Obsessive-compulsive disorder. The effect of research on nursing care

The purpose of research is the expansion of knowledge. Research with greatest impact on the discipline is that which expands knowledge to enable the provision of effective care. Nursing, as an applied science, responds to changes in the knowledge base with concomitant changes in the application of the nursing process. OCD is an example of an expansion in knowledge after a history of care based on a limited understanding of the etiology of the disorder. The impact on the nursing care of the client with OCD includes the importance of careful assessment with attention to behaviors, feelings, and cognitions. The implementation of nursing actions is guided by a focus on the present and includes physical and emotional support provided for needs created by both the symptoms of OCD and the accompanying symptoms of anxiety and depression, as well as client education regarding OCD and the safe use of clomipramine when it is prescribed.     

Understanding and assessing adverse drug reactions

Establishing causality between a medication exposure and the development of an adverse event (AE) is a difficult process. If a causal relationship can be confirmed, an AE is referred to as an adverse drug reaction (ADR). The reported signs or symptoms of an AE could be due to the drug, the underlying disorder, or other unrelated or concurrent factors. The conventional approach to defining ADRs is based on a clinical judgment that the link between drug exposure and AE is definite, probable, possible, or doubtful. The validity and reliability of this assessment varies according to the knowledge, background, and experience of the clinician making the assessment. A systematic and validated method for estimating the probability of an ADR has been described by Naranjo et al. This method solicits answers to 10 questions; the total score is then used to quantify the probability of an ADR.     

Parental mental health and child protection—making the links through training

This article refers to the impact on single discipline working on professional understanding of mental disorder, particularly as it relates to child protection. The dilemmas of bringing a multi‐agency group with diverse experiences and knowledge base together into one training event are considered, with suggestions as to how the difficulty might be addressed. Topics of common concern are identified and training techniques and methods described. The benefits and outcomes of joint training across disciplines and agencies is acknowledged in relation to child protection and parental mental disorder Copyright © 2003 John Wiley & Sons, Ltd.     

Schizophrenia and genomics: linking research to practice

New knowledge about genetics and genomics is emerging at a rapid pace. This article discusses how this emerging knowledge related to schizophrenia affects the nursing care of patients with the disorder. Newly defined competencies related to genetics are also addressed. The relevance of this knowledge and the application of the competencies are demonstrated in an individual example.     

Cultural aspects of bipolar disorder: Interpersonal meaning for clients & psychiatric nurses

Bipolar disorder is a complicated mental illness to diagnose and treat. The symptoms of the disorder cause a multitude of fluctuations in mood and behavior, affecting the way individuals function and interact with others on a daily basis. Individuals diagnosed with bipolar disorder experience symptoms within a framework that is grounded in their cultural beliefs, values, and norms. Culture is a complex and personal biopsychosocial phenomenon that provides meaning within life for an individual, a group, or a community. It is essential that psychiatric-mental health (PMH) nurses understand the role of culture and integrate this knowledge into the biopsychosocial care of clients. The development and maintenance of the interpersonal therapeutic relationship between PMH nurses and their clients requires the use of a cultural framework, which refers to the connection of culture and cultural competence. The purposes of this article are to define culture and the process of cultural competence, provide a brief overview of bipolar disorder, propose the use of a cultural framework for bipolar disorder, and discuss the implications for PMH nurses who care for culturally and ethnically diverse clients.     

Peritraumatic Tonic Immobility and Trauma-Related Symptoms in Adult Survivors of Childhood Sexual Abuse: The Role of Posttrauma Cognitions

Tonic immobility is a set of involuntary motor responses elicited under conditions of extreme fear and perceived inescapability, and it is one type of peritraumatic distress reported by survivors of child sexual abuse. Experiencing tonic immobility during child sexual abuse is associated with increased risk for developing symptoms of post-traumatic stress disorder, although less is known about relations between tonic immobility and other established risk factors for post-traumatic stress disorder. We investigated posttraumatic cognitions as a potential mediator of the relations between peritraumatic fear, perceptions of inescapability, tonic immobility, and post-traumatic stress disorder symptoms. Specifically, we tested posttraumatic negative beliefs about the self, the world, and self-blame as pathways that might increase risk for post-traumatic stress disorder symptoms in child sexual abuse survivors who had experienced tonic immobility. Forty-six women with a history of unwanted childhood sexual contact completed questionnaires measuring peritraumatic tonic immobility, posttraumatic cognitions, and current posttraumatic stress symptoms. Negative beliefs about the self independently mediated the relation between peritraumatic perceptions of inescapability and post-traumatic stress disorder symptoms, but the data did not support similar path model for the physical symptoms of tonic immobility and post-traumatic stress disorder. We discuss ways in which treatment of survivors and future research on CSA can benefit from attention to the impact of peritraumatic distress on posttraumatic beliefs.     

