Health Related Quality of Life in Children with Congenital Heart Disease

Health-related quality of life in children with congenital heart disease (CHD) was compared to that of healthy children. Furthermore, agreement between child and parent reports was examined. In addition, differences in quality of life related to the severity of CHD were evaluated. One hundred children with CHD aged between 8-18 years and their parents answered a health-related quality of life-questionnaire during their visit to the paediatric cardiology outpatient department. CHD children reported reduced motor functioning and autonomy compared to healthy children. Parents of children with CHD reported their children to have a reduced quality of life in the domains of: motor functioning, autonomy and cognitive functioning. Agreement between child and parent reports was moderate. Children systematically reported lower health related quality of life on the domain of positive emotions than did parents. Health related quality of life in children with CHD appeared not to be influenced by severity of the disease. In conclusion, regardless of the severity of the disease, children with CHD reported their health related quality of life on several domains to be lower than that of healthy children. This means that on several domains, the emotional impact of problems in health status is greater for children with CHD than for healthy children. When CHD patients visit the clinic, it is important that physicians actively ask patients as well as parents about the child's motor functioning, autonomy and cognitive functioning. Children with problems in these domains can then be identified, and psychological interventions can take place at an early stage.     

Adherence to Hormone Replacement Therapy: A Longitudinal Study Using the Theory of Planned Behaviour

The aim of this longitudinal study was to assess the stability and determinants of the intention to adopt HRT over a one-year period using the Theory of Planned Behaviour. At baseline, a total of 644 middle-aged premenopausal women who had never used HRT, were recruited. At follow-up, 417 women completed an interview to assess any change in their reproductive status and in their behavioural intention. Among women who stayed premenopausal (n = 172) and among those who became perimenopausal (n = 209), the intention to adopt HRT was quite stable over the one-year period. However, being perimenopausal had a significant effect on the intention to adopt HRT at follow-up, as did subjective norm, perceived behavioural control and moral norm measured at baseline. Attitude towards HRT did not have a significant effect on the intention to adopt HRT one year later. Therefore, interventions to support women's decision-making about HRT should be tailored to their menopausal status and take into account their perception of social pressure to perform, control over this behaviour and moral obligation.     

Direct and Indirect Effects of Adolescent Self-Control of Emotions and Behavioral Expression on Adult Health Outcomes

In the ongoing Jyväskylä Longitudinal Study of Personality and Social Development, we examined the direct and indirect effects of self-control of emotions and behavioral expression, as rated by teachers at age 14, on various self-reported health outcomes at age 36 in 123 women and 129 men. The relation between independent and dependent variables was expected to be mediated by health-related behaviors at age 36 (exercise, tobacco use, heavy drinking). Path analysis showed that, in men, low self-control of emotions was linked to self-assessed poor health and physical symptoms indirectly via health-risk behaviors, but directly to disabilities. Behavioral expression at age 14, indexed by social activity, was directly linked to disabilities. In women, behavioral expression was unrelated to health outcomes, but low self-control of emotions was indirectly linked to self-assessed poor health, physical symptoms, and disabilities via health-risk behaviors.     

Measuring Quality of Life in HIV and AIDS: A Review of the Recent Literature

This review addresses some of the recent issues surrounding the measurement of quality of life of people living with HIV and AIDS and discusses the properties of suitable instruments. More than 300 articles on quality of life in HIV and AIDS published since 1995 have been appraised. The structure and properties of two broad types of measure are considered: economic indicators or scales and subjective measures. While several good scales have been created for the assessment of people living with HIV infection, few were found to be conceptually comprehensive in terms of the dimensions offered for evaluation. Almost all these instruments were developed in the USA. Simple translation methods provide language versions that lack cross-cultural equivalence. A new cross-cultural methodology has recently been achieved in the development of the WHOQOL-HIV instrument as a measure for international research and its development is described.     

A Meta-Analytic Review of the Common-Sense Model of Illness Representations

A meta-analysis of empirical studies ( N = 45) adopting Leventhal, Meyer and Nerenz's (1980) Common Sense Model (CSM) of illness representations is presented. The average corrected intercorrelation matrix for the sample of studies showed that the CSM illness cognition dimensions of consequences, control/cure, identity and timeline followed a logical pattern supporting their construct and discriminant validity across illness types. A content analysis classified coping strategies into seven distinctive categories and health outcomes into six categories. Examining the average corrected correlation coefficients across the studies revealed that perceptions of a strong illness identity were significantly and positively related to the use of coping strategies of avoidance and emotion expression. In addition, perceived controllability of the illness was significantly associated with cognitive reappraisal, expressing emotions and problem-focused coping strategies. Perceptions of the illness as highly symptomatic, having a chronic timeline and serious consequences was significantly correlated with avoidance and expressing emotions coping strategies. Further, perceptions that the illness was curable/controllable was significantly and positively related to the adaptive outcomes of psychological well-being, social functioning and vitality and negatively related to psychological distress and disease state. Conversely, illness consequences, timeline and identity exhibited significant, negative relationships with psychological well being, role and social functioning and vitality. The analyses provide evidence for theoretically predictable relations between illness cognitions, coping and outcomes across studies.     

