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Frontiers in Psychiatry 2024There is a paucity of literature regarding ethical strategies for treating pregnant people with psychosis. While not uncommon, psychotic pregnancy denial is a psychotic... (Review)
Review
BACKGROUND
There is a paucity of literature regarding ethical strategies for treating pregnant people with psychosis. While not uncommon, psychotic pregnancy denial is a psychotic illness in which patients have the delusion that they are not pregnant. The authors provide a literature review regarding psychotic pregnancy denial, present an unpublished case and its questions and dilemmas, and offer recommendations for resolving the ethical challenges these cases raise.
CASE
A 26-year-old, single, unemployed woman of no fixed residence was admitted for suicidal ideation. She had a history of psychosis, had multiple ER visits and at least one previous hospitalization, had minimal contact with psychiatric outpatient clinics, and had been poorly compliant with treatment recommendations. She was discovered to be about 31 weeks pregnant in the emergency room. Ultrasound exams revealed no fetal anomalies. This was the patient's second pregnancy; her previous pregnancy resulted in an abortion. Her sole psychotic symptom was the delusional belief that she was not pregnant. On the rare occasions when the patient acknowledged being pregnant, she requested termination of pregnancy. Despite intensive pharmacological treatment of her psychosis, the patient continued believing that she was not pregnant and repeatedly said she would not participate in the labor and delivery process. She disagreed with the induction of labor or a cesarean section if needed. The patient developed gestational hypertension, an obstetric indication for delivery. Induction of labor was offered to avoid potentially disastrous outcomes for the pregnant woman and the fetus.
CONCLUSION
Psychotic pregnancy denial is potentially life-threatening. Delivery of the fetus requires carefully weighing risks and benefits and thoroughly considering the ethical framework.
TEACHING POINTS
Treatment of birthing people with psychotic denial of pregnancy is complex; it requires special clinical and ethical skills to determine the patient's level of decision-making impairment and to find a middle ground between the pregnant person's right to autonomy and the physicians' beneficence-based duties. Using a well-coordinated, interdisciplinary approach and a solid ethical framework, the decision to deliver the fetus while engaging the pregnant person, to the extent possible, in the decision-making process is essential.
PubMed: 38370555
DOI: 10.3389/fpsyt.2024.1337988 -
Frontiers in Psychology 2023Tinnitus is the perception of a sound in the absence of any corresponding external sound source. Current research suggests a relationship among emotional, cognitive, and...
INTRODUCTION
Tinnitus is the perception of a sound in the absence of any corresponding external sound source. Current research suggests a relationship among emotional, cognitive, and psychosomatic symptoms and the occurrence or maintenance of chronic tinnitus. This study aimed to detect the prevalence and role of psychosomatic conditions, as defined by the Diagnostic Criteria for Psychosomatic Research (DCPR), and cognitive functioning in a group of patients with tinnitus.
METHODS
Sixty-two patients with subjective tinnitus and 62 non-tinnitus controls were recruited from the Otorhinolaryngology Unit of the University of Bari. Pure-tone audiometry was performed in all tinnitus subjects, and sound level tolerance was evaluated. Additionally, tinnitus handicap (Tinnitus Handicap Inventory [THI]), psychopathological symptoms (Symptom Checklist-90, Revised [SCL-90-R]), anxiety (State-Trait Anxiety Inventory [STAI-Y1/2]), depression (Beck Depression Inventory [BDI]), cognitive impairment (Mini-Mental State Examination [MMSE]), executive functions (Frontal Assessment Battery [FAB]), and psychosomatic syndromes (DCPR) were evaluated. Parametric and non-parametric tests were used to detect cognitive and symptomatological differences between patients and controls. The predictivity of these factors for tinnitus severity was studied using multiple regression (Backward Elimination). All tests were considered significant at < 0.05 (family wise error corrected for each comparison).
RESULTS
69.4% tinnitus patients met multiple DCPR criteria, compared to 32.3% of controls. Tinnitus patients exhibited elevated rates of illness denial (ꭓ = 9.02; < 0.009), demoralization (ꭓ = 8.05; < 0.018), somatization (ꭓ = 4.92; < 0.063) and functional symptoms (ꭓ = 5.21; < 0.06) scoring significantly higher on the BDI, STAI-Y1, and STAI-Y2, and SCL-90-R compared to controls. Patients with tinnitus showed lower MMSE scores, compared to controls ( = -2.282; < 0.001). No association between tinnitus severity and global cognitive impairment emerged. Conversely, executive function deficits were associated to tinnitus severity. Among the cognitive and psychological factors, only trait anxiety, one or more psychosomatic syndromes, and somatization clusters were strongly correlated with tinnitus severity.