Parental knowledge trajectory and its relationships with parental warmth and adolescent disclosure for Korean adolescents

The purpose of this study was to expand the knowledge base on parental knowledge by assessing a developmental trajectory and factors that might predict parental knowledge among Korean adolescents. To address this purpose, the current study assessed changes in parental knowledge during the transition to adolescence using hierarchical linear modeling (HLM). In addition, parental warmth and adolescent disclosure were considered as time-variant predictors of knowledge. The data from Korea Youth Panel Survey (KYPS) of Grade 4 students who were followed for five years was analyzed. The results indicated that there was a significant average increase followed by a slight decrease in parental knowledge over time; that is, the data followed a quadratic trend. Controlling for gender and family structure, the study found that parental warmth and adolescent disclosure had significant effects on parental knowledge over time. The study's results suggest that parental warmth and adolescent disclosure are important elements to be emphasized in prevention and intervention programs that promote parental knowledge.     

Factors Associated With Substance Use Disorders Among Traumatized Homeless Youth

This study aimed to identify homeless youths’ lifestyle and trauma-related risk factors as well as protective factors associated with alcohol use disorder or no disorder and drug use disorder or no disorder. Youth receiving homeless services in Denver (n = 201), Austin (n = 200), and Los Angeles (n = 200; N = 601) completed quantitative interviews assessing demographic information, alcohol and drug use, homeless lifestyle risk factors, trauma-related risk factors, and protective factors. Findings showed differences in trauma-related risk factors between alcohol and drug use disorders, but not homeless lifestyle risks. Protective factors predicted substance use disorders beyond risk factors. Understanding trauma-related risk and protective factors associated with substance use disorders could improve interventions.     

Genito-Pelvic Pain Through a Dyadic Lens: Moving Toward an Interpersonal Emotion Regulation Model of Women’s Sexual Dysfunction

Researchers and clinicians alike widely acknowledge the inherently interpersonal nature of women’s sexual dysfunctions given that both partners impact and are impacted by these difficulties. Yet theoretical models for understanding the role of interpersonal factors in women’s sexual dysfunctions are severely lacking and have the potential to guide future research and inform more effective interventions. The most widely studied sexual dysfunction in women that has espoused a dyadic approach by including both members of affected couples is genito-pelvic pain/penetration disorder (GPPPD). In this article we use the example of GPPPD to introduce a novel interpersonal emotion regulation model of women’s sexual dysfunction. We first review current knowledge regarding distal and proximal interpersonal factors in GPPPD. Then, we describe our theoretical model and consider relevant pain and sex-related research on emotion regulation processes—emotional awareness, expression, and experience—in the context of GPPPD, including sexual function, satisfaction, and distress. Next, we review how existing theories from the fields of chronic pain and sex and relationships research have informed our model and how our model further builds on them. Finally, we discuss the implications of our model and its applications, including to other sexual dysfunctions in women.     

Exploring Posttraumatic Outcomes as a Function of Childhood Sexual Abuse

There is sparse systematic examination of the potential for growth as well as distress that may occur for some adult survivors of childhood sexual abuse. The presented study explored posttraumatic growth and its relationship with negative posttrauma outcomes within the specific population of survivors of childhood sexual abuse (N = 40). Results showed that 95% of the participants experienced clinically significant post-traumatic stress disorder symptomatology related to their childhood sexual abuse. In conjunction with these high levels of negative symptoms, the population evidenced posttraumatic growth levels that were comparable to other trauma samples. This research has clinical relevance in terms of adding to the knowledge base on sexual abuse and the usefulness of this knowledge in therapeutic interventions and relationships.     

