A three city comparison of the public's knowledge and attitudes about AIDS

A survey of knowledge, beliefs and attitudes about AIDS was administered simultaneously in San Francisco, New York and London to a total of 399 persons. The aim was to investigate how such knowledge and attitudes may he influenced by social and cultural contexts, as well as by disease epidemiology. Across all samples of the general public (excluding risk group members) in the three cities, general fear of AIDS and anti-gay attitudes were significantly negatively correlated with knowledge about AIDS. In the London sample, general fear of AIDS and anti-gay attitudes were significantly and positively associated with both sexual and general health behavior change. Only sexual behavior change, however, was significantly correlated with general fear of AIDS and anti-gay variables for the New York sample. Neither of these variables was significantly associated with behavior change of any kind in the San Francisco sample. We accounted for these inter-city differences by proposing a four-stage model of public response to an epidemic over time. Our data support the need for specific programs aimed at the general public that take into account sociocultural and AIDS epidemiologic differences across different sociocultural contexts.     

Anticipatory nausea and vomiting among cancer patients: A Review

Abstract

Anticipatory nausea and vomiting (ANV), as a side-effect of cancer chemotherapy, is a well recognized phenomenon. The literature is reviewed for data on: prevalence rates, factors contributing to onset and psychological treatments used to attempt a remission in the symptoms. From the available evidence it appears that ANV is a substantial problem with one major review indicating an average combined prevalence of 32%. Although explicable using a conditioning model it has a complex aetiology with emotional and cognitive elements, as well as specific pharmacological factors, playing a role in onset. ANV appears to be responsive to psychologically-based treatment methods, with a good outcome overall. However, more process evaluation is needed in order to understand aetiologic and treatment mechanisms and to determine how best to treat cases of ANV with different aetiologies. It is considered that procedures for identifying and referring patients with ANV should be routinely incorporated into the care of cancer patients receiving repeated cycles of chemotherapy.     

Encouraging patient participation in general practice consultations: Effect on consultation length and content,patient satisfaction and health

Abstract

Following the evidence from earlier research that one-to-one interventions can increase the patient's contribution to the consultation, this paper reports the results from a randomised control trial which assessed the effects of a leaflet designed to enhance patient participation in consultations. A random sample of patients (aged 16 to 74) waiting to see a general practitioner were given either an intervention leaflet, which encouraged the patient to take an active role in the consultation, or a control leaflet which gave dietary advice. The effects of the intervention were assessed by measuring length of consultation, number of questions asked by the patient, patient satisfaction score, doctor's feelings about the consultation, the change in patients' health in the 4 weeks following the consultation (measured by the SF-36 Health Survey) and the number of patient visits to a GP in the following year. The results showed that patients in the intervention group had significantly longer consultations than those in the control group and tended to ask more questions but there was no significant effect on patient satisfaction. The doctor tended to feel that he had a better understanding of patients in the intervention group. Overall there was no significant effect on SF-36 scores but, for patients under the age of 40, and for those in higher social classes the scores of patients in the intervention group improved to a significantly greater degree than did those for the control group. The intervention did not have any effect on the number of GP visits made by patients in the subsequent year. The study results show that a relatively simple leaflet can have an impact on patients' behaviour during the consultation, even though there were no effects on patient satisfaction with the consultation or in the number of GP visits in the following year.     

Multiple identities and career development of GLB immigrants

There has been increasing interest in the study of career development and career counselling for the gay men, lesbian women and bisexual (GLB) people given the clear link between sexual orientation and career development in the past two decades. Yet, there is still a relatively dearth of literature in this area, especially, much is unknown about the career identity and other related identity development experiences of GLB immigrant adults whose acculturation process intersects with cultural identity, race and ethnicity and sexual identity as they rebuild their careers in the host country. This article aims to explore the connections between multiple cultural identities and their affect on career development. It builds upon the current literature, uses some career development theories, and proposes career development and career counselling interventions for the target group.     

