Out in the midday Sun: Risk behaviour and optimistic beliefs among residents and visitors on tenerife

Abstract

A questionnaire was distributed to 107 local residents on a beach on the island of Tenerife and to 108 visitors from Britain and continental Europe. Measures included perceived danger of sun exposure. environmental concern. value of a suntan, optimism regarding personal risk of skin damage relative to others of one's age and gender, amount of midday sun exposure, sunscreen use and skin type. Use of sunscreen protection was greatly below recommended levels, though higher for women (N = 103). Among visitors, the British (N = 54) showed the riskiest behaviour. Relationship between behaviour. beliefs and background variables varied between groups. Overall there was a significant optimistic bias. This was stronger for the British, and for men. The relationships between optimism and other measures varied between the different national groups. In particular, among the British. greater optimism was associated with placing a higher value on a suntan, with having a more sensitive skin type, with using less adequate sunscreen protection, and with spending a (nonsignificantly) greater proportion of time exposed to the sun in the middle of the day. Among locals and visitors from continental Europe, optimism was associated with less midday exposure. It is concluded that these data offer evidence for two complementary interpretations of the relationship between optimism and health behaviour. On the one hand, those who perceive themselves to be at greater risk may be motivated to take more precautions. while risk-taking may be greater among those regard themselves as less vulnerable. On the other hand. those who take more precautions may infer that their own relative risk is lower. It is argued that research should not assume a single process relating perceived risk to behaviour, but consider factors that might predict the relative importance of alternative processes.     

Post-traumatic stress symptoms in mothers of children with leukaemia undergoing the first 12 months of therapy: Predictive models

The aim of this study consists in the measurement of psychological health and adaptation in mothers of children during the first 12 months of treatment for leukaemia and in the identification of possible early predictors. Ninety-four mothers were followed longitudinally at one week (T1), one month (T2), six months (T3) and 12 months (T4) post-diagnosis. The instruments used were: PTSD symptom checklist, BSI-18, Problem Scale, Ladder of life and an in-depth interview (EFI-C). Couple connectedness, family routine reorganisation, parental communication around the child's illness and trust in the medical care significantly increased from T1 to T4. Two models are proposed concerning possible predictors of mothers’ PTSS at T2 and at T3. Clinical suggestions are proposed on the basis of our empirical findings in order to plan informative, clinical and practical interventions for mothers of children under treatment for leukaemia.     

Diagnosis and treatment of respiratory tract infections in primary health care by the nurse versus the physician: Efficacy and patient attitudes

Abstract

Five district physicians and one registered nurse were compared regarding their effectiveness in diagnosing and treating acute upper respiratory tract infections in patients (n=186) at a Swedish community health centre. Attitudes and views of the patient, or of the accompanying adult when the patient was a child, regarding the consultation itself, as well as more general aspects of health care were investigated (n=99) using a questionnaire. The questionnaire included 42 propositions of a “fuzzy” type to be judged on a 100-point truth-value scale, 18 of them concerning the consultation and 24 the more general aspects. No differences between the physicians and the nurse were found in their efficacy of diagosis and treatment. Subjects' overall attitudes were found to be positive toward both the physicians and the nurse. Results of multivariate analyses of variance performed for the consultation and general aspects of health care items separately and concerning type of persons providing health care (physician/nurse), treatment (antibiotics/no antibiotics) and patient age (child/adult), revealed overall differences in questionnaire response as regards patient age in relation to the consultation items.     

Delays in seeking cancer diagnosis in relation to beliefs about the curability of cancer in patients with different disease locations

This study is aimed at investigating factors leading to delayed oncologic examinations versus immediate consultation with a physician in patients with various cancers. We analysed the results of a study of patients (n?=?291) reporting for their first oncologic examinations. We conducted structured interviews containing social, demographic and clinical data, the Spielberger State-Trait Anxiety Inventory, the Beck Depression Inventory and Harris and Guten's health appraisal scores. Based on an analysis of decision-making trees, the results indicate that it is possible to predict beliefs regarding the curability of cancer and immediate versus delayed reporting to a physician. Delayed reports may be predicted on the basis of two factors: (1) a belief that cancer is incurable combined with increased state anxiety, ‘good’ or ‘very good’ self-appraisal of health and low depression; and (2) a belief that cancer is incurable accompanied by increased anxiety and depression. The characteristics of patients delaying a visit to the oncologist suggest the existence of three independent factors leading to both considerable (longer than nine months) and minor (up to one month) delays in seeking treatment.     

Sun protection behaviour of children and their parents at the beach

Abstract

The present study observed the sun protection behaviour of 8–12 year old children and their parents on the beach. Interviews with children and parents were then conducted to examine possible influences on sun protection and the relationship between observed and self reported behaviour.

The sample consisted of 50 children and 68 parents. All 50 children were observed and interviewed. All the parents were observed and 33 were interviewed. Indices of sun protection cover were computed as a sum of clothing and sunscreen cover. Most parents and children were inadequately covered against the sun. Factors related to children's sun protection included parent's cover and the child's tan level. The relationship between attitude to sun protection and observed behaviour could not be examined as all children and parents indicated they thought it was important to protect their skin against the sun.

