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AJR. American Journal of Roentgenology Sep 2021Child abuse is a global public health concern Injuries from physical abuse may be clinically occult and not appreciable on physical examination. Imaging is therefore... (Review)
Review
Child abuse is a global public health concern Injuries from physical abuse may be clinically occult and not appreciable on physical examination. Imaging is therefore critical in identifying and documenting such injuries. The radiologic approach for a child who has potentially been abused has received considerable attention and recommendations according to decades of experience and rigorous scientific study. Nonetheless, fringe beliefs describing alternative explanations for child abuse-related injuries have emerged and received mainstream attention. Subsequently, imaging findings identified in abused children have been attributed to poorly supported underlying medical conditions, clouding the evidence basis for radiologic findings indicative of nonaccidental trauma. Fringe beliefs that attribute findings seen in child abuse to alternate pathologies such as genetic disorders, birth trauma, metabolic imbalances, vitamin D deficiency, and short-distance falls typically have limited evidence basis and lack professional society support. Careful review of the scientific evidence and professional society consensus statements is important in differentiating findings attributable to child abuse from fringe beliefs used to discount the possibility that a child's constellation of injuries is consistent with abuse. This review refutes fringe beliefs used to provide alternative explanations in cases of suspected child abuse and reinforces the key literature and scientific consensus regarding child abuse imaging.
Topics: Child Abuse; Denial, Psychological; Diagnostic Imaging; Female; Humans; Infant; Magnetic Resonance Imaging; Male; Radiology; Reproducibility of Results; Tomography, X-Ray Computed
PubMed: 33908266
DOI: 10.2214/AJR.21.25655 -
Social Psychiatry and Psychiatric... Nov 2022Victimization contributes to mental and behavioral health inequities among transgender and gender diverse (TGD) people, but few studies have simultaneously examined...
PURPOSE
Victimization contributes to mental and behavioral health inequities among transgender and gender diverse (TGD) people, but few studies have simultaneously examined health-promoting resiliencies. We sought to identify classes of risk and resilience among TGD adults, assess characteristics associated with these classes, and examine their relationship with mental health and substance use outcomes.
METHODS
Cross-sectional data were from the 2015 US Transgender Survey, a non-probability study including 26,957 TGD adults. Using latent class analysis, we classified patterns of vulnerability and resilience based on risk (past-year denial of equal treatment, verbal harassment, physical attack, bathroom-related discrimination; lifetime sexual assault, intimate partner violence) and protective (activism; family, work, classmate support) factors. Regression models were fit to (1) determine the association between sociodemographic and gender affirmation characteristics and latent classes; (2) model associations between latent classes and mental health (current serious psychological distress, past-year and lifetime suicidal thoughts and attempts, and lifetime gender identity/transition-related counseling) and substance use (current binge alcohol use, smoking, illicit drug use; past-year drug/alcohol treatment) outcomes.
RESULTS
Three latent classes were identified: high risks, with activism involvement ("risk-activism," 35%); low risks, with not being out about one's TGD identity ("not-out," 25%); and low risks, with high family support ("family-support," 40%). Gender affirmation and sociodemographic characteristics, such as race/ethnicity and sexual orientation, were associated with latent classes. Risk-activism class membership was associated with higher odds of negative mental health and substance use outcomes, while the family-support class had lower odds of these outcomes.
CONCLUSIONS
Interventions leveraging family support, and policy protections from discrimination and victimization, may promote TGD mental and behavioral health.