MILL'S ARGUMENT FOR OTHER MINDS

Montesquieu's Considérations sur les causes de la grandeur des Romains et de leur décadence (1733/1734) is a methodological exercise in causal explanation on the meso-level applied to the subject of the military rise and fall of Rome. Rome is described as a system with contingent initial conditions that have a strong path-determining effect. Contingent and plastic initial configurations become highly determining in their subsequent operation, thanks to self-reinforcing feedback loops. Montesquieu's method seems influenced by the ruthless commitment to efficient causality and the reductionism of seventeenth-century mechanicist philosophy; but in contrast to these predecessors, he is more interested in dynamic processes than in unchangeable substances, and his use of efficient causality in the context of a system approach implies a form of holism that is lacking in his predecessors. The formal and conceptual analysis in this article is in many ways complementary with Paul Rahe's recent predominantly political analysis of the Considérations. At the same time, this article points to a problem in the works on the Enlightenment by Jonathan Israel: his account stresses a one-dimensional continuum consisting of Radical, Moderate and Counter-Enlightenment. This invites Israel to place the combined religious, political and philosophical views of each thinker on one of these three points. His scheme runs into trouble when a thinker with moderate religious and political views produces radical philosophical concepts. Montesquieu's Considérations is a case in point.     

Patterns of extreme responses to items in self-esteem scales: Does conceptualisation and item content matter?

Self-esteem (SE) scales are particularly susceptible for various response-sets. Systematic response alterations, often mirroring self-presentational item characteristics, can be triggered differentially depending on the content of items in a scale. The present study examined extreme responding to items in the global SE scale (Rosenberg, 1965) and the basic SE scale (Forsman & Johnson, 1996). The results showed that global SE scores were determined to a higher extent by extreme responses, in particular rejecting negative item content, than basic self-esteem scores. The implications of self-presentation contra self-esteem for an asymmetry in response patterns between the two scales are discussed.     

Chaos,creativity, and counseling: Aspects of a Transtheoretical model of the counseling process

Counselors ask their clients to become creative in their personal lives and within their counseling process. The process of counseling is a creative process. Growth is necessary for effective improvement in the counseling process. This paper will examine creativity from the point of view of the affective experience of the creator, and the relationship of this experience to the client in counseling.

The position here is that the process of counseling is both a creative process and one that involves tensions and turbulence. Based on a model of nonlinear dynamics, and ideas about the creative process, this study draws a dynamical fractal movie of the counseling process in which the counselor serves as an attractor for the construction of opposites in the client behavior that allow for growth and the construction of a new state of psychosocial events.     

Childhood abuse and vulnerability to depression: Cognitive scars in otherwise healthy young adults

Models of depression vulnerability posit that negative early experiences, such as exposure to childhood abuse (CA), increase vulnerability to depression later in life. Though most victims of CA do not go on to develop depression, the question remains as to whether these individuals retain cognitive ‘scars’ that may contribute to depression vulnerability. The present study examined the relationship between self-reported, retrospective CA and cognitive vulnerability to depression in a carefully selected sample of young adults without current or past psychopathology. We measured cognitive vulnerability with both a self-report questionnaire, the Dysfunctional Attitudes Scale (DAS), and a measure of information processing bias, the Scrambled Sentences Test (SST). Self-reported severity of CA was associated with increased cognitive vulnerability to depression on both the DAS and SST. Vulnerability to depression as measured by the SST, but not by the DAS, prospectively predicted increases in depressive symptoms over a 6-month period. Scores on the SST also interacted with CA to predict increases in depressive symptoms. These findings demonstrate the pernicious effects of CA even in those without current or past psychopathology.     

Survival

This article describes the trauma and subsequent struggle of surviving a serious car accident. It deals with the physical efforts to keep me alive as well as the emotional impact and suffering. I was an "active sixty-three" when my life changed drastically. The car I drove en route to a vacation unexplainedly swerved, landed in a ditch and rolled over. I became QUADRIPLEGIC in one instant-paralyzed from the neck down, permanently confined to a wheelchair. I spend several unforgettable months in a Florida hospital, hooked up to life supports, hovering between life and death. I was then flown to New York for rehabilitation. A devoted medical team and supportive family taught be to become somewhat independent with the help of high-tech equipment, preparing me to face the world as a "QUAD." Six years have passed and I still mourn my "body beautiful," but I have accepted my limitations and found new challenges in life.