Complexity of health care needs and interactions in multidisciplinary medical teams

By using an information processing and social identity approach, this study examines the relationships between the complexity of the health care needs of a patient and (1) the interactions among physicians during team meetings and (2) how the meeting participants evaluate the discussion. Three dimensions of the complexity of the health care needs are related to the interactive behaviour of medical specialists during meetings of multidisciplinary medical teams. Three medical teams from a Dutch university hospital, each discussing a total of 40 patients, were observed. The results show that component complexity was positively related to the amount of information team members exchanged, to positive reactions, and to the positive evaluation of the discussion. Two other dimensions (interrelatedness of needs and ambiguity) have to be considered in concert: interrelatedness was positively related to negative reactions but only if ambiguity was low; and, further, ambiguity was positively related to evaluative behaviour and to positive reactions, and negatively to the evaluation of the discussion, but only if interrelatedness was low.     

Emotion experience and expression across the adult life span: insights from a multimodal assessment study

This investigation represents a multimodal study of age-related differences in experienced and expressed affect and in emotion regulatory skills in a sample of young, middle-aged, and older adults (N=96), testing formulations derived from differential emotions theory. The experimental session consisted of a 10-min anger induction and a 10-min sadness induction using a relived emotion task; participants were also randomly assigned to an inhibition or noninhibition condition. In addition to subjective ratings of emotional experience provided by participants, their facial behavior was coded using an objective facial affect coding system; a content analysis also was applied to the emotion narratives. Separate repeated measures analyses of variance applied to each emotion domain indicated age differences in the co-occurrence of negative emotions and co-occurrence of positive and negative emotions across domains, thus extending the finding of emotion heterogeneity or complexity in emotion experience to facial behavior and verbal narratives. The authors also found that the inhibition condition resulted in a different pattern of results in the older versus middle-aged and younger adults. The intensity and frequency of discrete emotions were similar across age groups, with a few exceptions. Overall, the findings were generally consistent with differential emotions theory.     

Immigration, suicidal ideation and deliberate self-injury in the Boston youth survey 2006

The prevalence and immigration-related correlates of deliberate self-injury (DSI) and suicidal ideation (SI) were estimated in a sample of Boston public high school students in 2006. Compared with U.S.-born youth, immigrant youth were not at increased risk for DSI or SI, even if they had experienced discrimination due to their ancestry. By contrast, U.S.-born youth who reported having been discriminated against because of their ancestry had an increased risk of deliberate self-injury (odds ratio [OR] = 3.1, 95% confidence interval [CI] = 1.6-5.9) and suicidal ideation (OR = 2.1, 95% CI = 1.2-3.8). The combination of being U.S.-born and experiencing ancestry-based discrimination identifies youth at increased risk for suicidal behavior.     

The moderating role of executive functioning in older adults' responses to a reminder of mortality

In previous research, older adults responded to mortality salience (MS) with increased tolerance, whereas younger persons responded with increased punitiveness. One possible explanation for this is that many older adults adapt to challenges of later life, such as the prospect of mortality, by becoming more flexible. Recent studies suggest that positively oriented adaptation is more likely for older adults with high levels of executive functioning. Thus, we hypothesized that the better an older adult's executive functioning, the more likely MS would result in increased tolerance. Older and younger adults were randomly assigned to MS or control conditions, and then evaluated moral transgressors. As in previous research, younger adults were more punitive after reminders of mortality; executive functioning did not affect their responses. Among older adults, high functioning individuals responded to MS with increased tolerance rather than intolerance, whereas those low in functioning became more punitive.     

Methods Used to Document Procedural Fidelity in School-Based Intervention Research

There has been a paucity of guidance on the methodological details needed for measuring and sampling the independent variable or actual intervention occurrences in research and practice. Furthermore, the planning and support necessary to document the independent variable in both circumstances may be considerable. The current study extends prior research by reviewing the methods used to document procedural fidelity in school-based intervention research with student participants published between 2005 and 2012 in journals known for publishing school-related intervention studies. Two hundred sixty-six articles met the inclusion criteria and the majority (70 %) used fidelity data in the analysis of intervention effectiveness. By systematically examining contributions of school-based intervention researchers across targeted variables as well as qualities of interventions and settings, suggestions can be made for (a) planning measurement of fidelity across phases of the intervention, (b) sampling fidelity occurrences, (c) preventing intervention failure by providing needed supports, and (d) responding to patterns of fidelity required for intervention and outcome measurement in both research and practice.     

