clinical examis a psychological screening by the use of some tests and by observation of play.
The following set of tests are used: W.I.P.P.S., WISC-r, Favole Duss, KOCH, CORMAN, DAP.
Our data show in the tested children an enhancement of cognitive competences, a higher level in socialization and in archieved autonomies; the degree of presented insecureness (which was analyzed by specific graphic tests) went on in diminushing during the experimentation.
In the same way, parents seen to have fained a higher level of competence in the interaction with the handicapped child; comunications inside the family seen to be improved too.
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CHARACTERISTICS OF ANGER IN CHILDREN: THE BOGALUSA HEART STUDY.
JOHNSON, Carolyn C.; WEBBER, Larry S.; MYERS, Leann B.A. and BERENSON, Gerald S.; Tulane Center for Cardiovascular Health, School of Public Health & Tropical Medicine, New Orleans, LA.
Participants in a Bogalusa, LA, cross-sectional survey (2,666 children, ages 8-18) completed the Jacobs Anger Questionnaire, which assesses two factors, "anger-in" (feelings of anger held in), and "anger-out" (outward expression of anger). Factor analysis confirmed the existence of these two factors for this population. The scores for both factors were normally distributed for all race/sex groups.
No race/sex group had significantly higher scores on one factor compared with the other, but in general male scores for both factors were higher than female scores. In white females, grams of alcohol consumed were positively correlated with anger-out scores (r=.28, p<.02, n="72)," and negatively correlated with anger-in scores (r="-.24," p<.04, n="72)." No significant relationship with smoking was found.
Anger-out was estimated with five questions similar to those for the hostility component of the Hunter-Wolf Type A Questionnaire. When anger and Type A hostility scores were analyzed, a good discrimination was reflected in the positive association of anger-out (r=.44, p<.0001), and in the negative association of anger-in (r="-.44," p<.001) with hostility for N="2354."
In summary, males tested more angry than females. For white females, as alcohol consumption increased, anger that was repressed declined and anger that was expressed increased. At least for white females, the expression of anger appears to be associated with alcohol consumption.
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FAMILY COPING WITH PEDIATRIC CANCER: A 12 YEAR STUDY.
KUPST, Mary Jo; Medical College of Wisconsin, Milwaukee, USA.
NATTA, M.B.; Loyola University, Chicago, USA.
RICHARDSON, C.C.; Chicago, USA.
SCHULMAN, J.L. and DAS, Lakshmi; Northwestern University, Chicago, USA.
LAVIGNE, J.L.; Children´s Memorial Hospital, Chicago, USA.
Findings of a 12 year prospective study of family coping with pediatric leukemia are described. Aims were to: assess coping and adjustment to diagnosis, treatment and long-term survival; determine correlates of coping; and assess efficacy of psychosocial intervention. 64 families of newly diagnosed patients were randomly assigned to 1 of 3 intervention groups and assessed at diagnosis, early and late treatment, 1, 2, 6, and 12 years post-diagnosis. Issues relevant to each phase of treatment are discussed. Psychosocial intervention was found to be significantly effective with mothers early in treatment, but not significantly so at later points. Most children and their parents were found to have adjusted well, with a significant increase at 6 years and no serious psychopathology noted. Coping strategies varied over time and across individuals. In the 12 year evaluation, positive correlates of coping included: older age at diagnosis, adequacy of maternal coping, seeking social support and positive reappraisal. Perceived adjustment was negatively related to escape/avoidance. Based on results, recommendations include: early assessment of coping and adjustment; early behavioral intervention with focus on adjusting to procedures and treatment; regular follow-up for late effects and referral to relevant programs. Issues surrounding the conduct of longitudinal research with this population are discussed.
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THE TERAPEUTIC PROPOSAL FOR MULTI-TRANSPLANT OF ORGANS IN ADOLESCENTS WITH CYSTIC FIBROSIS: FEARS, FANTASIES, REALITY.
BIONDI, G.; TABARINI, P.; ROSSI, A.; LUCIDI, V.; CASTRO, M.; PARISI, F.; SQUITIERI, C. and MARCELLETTI, C. "Bambino Gesù" Children's Hospital, Rome, Italia.
The present work takes into examination the adolescent problems of youngsters with a high- risk clinical condition which because of its chronicity conditions their individual development and relationship with the family and outside world. In particular, the psychological work done is analyzed; the work reahzed during the various phases of the protocol used preparatory to the multi-transplant of organs agreed upon by the Psycho-Social Department, the Cystic Fibrosis Center and Department of Pediatric Cardiology and Cardio-Surgery of the Pediatric Hospital "Bambino Gesu" regarding seven patients (M-1, F-6) followed at the Center of Cystic Fibrosis for at least two years.
The clinical sittings, after an initial refusal of the proposed treatment, permitted the elaboration of fears and fantasies connected with the new itinerary, allowing the young-sters a gradual and personal adaption to the new surgical program. Moreover, the operating difficulties encountered and possible strategies used to overcome these difficulties will be analyzed: (strategies for example: a clear and realistic communication, the "predictability' of the surgical interventions andwhere, a continuity of relationship with the medical personnel).
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HEALTH PSYCHOLOGY IN CHILDREN II
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SECULAR TRENDS OF ALCOHOL CONSUMPTION IN CHILDREN AND YOUNG ADULTS (1981-91): BOGALUSA HEART STUDY.
JOHNSON, Carolyn C.; MYERS, Leann; WEBBER, Larry S.; SRINIVASAN, Sathanur R.; BERENSON, Gerald S.; Tulane Center for Cardiovascular Health, New Orleans, LA.
Alcohol consumption data from children and adolescents, grades 3-7 (3 cross-sectional surveys, N%1200 each survey) and young adults [3 post high school surveys, N>1000] were examined for secular trends, over a period of 10 years. Across ages, a greater percentage of males (p<.001) and whites (p<.01) drank than females and blacks, with white males consuming the highest and black females the lowest. Patterns of adoption and maintenance were different for each race/sex group, with more white males starting earlier, black males starting a little later. Consumption increased with age for all race/sex groups except for white females whose intake declined. An overall downward trend in alcohol consumption over the decade was observed, especially among white males, ages 18-23 years. Beer was the most prevalent beverage reported by all race/sex groups. Most respondents reported drinking 1-2 times/week. Young adult white females who drank had higher HDL-C (p<.0001) than non-drinkers and a similar trend was noted for other race/sex groups. Increased alcohol consumption also was associated with higher ponderal index (r=".47," p<.05) for black females. Even though slight reductions in drinkers have been observed, male consumption begins early and increases dramatically with age. At the end of the decade black male drinkers have increased to equal white males and progressively increased in beer and hard liquor consumption. Alcohol use continues to be a prevalent health risk even at young ages.
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THE CONNECTIONS BETWEEN BEHAVIOR OF THE THREE-YEAR-OLD CHILD AND NUTRITION.
TARMI-MATTSSON and KESKINEN, S.; Department of Psychology, University of Turku, Turku, Finland.
From the beginning 1990, 1000 families with a six month old child started to participate in health and nutrition education program (STRIP Baby -project). The aim of the project is to prevent atherosclerosis risk factors by changing life habits of the families. The intervention group A (n=500) receives individualized dietary advice and health and nutrition education than in control group B (n=500). Children in group B followed a regular diet according to present nutrition recommendations. Lipid values are measured frequently in all family members.
The aim of this psychological study is to elucidate what kind of connections can be found between the behavior of the three-year-old child and nutrition, and to clarify the possible differences between groups A and B.
The study group are those now 3-year-old children who have participated in the project from the start. Their parents have filled out a chart which measured their child´s behavior (C-Behscale) and a diarys of nutrition (3-4 days at time, in every sixth month). These two methods will put together by using statistical analyses.
The pilotmaterial of the first 400 children is now under analysing. After these results we´ll plan how to continue.
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WHAT KIND OF HEALTH CARE DO CHILDREN EXPECT OF THEIR MOTHERS AND FATHERS?.
JUTRAS, Sylvie and HANIGAN, Doris; Universite du Quebec a Montreal, Quebec, Canada.
KALNINS, Ilze; University of Toronto, Toronto, Canada.
NORMANDEAU, Sylvie; Universite de Montreal, Montreal, Canada.
This study describes children's expectations of care by mothers and fathers when a child feels sick and it identifies differences related to gender, age, family structure and geographic and socioeconomic milieu. Living in different regions in Quebec (urban or rural) and in different socioeconomic backgrounds, the children (n=1,675, 5-12 years old) were evenly distributed in terms of gender and age in three experimental conditions. All children were presented with the picture of a child that does not feel well; the child comes into the living room where either (1) the mother, or (2) the father, or (3) both parents are watching television. The child is asked to tell a story about what will the mother, father or both say or do. Answers were noted verbatim and categorized for content analysis. The material was codified by two independent judges, specially trained for this procedure. Overall inter-rater reliability was high (kappa= 0,87).