Inconsistencies between observed and self-reported sun protection were found for children who were not protecting themselves. The possibility that self-report may overestimate actual protective behaviour is discussed.     

Lifestyle differences between smokers,ex-smokers and non-smokers,and implications for their health

Abstract

Much evidence has been published in order to demonstrate that smoking cessation leads to a decrease in morbidity and mortality. Using data from the Health and Lifestyle Survey respondents were divided into three groups: smokers, ex-smokers and non-smokers and lifestyle characteristics such as diet and exercise were compared. Smokers were more likely to eat chips (French fries), fried food, butter and less likely to eat fresh fruit in winter, green vegetables and margarine high in polyunsaturated fats. Non-smokers were more likely than smokers and ex-smokers to take part in keepfit, jogging and swimming. Non-smokers in smoking households were more likely than non-smokers in non-smoking households to eat fried food, chips and butter and less likely to eat fruit in winter or margarine high in polyunsaturated fats. Results suggest that part of the assumed health benefits of smoking cessation are due to ex-smokers having a healthier diet than that of smokers.     

‘Use what God has given me’: Difference and disparity in breast reconstruction

African-American women are significantly less likely to undergo postmastectomy breast reconstruction compared to white women in the USA. These observed differences have been interpreted as evidence of a healthcare disparity. The current study examines breast reconstruction decision-making among African-American women, locating reconstruction decisions in a context of culture, racial inequality and biomedicalisation. Semi-structured interviews were conducted with 27 African-American women who underwent mastectomy for breast cancer to add patient-centred perspectives to existing conceptualisations of racial/ethnic differences in reconstruction. Participants were socio-demographically diverse, and resided in the New York metropolitan area. Data analysis was informed by grounded theory. Spiritually and culturally informed body ethics often guided surgery decisions. Participants expressed reservations about breast implants, preferring autologous procedures that use ‘what God has given’. For some, breast reconstruction restored a sense of normalcy after cancer; others challenged an imperative to reconstruct. Several participants redirected our focus on access to reconstruction toward access to alternatives, noting the low reimbursement for prostheses, or their unavailability in patients’ skin tones. We suggest that a framework of ‘stratified biomedicalization’ better addresses the complexities of race, class and gender that inform preference, access and recommendations for breast reconstruction, and focuses attention on access to high and low-tech interventions.     

The regulation of subjective well-being in cancer patients: An analysis of coping effectiveness

Abstract

The hypothesis that individual coping efforts affect subjective well-being in the face of severe chronic disease is examined with questionnaire data from N=332 cancer patients in a one-year longitudinal study. After depicting conceptual and methodological requirements for the analysis of coping effectiveness, the following five coping modes were investigated in the sample: Rumination, search for affiliation, threat minimization, search for information and search for meaning in religion. Results from a series of hierarchical regression analyses yielded findings that questioned the underlying assumption of a general uniform causal direction within coping-adjustment relationships. Threat minimization proved to be the only coping mode that obviously was “effective” in well-being regulation, that is, was revealed to be predictive of well-being changes over time and to be unaffected by prior levels of well-being. It is argued that the problem of causal directionality has to be carefully examined in future studies on coping effectiveness since interindividual differences in coping behaviors might be a consequence rather than the cause of differences in adjustment status.     

Risk-appraisal,outcome and self-efficacy expectancies: Cognitive factors in preventive behaviour related to cancer

Abstract

Health education often attempts to influence or persuade through risk-appraisal of impending danger or harm. Risk: appraisal implies cognitive processes concerning the severity of the threatening event and the probability of its occurrence. In two studies we investigated whether risk factors could adequately predict preventive behaviour with respect to cancer. The tint study concerned the health belief model. the second study the protection motivation theory. Protection motivation theory includes the health belief factors but also self-efficacy expectancy. The most important finding is that risk-appraisal does not predict preventive behaviour adequately: outcome expectancy and self-efficacy expectancy should be included in the prediction of preventive behaviour. In general, our findings suggest the superiority of the protection motivation theory to the health belief model in predicting preventive behaviour with respect to cancer.     

End notes: two unpublished presentations by Michael Fordham

Following the publication in this journal of two of Fordham's unpublished papers selected by James Astor (2010, 55, 5), the editors have asked me to select a further two. I have chosen two clinical pieces, one clinical notes and the other notes that refine his previous thinking, which Fordham wrote at the end of his life. Both are examples of the way Fordham continued throughout his analytic work to turn to patients as his primary source of learning. Fordham presented the first piece, ‘A case study’, to Parkside Clinic in 1988. Its subject is his last child patient, a nine‐year‐old boy with behaviour problems that destroyed the analytic frame. The second is clearly for an SAP (Society of Analytical Psychology) audience and written probably around 1992–93. It is titled ‘Some comments on transference and countertransference’ and contains material from the patient who has become known through papers in this journal as ‘K’. The two pieces are presented together within a commentary rather than separately with footnotes, in order to provide some context for Fordham's thinking in his late years.