Daily hassles,their antecedents and outcomes among professional first responders: A systematic literature review

Occupational groups such as firefighters, military officers, paramedics and police officers are exposed to a combination of acute, severe and accumulated everyday stress. Drawing on the daily hassles perspective on stress, the aim was to synthesize existing research on daily hassles in professional first responder settings into a theoretical model. A systematic mixed studies review with an integrated design was undertaken. The selection process resulted in 40 articles meeting the inclusion criteria. The selected papers represented two literature reviews, one qualitative study, eight longitudinal studies and 29 cross‐sectional studies. Five superior categories emerged in the analysis: Individual antecedent and continuously framing factors, Environmental antecedent and continuously framing factors, Appraisal and coping processes, Daily hassles and Outcome. Suggestions for future research are presented.     

Making good choices: toward a theory of well-being in medicine

The principle of beneficence directs healthcare practitioners to promote patients’ well-being, ensuring that the patients’ best interests guide treatment decisions. Because there are a number of distinct theories of well-being that could lead to different conclusions about the patient’s good, a careful consideration of which account is best suited for use in the medical context is needed. While there has been some discussion of the differences between subjective and objective theories of well-being within the bioethics literature, less attention has been given to the questions of what work a theory of well-being needs to do in bioethics and which standards of success ought to be used in selecting a theory of well-being for use in medicine. In this article, I argue that traditional theories of well-being developed in philosophy are not well suited to meet the needs of the medical context. For the principle of beneficence to be most useful, the underlying account of well-being should satisfy two conditions: first, it needs to lead to a concrete, action-guiding determination of the patient’s good; and, second, any recommendations it offers need to be justifiable to patients. Standard accounts of well-being have difficulty satisfying both conditions. Exploring the limitations of these theories when applied to treatment dilemmas helps point the way toward the development of an account of well-being better suited to healthcare.     

Developmental dissociation in the neural responses to simple multiplication and subtraction problems

Mastering single‐digit arithmetic during school years is commonly thought to depend upon an increasing reliance on verbally memorized facts. An alternative model, however, posits that fluency in single‐digit arithmetic might also be achieved via the increasing use of efficient calculation procedures. To test between these hypotheses, we used a cross‐sectional design to measure the neural activity associated with single‐digit subtraction and multiplication in 34 children from 2nd to 7th grade. The neural correlates of language and numerical processing were also identified in each child via localizer scans. Although multiplication and subtraction were undistinguishable in terms of behavior, we found a striking developmental dissociation in their neural correlates. First, we observed grade‐related increases of activity for multiplication, but not for subtraction, in a language‐related region of the left temporal cortex. Second, we found grade‐related increases of activity for subtraction, but not for multiplication, in a region of the right parietal cortex involved in the procedural manipulation of numerical quantities. The present results suggest that fluency in simple arithmetic in children may be achieved by both increasing reliance on verbal retrieval and by greater use of efficient quantity‐based procedures, depending on the operation.     

Care Versus Control: The Identity Dilemmas of UK Homelessness Professionals Working in a Contract Culture

UK voluntary and community sector organizations (VCOs) play a key role in caring for homeless people. However, there are widespread concerns about the impact of increasing government contracting on the quality of their services. This paper examines understandings of homelessness and identities as homelessness professionals, as expressed by VCO professionals. By so doing, it considers how ‘partnership working’ enables or undermines their capacities to care. The paper uses 24 in‐depth interviews and four focus groups with London‐based homelessness professionals. Professionals expressed deep tensions in their experience of their role. On one hand, they reported a deep ethical commitment to care and to develop quality supporting relationships to respond to their clients' complex needs. On the other, their capacity to care was undermined by their dependence on statutory resources and the controls this involved over the way VCOs delivered care. Professionals had to adjust to statutory monitoring frameworks and hard performance targets, which detached them from the human and intimate encounter with their clients and constrained their person‐centred caring interventions. The findings highlight the contradictory nature of contemporary systems of ‘joined up’ welfare that neglect the very human and complex nature of the issues that they were originally created to address. Copyright © 2013 John Wiley & Sons, Ltd.     

Conceptualizing Genetic Counseling as Psychotherapy in the Era of Genomic Medicine

Discussions about genetic contributions to medical illness have become increasingly commonplace. Physicians and other health-care providers in all quarters of medicine, from oncology to psychiatry, routinely field questions about the genetic basis of the medical conditions they treat. Communication about genetic testing and risk also enter into these conversations, as knowledge about genetics is increasingly expected of all medical specialists. Attendant to this evolving medical landscape is some uncertainty regarding the future of the genetic counseling profession, with the potential for both increases and decreases in demand for genetic counselors being possible outcomes. This emerging uncertainty provides the opportunity to explicitly conceptualize the potentially distinct value and contributions of the genetic counselor over and above education about genetics and risk that may be provided by other health professionals. In this paper we suggest conceptualizing genetic counseling as a highly circumscribed form of psychotherapy in which effective communication of genetic information is a central therapeutic goal. While such an approach is by no means new—in 1979 Seymour Kessler explicitly described genetic counseling as a “kind of psychotherapeutic encounter,” an “interaction with a psychotherapeutic potential”—we expand on his view, and provide research evidence in support of our position. We review available evidence from process and outcome studies showing that genetic counseling is a therapeutic encounter that cannot be reduced to one where the counselor performs a simple “conduit for information” function, without losing effectiveness. We then discuss potential barriers that may have impeded greater uptake of a psychotherapeutic model of practice, and close by discussing implications for practice.     