Therapeutic actions (medication and rest) are the predominant expectations of the children, followed by diagnosis (examining the child, asking questions). Interactions (mostly reassurance and caring) and reference to a health care professional are the other important expectations. Neither the children's milieu nor gender are related to any type of expectations. Some interesting and significant differences are noted between children's expectations at different ages. First, diagnosis is more important at 11-12 years old, whilst reassurance and caring are slightly discounted for children from 9 to 12 years old. Second, age is related to children's tendency to qualify reference to a health care professional. Finally, the proportion of therapeutic actions and interactions expected of the mother decreases with age but remains constant for the father. Older children seem to show more variety in the expected actions of the mother.
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MALFORMED CHILD AND ADOLESCENT NEEDS FOR THERAPEUTIC ACTION.
LUCONE VIANA, Marcia; PUCRS/Ritter dos Reis, Brazil.
TIELLET NUNES, Maria Lucia; PUCRS/UFRGS, Brazil.
Normal development is known as a complex issue in itself. When variables such as malformation confront the growing child and adolescent the entire process challenges the person, his/her family and professionals involved in different sorts of treatment. Nevertheless few studies deal with therapeutic action for children or adolescents with facil malformation.
The aim of this paper is to show the psychosocial developmental problems and possible therapeutic action in the case of lip-cleft palate malformation. Two case studies are presented. One boy, three years old, has had a seven month prophylatic treatment in order to enable him to undergo surgical and orthodontic procedures. Another boy, twelve years old, after early intervention was evaluated and prepared to start psychotherapy. Both cases involved interviews with the patient, his family and the professionals of the school of dentistry atending them. The cases are discussed concerning the symptomatology surrounding the lip/cleft palate and the special needs for psychological services for such persons.
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PSYCHOLOGICAL RESPONSES AND CORRELATES IN ILLNESS AND TREATMENT
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PSYCHOSOCIAL ADJUSTMENT AND ADHERENCE TO DIALYSIS TREATMENT REGIMES
FIELDING, Dorothy M. St James's University Hospital, UK.
Sixty children and adolescents in end stage renal failure who were undergoing either haemodialysis or continuous ambulatory peritoneal dialysis at one of five UK dialysis centres were assessed on psychosocial adjustment and adherence to their fluid intake, diet and medication regimes. Parental adjustment was also measured and data on sociodemographic and treatment history variables collected. A structured family interview and standardized questionnaire measures of anxiety, depression and behavioural disturbance were used. Multiple measures of treatment adherence were obtained, utilizing children's and parents' self reports, weight gain between dialysis, blood pressure, serum potassium level, blood urea level, dietitians' surveys and consultants' ratings.
Correlational analyses showed that low treatment adherence was associated with poor adjustment to diagnosis and dialysis by children and parents, age (adolescents tended to show poorer adherence than younger children), duration of dialysis, low family socio-economic status, and family structure. The implications of these findings are discussed with reference to future research and health care provision to this group of children.
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MOMENTARY AND RETROSPECTIVE REPORTS OF PATIENTS' EMOTIONAL EXPERIENCE DURING HOSPITALIZATION
DUBÉ, Laurette. Université de Montréal, Montréal, Canada.
MORGAN, Michael S. Cornell University, Ithaca, USA.
In this study, 93 patients who stayed on average 4.5 days in an acute care french-canadian healthcare facility made momentary (daily; 5 p.m.) and retrospective (upon departure) reports of their emotional states (PANAS scale; Watson, Clark and Tellegen 1988). Changes over time in consumers' daily reports of their positive and negative emotions were modeled with a continuous-time dynamic model. Results show that over time, positive emotions increased concavely and negative emotions decreased convexly. Retrospective reports of the positive and negative emotions patients had felt overall during the stay were accurately predicted by modeling their daily states. Moreover, positive and negative emotional states were sensitive to different health covariates (physical activity and perceived health status). Regression analyses revealed that in forming retrospective reports of their emotional states, subjects took into account average momentary states, velocity and magnitude of change. Implications of the findings on patient satisfaction and on the management of the quality of care are discussed.
Watson, Clark, L. A., and Tellegen, A. (1988), "Development and Validation of Brief Measures of Positive and Negative Aftect: The PANAS Scale," Journal of Personality and Social Psycholo y, 54:6, 1063-1070.
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ISOKINETIC PERFORMANCE IN LOW BACK PATIENTS: THE ROLE OF EFFICACY EXPECTANCIES.
KAIVANTO, Kim; Institute of Occupational Health, Helsinki, Finland.
ESTLANDER, Ann-Mari; Finnish Back Institute, Helsinki, Finland.
MONETA, Giovanni B.; Institute of Occupational Health, Helsinki, Finland.
Self-efficacy expectancies have been found to predict isokinetic performance better than anthropometric variables. The question posed in this study asks whether depression and perceived dis-ability also affect isokinetic performance, seeking to elucidate their relationship to expectancies.
A group of 105 chronic back pain patients was administered Beck's Depression Inventory (BDI), the Self-Efficacy Scale (SES), the Pain Self-Efficacy Questionnaire (PSEQ), and the Oswestry low back pain disability questionnaire (OSWESTRY). Total isokinetic work done was then measured at slow, medium and high speeds. Multiple regression models were fitted for total work done, controlling for sex, age, weight and height.
The results confirmed SES to be the best overall predictor of isokinetic performance. The data suggest that the variables BDI, PSEQ and OSWESTRY retain little independent predictive value once the effect of SES is accounted for. The models also revealed that SES predicts less well with increases in the test-speed; OSWESTRY almost overtakes SES as the best predictor by the fastest speed of flexion, whereas it actually does so by the fastest speed of extension. An extended analysis of the correlation structure between disability and expectancy measures revealed a lack of discriminant validity, suggesting that further research is needed to clarify the nature of self-efficacy expectations among chronic back pain patients.
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REMEMBERING TO TAKE MEDICATION CORRECTLY: COGNITIVE AND PSYCHOSOCLAL PREDICTORS.
PARK, Denise C.; MORRELL, R.W. and KIDDER, D.; University of Georgia, Athens, USA.
HERTZOG, C.; Georgia Institute of Technology, Atlanta, USA.
LEVENTHAL, H.; Rutgers University, New Brunswick, USA.
BICHMORE, D.; Wilmington Veterans Administration Hospital, Wilmington, USA.
We utilized micro-electronic adherence devices to examine the medication adherence behaviors of 40 elderly osteoarthritis patients. All subjects were taking at least three prescription medications and all medications were monitored for one month using either the Medication Event Monitoring System or the Videx Time Wand system. All subjects completed an eight hour psychosocial/cognitive battery which included measures of coping, pain, functional mobility, depression, illness representation, long term memory, working memory, text comprehension, and metamemory.
The major findings were that (a) there were no significant differences between the Medication Event Monitoring System and Videx Time Wand system in adherence rates; (b) the observed rates of adherence differed as a function of medication category, with the highest nonadherence observed for nonsteroidal antiinflammatory drugs (NSAIDs); (c) psychosocial variables were generally better predictors of medication adherence than cognitive variables; and (d) different variables predicted adherence for different classes of medications.
These findings will be used as the basis for both a methodological discussions regarding measurement of adherence behaviors, as well as to present a preliminary conceptual model for understanding adherence behaviors.
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COMPUTERISED NEUROPSYCHOLOGICAL ASSESSMENT OF COGNITIVE IMPAIRMENTS IN PARKINSON'S DISEASE
SCHOLEY, Andrew; University of Northumbria at Newcastle, UK.
The hypothesis that Parkinson's disease may be associated with fronto-striatal dysfunction resulting in cognitive, especially attentional, deficits was evaluated by testing PD patients and matched controls in several computerised tests, two of which are focused on here. The first, the Conditioned Learning Paired Associate (CLPA) task, is drawn from the Cambridge Neuropsychological Test Automated Battery (CANTAB; Morris et al., 1987) and is a test delayed responding where the number of stimuli ranges from set size 2 to 8. In addition to a mnemonic component, which requires intact temporal lobe structures, this task also includes a conditional component sensitive to frontal lobe damage. The second is a novel touch- window computerised test (Sahgal and Steckler, 1994), the Multiple Choice Serial Reaction Time task (MCSRT), which provides ameasure of attentional ability.
The PD patients' CLPA performance was impaired, and this impairment depended on set size. MCSRT latencies were increased and there was an indication that PD patients were less accurate than controls on this task. Since the PD group was unimpaired on other CANTAB tests measurin mnemonic performance, these results suggest that PD is primarily associated with attentional dysfuntion which may be based on fronto-striatal damage.