Topics: Adult; Female; Humans; Male; Transgender Persons; Gender Identity; Mental Health; Cross-Sectional Studies; Substance-Related Disorders
PubMed: 36112161
DOI: 10.1007/s00127-022-02359-y -
Blood Advances Apr 2023Caregivers of patients with hematologic malignancies undergoing hematopoietic stem cell transplantation (HSCT) must cope with substantial caregiving burden, high rates... (Randomized Controlled Trial)
Randomized Controlled Trial
Caregivers of patients with hematologic malignancies undergoing hematopoietic stem cell transplantation (HSCT) must cope with substantial caregiving burden, high rates of psychological distress, and diminished quality of life (QOL). However, data describing coping strategies before HSCT and the association between coping, QOL, and psychological outcomes in this population are lacking. We conducted a secondary analysis of data collected during a multisite randomized clinical trial of a supportive care intervention in HSCT recipients and their caregivers. Caregivers completed the Brief COPE, Hospital Anxiety and Depression Scale, and the Caregiver Oncology Quality of Life Questionnaire to measure coping strategies, psychological distress, and QOL, respectively. We grouped coping into 2 higher-order domains: approach-oriented (ie, emotional support and active coping) and avoidant (ie, self-blame and denial). We used the median split method to describe the distribution of coping and multivariate linear regression models to assess the relationship between coping and caregiver outcomes. We enrolled 170 caregivers, with a median (range) age of 53 (47-64) years. Most were White (87%), non-Hispanic (96%), and female (77%). Approach-oriented coping was associated with less anxiety (β = -0.210, P = .003), depression symptoms (β = -0.160, P = .009), and better QOL (β = 0.526, P = .002). In contrast, avoidant coping was associated with more anxiety (β = 0.687, P<.001), depression symptoms (β = 0.579, P < .001), and worse QOL (β = -1.631, P < .001). Our findings suggest that coping is related to distress and QOL among caregivers of HSCT recipients even before transplant. Hence, caregivers of patients with hematologic malignancies undergoing HSCT may benefit from resources that facilitate adaptive coping with the demands of caregiving.
Topics: Humans; Female; Middle Aged; Caregivers; Quality of Life; Depression; Adaptation, Psychological; Hematologic Neoplasms; Hematopoietic Stem Cell Transplantation
PubMed: 36398978
DOI: 10.1182/bloodadvances.2022008281 -
Artificial Organs Mar 2022After the rehabilitation program, patients with left ventricular assist device (LVAD) are discharged home, but the adaption to the daily life with the implant is... (Observational Study)
Observational Study
BACKGROUND
After the rehabilitation program, patients with left ventricular assist device (LVAD) are discharged home, but the adaption to the daily life with the implant is challenging, both with practical and psychological consequences. Literature is lacking detailed information about the quality of life of LVAD patients and caregivers after discharge to home.
OBJECTIVE
This study aimed at evaluating the post-discharge outcomes of both LVAD patients and their caregivers in terms of quality of life, affectivity, and psychological health.
METHODS
In this observational follow-up study, LVAD dyads discharged home from 1 year to 6 years were re-contacted by phone and received by mail an envelope with self-report questionnaires. Responses of 39 complete dyads of patients (mean age 68.59 ± 4.31; males: 92.31%) and their caregivers (mean age 61.59 ± 11.64; males: 17.95%) were analyzed.
RESULTS
Patients and caregivers reported the moderate levels of anxiety, depression, and caregiver strain, and Illness denial and conscious avoidance were associated between them. The couples often reported that the LVAD has impairments for their sleep and for their affective-sexual relationship. Caregivers often reported impairment in social life and self-care.
DISCUSSIONS
Despite the satisfaction for the medical and territorial assistance, patients showed psychological difficulties such as anxious and depressive symptoms and caregivers tend to neglect themselves. Even after a long time from discharge to home, the psychological distress of LVAD patients and caregivers is still considerable. Structured and continuous psychological interventions are required to support their psychological health overtime after the discharge to home.
Topics: Aged; Anxiety; Attitude to Health; Caregivers; Denial, Psychological; Depression; Female; Follow-Up Studies; Heart-Assist Devices; Humans; Male; Mental Health; Middle Aged; Quality of Life; Stress, Psychological
PubMed: 34519060
DOI: 10.1111/aor.14071 -
Preventive Medicine Reports Sep 2021This study aimed to quantify and examine reproductive healthcare denials experienced by individuals receiving employer-sponsored health insurance. We conducted a...