DISCUSSION
Our findings suggest a relationship between tinnitus severity, psychological, psychosomatic symptoms, and frontal impairment. Additionally, the influence of tinnitus on cognitive functions paves the way for integrated, multidisciplinary diagnostic and treatment options for patients. Although preliminary, our findings highlight the importance of early cognitive and psychological screening to improve patients' quality of life.
PubMed: 38192387
DOI: 10.3389/fpsyg.2023.1256291 -
Reumatologia Clinica Jan 2024To explore the patient journey of people with fibromyalgia (FM) in Latin American countries in order to identify problems in health care and other areas that may be...
OBJECTIVES
To explore the patient journey of people with fibromyalgia (FM) in Latin American countries in order to identify problems in health care and other areas that may be resolvable.
METHODS
Qualitative study with phenomenological and content analysis approach through focus groups and patient journey (Ux; User Experience) methodology. Nine virtual focus groups were conducted with FM patients and healthcare professionals in Argentina, Mexico and Colombia recruited from key informants and social networks.
RESULTS
Forty-three people participated (33 were clinicians and 10 were patients). The agents interacting with the patient in their disease journey are found in three spheres: healthcare (multiple medical specialists and other professionals), support and work life (including patient associations) and socioeconomic context. The line of the journey presents two large sections, two loops and a thin dashed line. The two major sections represent the time from first symptoms to medical visit (characterized by self-medication and denial) and the time from diagnosis to follow-up (characterized by high expectations and multiple contacts to make life changes that are not realized). The two loop phases include (1) succession of misdiagnoses and mistreatments and referrals to specialists and (2) new symptoms every so often, visits to specialists, diagnostic doubts, and impatience. Very few patients manage to reach the final phase of autonomy.
CONCLUSION
The journey of a person with FM in Latin America is full of obstacles and loops. The desired goal is for all the agents involved to understand that self- management by the patient with FM is an essential part of success, and this can only be achieved with early access to resources and guidance from professionals.
Topics: Humans; Fibromyalgia; Latin America; Mexico; Qualitative Research; Focus Groups
PubMed: 38182526
DOI: 10.1016/j.reumae.2023.12.002 -
Clinical Nursing Research Nov 2023This study investigates the association between insurance coverage denial and delays in care during pregnancy and postpartum. An online survey was administered in March...
This study investigates the association between insurance coverage denial and delays in care during pregnancy and postpartum. An online survey was administered in March and April 2022 to women who were either pregnant or within 1 year postpartum ( = 1,113). The outcome was delayed care, measured at four time points: during pregnancy and 1 week, 2 to 6 weeks, and after 7 weeks postpartum. The key covariate was insurance coverage denial by providers during pregnancy. Delayed care due to having an unaccepted insurance and being "out-of-network" was more pronounced at 1 week postpartum with 3.37 times and 3.47 times greater odds and in 2 to 6 weeks postpartum with 5.74 times and 2.97 times greater odds, respectively. The association between insurance denial and delays in care encapsulated transportation, rural residency, time issues, and financial constraints. The findings suggest that coverage denial is associated with significant delays in care, providing practical implications for effective perinatal care.
Topics: Pregnancy; Humans; Female; United States; Postpartum Period; Insurance Coverage; Surveys and Questionnaires
PubMed: 37264856
DOI: 10.1177/10547738231177332 -
Ciencia & Saude Coletiva Oct 2023This study aimed to reconstruct and analyze the discourses of the pandemic in the post-COVID-19 era. The methodology was based on a critical review of the scientific... (Review)
Review
This study aimed to reconstruct and analyze the discourses of the pandemic in the post-COVID-19 era. The methodology was based on a critical review of the scientific literature on the pandemic, selecting 80 non-biomedical, clinical, or pharmacological articles published in journals indexed in Scopus or Web of Science from a sample of the 500 most cited scientific articles on the pandemic in Google Scholar. The theoretical approach was based on the debates on predictability, unpredictability, determination, and indeterminacy in the health and social sciences. As a result, six theses on the pandemic were identified and analyzed: a) the thesis of the unpredictability of pandemics; b) the thesis of pandemic denial; c) the thesis of the pandemic as a failure in predictability systems; d) the thesis of the prevention of catastrophic events with timely interventions; e) the thesis of the structural postponement of predictive care by non-developed countries; and f) the environmentalist-health thesis, of foreseeing a critical phase for the planet and humanity. We concluded on the limits of resilience as the center in preparing Latin American health systems in the post-pandemic.