Health disparities in military veterans with PTSD: influential sociocultural factors

Health disparities based on sociocultural factors such as gender, race and ethnicity, socioeconomic status, culture, and access to health care can potentially complicate the early diagnosis and effective management of posttraumatic stress disorder (PTSD). Research indicates that among those individuals affected by health disparities, there is a greater burden of illness and disability, higher morbidity and mortality rates, and increased behavioral risk factors. The purpose of this article is to highlight the sociocultural factors that affect the development of PTSD and to publicize health disparities in military combat veterans.     

How useful is the term "Cumulative Trauma Disorder"?

Cumulative trauma disorder is a widely accepted construct that refers to illnesses of the soft tissues which supposedly occur due to biomechanical workplace risk factors. However, is the term "cumulative trauma disorder" a useful term for describing the illness attributed to it? This paper will scrutinize this question by specifying the meaning of "cumulative trauma disorder" and examining this construct to see if the belief in it is justified, and if this belief is leading to the elucidation of the phenomenon it is purporting to notate. Anomalous findings will be identified and used to help evaluate the accuracy of the belief system currently surrounding the term. Finally the ability of the construct "cumulative trauma disorder" to provide an adequate foundation for research in this area will be explored. A model of alternate pathomechanisms for this illness is advanced to provide a method of studying the disorders associated with the term.     

Toward an Integrated Theoretical Model of Risk Factors for Post-Deployment PTSD and its Implications for Justice-Involved Veterans

At present, very little knowledge exists about individual differences in susceptibility to posttraumatic stress disorder (PTSD) after combat trauma. Two differing perspectives have emerged. Some researchers maintain that a distinct linear dose-response relationship exists between the severity of combat trauma and the later development of PTSD. Conversely, others have questioned whether differential exposure to combat alone is sufficient to explain differences in the prevalence of post-deployment PTSD. This debate has implications for military veteran offenders who suffer from PTSD. In this paper, I propose a cumulative stress model that posits that it is the particular combination of psychosocial factors and combat exposure that interact to predict the likelihood of developing and maintaining PTSD after deployment. Therefore, PTSD influences post-deployment offending and antisocial behavior through this mechanism. Finally, this paper will discuss implications for criminal justice policy and practice.     

Race,Substance Abuse,and Mental Health Disorders as Predictors of Juvenile Court Outcomes: Do They Vary By Gender?

Predicting juvenile court outcomes based on youthful offenders’ delinquency risk factors is important for the adolescent social work field as well as the juvenile justice system. Using a random sample of 341 delinquent youth from one Midwestern urban county, this study extends previous research by examining if race, substance abuse, and mental health disorders influence important delinquency outcomes (number of court offenses, felony conviction(s), probation supervision length, detention length, and number of probation services) differently for male and female juvenile offenders. Multivariate analysis findings revealed that race was significant only for males, and having a substance use disorder was a stronger predictor of delinquency outcomes for males; whereas, having a mental health disorder was a stronger predictor of delinquency outcomes for females. Implications for this research include the importance of early disorder identification and subsequent availability of gender-focused treatment.     

Practice guidelines: therapeutic interventions aimed at assisting people with bipolar affective disorder achieve their vocational goals

Based on a thorough review of literature and findings from an earlier study on what are the factors helping individuals with bipolar disorder to find and remain in employment, the practice guidelines are proposed to aim at assisting individuals affected by bipolar disorder or other persistent mental disorder achieve their vocational goals. The proposed guidelines emphasise an integrated approach to the employment problem, incorporating clinical, vocational training and employment services. The guidelines advocate quick job placements as opposed to prolonged pre-vocational assessment and training are preferable for people with bipolar disorder in view of their usual high educational achievements and vocational experiences prior to the onset of illness. When necessary, a graduated approach to immediate placement may be adopted. Interventions proposed in these guidelines involve working with an individual client, mobilising support from family, workmates, managers, advising the employers on provision of support systems within the actual workplace and liaising with government agencies to reinforce client's aspiration to work.     