Walking in the lost child's tracks: revisiting the therapeutic nature of reclaiming

This paper outlines the research methodology used as part of a professional doctorate in psychoanalytic psychotherapy. The project researched the maternal state of mind following the loss of an infant or small child and the birth of the next baby. Three mothers were seen for psychoanalytic psychotherapy on a weekly basis as part of this research. They were encouraged to bring their new baby to sessions. The author describes how an interest in this area of research developed as a result of working as a child psychotherapist with 'replacement children' (Cain and Cain, 1964). An argument is made to show that the psychoanalytic method is unique and that the psychoanalytic setting may be considered an 'ideal laboratory' (Fonagy and Moran, 1993) for psychoanalytic psychotherapeutic research. Clinical material is used from one case study to show how material can be analysed and demonstrates the research methodology used within the project. The material explores the developing therapeutic relationship and focuses on the way one mother in the research group experienced the loss of a small child prior to the birth of her next baby. Cet article décrit brièvement la méthodologie de recherche employée dans le cadre d'un doctorat professionnel en psychothérapie psychanalytique. Le projet de recherche porte sur l'état psychique maternel à la suite de la perte d'un nourrisson ou d'un enfant en bas âge lorsque un nouveau bébé vient à naître. Dans le cadre de cette recherche, trois mères ont bénéficié d'une psychothérapie psychanalytique à raison d'une séance hebdomadaire. Il leur était proposé d'amener leur bébé aux séances. L'auteur décrit comment son intérêt pour ce champ de recherche s'est développé à partir de son travail de psychothérapeute d'enfants auprès d'"enfants de remplacement" [A. Cain & B. Cain 1964]. Elle affirme que la méthode psychanalytique à sa propre valeur et que le cadre psychanalytique peut être considéré comme un "laboratoire idéal" [P. Fonagy & G. Moran 1993] pour la recherche en psychothérapie psychanalytique. Le matériel clinique d'une étude de cas montre comment l'analyser et illustre la méthodologie de la recherche employée dans ce projet. Ce matériel explore l'évolution de la relation thérapeutique et traite en détail de la façon dont une des mères de l'échantillon a vécu la perte d'un enfant en bas âge avant la naissance de son bébé actuel. Questo articolo mette in rilievo la metodologia di ricerca utilizzata come parte di un dottorato professionale in psicoterapia psicoanalitica. Il progetto di ricerca studiava lo stato mentale materno conseguente la perdita di un neonato o bambino piccolo e la nascita del bambino successivo. Come parte della ricerca tre madri furono seguite una volta alla settimana in psicoterapia psicoanalitica, ed incoraggiate a portare alle sedute i loro nuovi bebe'. L'autore descrive come il suo interesse in questa area si e' sviluppato conseguentemente al suo lavoro come psicoterapeuta infantile con 'bambini sostituti' (Cain e Cain, 1964. Si cerca di mostrare l'unicita' del metodo psicoanalitico e come esso possa essere considerato un 'laboratorio ideale' (Fonagy e Moran, 1993) per la ricerca in psicoterapia psicoanalitica. Viene usato il materiale clinico di un caso per mostrare come esso possa essere analizzato e illustrare il metodo di ricerca usato nel progetto. Il materiale esplora la relazione terapeutica nel suo evolversi e si concentra sul modo in cui una madre nel gruppo di ricerca visse la perdita di un bambino piccolo precedente la nascita dell'altro bebe'. Dieser Artikel umreisst die Forschungsmethodik, die als Teil einer Doktorarbeit in psychoanalytischer Psychotherapie verwendet wurde. Das Projekt erforschte den müterlichen Gemütszustand nach dem Verlust eines Babys oder kleinen Kindes und der Geburt des nächsten Babys. Als Teil dieser Forschung wurden drei Mütter einmal wöchentlich in Psychotherapie gesehen. Sie wurden ermuntert, ihr Neugeborenes zu den Stunden mitzubringen. Die Autorin beschreibt, wie das Interesse in diesem Forschungsbereich sich als Folge ihrer Arbeit als Kinderpsychotherapeutin mit 'Ersatzkindern' entwickelt hatte. (Cain und Cain 1964). Es wird argumentiert, dass die psychoanalytische Methode einzigartig ist und das psychoanalytische Setting als ein 'ideales Labor' (Fonagy und Moran,1993) für psychoanalytische psychotherapeutische Forschung angesehen werden kann. Es wird klinisches Material einer Fallstudie benutzt, um zu zeigen, wie das Material analysiert werden kann und es demonstriert die Forschungsmethodik, die im Projekt benutzt wird. Das Material erforscht die sich entwickelnde therapeutische Beziehung und legt den Schwerpunkt auf die Art und Weise, wie eine Mutter in der Forschungsgruppe den Verlust eines kleinen Kindes vor der Geburt ihres nächsten Babys erlebte.     