Topics: Humans; COVID-19; Pandemics; Bibliometrics; Humanities
PubMed: 37878940
DOI: 10.1590/1413-812320232810.10182023 -
Journal of the International AIDS... Aug 2023The HIV response has long recognized that certain "key populations" such as individuals in detention, adolescent girls and young women, sex workers, people who use...
INTRODUCTION
The HIV response has long recognized that certain "key populations" such as individuals in detention, adolescent girls and young women, sex workers, people who use drugs, LGBTQ individuals, migrants and others face higher barriers to access to, uptake of, and retention in HIV prevention and treatment services. One approach to addressing these barriers is the training of community paralegals to advocate for the rights of individuals and to address discrimination in health settings.
DISCUSSION
Community paralegal programmes have been able to successfully address rights violations that impact access to health services and underlying determinants of health across a range of countries and populations, focusing upon issues such as discrimination and the denial of health services; unlawful detention of outreach workers, sex workers, persons who use drugs and men who have sex with men; and harmful traditional practices and gender-based violence. In addition to resolving specific cases, evaluations of paralegal programmes have found that these programmes increased legal literacy among key populations at risk of HIV and increased understanding of human rights among healthcare providers, resulting in improved access to HIV services. Some evaluations have noted challenges related to the sustainability of paralegal programmes similar to those raised with community health worker programmes more broadly.
CONCLUSIONS
To achieve global HIV goals, funding for legal literacy and paralegal programmes should be increased and interventions should be rigorously evaluated. Efforts should target discrimination in access to HIV prevention and treatment and criminalization of key populations, two key barriers to ensuring access to HIV prevention and treatment services.
Topics: Male; Adolescent; Humans; Female; Homosexuality, Male; Acquired Immunodeficiency Syndrome; HIV Infections; Sexual and Gender Minorities; Social Justice; Sex Workers
PubMed: 37535441
DOI: 10.1002/jia2.26146 -
Historia, Ciencias, Saude--Manguinhos 2023Between March 2020 and March 2022, more than 213,000 Peruvians died of covid-19. In this research note, we will identify and analyze the various social responses to...
Between March 2020 and March 2022, more than 213,000 Peruvians died of covid-19. In this research note, we will identify and analyze the various social responses to covid-19 in Peru: denial, panic, search for culprits, search for "magic remedies," and, in some sectors, mistrust towards the State and science. We argue that these social responses have been common throughout history, both in pandemics prior to the development of the bacteriological era and in the most recent ones. We intend to show that, in Peru, scientific ideas around health and disease coexist with religious ideas, conspiracy theories and traditional knowledge.
Topics: Humans; COVID-19; Peru; Pandemics; Knowledge
PubMed: 37585976
DOI: 10.1590/S0104-59702023000100031 -
Women's Health (London, England) 2024Transgender and gender diverse people presumed female at birth experience gynaecological conditions, such as chronic pelvic pain at elevated rates, estimated to impact... (Review)
Review
Transgender and gender diverse people presumed female at birth experience gynaecological conditions, such as chronic pelvic pain at elevated rates, estimated to impact between 51% and 72% of this population, compared to rates of up to 26.6% in cisgender women. The negative impact of these conditions is likely amplified due to limited access to safe and affirming healthcare. Despite this high prevalence rate, there is limited research investigating the prevalence, presentation or management options for trans and gender diverse people with endometriosis. Cisgender women with endometriosis report barriers to accessing care, with lengthy times to diagnosis and limited treatment options available. However, barriers for trans and gender diverse individuals are enhanced by physician bias and lack of education in gender-affirming care. This is reflected in stories of discrimination and denial of basic healthcare. A healthcare environment built on the presumption that gynaecological patients are women, others trans and gender diverse patients, which can result in avoidance of needed medical care. A lack of knowledge of gender-affirming care alongside healthcare provider bias highlights a need for gender-affirming care and bias reduction training in undergraduate healthcare provider curricula. Research to date assessing current curriculum in Australia and Aotearoa (New Zealand) shows limited inclusion of lesbian, gay, bisexual, trans, queer, intersex, asexual and other related identities content as a whole with gender-affirming care being among the least-frequently addressed topics. This review will detail barriers to accessing gender-affirming healthcare specific to gynaecology, interweaving the experiences of a non-binary individual seeking access to gender-affirming endometriosis care.