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FREITAS, C.; LEITE, E. and CUNHA-VAZ, J.; University Hospital de Coimbra, Portugal.
The aim of this study was to assess Quality of Life functions changes caused by the improvement of visual functioning. Forty ophthalmic patients undergoing Photorefractive Keratectomy by Excimer Laser were evaluated before surgery and three months after first eye treatment by means of specially designed self-report questionnaires directed to the impact of vision change on the patients' Functional Status (FS), General Weeçll-Being (GWB) and Satisfaction With Surgery (SWS). ANOVA for Repeated Measures: (1) FS: (a) physiscal functionain: significant improvement between preoperative and postoperative scores in the total group (low myopia group presented a significant difference in th results before and after surgery but high myopes did not); (b) social functioning: the values increased during the postoperative period (low myopia subjects showed a significant improvement on social activities; high myopia subjects did not); (c) role functioning: were shown significant trends to improvement of the capacity to work after treatment (low myopes showed a clearly increase after surgery; high myopes did not report a significant difference); (d) mental status: the psychopathological characteristics evaluated by th SCL-90-E have clearly decreased after surgery, specially concerning somatization, interpersonal sensivity, depression and hostility (changes in obsession, anxiety, phobia and paranoid ideation items were not significant in the high myopes).
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CHRONIC LOW BACK PAIN AND COPING WITH DAILY HASSLES: IMPLICATIONS FOR TREATMENT.
KEES, Venselaar; Groot Klimmendaal Center for Rehabilitation, Arnhem, The Netherlands.
Chronic low back pain - CLBP - can be very resistent to treatment. In this study is investigated whether coping with daily hassles is related to the chronic pain problem of patients suffering from CLBP. Coping and CLBP can be linked according to two different approaches. The first is the constitutional predisposition model. According to this point of view physical weakness leads to CLBP. In treatment the search is for an energy saving coping style since CLBP on its own consumes much energy in everyday life. The second approach views the personality as precipitator of CLBP: a certain coping style plays a role in the etiology of the pain problem, and in treatment attention should be given to the aspects of the coping style that put health at risk. Both - not mutually exclusive - points of view lead to the recognition that a change in coping style can help patients to function better in everyday life.
Subjects were 53 men and 79 women who were referred for evaluation to the rehabilitation unit. Coping behaviour with everyday hassles and several biographic variables related to health status were assessed.
Multiple regression analysis with coping behaviour as independent variable shows that coping behaviour explains a small but significant proportion of variance in reported pain intensity.
Cluster analysis reveals sub-groups which can be distinguished according to their coping profile. The relevance of the various clusters for treatment will be discussed. An example of a treatment aimed at a change in coping style will be given.
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SEVERE PSYCHOLOGICAL SEQUELAE AFTER CARDIAC SURGERY.
ZLOTOGORSKI, Zoli and Rinat Rudis, M.A.; Hebrew University of Jerusalem, Jerusalem, Israel.
During the early post-operative period after cardiac surgery, approximately 20-30% of patients demonstrate significant emotional and cognitive disturbances. The present study examined the correlation between two cognitive-behavioral variables and the occurrence of these severe sequelae. Sixty-three consecutive patients hospitalized for cardiac surgery were administered the Brief Symptom Inventory (BSI), the Self Control Schedule (SCS) and the Sense of Coherence Questionnaire (SOC).
Post-operatively the patients were assigned to one of two groups based on the independent blind ratings of two staff members. Patients were either classified as normally adjusting or emotionally/cognitively disturbed, based on DSM-III-R criteria. No significant differences were found on the BSI between the former (N=48) and later (N=15) groups pre-operatively. Data analysis revealed differences between the groups on the SOC and the SCS measures. In conclusion the present study demonstrates a relationship between cognitive-behavioral repertoires and the occurrence of post operative psychological disturbance. These findings have both theoretical and direct applications for clinical care.
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MALE SEX INDUSTRY WORK-THERAPY OR SURVIVAL
DOCKRELL, J.E.; University of London, London, U.K.
This paper reports the social and personal beliefs of young , male sex industry workers abaout male prostitution and safer sex behavior. They were interview in depth abuot their working practices; the specific benfits and disadvantages of working in the sex industry; their knowledge of AIDS/HIV and its transmission; their attituydes to HIV and sexual behavior; problems with sexual relationships and the negotiation of safer sex. A questionnaire was administered covering sexual history, recent sexual behavior, and demographic details.
These men are a heterogeneous group with varying strengths and needs. For some their occupation is a high risk life style, an habitual and rewarding pattern of activity which they began while young. For others it is a form of employment where they help others, "provide therapy", in a supportive and lucrative occupation. Yet others report arriving in London, often after a family argument, with an established pattern of homosexuality, no friends to turn to, little money and apparently without the skills to earn any. For them, sellin sex is a means of survival.
We highlight the range of resources which will be needed to support and empower these very different groups of young men.
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JOB-RELATED TENSION AND HEALTH OUTCOMES AMONG FEMALE AND MALE EMPLOYEES: A TEST OF THE PERSON-ENVIRONMENT FIT MODEL.
GUTIERRES, Sara E. and SAENZ, West Delia S.; Arizona State University, (U.S.A.).
GREEN, Beth; University of Pittsburgh, (U.S.A.).
As more and more women enter the workforce, employers have begun to recognize the importance of consideration of gender issues. The link between occupational strain and poor health outcomes has been well documented in the literature, but the relationship with gender is less well understood. One framework that has proven useful in understanding psychological strain in the workplace is the Person-Environment Fit model (Van Harrison, R. (1985). The PEF model suggests that stress or psychological strain will result when incongruence exists between an individual's abilities and needs and the environmental demands and resources. The present study examined the impact of structural (proportional representation of one's gender group) and social contextual (perceived discrimination against women) factors on job-related tension and health outcomes for female and male employees.
Survey questionnaires were mailed to 1456 university employees (612 males and 844 females). The questionnaire included demographic information, questions related to the structure of the workplace in terms of gender, the Job-Related Tension Index, the Perceived Discrimination Index and the Health Problems Checklist.
Multiple regression analyses showed that women who perceive themselves to be in the minority experience relatively more stress than do women who work predominantly with females. Males' stress levels were unaffected by this factor. In contrast, males who perceive themselves in the minority in their work setting reported more health problems than males in majority positions or females in minority or majority situations. Further, both females and males experience increased health problems when they perceive that discrimination against women exists in their work unit. Implications of these findings for the workplace of the future are discussed.
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WAYS OF COPING WITH THE PSYCHOLOGICAL CONSEQUENCES OF WORK LOAD. A HEALTH PSYCHOLOGICAL APPROACH.
STEINHARDT, Gerald; Vienna University of Techn., Austria.
Traditional industrial science often exclusively interprets those elements of work as strain if they cause somatic harm in a direct way. Any kind of psychological harm is usually ignored.
Based on an empirical study, this paper sets out to analyse the psychological and psychosomatic impacts of work load and to examine the different strategies employed to cope with it. In particular, an in depth look is taken at unskilled and semi-skilled female workers who, in spite of experiencing restrictive working conditions which threaten their identity, still manage to regain and maintain their individual ability to act.
One essential finding is the identification of three different approaches in coping with work load: (1) active confrontation, (2) dramatisation, i.e. associating the harm from which they are suffering with positive connotations, (3) de-dramatisation - i.e. resigning oneself to accept the facts as they appear. Conclusions are drawn from the results of the study focusing on psychological aspects of health promotion at work.
The empirical study in question was carried out using qualitative methods. 50 in depth biographical interviews were held with Austrian women aged between 25 and 55. All interviewees were working ir unskilled or semi-skilled jobs. The interviews were transcribed and analysed according to the principles of social scientific hermeneutics.
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WHAT STRESSES POLICE OFFICERS AND HOW STRESSED ARE THEY? .
WALKER, Leslie W. and ALEXANDER, D.A.; University of Aberdeen, Foresterhill, Aberdeen, UK.
A study was carried out to evaluate the extent to which stress was a problem in a UK Police Force, to identify the stressors, to determine the effects of these stressors on work performance, health and family life, and to establish ways in which the impact might be alleviated.
Seven hundred and fifty-eight officers took part (76% response rate). They completed various adhoc questionnaires to assess exposure to stressors such as incidents, circunstances and organisational factors, and the coping strategies they employed; they also completed various standardised psychometric tests including the Eysenck Personality Questionnaire, the Hospital Anxiety and Depression Scale and the Courtauld Emotional Control Scale. In addition, spouses completed various questionnaires. In order that the findings could be put in perspective, data were also obtained from firemen, prison officers and nurses.