“I’m not a lesbian; I’m just a freak”: A Pilot Study of the Experiences of Women in Assumed-Monogamous Other-Sex Unions Seeking Secret Same-Sex Encounters Online,their Negotiation of Sexual Desire,and Meaning-Making of Sexual Identity

This pilot study looked to examine the experiences of women who are “undercover,” the meaning-making of their sexual identity, how they came to negotiate their same-sex sexual desires alongside their primary other-sex unions, and their experience of a secret, compartmentalized life. The study sought to understand their experiences as well as their meaning-making in the course of maintaining a public heterosexual persona while balancing their secret desire for sex with women. The thirty-four women in this study report lifelong incidence of attraction to and encounters with other women as well as men. They are not transitioning toward a lesbian identity nor experiencing fluidity; rather, clandestine encounters are part of an ongoing means to negotiate their opposite-sex marriages. For them, our culture’s limited notions of sexual identity are less than useful. It was important to their self-concept that their sexuality be understood in terms of its intensity and their desire for frequency and diversity of acts. They defined themselves on their own terms and by their sexual personalities and inclination toward what they considered “hypersexuality” or “freakiness.” Despite conventional ideas that women are emotionally driven in their extra-relational affairs and need to “fall in love” to participate in extra-relational sexual activity, all of the women were clear in their desire to limit their association with their same-sex partners to sexual encounters only.     

An Application of the Complier Average Causal Effect Analysis to Examine the Effects of a Family Intervention in Reducing Illicit Drug Use among High‐Risk Hispanic Adolescents

The Complier Average Causal Effect (CACE) method has been increasingly used in prevention research to provide more accurate causal intervention effect estimates in the presence of noncompliance. The purpose of this study was to provide an applied demonstration of the CACE analytic approach to evaluate the relative effects of a family‐based prevention intervention, Familias Unidas, in preventing/reducing illicit drug use for those participants who received the intended dosage. This study is a secondary data analysis of a randomized controlled trial designed to evaluate the relative efficacy of Familias Unidas with high‐risk Hispanic youth. A total of 242 high‐risk Hispanic youth aged 12–17 years and their primary caregivers were randomized to either Familias Unidas or Community Practice and assessed at baseline, 6 months and 12 months postbaseline. CACE models were estimated with a finite growth mixture model. Predictors of engagement were included in the CACE model. Findings indicate that, relative to the intent‐to‐treat (ITT) analytic approach, the CACE analytic approach yielded stronger intervention effects among both initially engaged and overall engaged participants. The CACE analytic approach may be particularly helpful for studies involving parent/family‐centered interventions given that participants may not receive the intended dosage. Future studies should consider implementing the CACE analysis in addition to ITT analysis when examining the effects of family‐based prevention programs to determine whether, and the extent to which, the CACE analysis has more power to uncover intervention effects.     

Facial emotion recognition: a cross-cultural comparison of Chinese,Chinese living in Australia,and Anglo-Australians

This study investigated how the cultural match or mismatch between observer and perceiver can affect the accuracy of judgements of facial emotion, and how acculturation can affect cross-cultural recognition accuracy. The sample consisted of 51 Caucasian-Australians, 51 people of Chinese heritage living in Australia (PCHA) and 51 Mainland Chinese. Participants were required to identify the emotions of happiness, sadness, fear, anger, surprise and disgust displayed in photographs of Caucasian and Chinese faces. The PCHA group also responded to an acculturation measure that assessed their adoption of Australian cultural values and adherence to heritage (Chinese) cultural values. Counter to the hypotheses, the Caucasian-Australian and PCHA groups were found to be significantly more accurate at identifying both the Chinese and Caucasian facial expressions than the Mainland Chinese group. Adoption of Australian culture was found to predict greater accuracy in recognising the emotions displayed on Caucasian faces for the PCHA group.     

Evaluation of Breast Cancer Patients with Genetic Risk in a University Hospital: Before and After the Implementation of a Heredofamilial Cancer Unit

The identification of patients at risk for breast cancer by genetic testing has proven to reduce breast cancer mortality. In 2010, due to a lack of systematization in hereditary cancer assistance in our center, we implemented a multidisciplinary Heredofamilial Cancer Unit (HFCU). We analyze if the HFCU improved the rates of referrals and preventive management of breast cancer patients with genetic risk. We retrospectively compared family history records, referrals of high-risk patients to genetic counseling, and detection and management of patients with BRCA1/2 mutations in two cohorts of breast cancer patients diagnosed before (first period: 2007–2010) and after the creation of the HFCU (second period: 2010–2013). In the first period, 893 patients were included, and 902 were included in the second. Due to the inability to establish their genetic risk, 142 patients (15.9%) vs. 70 (7.8%) were excluded from analysis (p?<?0.001). Among the evaluable patients, 194 (25.8%) vs. 223 (26.8%) fulfilled one or more risk criteria (p?=?0.65). Family history documentation in patient’s medical records (92.4 vs. 97.8%, p?<?0.001) and referral rate (26.3 vs. 52%, p?<?0.0001) significantly increased in the second period. Eight BRCA1/2 mutations were detected among patients referred in the first period and 17 among those referred to the HFCU. The rate of preventive surgeries in patients with BRCA mutations significantly increased in the second period (25 vs. 76.5%, p?=?0.03). In conclusion, there was a clear improvement in family history records, referrals, and preventive surgeries in breast cancer patients with genetic risk after the implementation of the HFCU.