Burnout in Spanish physiotherapists

Diverse works on health sciences emphasise the importance of burnout in specific jobs. However, there is a lack of research about the presence of this syndrome in Spanish physiotherapists. The aims of this study were to determine the prevalence of burnout among physiotherapists and the relationship with work-related factors. 462 questionnaires were sent to health-centres. The questionnaire of work-related factors was administered, as well as the Maslach burnout inventory (MBI). 258 responses were received (55.8% response rate) from Murcia and Valencia. Regarding results 10 (4%) physiotherapists showed severe burnout. In relation to work-related factors, significant differences were observed. Although the percentage of physiotherapists with severe burnout was relatively low, it is important take into account that the syndrome requires the combined presence of three dimensions, which implies a very relevant situation of mental deterioration.     

Design and power analysis: n and confidence intervals of means

In this study, we analyzed the validity of the conventional 80% power. The minimal sample size and power needed to guarantee non-overlapping (1-alpha)% confidence intervals for population means were calculated. Several simulations indicate that the minimal power for two means (m = 2) to have non-overlapping CIs is .80, for (1-alpha) set to 95%. The minimal power becomes .86 for 99% CIs and .75 for 90% CIs. When multiple means are considered, the required minimal power increases considerably. This increase is even higher when the population means do not increase monotonically. Therefore, the often adopted criterion of a minimal power equal to .80 is not always adequate. Hence, to guarantee that the limits of the CIs do not overlap, most situations require a direct calculation of the minimum number of observations that should enter in a study.     

Inventory of Overburden in Alzheimer's Patient Family Caregivers with no Specialized Training

Background/Objective: Alzheimer-type dementia is one of the most frequent causes of dependence in an aging population, which combines with a considerable demand for care. Furthermore, when the caregiver is a family member or person without specialized training, such care impacts on that person's health. The Inventory of Overburden in Alzheimer's Patient Family Caregivers with no Specialized Training (IPSO-CA24) was designed to find out the needs of these caregivers and evaluate the caregiver's burden or distress. Method: The psychometric properties of the questionnaire were analyzed (in a reliability analysis, exploratory factor analysis and confirmatory analysis) based on the responses of 255 caregivers. Results: The factor analyses showed a six-factor structure (Reaction to diagnosis, Physical health, Psychological symptomatology (caretaker), Behavioral symptomatology (patient), Knowledge of the illness, and Level of dependence) explaining 66.52% of the total variance with a reliability of .75 to .93. Support was also found for its convergent validity. Conclusions: The IPSO-CA24 responds to the need for an instrument enabling multidimensional evaluation of the burden on the family caregiver without specialized training.     

Implicit and explicit self-esteem discrepancies in paranoia and depression

The main purpose of the present study was to examine implicit and explicit self-esteem (SE) in patients with persecutory delusions. In samples of paranoid patients, depressed patients, and healthy controls, implicit SE was assessed using the experimental go/no-go association task, whereas explicit SE was measured using 2 self-reporting questionnaires: the self-worth subscale of the World Assumption Scale (Janoff-Bulman, 1989) and the self-acceptance subscale of the Scales of Psychological Well-Being (Ryff & Keyes, 1995). Our analysis revealed that depressed patients showed lower explicit SE than did paranoid and healthy control participants. However, participants with persecutory delusions had significantly lower implicit SE scores than did healthy controls. We interpret the discrepancies observed between overt and covert measures in the paranoid group as psychological defense mechanisms. The present study stresses the clinical and theoretical importance of the use of implicit measures in psychopathology.     

Empirical and Theoretical Conclusions of an Analysis of Outcomes of HIV-Prevention Interventions

ABSTRACT— Over two decades of HIV-prevention attempts have generated a most impressive ecological data set for the test of behavioral-change and persuasion theories in the domain of condom use. An analysis of this evidence has yielded five important empirical and theoretical conclusions. First, interventions are more successful at achieving immediate knowledge and motivational change than they are at achieving immediate behavioral change. Second, the immediate motivational change decays over time, whereas behavior change increases over the same period. Third, interventions that engage audiences in particular activities, such as role-playing condom use, are more effective than presentations of materials to passive audiences. Fourth, interventions consistent with the theories of reasoned action and planned behavior, with self-efficacy models, and with information-motivation and behavioral-skills models prove effective, whereas interventions designed to induce fear do not. Fifth, expert intervention facilitators are more effective than lay community members in almost all cases. When populations are unempowered, expert facilitators are particularly effective, and they are most effective if they also share the gender and ethnicity of the target audience.     