Fourteen per cent of male police officers and 24% of female officers had scores indicative of clinically significant anxiety. Fifteen per cent of male and female officers reported moderate-high risk alcohol consumption. Twenty per cent had a current health problem. Whilst exposure to various incidents was undoubtedly perceived to be stressful, univariate and multivariate analyses indicated that more enduring features of the work environment such as lack of personal recognition and frustration from perceived unnecessary obstacles were especially important predictors of various signs of distress.
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SOUTIENS SOCIAUX, BIEN-ETRE PSYCHOLOGIQUE ET CONSOMMATION DE MEDICAMENTS EN SITUATIONS COMPAREES DE CHOMAGE ET DE TRAVAIL.
ALMUDEVER, Brigitte & HAJJAR, Violette, Université de Toulouse-Le Mirail, Toulouse, France.
DAMASE, Michel C. & LAPEYRE-MESTRE, Maryse, Laboratoire de Pharmacologie médicale et clinique de Toulouse, INSERM U317, Toulouse, France.
La recherche a été effectuée aupres de deux groupes, composés l'un de 120 chômeurs et l'autre de 120 sujets occupant un emploi. Elle se propose d'examiner l'impact du soutien social sur le bien-être psychologique des sujets et sur les modes de coping qu'ils mettent en oeuvre pour faire face: les premiers à l'absence d'emploi, les seconds au stress professionnel.
Une échelle de soutien social a été construite pour évaluer l'intensité des aides reçues selon leur source (formelle/informelle) et selon leur nature (soutien émotionnel, pratique, cognitif).
Le niveau de bien-être psychologique est mesuré à l'aide du GHQ-12 de Golberg.
Le recours à un mode de coping de type "évitement" est inféré à partir de la mesure des consommations de médicaments et autres substances (tabac, alcool, etc.) pouvant entraîner une pharmacodépendance.
Les résultats obtenus, nous amènerons à préciser les rôles comparés du soutien social sur les effets de la privation d'emploi et du stress professionnel, afin de dégager des propositions d'action:
- susceptibles d'améliorer les dispositifs d'aide à l'insertion des chômeurs;
- susceptibles de contribuer à l'élaboration d'un suivi des chômeurs lors de leur retour à l'emploi.
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PROFESSIONAL ISSUES IN HEALTH PSYCHOLOGY
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CHARACTERISTICS OF SUCCESSFUL THERAPEUTIC OUTCOME: A STUDY OF AUSTRALIAN OCCUPATIONAL THERAPISTS
ADAMSON, B. J. University of Sydney, Sydney, Australia.
In recent years the biomedical approach in the delivery of health care has been challenged by the "new public health" model which promotes a humanistic, holistic approach to health care. While occupational therapy has traditionally embraced this latter approach, evidence suggests that within the profession there is concern that technical advances (e.g. the introduction of highly specialised aids and appliances) have eroded many of the characteristics of a humanistic orientation to therapy.
The extent to which occupational therapists endorse this new model was addressed in a survey of attitudes of practising occupational therapists (N = 378). A 22-item questionnaire including aspects of therapist's knowledge and techniques, client characteristics, client/therapist relationship, and approaches to professional practice was modified and adapted for use with occupational therapists.
The findings indicated that attitudes reflecting the "new public health" model emphasizing client therapist interaction, client responsibility and holistic attitudes toward health care prevailed, together with the therapist's knowledge and skills. Age and years of professional experience yielded significant differences with older (30 or more years of age) and more professionally experienced (6 years or more) therapists endorsing to a greater extent a humanistic approach to therapy and a greater emphasis on promoting the resources of the client. Recommendations for the education of occupational therapists are made. Implications of the findings for practitioners are discussed and suggestions for further research presented.
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MENTAL MODELS IN CARDIAC INTENSIVE CARE: NURSES AND THE PATIENT-MONITOR SYSTEM.
GILBERT, Amanda K. and CHMIEL, Nik; University of Sheffield, Sheffield, England.
This paper will describe a study of Intensive Care (IC) nurses and their uses of technology within a British Cardiac Intensive Care Unit. The research focuses on mental models and it is argued that these are employed by IC nurses in understanding, and working with, the patient-monitor system.
Mental models are held to preserve structural information about a system and to allow for predictive judgements based on a perception of causal links between its elements. It was hypothesised that expert IC nurses would employ richer mental models than novices. Expert mental models would be more structurally complex and allow greater flexibility of processing than novice mental models.
Knowledge elicitation interviews with expert nurses were used to identify the domain of knowledge required by IC nurses and to explore the role of the monitoring system. Identified concepts were used to develop questions and scenarios which would tap IC nurses' mental models.
Interview data demonstrated the importance of integrating information from different sources in understanding the patient's condition. Novice errors tended to arise from an inability to consider multiple factors underlying interrelated informadon, indicating a less sophisticated knowledge structure. Comparisons of performance between groups of novices, experts and "super" experts indicate increasing sophistication in perceived relationships within the system.
Implications and applications for mental models research and training interventions are discussed.
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DISTRESS FACTORS OF MINORITY ELEMENTARY SCHOOL TEACHERS IN A LOW SOCIO-ECONOMIC METROPOLITAN AREA.
JOHNSON, Carolyn C.; MYERS, Leann B.A.; KATZMAN, Barbara A. B.S., and BERENSON, Gerald S.; Tulane Center for Cardiovascular Health, School of Public Health & Tropical Medicine, New Orleans.
Elementary teachers (N=63) undergoing a cardiovascular risk examination in two low socio-economic status minority schools responded (80%) to a questionnaire regarding personal and occupational stress factors. Most were black (93%), female (87%) and married (52%), while 33% were divorced. Years teaching ranged from 1 to 42 yrs (=19 yrs), and mean age was % 44 yrs, with a range of 25-67 yrs. The most common stress symptoms reflected burnout: fatigue (53%); negative feelings toward students and others, e.g., frustration (32%), irritability (29%), impatience (24%), and helplessness (16%). Experiences of anger (76%), anxiety (66%), aggressive feelings (52%), and depression (39%) were common. Prevalent muscle symptoms included headache (66%), stiffness in neck and shoulders (63%), and lower back ache (50%). The most common life stress events were: additional job responsibilities (50%); personal injury/illness (42%); large personal debt (32%); death of a close friend (32%); moved (29%); close friend/relative in a fight or jail (27%); a new job (25%); and crime victim (23%). Insufficient time and money contributed to distress, as well as job ambiguity and discomfort. The most common coping strategy was prayer (82%), and more than half of the teachers used: talking to someone (78%); music (59%); humor and work (58%); and TV (58%). Relaxation strategies were not common and exercise was reported by % one-fourth of the sample. Factors contributing to teacher distress in inner-city schools could contribute to excess CV risk and poor health practices.
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HEALTH PROMOTION AND EDUCATION
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A SYSTEMIC APPROACH IN THE REHABILITATION OF THE YOUNG DISABLED: THE CONSTRUCTION AND THE PROMOTION OF HEALTH.
BESIO, Serenella; Institute for Educational Technology, National Research Council, Genova, Italy.
CHINATO, Maria Grazia; Italian Association for Spast, Savona, Italy.
Rehabilitation theories today in use in the field of rehabilitation of young disabled deal with limited topics, for which they propose interventions in form of exercises, or are polluted by a "globalism" ineffective in an operative sense. In any case, a serious reflection on the therapeutic relationships isn't recognizable in the rehabilitation culture. We shall here describe and analyze a proposal to arrange the rehabilitation therapy process within the systemic approach, as it has been outlined by the Milan Team of Family Therapy (L. Boscolo and G. Cecchin), since the mid 1970s. We'll refer to its foundation concepts, defined in the systemic-constructivist approach (from G. Bateson to H. von Foerster, to H. Maturana and F. Varela): the awareness and the turning to account of the mutual relationship between the individual and his vital context; the connection between ideas and acts; the importance of the institutional context and, after all, the mutuality and reflexivity processes among all these elements. So this approach can be advantageous in constructing and promoting welfare, and a clinical practice by which the individual is viewed as an active subject, never detached from all his relationships.
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PERCEIVED HEALTH AND LIFE CONTROL.
SUOMINEN S.; BLOMBERG H.; BÄCKMAN G.; HELENIUS H.; KOSKENVOU M.; Abo Akademi University, Finland.
