Staff survey results and characteristics that predict assault and injury to personnel working in mental health facilities

The purpose of this study was to complete a mental health staff opinion survey to identify patient and staff characteristics associated with staff assault and injury in psychiatric treatment settings and to develop a model of prediction for staff assault and injury utilizing these survey variables. The data consisted of opinion surveys sent to staff of 15 child, adolescent, and adult psychiatry inpatient units in the United States. Multivariate logistic regression was used to determine the level of assault and staff‐reported injury prediction that could be obtained from the staff‐completed opinion survey. Responses indicated a high prevalence of reported aggression, with 62.3% of staff endorsing verbal and physical aggression, property destruction, and self‐injurious behavior as being prevalent at their site, whereas only 4.1% rated none of these as prevalent. Staff working with children and adolescents in settings with high rates of psychiatric diagnoses reported increased frequency of assault and injury compared with those working with adults. Younger, less experienced staff reported higher rates of assault and injury. Staff working with female patients reported similar rates of assault and injury to those working with males. A logistic regression analysis using staff‐reported survey results of both staff and patient characteristics predicted assault correctly 73.7% of the time and injury 66.1% of the time. Resources for violence prevention and staff training programs in violence prevention are needed in child and adolescent psychiatry wards. Results are consistent with theories emphasizing the importance of negative emotions and affects, impulsivity, and frustration in goal‐directed activities in human aggression. Aggr. Behav. 29:31–40, 2003. © 2003 Wiley‐Liss, Inc.     

Do beliefs about aggression predict physical aggression to partners?

Three hypotheses concerning the association between instrumental (I) and expressive (E) beliefs about aggression and physical aggression were assessed among a sample comprising students (n=40), women from a domestic violence shelter (n=29), and male prisoners (n=46), all of whom had committed at least one act of physical aggression to a partner. Participants completed an adapted version of the EXPAGG [Archer and Haigh (1997a): British Journal of Social Psychology 35:1–23] to measure I and E beliefs about aggression, the Conflict Tactics Scale (CTS) [Straus (1979): Journal of Marriage and the Family 41:75–88] for themselves and their partner, and measures of fear and injuries resulting from partner violence. I beliefs predicted self‐reported physical aggression to the partner, most CTS acts of physical aggression, and injuries to the partner, with only minor and limited associations for E beliefs. Correlations for the student and prisoner samples, and for men and women, showed different strengths. The findings supported a general link between I beliefs and aggression but offered no support for the predictions that the link would be restricted to men or to men who showed a persistent pattern of violence to their partners. Aggr. Behav. 29:41–54, 2003. © 2003 Wiley‐Liss, Inc.     

Validation of the Multidimensional Blood/Injury Phobia Inventory: Evidence for a Unitary Construct

The Multidimensional Blood/Injury Phobia Inventory (MBPI) was developed from a theoretical framework to characterize a broad range of feared stimuli and phobic reactions associated with this pathology. The MBPI consists of 40 items that cross 4 types of stimulus content (injections, hospitals, blood, injury), 5 types of phobic responses (fear, avoidance, worry, fainting, disgust), and a self versus other focus. This study reports on administration of the MBPI to 558 undergraduates, 9 of whom had blood/injury phobia. The instrument had a Cronbach's alpha of .91 and demonstrated good concurrent validity, convergent validity, and discriminant validity. One large factor emerged in an unrotated principal components analysis, suggesting that blood/injury phobia is a unitary psychometric construct. Exploratory factor analyses revealed a 6-factor solution defined by stimulus content domains and fainting, each of which may be important to consider clinically when assessing the unique concerns of treatment-seeking individuals.     

Neurocognitive outcomes following pediatric brain injury: A developmental approach

Developmental neuropsychologists postulate that “immaturity” of the cerebral cortex should no longer be perceived as a protective factor. They argue that injury to the young brain may affect new learning by disrupting the skills in the midst of being acquired and skills that are yet to be developed. Cognitive deficits or weaknesses that are not detectable in the acute phase following a traumatic brain injury (TBI) may emerge over development as more complex skills are needed, thereby creating a developmental lag between children who sustained a pediatric TBI and typical age peers. This literature review was conducted to evaluate the developmental perspective on neurocognitive recovery/development following a TBI. Overall, the described findings support a developmental view and suggest that predictions of prognosis should be based on the child's remaining ability to learn.     