This study aimed to quantify and examine reproductive healthcare denials experienced by individuals receiving employer-sponsored health insurance. We conducted a national cross-sectional survey using probability and non-probability-based panels from December 2019-January 2020. Eligible respondents were adults employed by any Standard and Poor's 500 company, who received employer-sponsored health insurance. Respondents (n = 1,001) reported whether anyone on their healthcare plan had been denied a reproductive healthcare service in the past five years and details about their denials. We conducted bivariate analyses and multiple logistic regression to estimate factors associated with denials. Eleven percent of respondents (14% of women; 10% of men) reported a denial. Compared to lower-income respondents, those with income ≥ $50,000/year were less likely to experience a denial (aOR = 0.53; 95% CI 0.29-0.97). Compared to respondents who were never married, being married (aOR = 2.33; 95% CI: 1.03-5.30) or cohabiting (aOR = 2.43; 95% CI: 1.03-5.72) significantly increased odds of experiencing a denial. In 38% of cases the patient learned of the denial at a scheduled visit, while 23% learned in an emergency setting, and 13% after the encounter. Individuals covered by employer-sponsored health insurance continue to be denied coverage of preventive services. Employers and insurers can facilitate access to reproductive healthcare by ensuring that their plans include comprehensive coverage and in-network providers offer comprehensive services.
PubMed: 34258172
DOI: 10.1016/j.pmedr.2021.101450 -
European Archives of Psychiatry and... Jun 2021
Topics: Denial, Psychological; Humans; Mental Disorders
PubMed: 33942147
DOI: 10.1007/s00406-021-01272-w -
Journal of Clinical Medicine Feb 2023Pregnancy loss can be defined as a loss before either 20 or 24 weeks of gestation (based on the first day of the last menstrual period) or the loss of an embryo or fetus... (Review)
Review
Pregnancy loss can be defined as a loss before either 20 or 24 weeks of gestation (based on the first day of the last menstrual period) or the loss of an embryo or fetus less than 400 g in weight if the gestation age is unknown. Approximately 23 million pregnancy losses occur worldwide every year, equating to 15-20% of all clinically recognized pregnancies. A pregnancy loss is usually associated with physical consequences, such as early pregnancy bleeding ranging in severity from spotting to hemorrhage. However, it can also be associated with profound psychological distress, which can be felt by both partners and may include feelings of denial, shock, anxiety, depression, post-traumatic stress disorder, and suicide. Progesterone plays a key part in the maintenance of a pregnancy, and progesterone supplementation has been assessed as a preventative measure in patients at increased risk of experiencing a pregnancy loss. The primary objective of this piece is to assess the evidence for various progestogen formulations in the treatment of threatened and recurrent pregnancy loss, postulating that an optimal treatment plan would preferably include a validated psychological support tool as an adjunct to appropriate pharmacological treatment.
PubMed: 36902614
DOI: 10.3390/jcm12051827 -
Journal of Education and Health... 2022Health-care providers, including physicians and nurses, are vital resources of the health-care system, and their health is essential to ensure safe care and to control...
BACKGROUND
Health-care providers, including physicians and nurses, are vital resources of the health-care system, and their health is essential to ensure safe care and to control outbreaks in the community. The aim of this study was to explore the experiences of physicians and nurses infected with COVID-19.
MATERIALS AND METHODS
This descriptive exploratory qualitative study was conducted in 2020. To conduct this study, 19 participants (5 physicians and 14 nurses) were selected using purposive sampling. Data were collected using semi-structured interviews. Data analysis was performed using conventional content analysis.
RESULTS
Eight main categories of "Fear and anxiety," "Fighting against COVID-19," "Feeling abandoned during home quarantine period," "Denial of disease despite testing positive," "Recovery: the second opportunity," "Imposition of psychological burden after returning to work," "Promotion of the health professional perception," and "Promising supportive resources," as well as 21 subcategories, were extracted from the participants' experiences.
CONCLUSION
The experiences of physicians and nurses with COVID-19 revealed that their perception of the profession and providing care had changed. This experience has highlighted the focus and effort to promote patient-centered care and interprofessional collaboration among them.