In 1989 a questionnaire study of a sample of 4 517 persons representing the Finnish working age population was started. The aim was to study the connection between perceived health and life control determined according to the strength of sense of coherence (SOC) and life satisfaction. The research material consisted of 3 115 (69%) answers. Analyses of variance showed that strong life control was explained (p<0.001) by good, subjective state of health, strong social integration measured by the number of friends, a good socio-economic situation, low perceived strain at work and an active time of leisure. According to cumulative logistic models strong social integration, a good socio-economic situation, low perceived strain at work and an active time of leisure explained (p<0.05) good, subjective state of health. According to log linear models good, subjective state of health and strong life control were associated with each other (p<0.001) and with strong social integration, good social support and a good socio-economic situation. Life control was, however, nor similarily associated to age and time of leisure than subjective state of health. Therefore it can be stated that life control is associated with health as well as with the social determinants of health and mediates environmental health-effects.
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PATIENTS AND PHYSICIANS TALK ABOUT LIFESTYLE IN PRIMARY HEALTH CARE
JOHANSON, Marita. Vánesborg College of Health and Caring Sciences. Vánesborg, Sweden.
The study is a part of a project "Lifestyle Questions in Primary Health Care", which has been carried out at two primary health care centres in central Sweden. The participants consisted of 42 patients and 12 physicians. The analyses concem the interactional patterns in the dialogues between patients and physicians. In relative terms the results show similarities of the patients' and physicians' use of the discourse space. However, salient differences were found in following way: The physicians not omy introduced and closed lifestyle topics more frequently than the patients did, they also used a strategy of a predetermed communicative aim while the patients used a strategy of a temporarily shared history. By taking the reference in life world while talking about lifestyle topics the patients gave information in order to explain themselves and their life situation. In this way they seemed to create their own identities as individuals. By taking the reference within the medical frame, the physicians, in contrast to the patients, mainly talked about lifestyle topics to get information in order to create an identity of a patient, not an individual. In this way, dialogues about lifestyle topics can be seen as a way of contextualizing medical issues.
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EDUCATION PROTOCOLS: A WAY TO STANDARDIZE PATIENT EDUCATION IN DAILY PRACTICE
MESTERS, Ilse; University of Limburg, The Netherlands.
This paper describes the development of an education protocol for parents of children (0-4 years) with asthma. The education protocol is intended to enable health care providers to provide systematic and coordinated education to asthma patients and their parents. Today the relevance of adequate education for patients with asthma will hardly be under discussion. It is accepted that patient education should be integrated in the overall care for patients, but how this should be achieved remains rather unclear. Education protocols have been suggested as a promising way to achieve a systematic and coordinated approach to patient education in routine care. An education protocol has several functions. The present education protocol arranges the organization of the patient education, the content of the patient information, as well as the transfer of information from care providers to patients. The organizational function of the protocol is to give directions about who will provide what education. Directions about the content of the patient information can be restricted to the synopsis of the subject matter of the information. Finally, the third function of the protocol addresses ways of transferring patient education to the target population, such as techniques to enhance communication.
Even though we know of what elements an education protocol should consist, there is limited experience with the development of such protocols. This paper describes one of the first examples that shows the systematic steps that are to be undertaken to develop an education protocol.
The most essential points of the steps undertaken and the main results obtained will be presented.
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CANCER AND CHEMOTHERAPY
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COGNITIVE-BEHAVIORAL INTERVENTION FOR THE CONTROL OF ANTICIPATORY REACTIONS TO CHEMOTHERAPY.
FERNÁNDEZ MARCOS, Ana M.; Universidad Complutense de Madrid, Madrid, Spain.
The cognitive-behavioral program that is described has as final aim, to test the effectiveness of a structured psychological treatment for the prevention of anticipatory reactions to the chemotherapy within a hospital context of public health.
Fist of all, it is shown the assessment method designed to register the data concerning to: variables which predict the disclosure of anticipatory nausea and vomiting, anticipatory and post-chemotherapy effects, anxiety, quality of life and depression.
The assessment instruments include a small registration note-book which assess the intensity of anxiety and nausea, so as the number of vomits during the day before, two days after and the day itself of the administration of the chemotherapy, in each treatment.
They include as well, the use of the Beck's Depression Inventory and the Functional Living Index Cancer to assess depression and quality of life.
Afterwards, the psychological intervention is described and the results obtained in the preliminary research with 20 breast cancer patients are shown.
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PREVALENCE OF ANTICIPATORY AND POST-CHEMOTHERAPY REACTION IN CANCER PATIENTS.
FERNÁNDEZ MARCOS, Ama Mª and CRUZADO RODRÍGUEZ, Juan A.; Facultad de Psicología, Universidad Complutense de Madrid, Madrid, Spain.
MARTÍN JIMÉNEZ, Miguel; Servicio de Oncología Médica, Hospital Universitario San Carlos, Madrid, Spain.
The main aim of this paper is to show the results obtained in a study carrled out in the Medical Oncology Unit at the HH.UU. San Carlos (Madrid) to know the prevalence of anticipatory and post-chemotherapy reactions in a sample of oncological patients treated in the above mentioned Unit.
The variables studied vere: post-chemotherapy vomiting, post-chemotherapy nausea, anticipatory vomiting, anticipatory nausea and anticipatory anxiety. Other variables taken in account were: age, sex, marital status, place of administration, type of chemotherapy treatment, type of antiemetic drugs, and the stimuli related to the arising of anticipatory reactions.
Method; We designed a 2-page protocol to register all the variables in each treatment of chemotherapy received by the patient (6 treatments maximum). This protocol was administered to 104 patients in a prospective vay by the psychological and medical team at the Unit.
Vomiting was registered as the maximum number of vomits shown by the patient in each treatment, nausea and anxiety were evaluated in their intensity (0=Nothing, 1=Light, 2=Moderate, 3=Severe).
Results; The prevalence rates obtained in the first global analysis of the data were as follows: Post-chemotherapy Vomiting = 69 2%, Post-chemotherapy Nausea = 76.9%, Anticipatory Vomiting = 10.6%, Anticipatory nausea = 25%, Anticipatory Anxiety = 71%.
Moreover, further analysis were developed to know the prevalenoe rates within the greatest subgroup (breast cancer patients). These were the results: Post-chemotherapy Vomiting = 71.6%, Post-chemotherapy Nausea = 77.6%, Anticipatory Vomiting = 10.4%, Anticipatory Nausea = 26 9%, Anticipatory Anxiety = 71.6%.
The stimuli related to the arising of anticipatory reactions among the majority of the patients were; Visual Stimuli (24%), Cognitive Stimuli (22.5%) and Olfactive Stimuli (15%).
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PROGRAM TO SOFTEN THE DIAGNOSIS'S IMPACT OF WOMEN WITH BREAST CANCER.
MARTINEZ-TABOADA, Cristina; ERRO, Mayte and GARCÍA, Carmen; Universidad del País Vasco, San Sebastián, Spain.
This study is made in collaboration with: Women's Breast Cancer Association of Guipuzcoa, Oncologic Hospital of Guipuzcoa, and the Social Psychology Department of the Psychology Faculty of the Basque Country University.
The aim of this Program is to offer psychological support to women with breast cancer diagnosis and next to mastectomy.
Specific Objectives: to re-establish certain feeling of control; to develop confronting strategies; to offer support by a psychologist in coordination with the medical assistance offered in the hospital.
Sample: the sample will depend on those women diagnosed with breast cancer and sent to this Program during a period of six months.
Instruments: a diagnosis-file to coordinate: medical staff-psychologist-surgeon. This instrument is included in the protocol of all the professionals engaged with the Program. In addition to, two semi structured interviews before mastectomy, and one post operation semi structured interview to analyse patient's own condition and the need of following her up.TS HLT 10
PERSONALITY VARIABLES AND HEALTH
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ASSESMENT OF THE PERSONALITY TIPO A AND THE HOSTILITY /EXCITABILITY IN DIFFERENTS GROUPS OF PATIENTS.
MESTRE ESCRIVA, V. & PENAS MADURGA, C.; University of Valencia, Valencia. Spain. VELASCO RAMI, J. A.; Hospital General de Valencia, Valencia, Spain.
The psicologic factors play an important role in the cardiovascular disease. The literature remarks that the emotional personal, social and working aspects are important to adrive a better knowedge of the disease.
In the 60 s Rosenman & Friedman (1.974). noticed that most of the patients with cardiovarcular problems show some especific conducts: this observation carry them to develope what they called "Patrón de Conducta Tipo A".
In this study we wanted to evaluate both the Patrón de Conducta Tipo A as the Hostility/ Excitability. The sample studied are 207 men with ages comprised between 31-73 belonging to a middle-long social class and clasified in five well diferenced groups;
1.- Patients with I.M in a Coronary Care Unit. 50 men with ages mean values of 59.
2.- Patients attending to a Cardiac Rehabilitation Program. 59 men with ages mean values of 59.
3.- Diabetic Patients. 47 men with ages mean values of 54.
4.- Hypertens patients: 16 men with ages mean values of 52.