The relevance of the Oedipus myth to fostered and adopted children

The paper makes a conceptual distinction between aggressive phantasies and acts against the object and a destructive form of potentially objectless violence resulting from attacks on the mental capacity for linking terms of –K. In thinking about the issue of the internal states leading to mindless destructiveness, the author suggests that such behaviour may result from active envious attacks on the capacity for linking, but that, in some cases, early trauma may result in a more passive breakdown of the human disposition for creating emotional mental links. The discussion of the clinical history of a destructive latency child who was born at six months of gestational age connects the traumatic beginning of his life with his violent behaviour.     

On childhood stuttering and the theory of clinging

In the treatment of stuttering I use the same therapeutic approach as with any other neurotic condition. I do not attempt to deal directly with the symptom, but try to make use of the child’s repetitive play to bring the damaging experience to the surface and to understand the underlying connections. This may, in part, be interpreted to the child. Difficulties to do with the need for an object (‘clinging’) are central. These are generally resolved spontaneously in a therapeutic relationship which offers security. Other problems, which manifest themselves in the negative transference, can be interpreted. Where the stuttering is long established and convulsive, it is not enough to understand the underlying dynamics. The child needs also to have repeated experience of spontaneous relaxation, e.g. in the course of joyful manual activity which can become a behaviour pattern (internalized). An important part of the therapeutic task is to deal with and relieve the anxiety of the mother. When the child has been stuttering for a time, a vicious circle can develop where the child’s stuttering induces anxiety in the mother and mother’s anxiety increases the child’s tendency to stutter. Case histories are used to illustrate the theme.     

Dying to live: mourning,melancholia and the adolescent process

The author reviews the main points in Freud's 1917 paper 'Mourning and Melancholia' and relates them to the process of both normal and troubled adolescent development. Using clinical examples she illustrates the ways in which the processes Freud describes in melancholia operate in some disturbed adolescents such that instead of mourning the lost objects of their childhood, they become stuck, remaining ambivalently attached to them and incorporating them into their final adult identity and sexual organization.

L'auteur passe en revue les points essentiels du texte de Freud « Deuil et mélancolie » (1917e [1915]) et les relie aux processus du développement, normal et pathologique, de l'adolescence. À l'aide d'exemples cliniques, il illustre la manière dont les processus décrits par Freud dans la mélancolie sont mis en ?uvre chez certains adolescents perturbés?:?au lieu de faire le deuil des objets perdus de leur enfance, ils restent bloqués dans l'ambivalence de leur attachement À ceux-ci et s'efforcent de les incorporer dans leur identité adulte et leur organisation sexuelle finale.

L'autrice passa in rassegna i punti principali dell'articolo del 1917 di Freud 'Lutto e melanconia' e li mette in relazione al processo dello sviluppo adolescenziale sia normale che disturbato. Utilizzando esempi clinici l'autrice illustra i modi in cui i processi che Freud descrive nella melanconia operano in alcuni adolescenti disturbati cosi' che invece del lutto per la perdita degli oggetti dell'infanzia, gli adolescenti rimangono incastrati e ambivalentemente attaccatti ad essi, incorporandoli nella loro identita' adulta finale e nell'organizzazione sessuale.

Die Autorin rezensiert die Hauptpunkte in Freud's Abhandlung ' Trauer und Melancholie' und bezieht sie auf den Prozess sowohl der normalen als auch der gestörten adoleszenten Entwicklung. Anhand von klinischen Beispielen illustriert sie die Art und Weise, in denen die Prozesse, die Freud in der Melancholie beschreibt, in einigen gestörten Jugendlichen operieren, so dass sie anstatt die verlorenen Objekte ihrer Kindheit zu betrauern, sie festgefahren sind und ambivalent an sie gebunden bleiben und sie letztlich in ihre Erwachsenenidentität und sexuelle Organisation inkorporieren.     

When a Picasso is a “Picasso”: The entry point in the identification of visual art

We investigated whether art is distinguished from other real world objects in human cognition, in that art allows for a special memorial representation and identification based on artists’ specific stylistic appearances. Testing art-experienced viewers, converging empirical evidence from three experiments, which have proved sensitive to addressing the question of initial object recognition, suggest that identification of visual art is at the subordinate level of the producing artist. Specifically, in a free naming task it was found that art-objects as opposed to non-art-objects were most frequently named with subordinate level categories, with the artist’s name as the most frequent category (Experiment 1). In a category-verification task (Experiment 2), art-objects were recognized faster than non-art-objects on the subordinate level with the artist’s name. In a conceptual priming task, subordinate primes of artists’ names facilitated matching responses to art-objects but subordinate primes did not facilitate responses to non-art-objects (Experiment 3). Collectively, these results suggest that the artist’s name has a special status in the memorial representation of visual art and serves as a predominant entry point in recognition in art perception.