Psychological Variables Associated with Pain Perceptions Among Individuals with Chronic Spinal Cord Injury Pain

Structural equation modeling was used to examine the relationships between selected psychological variables and pain perceptions in 103 individuals experiencing chronic pain following traumatic spinal cord injury (SCI). Previous studies have suggested strong relationships between psychological variables and chronic SCI pain, but further delineation of such relationships is needed in order ultimately to develop more effective pain management strategies for individuals afflicted with such pain. Anger was found to be significantly related to perceptions of pain (p < .05), but neither guilt nor anger suppression was significantly associated with perceived pain. Internal health locus of control was associated with decreased pain perceptions (p < .05), but there was no significant relationship between internal health locus of control and anger. Punishing responses from significant others to pain complaints were related to feelings of guilt (p < .05) and perceived pain (p < .05), but this relationship was not mediated by guilt.     

Brain Oxidative Damage Following Acute Immobilization and Mild Emotional Stress

We studied the role of free radicals on brain oxidative damage in rats after acute immobilization stress (restraint) and mild emotional stress (handling). To investigate brain oxidative damage, CuZn and Mn dependent superoxide dismutase (CuZn SOD, Mn SOD) activities, lipid peroxidation (TBARs), Na ⁺ K ⁺ ATPase activity, protein carbonyl (PrC), and reduced and oxidized glutathione (GSH, GSSG) levels were measured in the cerebral cortex (CTX), hippocampus (HIP), and striatum (ST) of the animals after the two different stress stimuli. Because stress produces abnormalities in the hypothalamic-pituitary-adrenal axis, the intensity of the two stress conditions were measured by plasmatic corticosteroid (COR) levels: particularly, COR levels doubled in handled rats and increased 15-fold in restrained animals. The SOD activities increased in CTX and decreased in HIP of the handled rats, while in ST a significant decrease in handled animals but an increase in restrained animals occurred. TBARs, GSH, and GSSG levels remained unchanged, while an index of glutathione redox decreased significantly in ST of handled animals and in CTX of restrained ones. Na ⁺ K ⁺ ATPase activity increased significantly in the HIP and ST of both groups of stressed rats. The stress induced a remarkable increase in PrC levels in all studied cerebral areas. These findings provide evidence to support the idea that stress produces oxidants but that the oxidative damage in stress differs in cerebral areas and could contribute to the degenerative mechanism of aging.     

The effects of sport dance on brain connectivity and body intelligence

Dancing is characterised by physical movement in accordance with rhythm perception. Twelve sport dancers and 12 age- and sex-matched young adults who had no dance experience (control group) were recruited. Body intelligence and brain activity were assessed in both groups using the Body Intelligence Scale (BIS) and resting state functional magnetic resonance imaging. BIS scores of dancers were higher than those of control subjects. The dancer group showed increased functional connectivity from the precentral gyrus to the right cingulate gyrus, right occipital fusiform gyrus, right inferior frontal gyrus, right medial frontal gyrus, left inferior frontal gyrus, right parietal postcentral gyrus, and right frontal lobe compared with control subjects. Sport dancers had increased body intelligence sensitivity compared with matched controls. In addition, the characteristics of dance, including physical movement in accordance with rhythm perception, might be associated with increased brain activity in the somatosensory and rhythm perception networks.     

Tool use in left brain damage and Alzheimer's disease: What about function and manipulation knowledge?

Tool use disorders are usually associated with difficulties in retrieving function and manipulation knowledge. Here, we investigate tool use (Real Tool Use, RTU), function (Functional Association, FA) and manipulation knowledge (Gesture Recognition, GR) in 17 left‐brain‐damaged (LBD) patients and 14 AD patients (Alzheimer disease). LBD group exhibited predicted deficit on RTU but not on FA and GR while AD patients showed deficits on GR and FA with preserved tool use skills. These findings question the role played by function and manipulation knowledge in actual tool use.     

脑死与放弃治疗

符合医学标准又为亲属认定已死亡者,理应放弃治疗;符合脑死亡标准,应说服亲属同意作放弃治疗决策;对已确无救治希望,或虽经抢救治疗必然发生植物生存状态的极重病例,或已是植物生存状态者,也应作出放弃治疗的决策,除遵循医学原则和生命的价值、伦理原则外,要充分尊重病重的意志。放弃治疗的决策还应考虑到亲属的心理承受问题。