5.- Group control: 35 men with ages mean values of 53.
All the patients have been evaluated through the next questionnaires:
- Questionnaire to evaluate the "Patrón de conducta Tipo A".
- Questionnaire to evaluate the Hostility / Excitability.
The results shown significative difference between the groups studied, reflecting how the Patrón de Conducta Tipo A and the Hostility / Excitability are determinant psicologic factor in the cardiovascular disease.
TS HLT (10) 2
REPRODUCTION AND TYPE A BEHAVIOUR PATTERN.
CHACÓN-PUIGNAU, Grace; Universidad Simón Bolívar, Venezuela.
This study relates several reproductive parameters (the reproductive age, number of children, and spousal similarity for age and education) with the type A behaviour pattern (TABP) in 312 couples of medicine student's parents who completed the Jenkins Activity Survey (JAS).
No relationship was found between the composite score of the JAS, the speed and impatience scale and reproductive behaviour. After controlling for the spousal similarity for education, there were more couples with similar levels of job involvement and hard driving behaviours than what could be expected by random pairing. Besides, subjects with high job involvement had more children and were more selctive for the educational level of their partners than those subjects with low levels. Higher levels of hard driving were associated with less children and lower selection for partner's age.
The results are discussed within a psychobiological approach, which relates neuroendocrine correlates, TABP concept and reproductive behaviour.
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PSYCHOLOGICAL FACTORS AS PREDICTORS OF ANXIETY, SOMATIC SYMPTOMS AND HEALTH.
SANDIN, Bonifacio; CHOROT, Paloma and SANTED, Miguel A.; Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain.
JIMÉNEZ, M. Pilar; Facultad de Psicología, Universidad de Salamanca, Salamcanca, Spain.
There is now evidence to suggest that health is a complex phenomenon related to several psychological factors. However, it appears that a good deal of evidence of such a relationship could consist in an association more with anxiety (and other possible negative emotions) and related aspects, such us psychosomatic complaints (a main self-report measure of physical health), than with health itself. We investigate in a sample of undergraduate students predictive power of some health-relevant psychological factors such as affectivity (positive vs. negative affect), neuroticism and alexithymia on indicators of health (medical diagnoses and general health measures), anxiety and somatic complaints. Subjects completed the following trait questionnaires: The Positive and Negative Affect Schedule of Watson, Clark and Tellegen, the Eysen~ Personality Questionnaire of Eysenck and Eysenck, the Taylor's Alexithymia Scale of Taylor, Ryan and Bagby, and the Stress Reactivity Index of González de Rivera. Levels of anxiety and somatic complaints were measured longitudinally (during 8 consecutive days) by means of the Anxiety State Behavioral Scale of Chorot and Sandín and the Somatic Symptoms Scale of Sandín and Chorot. We assessed medical diagnoses and indicators of general health using a structured interview. Overall, results suggest that psychological factors may be related with both a distress/anxiety component and a health dimension. Theoretical and empirical implications are discussed.
TS HLT (10) 4
CONSUMPTION OF CAFFEINE AND PERSONALITY VARIABLES.
BENEIT, P. J.; Universidad de Castilla-La Mancha, Cuenca, Spain.
LATORRE, J.M.; Universidad de Castilla-La Mancha, Albacete, Spain.
Altough the consumption ob substances containing caffeine is widespread in society, there has been relatively little research anaysing the psychological variables pertaining to caffeine consumption (Lieberman, 1992).
This work examines the relationship between caffeine consumption and different personality variables in a sample (N=201) of university students. The results demostrate that firstly, a large percentage of subjects (91.54) regulary consume caffeine and that the consumption is significantly higher among women that among men; Secondly, the analisys of the discriminating function shows that the regular consumption of caffeine is associated, along with other variables, with: (1) a low level of psycho-physiological activation; (2) anxiety of a physiological-cognitive nature and (3) and absence of a type A personality. Lastly, a multiple regression analysis indicates that the best predictor of the quantity of coffee consumed (mg./bodily weight) is the degree of activation.
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TYPE A BEHAVIOR PATTERN AND HEART RATE (HR) CONTROL: THE MEDIATING ROLE OF ANGER
FERNANDEZ JIMENEZ DE CISNEROS, Inmaculada. Universidad de Sevilla, Sevilla, Spain.
The main purpose of the present study was to analize TABP and TBBP differences in the bidirectional control of HR through biofeedback training, and the possible mediating role of anger. 232 Subjects (volunteer students of Psychology) were administered the Multidimensional Anger Inventory (Siegel, 1982) and the Bortner scale to assess pattern of behavior. 29 Subjects were selected, 14 TAs and 15 TBs and randomly assigned to the "short" (7 TAs and 8 TBs) or "long" (7 TAs and 7 TBs) condition. Every subject received 3 sessions, each of one consisted of initial baseline (5 min), trials (3 min) separated by 1 min intertrial interval and final baseline (5 min), in the short condition there were 4 trials and 8 in the long. In the first session subjects were asked to observe a signal on the monitor during the trials, in the second and the third they were required to increase (short 2 trials, long 4) and decrease the signal (2 vs. 4 trials). Main results showed that BFB training was effective to produce a statistically significant difference between HR increase and decrease and that this difference increased with the number of sessions (repeated measures Wilks lambda=.45, F(2/21)=12.57, p=.0001). In relation to initial baseline, subjects were able to increase but not decrease significantly their HR (second session t(25)=3.07, p=.005; third session t(22)=2.17, p=.04). There were no statistically significant differences due to the training duration (short vs. long). The pattern of behavior introduced differences in the increase trials (F(1/21)=7.98, p=.01) and the decrease (F(1/21)=10.22, p=.004). MAI total score did not significantly covariate with any HR dependent measure.
This work was supported by Grant PM90/0170 from the Spanish DGICYT.
TS HLT 11
HEALTH EDUCATION AND SOCIAL REPRESENTATIONS
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GROUPAL INTERVENTION IN HEALTH EDUCATION.
SÁNCHEZ-CANDAMIO MENDEZ, Margarita; Universidad de Gerona, Gerona, Spain.
The essay here introduced is based on the study and the definition of the characteristics of groupal intervention in Health Education.
Health Education or Education for Patients is based in apprenticeship for change in individual behaviors related with health as well as for change in the ways of life of society. In this context, groupal intervention is considered and used, basically, as a methodological tool to obtain de change.
All this is showed analysing the position of W. H. O., about this subject, the publication in public health, activities for education of professional programmes developed by public administration.
Finally this study describes the specific characteristics of this type of intervention as an educational and groupal activity. As well as how usefull can be as a tool of change to prevent illness and/or promote healty.
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MODIFICATION OF DAILY HABITS IN COLLEGE STUDENTS. EVALUATION OF A PREVENTIVE PROGRAM IN HYPERTENSION.
GUARINO CIANO, Leticia; Universidad Simón Bolivar, Venezuela.
A behavior modification program was applied during 10 weeks to 20 college students for changing their specific daily habits, as part of a global program for reducing hypertension risk factors. The objetives of the program were to reduce inadequate behaviors such as salt intake and smoking, as well as to increase their adequate alimentary habits, sleep, physical and recreational activities.
Several behavior modification procedures were included in the program such as: stimulus control, information, self-reinforcement, self-monitoring, positive social reinforcement and cognitive tecniques. An A-B-A design was used.
Results indicate that behavior modification procedures were effective for modifying student's daily habits. Likewise, a reduction of other hypertension risk factors like colestherol level, systolie and diastolie blood pressure was observed.
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SOCIAL REPRESENTATIONS AND HEALT.
MOÑIVAS, Agustin; Universidad Complutense, Madrid, Spain.
This paper sets out to deal whit the activity of perception, thinking and intervention from Psychology through Social Representations. A characteristic of psychology which is increasingly important is to analyse cognitive activity and behaviour in context. The context, at the moment of incorporating collective systems of signiflcance, fixes the social representation construct as a mediator between theoretical model and intervention. Social representations articulate social, mental and affective elements, bringing together cognition, language and communication, social relations and the material, social and ideal reality in which the profesional has to operate. Construction, then, social representations in an area of reality (social representations are constructed interactively at the level of common-sense) is the first step to select a model of intervention and adapt it to the context.
Social representations, in this work, is applied to health. The concept of health, is understood to be defined the integral state of well-being in the three basic dimensions which constitute humane nature: biological, psycological and social. From this perspective, different research and cases are taken into account which exemplify the determination which social representations have both in the succes or failure of each intervention, as well in the well-being of individual, group or community.