PubMed: 35281391
DOI: 10.4103/jehp.jehp_604_21 -
L'Encephale Jun 2020Emerging infectious diseases like Covid-19 cause a major threat to global health. When confronted with new pathogens, individuals generate several beliefs about the...
Emerging infectious diseases like Covid-19 cause a major threat to global health. When confronted with new pathogens, individuals generate several beliefs about the epidemic phenomenon. Many studies have shown that individual protective behaviors largely depend on these beliefs. Due to the absence of treatment and vaccine against these emerging pathogens, the relation between these beliefs and these behaviors represents a crucial issue for public health policies. In the premises of the Covid-19 pandemic, several preliminary studies have highlighted a delay in the perception of risk by individuals, which potentially holds back the implementing of the necessary precautionary measures: people underestimated the risks associated with the virus, and therefore also the importance of complying with sanitary guidelines. During the peak of the pandemic, the salience of the threat and of the risk of mortality could then have transformed the way people generate their beliefs. This potentially leads to upheavals in the way they understand the world. Here, we propose to explore the evolution of beliefs and behaviors during the Covid-19 crisis, using the theory of predictive coding and the theory of terror management, two influential frameworks in cognitive science and in social psychology.
Topics: Adaptation, Psychological; Attitude to Health; Betacoronavirus; Brain; COVID-19; Communicable Disease Control; Coronavirus Infections; Culture; Denial, Psychological; Fear; Guideline Adherence; Guidelines as Topic; Health Behavior; Health Risk Behaviors; Humans; Hygiene; Models, Psychological; Pandemics; Pneumonia, Viral; Protective Devices; Risk Management; Risk Reduction Behavior; SARS-CoV-2; Universal Precautions
PubMed: 32517998
DOI: 10.1016/j.encep.2020.05.012 -
Health Expectations : An International... Dec 2022A person-centred model of care, developed in the early days of the HIV epidemic when there were no effective treatments for HIV, led to relatively close relationships...
INTRODUCTION
A person-centred model of care, developed in the early days of the HIV epidemic when there were no effective treatments for HIV, led to relatively close relationships between carers and people living with HIV (PLWH). Our study examines the experiences of carers using a relational framework, exploring the traumas and challenges involved, coping practices instigated by carers and the emergence of 'relational traumatic growth' opportunities.
METHODS
Twenty-two UK healthcare workers and charity volunteers working with PLWH from the early years of the epidemic were recruited. Semistructured interviews were used to elicit participants' own stories of working with PLWH, from their initial involvement to the present time, and their reflections on the personal impact of working in the field of HIV. Data were analysed using a thematic approach employing relational categories.
RESULTS
The impact of care was related to the formation of close relationships, identification with PLWH, high numbers of deaths and the difficulties and challenges encountered relationally. Participants described attempts to cope through informal and formal support, as well as endeavours to manage professional boundaries. Various ways of making sense of experiences were described, ranging from denial to abandoning the HIV field, to intense commitment. For some, traumatic experiences lead to validation, a search for personal meaning and managing the sense of loss with an exploration of further ventures, contributing to the achievement of relational traumatic growth.
CONCLUSION
The intensity of relationships in HIV work, developed through the emotional and practical work of caring for PLWH, led healthcare workers and volunteers to experience a range of psychological consequences, both negative (including distress and emotional exhaustion) and also positive (such as acquiring a sense of purpose).
PATIENT OR PUBLIC CONTRIBUTION
People living with HIV and those working with them were involved in the initial study conceptualization and design. The second and fourth authors of this paper were professionals working in HIV throughout the pandemic and have led on all aspects of the study. People living with HIV and those working with them additionally guided participant selection by suggesting participants and supporting recruitment. Narrative transcripts were checked and amended (if necessary) by participants. Initial findings were presented at the AIDS impact conference, where PLWH and those working with them attended and feedback on important ideas that helped to prioritize and shape the study findings.
Topics: Humans; Caregivers; Adaptation, Psychological; HIV Infections; Emotions; Narration
PubMed: 36181714
DOI: 10.1111/hex.13619