Topics: Humans; Endometriosis; Female; Transgender Persons; Male; Health Services Accessibility; Australia; Gynecology
PubMed: 38742674
DOI: 10.1177/17455057241251974 -
Sensors (Basel, Switzerland) Sep 2023Cybersecurity is a critical issue in today's internet world. Classical security systems, such as firewalls based on signature detection, cannot detect today's...
Cybersecurity is a critical issue in today's internet world. Classical security systems, such as firewalls based on signature detection, cannot detect today's sophisticated zero-day attacks. Machine learning (ML) based solutions are more attractive for their capabilities of detecting anomaly traffic from benign traffic, but to develop an ML-based anomaly detection system, we need meaningful or realistic network datasets to train the detection engine. There are many public network datasets for ML applications. Still, they have limitations, such as the data creation process and the lack of diverse attack scenarios or background traffic. To create a good detection engine, we need a realistic dataset with various attack scenarios and various types of background traffic, such as HTTPs, streaming, and SMTP traffic. In this work, we have developed realistic network data or datasets considering various attack scenarios and diverse background/benign traffic. Furthermore, considering the importance of distributed denial of service (DDoS) attacks, we have compared the performance of detecting anomaly traffic of some classical supervised and our prior developed unsupervised ML algorithms based on the convolutional neural network (CNN) and pseudo auto-encoder (AE) architecture based on the created datasets. The results show that the performance of the CNN-Pseudo-AE is comparable to that of many classical supervised algorithms. Hence, the CNN-Pseudo-AE algorithm is promising in actual implementation.
PubMed: 37837004
DOI: 10.3390/s23198174 -
Journal of Cancer Research and Clinical... Jul 2023Receiving a cancer diagnosis significantly impacts patients' lives, and how the bad news is delivered influences patients' trajectory, psychosocial adjustment and...
PURPOSE
Receiving a cancer diagnosis significantly impacts patients' lives, and how the bad news is delivered influences patients' trajectory, psychosocial adjustment and openness to psycho-oncological support. We explored how patients' experiences, reactions and preferences were when receiving the news and which optimization recommendations can be made.
METHODS
We conducted an exploratory qualitative study with patients who enrolled in the new integrated cross-sectoral psycho-oncological care programme 'isPO', being enrolled 12 months post-diagnosis. Data on the main issue (i.e. perception of the moment when the diagnosis is received) were collected via telephone interviews that were fully audiotaped and transcribed. Two independent coders conducted inductive content analyses using MAXQDA.
RESULTS
Out of 38 approached patients, 23 cancer patients with 13 different tumour entities participated. They had a mean age of 54.2 (SD 16.2); n = 17 (74%) were female. Three major themes with 14 corresponding subthemes emerged: (1) patients' experiences with the bad news delivery, including setting, mode, preparation and perceived needs; (2) patients' reactions to the bad news, such as shock, fear and helplessness, disbelief and denial, anger and feeling of injustice, thankfulness and depression; and (3) patients' receiving preferences, including psycho-oncological support, addressing informational needs, needs-driven comprehensive support and a competent multidisciplinary support team.
CONCLUSIONS
The quality of bad news delivery and addressing patients' needs should be strongly considered by physicians. We recommend integrating patients' perspective on the quality management processes of breaking bad news. For providing needs-centred high-quality care, applying existing guidelines and acquiring patient-centred communication skills are central.
Topics: Humans; Female; Middle Aged; Male; Physician-Patient Relations; Truth Disclosure; Neoplasms; Patient Preference; Communication
PubMed: 35999331
DOI: 10.1007/s00432-022-04311-8