TS HLT 12
GENERAL APPLIED ISSUES IN HEALTH PSYCHOLOGY I
TS HLT (12) 1
DIFFERENCES IN SUBJECTIVE SLEEP REPORTS AND GASTROINTESTINAL COMPLAINTS AMONG MEN, PREGNANT AND NONPREGNANT WOMEN.
BABKOFF, Harvey; WELLER, Aron and LAVIDOR Michal; Bar-Ilan University, Ramat-Gan, Israel.
Subjective reports of sleep characteristics and gener health were obtained from 146 young (20-40 yrs, av age 29. 15) healthy men (N= 43), nonpregnant (N=70) and pregnant women (N=33). Three types of subjective sleep reports were obtained: 1) Sleep logs completed upon awakening on three successive workdays; 2) general estimates of sleep habits; 3) sleep complaints. Correlations of sleep measures acros the 3 nights were highly significant. General estimates Or sleep latency and of sleep duration were correlated with sleep log reports of latency and duration for men only, bu not for pregnant or nonpregnant women. Sleep latency predicts sleep complaints for men (54% of variance) and nonpregnant women (39% of variance), but not for pregnant women. Sleep latency predicts gastrointestinal complaints for men ( 73% of variance) but not for women. Pregnant women report shorter sleep, longer sleep latency, significantly more awakenings and gastrointestinal complaints than either men or nonpregnant women. In general, men show the greatest sleep log and sleep estimate stability; nonpregnan women, less, and pregnant women, the least stability.
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LAY AND PROFESSIONAL REPRESENTATIONS OF ALZHEIMER'S DISEASE.
CROMBECQUE, A.; Clinique de Psychiatrie Gériatrique, IUPG, Genève, Switzerland.
How do family members (as non-professionals) taking care of a relative suffering from AD, often over a long period of time, represent this particular illness? Firstly, is AD really perceived as a disease by families? Prior research has given some evidence that lay representations of illness in general and of mental disease in particular are structured differently. Do lay representations of AD, which is an organic cerebral disease, but which provokes mental disorders, share some common traits with representations of illness in general and/or of mental illness in particular? How has recent mediatic dmusion of information concerning AD influenced the representation of AD by family members?.
This paper deals with the results of a research aimed at answering the above questions, for, lay representations of an illness may influence the adaptation of the relatives to caregiving situation, as well as their medical demands and their expectations when dealing with medical staff.
Furthermore, we assume that communication between relatives and professionals depends to some extent on their respective representations of the disease. Therefore, we have also examined "specialized AD's representations by doctors and nurses in order to point out differences and similarities with those of the relatives.
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A PATH ANALYTIC MODEL OF FACTORS ASSOCIATED WITH THE QUALITY OF LIFE OF COUPLES SEEKING IN VITRO FERTILIZATION.
EVANS, David R.; University of Western Ontario, Canada.
HEARN, Margaret T.; NEWTON, Christopher R.; YUZPE, Albert A. and SHERARD, Wendy P.; University Hospital, Canada.
In this study a model of those factors influencing quality of life in a sample of individuals seeking in vitro fertilization was evaluated. A sample of 580 couples completed the Personality Research Form-E, the Family Environment Scale, the Ways of Coping Checklist, the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Inventory of Socially Supportive Behaviors, the Life Appraisal Inventory, and the Life Satisfaction Inventory two months prior to assessment for in vitro fertilization. Analyses indicated significant gender differences, hence, separate analyses of the model were computed for husbands and wives. Quality of Life was measured using the Index of Well-being, computed from the Life Appraisal and Life Satisfaction Inventories. Block variables for personality, family environment, coping and negative affect were computed by regressing the respective measures on the Index of Well-being. For the wives personality had a direct effect on quality of life, and an indirect effect through coping and negative affect, while family environment had an indirect effect through negative affect. For the husbands both personality and family environment had a direct effect on quality of life, and an indirect effect through negative affect. Implications for future research and health promotion programs will be discussed.
TS HLT (12) 4
EXTRAVERSION AND HEALTH ORIENTED MEASURES.
SZIRMAK, Sophia; SOTE, Budapest, Hungary.
The trait approach to personality provides a good basis for investigating the interrelationship between personality and health measures. The present study relies on the results of the Hungarian personality taxonomy and searches for possible linkages between the extraversion factor of the taxonomic structure and different health oriented measures nalnely the Life Orientation Scale, Beck Depression Inventory, General Self Efficacy Scale, and the Satisfaction With Life Scale. In the presented paper the relevant correlations are discussed with special attention to the redundancy of certain health measures in relation to personality measures.
TS HLT (12) 5
BLOOD PRESSURE AND FRONTALIS MUSCLE TENSION: IMPLICATIONS FOR THE BEHAVIOURAL TREATMENT OF ESSENTIAL HYPERTENSION.
KELTNER, Alfred A.;
Most findings support the conclusion that relaxation training is effective in reducing essential hypertension, but the necessary and sufficient components of the relaxation package have not been isolated. In the present study surface electromyography and latency of return to relaxation baseline of the frontalis muscle as well as systolic, diastolic and mean arterial blood pressure were assessed in 100 subjects. Significant positive correlations between such electromyographic measures and blood pressure values were obtained. These results suggests that muscle relaxation may play an important role in relaxation effectiveness. The practical relevance of these findings are further discussed in relation to the search for a direct relaxation factor to aid the construction of more efficient relaxation techniques in the behavioural treatment of essential hypertension. Future examinations of this issue should include the direct control of either blood pressure or frontalis relaxation in within subjects designs.
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IS REPRESSIVENESS A PERSONALITY TRAIT OF CANCER PATIENTS?.
KREITLER, Shulamith and KREITLER, H.; Tel Aviv University, Tel Aviv, Israel.
CHAITCHIK, S.; Ichilov Hospital, Tel Aviv, Israel.
Repression is commonly assumed to be a character trait of the cancer-prone personality. The basis for the thesis did not seem compelling to us. The study focused on examining whether repression is a response to the threat posed by cancer and whether cancer patients are more repressive by using a new assessment method and controlling for age. The subjects were 98 women of three groups: breast biopsy showed they were healthy, breast biospy showed they had cancer, they underwent surgery unrelated to cancer. Questionnaires of repression were administered pre - and post - surgery. Before surgery the groups did not differ in repression, or its components anxiety and defensiveness. After surgery, there were no differences in anxiety but MANOVA and chi-square analyses showed that in the malignancy group repression increased. The results indicate that repression could be a response to the threat posed by the cancer diagnosis and a means for controlling anxiety rather than a personality trait of cancer patients.
TS HLT 13
GENERAL APPLIED ISSUES IN HEALTH PSYCHOLOGY II
TS HLT (13) 1
INDUCTION OF BIAS BY HIDDEN COVARIATION IN THE MEDICAL SITUATION.
BONKE, Benno; Erasmus University, Rotterdam, The Netherlands.
Manipulated (hidden) covariations between nonsalient stimulus aspects X, and relevant other features Y, are sometimes held responsible for the induction of bias in the assessment of Y in new stimuli. Lewicki et al. (American Psychologist 1992; 47: 796-801) have repeatedly demonstrated such "nonconscious acquisition of information" (i.e., of the covariation between X and Y in a learning phase), but their results were difficult to replicate. We attempted to generalise the so-called 'hidden covariance detection' to the medical setting by manipulating a covariation between nonsalient patient features and the concomitant prognosis in a learning phase. In a test phase, volunteering doctors were requested to estimate the 5-years survival probability in new patients. We hypothesized that the manipulated covariation in the learning phase affected the estimated 5-years survival rates. Results will be discussed at the symposium.
TS HLT (13) 2
FOCUS GROUPS - THE ASCENDANCE OF QUALITATIVE RESEARCH FOR PROGRAM DEVELOPMENT: THE "GIMME 5" PROGRAM.
JOHNSON, Carolyn C.; RICE, Rochelle; NICKLAS, Theresa A.; Tulane Center for Cardiovascular Health, School of Public Health & Tropical Medicine, New Orleans.
Focus groups can provide insight into the dynamics underlying attitudes and behaviors of a defined target group unobtainable through self-report surveys. In Gimme 5, an NCI 5-a-day program for high school students with the goal of greater consumption of fruit and vegetables, it was found that very little nutrition information was available for these students, and program development required the input that focus groups could provide. Focus groups (12-15 participants each) were held in the targeted high schools with white boys and girls and black boys and girls of both higher and lower scholastic ability. Hypotheses examined included: (1) students would be resistant to a diet-change program (unsupported); (2) boys would be more resistant than girls (unsupported); (3) present consumption of fruit and vegetables would be low (supported); (4) students would be ambivalent regarding parental input (unsupported). Focus group input was primary in: development of program logo; methods of reaching parents; methods for effecting dietary change of students; and the main barriers to increased consumption of fruit and vegetables, namely, availability, variety, taste, and knowledge. Students, however, were interested in making changes for appearance, weight, academic and athletic productivity. Dynamic processes, similarities and differences between groups will be presented. Focus groups, qualitative research which continues to be underutilized, can be valuable in providing guidelines for educational program development.