Self-esteem,financial knowledge and financial behavior

Financial knowledge is an important but insufficient driver of responsible financial behavior. Having a positive evaluation of oneself may also be essential for individuals to initiate and persist with the daunting process of financial management. In this study, we distinguish subjective financial knowledge from objective financial knowledge, and we propose that self-esteem relates to financial behavior both directly as well as indirectly through subjective financial knowledge. Results based on a nationally representative dataset of U.S. adults suggest that self-esteem significantly relates to individual financial behavior after controlling for financial knowledge and other socioeconomic factors. The association between self-esteem and financial behavior could be both direct and indirect through subjective financial knowledge. These findings highlight the importance of psychological traits such as self-esteem in explaining financial behavior difference. Its implications are discussed.     

Evaluating social science and humanities knowledge production: an exploratory analysis of dynamics in science systems

Knowledge is gaining increasing importance in modern-day society as a factor of production and, ultimately, growth. This article explores the dynamics in university knowledge production and its effect on the state of university–industry–policy exchange in the Netherlands. Science systems are said to be in transformation. The university has evolved from performing conventional research and educational functions to serving as an innovation-promoting knowledge hub; dynamics that have received mixed reactions. The social sciences and humanities (SSH) take a special position, insofar as their focus seems primarily to be placed on conventional research and educational functions, and not directly on (commercial) valorization. Societal changes are, however, pressing for a reconsideration of the role of SSH. In our article, we distinguish between three important new movements that seem to be affecting SSH. It is believed that these movements, which are already having an impact today, will considerably influence SSH in the future. These developments are further differentiation, synthesis between the various subdisciplines of SSH and the natural sciences, and shifts in paradigms. The aims of this article are twofold: (1) to assess what is believed to be the most likely development of SSH by means of discovering relevant subsets of factors influencing university knowledge production; and (2) to discover whether the knowledge production factors show characteristics of a general development similar to the “Mode 2” concept. A systematic qualitative database was created by means of 22 semi-structured personal interviews with key representatives from business, university and the policy sector. Our explanatory framework employs an artificial intelligence method, i.e. rough set analysis. On the basis of these results, we find that a small minority of the respondents prefers a closer relationship of SSH to society, government and industry, and other institutional centers of authority, whilst interdisciplinarity in particular is regarded as having an overall positive influence on the future of SSH in the Netherlands. Consequently, the idea of a clear distinction between Mode 1 and Mode 2 knowledge production, i.e. traditional knowledge and knowledge carried out in the context of application, is not supported by our data.     

Trichotillomania. An overview and guide to understanding

Tichotillomania presents challenges to clinicians in various areas including assessment, treatment, and research. Characterized by an irresistible urge to pull out one's hair, which is preceded by tension and followed by relief or pleasure, trichotillomania can cause significant impairment and distress to those who suffer from it. Possible hypothesized causes include a biological basis for hair-pulling, as well as pulling in response to stressors in life. Several assessment techniques to measure the severity of trichotillomania exist, each of which has advantages and disadvantages in establishing a diagnosis. Because it is still a relatively poorly understood disorder, treatment options for patients reporting these behaviors are limited and generally are confined to pharmacological therapy and habit-reversal behavior therapy. Mansueto, Stemberger, Thomas, and Golomb have published a compelling comprehensive behavioral model that attempts to explain the various cues and factors in trichotillomania. It is useful to consider trichotillomania a biological, psychological, and social phenomenon requiring further research regarding the interaction of these variables in advancing the understanding of the disorder.     

知识经济时代的城市布局——以澳洲城市为例

在知识经济时代,知识的产出、产地、生产方式与生产者是一座城市的生活质量和竞争力的最主要决定因素之一。在世界各个角落,作为知识产出中心的那些城市有着各式各样的称谓,譬如：知识城市、创意城市、泛生态城市、智能城市等。本文主要研究这些城市的核心建筑群——“知识区”,它是指对知识生产既有“催化”作用又有“磁铁”作用的基础设施。作者首先在知识经济的范畴内探讨以知识为基础的城市发展的重要性,以及为知识生产奠定根基的知识社区的角色;其次研究以知识为基础的城市发展,尤其是知识社区的发展,并以波士顿为参照,分析悉尼、墨尔本和布里斯班三座城市的潜力。文章最后还就以知识为基础的发展问题为其他城市总结规律并提出建议。