The role of defensive confidence in preference for proattitudinal information: how believing that one is strong can sometimes be a defensive weakness

This series of studies identified individuals who chronically believe that they can successfully defend their attitudes from external attack and investigated the consequences of this individual difference for selective exposure to attitude-incongruent information and, ultimately, attitude change. Studies 1 and 2 validated a measure of defensive confidence as an individual difference that is unidimensional, distinct from other personality measures, reliable over a 2-week interval, and organized as a trait that generalizes across various personal and social issues. Studies 3 and 4 provided evidence that defensive confidence decreases preference for proattitudinal information, therefore inducing greater reception of counterattitudinal materials. Study 5 demonstrated that people who are high in defensive confidence are more likely to change their attitudes as a result of exposure to counterattitudinal information and examined the perceptions that mediate this important phenomenon.     

Effect of the similarity between target and global and local levels in hierarchical stimuli processing

The hypothesis of global precedence was investigated by manipulating the similarity between target and relevant level, and between target and global and local levels of hierarchical stimuli, both in divided and selective attention conditions. The similarity was measured on the basis of the amount of shared contour between two visual forms. The stimuli were circles, right-facing semicircles, i.e., 1/2 of the circumference missing, and right-facing partial circles with a 1/4 of the circumference missing. The circle was used as a target and, consequently, the similarity between target and semicircle and between it and the partial circle was 50% and 75%, respectively. In the divided attention condition, the results showed a local advantage in the two similarity conditions between target and distractor level (50% and 75%) and a bidirectional and symmetrical interference at both levels of similarity. However, in the 'selective attention condition', a local reaction time advantage was only found when the similarity between target and irrelevant level was of 50%. When attention was directed towards the global level, local interference increased depending on the decrease in the degree of the local level similarity. When the attention was directed towards the local level, there was global interference but it was independent of the degree of the global level similarity. These results show the importance of the physical shape of the local elements used in experiments with hierarchical stimuli, since they may determine the relative speed of global processing, facilitating or impairing it.     

Low heart rate variability is not caused by typical neuroleptics in schizophrenia patients

Both elevated cardiovascular mortality and low cardio-vagal (parasympathetic) heart rate variability (HRV)--a risk factor for postmyocardial infarction--are reported in schizophrenia (SZ). Since a number of medications have strong effects of cardiac conductivity, we thought it important to examine if typical neuroleptic medications might also affect HRV. We examined cardiac vagal activity during both neuroleptic treatment and a drug-free condition in seven SZ patients who were participating in a pilot double-blind, crossover study of placebo and haloperidol treatment. Twenty-four-hour Holter electrocardiograms were analyzed for high frequency HRV, quantitated as the percent of successive normal interbeat intervals greater than 50 milliseconds (PNN50), which is a good index of parasympathetic cardiac modulation. The patients showed unchanged PNN50 (8.4+/-9.5 versus 8.3+/-10.5; t=.22, df=6, P=.5) between the haloperidol treatment and drug-free conditions. Despite the elapsed time, change in medication, and altered clinical state, the PNN50s were highly correlated (Spearman r=.98, P=.000). SAPS positive symptom scores declined with treatment from 12.8+/-6.5 to 8.5+/-3.5; paired t=3.26: df=6; P=.01. PNN50s were significantly associated with positive (r=-.86, df=6, P=.012) and negative symptom scores (r=-.87, df=6, P=.01). We found low cardiovagal modulation in medication-free SZ patients that was associated with core SZ symptoms and was unchanged by haloperidol and benztropine treatment. The reduced HRV in SZ patients at baseline may render them at greater cardiovascular risk than healthy subjects when treated with medications having strong cardiovascular effects.     

Could stress cause psychosis in individuals vulnerable to schizophrenia?

It has long been considered that psychosocial stress plays a role in the expression of symptoms in schizophrenia (SZ), as it interacts with latent neural vulnerability that stems from genetic liability and early environmental insult. Advances in the understanding of the neurobiology of the stress cascade in both animal and human studies lead to a plausible model by which this interaction may occur: through neurotoxic effects on the hippocampus that may involve synaptic remodeling. Of late, the neurodevelopmental model of SZ etiology has been favored. But an elaboration of this schema that credits the impact of postnatal events and considers a role for neurodegenerative changes may be more plausible, given the evidence for gene-environment interaction in SZ expression and progressive structural changes observed with magnetic resonance imaging. Furthermore, new insights into nongliotic neurotoxic effects such as apoptosis, failure of neurogenesis, and changes in circuitry lead to an expansion of the time frame in which environmental effects may mediate expression of SZ symptoms.