Peer Culture and Body Image Concern Among Australian Adolescent Girls: A Hierarchical Linear Modelling Analysis

Peers may influence the body image concerns and disordered eating behaviours of adolescent girls through the creation of appearance cultures within friendship cliques. The present study investigates the role of friendship cliques and school gender composition in impacting upon adolescent girls’ body image concern and disordered eating behaviours, using hierarchical linear modelling (HLM), a statistical procedure employed in the analysis of nested data. A sample of 156 girls was drawn from four private schools located in the capital city of Western Australia (one single-sex school and three mixed-sex schools). Eighty students from the single-sex school and 76 female students from the mixed-sex schools, comprising 35 friendship cliques, completed questionnaires assessing body image, disordered eating, and a range of variables that have previously been associated with body image concern and disordered eating, including appearance-based social comparison, frequency of appearance-based conversation, appearance-based criticism, friends’ concern with thinness, media influence and media pressure. Hierarchical linear modelling analyses found that friendship cliques in all-girls schools exhibited similar levels of body image concern and dieting behaviours, with various peer and other media influence variables accounting for these similarities. Friendship cliques in mixed-sex schools were not found to be similar with regard to body image concern or disordered eating. These findings support the notion that friendship groups can be an important source of influence on the body image concerns of adolescent girls in single-sex schools, and show that both individual and friendship clique level measures of attitudes and behaviours make independent contributions to the prediction of these body image concerns.     

Prevalence and correlates of sexual morbidity in long-term breast cancer survivors

Objective: Breast cancer survivors report adverse sexual effects (sexual morbidity) such as disrupted sexual function, sexual distress and body dissatisfaction. However, most studies have failed to evaluate the persistence of these effects in long-term survivors. The present study comprehensively assessed the prevalence and predictors of sexual/body image problems among survivors three or more years post diagnosis.

Design/outcome measures: Eighty-three breast cancer survivors completed surveys a median of seven years post diagnosis. Survey items probed demographic, diagnostic and clinical information, in addition to sexual activity, sexual function (Female Sexual Function Index [FSFI]), body image, and distress regarding body changes and sexual problems (Female Sexual Distress Scale-revised; FSDS-R).

Results: Seventy-seven percent of all participants and 60% of sexually active participants qualified for sexual dysfunction based on the FSFI. Between 37 and 51% met criteria for female sexual dysfunction, based on two FSDS-R clinical cut-offs. Body satisfaction was worse than normative values, while body change stress was mid-range. Notable sexual morbidity predictors included mastectomy, which was associated with worse sexual/body change distress, and post-treatment weight gain, which predicted greater body dissatisfaction/body change stress.

Conclusions: Breast cancer survivors report substantial sexual morbidity years after treatment, especially after mastectomy or post-treatment weight gain. Breast cancer patients and their providers should be aware of these potential sexual effects.     

"I couldn't have seen it coming": The impact of negative self-relevant outcomes on retrospections about foreseeability

We examined a phenomenon related to hindsight bias, specifically, retrospective judgements about the foreseeability of an outcome. We predicted that negative, self-relevant outcomes would be judged as less foreseeable by the recipient of the outcome than by others, unlike either positive outcomes or outcomes that are not self-relevant. In the context of a "stock market decision-making game", the hypothetical stock selected by one of two players showed an extreme increase or decrease. As predicted, the player who received an extreme negative outcome reported that this outcome was less foreseeable than did the opponent and an observer, for whom the outcome was less self-relevant. For no other kind of outcome was there a difference between the recipient of an outcome, the opponent, and the observer. The findings have several implications, including the possibility that hindsight bias should be considered as a special case of retrospective foreseeability.