TS HLT (13) 3
THE ROLE OF NEGATIVE AFFECTIVITY IN THE STRESS PROCESS: TESTS OF ALTERNATIVE MODELS.
MOYLE, Penny J.; University of Oxford, Oxford, England.
The prominence of the personality trait of negative affectivity (NA) in the stress literature has increased over the last decade. NA has been widely reported to have both direct effects on measures of strain, and to act as a potential confounder of stressor-strain relations in self-report research However, more recent work has demonstrated that NA can also moderate environment-outcome relationships, acting as a vulnerability factor in the stress model, or that its influence may be mediated through perceptions of the work environment. In the present study, these four possible pathways through which NA may be implicated in job satisfaction and symptom report are examined.
In terms of symptom report, NA is found to have direct effects, to act as a partial confound, and to play a significant moderating (vulnerability) role. In comparison, for the prediction of job satisfaction the influence of NA is found to be mediated through perceptions of the work environment. It is concluded that all these potential roles of NA should be considered more thoroughly in future stress research.
TS HLT (13) 4
FISHERMEN'S TALES OF ACCIDENTS.
MURRAY, Michael; Memorial University of Newfoundland, St. John´s, Newfoundland, Canada.
Accidents are a major source of morbidity and mortality among fishermen. Despite this there have been few attempts to investigate the cognitive and behavioral causes of these accidents. One important factor is the extent to which fishermen value and implement safety measures. This paper describes a study of the safety attitudes and practices of inshore fishermen and related personnel in Newfoundland. The study involved detailed interviews with forty fishermen about their experience of accidents and the extent to which they and their colleagues followed safety guidelines. The interviews were tape-recorded, transcribed and subjected to content analysis. The findings are interpreted with reference to cultural tradition, the fisherman's identity and the perceived value of risk.
TS HLT 14
GENERAL APPLIED ISSUES IN HEALTH PSYCHOLOGY III
TS HLT (14) 1
ASSESSMENT OF QUALITY OF LIFE IN CARDIOVASCULAR PATIENTS.
PENAS MADURGA, C.; Facultad de Psicología, Universitat de Valencia, Valencia, Spain.
MESTRE ESCRIVA, V.; VELASCO RAMI, J. A. and RIDOCCI, F.; Hospital General de Valencia, Valencia, Spain.
The number of patients that survive after it miocardial infartion (M.I.) it's increasing during the last years in the developed countries. The improving of their quality of life (Q.L.) has become one of the main taks in the treatment of these patients. The concept of quality of life has adquiried a growing importance during the last decades (Lalonde, 1.974; Mandola & Pelligini, 1.979; Velasco J.A., 1.992 ). In this study we wait to evaluate the Q.L. of these patient depending on the age and date of M.I. The sample sutdied are 235 men with ages comprised between 30-75 inclosed in foru different groups:
1.- Patients with cardiovascular problems, under ambulatory treatment: 59 patients with age mean values of 60.
2.- Patients working in rehabilitation program after being affected by recent M.l. 105 patients with age mean values of 50.
3.- Patients attending to a long term rehabilitation program: 26 patients with age mean values of 54.
4.- Healthy mean: 46 patients with age mean values of 46.
All patients have been evaluated with the next questionnaires:
- Questionnaire for resolve the quality of life of J.A. Velasco & M.V. del Barrio.
- The quality of life questionnaire in patients post-infartion of Oldridge.
- Sicknnes Impact Prolife (S.l.P.).
The results show that the age is a discriminative variable in the Q.L. of the patients suffering a M.l. having the older patients a worst QL. Also, the M.l. is related with the Q.L., being better the more time has passed since the M.l.
TS HLT (14) 2
!NO, GRACIAS, NO FUMO!. A SMOKING PREVENTION PROGRAM
PALOMARES, Angel. C.E.TE.C.CO., Madrid, SPAIN.
This paper describes a smoking prevention program started in Arteixo, a near La Coruña locality. The program was applied to the whole school population, grades sixth to eighth, and it spreads throughout six lessons in which the several program components are developed: a) Information about tobacco and their short-term consequences through active learning methods; b) Training students skills to resist pressures to start smoking; c) Correction of normative expectatios concerning peer and adults smoking; d) Analysis of media pressures for adolescents to begin smoking cigarettes; and e) Decision-making and public commitment of participants concerning their no smoking decision. The program target population, goals and used techniques, way of application and evaluation made by students are specified.
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ANOREXIA NERVOSA: RESULTS OF A TREATMENT GRUPAL PROGRAMME
BEL, M.Teresa; TURON; V. GONZALEZ, A. MENCHON, J.M. and VALLEJO, J. Hospital Princeps d'Espanya, Hospitalet de Llobregat, Barcelona, Spain.
INTRODUCTION: The therapeutic approaches applied for the Anorexia Nervosa are designed in two different stages:
1. The restoration of normal weight.
2. Preventing relapse.
From preventing relapse, we applied a groupal cognitivebehavioral programme to anorexic outpatients.
MATERIAL AND METHODS:
- Studied poblation: 30 patients diagnosticated of Anorexia Nervosa.
- Material and methods: we carried out an evaluation before and after the application of the programme. The programme lasted 6 months with weekly sessions.
The questionnaires were: EAT (Eating Attitudes Test, Garner & Garfinkel, 1979), EDI (Eating Disorder Inventory, Garner, Olmested, Polivy, 1983), BSQ (Body Shape Questionnaire, Cooper, Tylor, Fairburn, 1987), STAI (Spielberg, 1967), BDI (Beck Depression Inventory, Beck et al., 1961), EMES-M y EMES-C (Escala de Expresión Social, Caballo, V., 1987), IA (Assertion Inventory, Gambrill & Richey, 1975) y Rosenberg SelfEsteem Scale (Rosenberg, 1979).
RESULTS: We present the results obtained before and after the treatment in order to evaluate the efficiency of the application of the programme to Anorexia Nervosa patients.
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EFFECTS OF MICROSTRESS AND LIFE EVENTS ON PSYCHOLOGICAL DISTRESS AND HEALTH.
CHOROT, Paloma; SANTED, Miguel A.; SANDÍN, Bonifacio and PÉREZ-LLANTADA, Carmen; Facultad de Psicología, UNED, Madrid, Spain.
JIMÉNEZ, Pilar; Facultad de Psicología, Universidad de Salamanca, Spain.
During the past two decades, abundant evidence exists that major life events, such as divorce, loss of a job or death of a relative, are linked to the onset and progression of a wide variety of physical and psychological disorders. Although a generally consistent relationship is found between life events and such adverse health outcomes, in several prospective studies the reported magnitude of associations has been typically low. This fact has led researchers to develope alternative measures of stressors and, in this way, it has become apparent that minor every day events (hassles and uplifts) influence health status and pschological well-being. When compared with major life events, daily hassles have been found to be better predictors of future illness. On the contrary, the literature has reported that daily uplifts made little contribution to health.
Using an undergraduate sample the present study addresses the extent to which specific clusters of both major life events and daily hassles contribute in predicting physical and emotional symptoms. In addition it would also be analized the contribution of "additive burden" and "chronic burden" models (Dohrenwend & Shrout, 1985). Consistent with previous reports, results revealed that minor events provide a more powerful association with health than were life events scores. Combined effects of major life events and daily stress on health outcomes are discussed.
TS HLT (14) 5
PSYCHOLOGICAL CARE TO INFERTILE COUPLES
GUERRA, Diana; Instituto Universitario Dexeus, Barcelona, Spain.
Fertility difficulties, along with their investigation and treatment, are widely believed to cause significant psychological problems.
There is increasing evidence that a behavioral approach might be efficacious in the treatment of the emotional aspects of infertility and may lead to increased conception rates.
Psychological improvements in infertile women attending a group behavioral treatment program were reported previously by other authors.
A group behavioral program for infertile couples in treatment was offered to patients attending our Assited Reproduction Service. The primary purpose of this program was stress reduction. Treatment included relaxation response training, stress management and cognitive restructuring.
All program participants completed the following psychological tests: General Health Questionaire, State Trait Anxiety Inventory, Infertility and Stress Questionaire, Beck Depression Inventory and a Staisfaction with Treatment Scale. State Anxiety reports were collected after the behavioral training.
Ratings were also obtained from a group of patients that did not attend to the program and that did not differ demographically to the attending group. Pregnancies occurring following completion of the program were recorded.
Results are presented and discussed in terms of the need of psychological care for infertile patients.