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Introducción: Se describe y se señalan los errores lógicos de la visión que adoptan algunas posturas dualistas según la cual lo mental puede padecer enfermedad y afectar al comportamiento, específicamente en el contexto de los casos en que un individuo reporta padecer síntomas de alguna enfermedad sin que exista un correlato patológico medicamente comprobable. Método: Se presenta el caso de un hombre adulto quien reporta padecer síntomas de diversas enfermedades no confirmadas por los estudios médicos que se realizó. El caso se aborda desde una perspectiva naturalista y de campo mediante la aplicación de la metodología del Análisis Contingencial derivada de la psicología interconductual. Se identificaron los factores, circunstancias y criterios valorativos relacionados con la presentación del "comportamiento enfermo" del usuario. Se diseñó e implementó una intervención para modificar los aspectos pertinentes. Resultados: La intervención permitió que el usuario desarrollara competencias para cumplir con lo que socialmente se esperaba de él y que dejara de reportar el padecimiento de enfermedades no demostrables medicamente. Conclusiones: Se señalan los beneficios de la postura naturalista de este trabajo en contrapartida de aquellas que conceptúan este tipo de casos como enfermedades mentales y cuyas intervenciones se orientan a la sanación de lo no corpóreo.
Introduction: The logical errors of visions adopted by dualistic positions are described and indicated, specifically in the context of cases that an individual reports suffering symptoms of a disease without a medically and verifiable pathological. According to this logic, the mental can suffer disease and affect the behavior. Method: A case of an adult man reporting different illnesses is exposed on this paper. The medical studies carried out do not confirm the presence of any pathology. This case is studied from a naturalistic and field perspective by applying the methodology of Contingential Analysis derived from interbehavioral psychology. The factors, circumstances and value criteria related to the presentation of the "illness behavior" of the psychological service user are identified. An intervention was designed and implemented to modify these aspects. Results: The intervention allowed the user to develop competencies to fulfill what was socially expected from him and to stop reporting the condition of diseases not medically demonstrable. Conclusions: The benefits of this naturalistic are indicated in ths work, compared to those that conceptualize this kind of cases as mental illnesses, whose interventions are oriented to the cure healing of the noncorporeal.
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Resumo O conceito de ruptura biográfica (RB) ganhou centralidade nos estudos sociológicos sobre a experiência de adoecimento crônico, ao mostrar que esta pode estar fortemente marcada por rupturas nas formas de viver e de organizar narrativamente a trajetória biográfica. Revisões críticas apontaram que o emprego generalizado do conceito esteve pouco atento a seus limites analíticos, por exemplo, diante de experiências relacionadas a doenças genéticas entre crianças, quando continuidades biográficas (CB) mais do que de RB estariam presentes. Neste artigo, empregou-se os conceitos de RB e de CB para analisar as relações entre as trajetórias de adoecimento de crianças com fibrose cística (FC) e as experiências de seus pais, tendo em perspectiva as narrativas sobre suas histórias e contextos familiares, depreendidas de entrevistas semiestruturadas realizadas com 10 crianças com FC e 14 familiares. Os resultados apontaram para potencialidades e limites dos conceitos de RB e CB para a análise pretendida. Conclui-se que ambos os conceitos podem ser aplicados à análise da experiência familiar com doenças genéticas infantis, desde que empregados de modo crítico e sensível aos sujeitos e contextos investigados, de forma atenta aos interesses teóricos mais amplos.
Abstract Biographical disruption (BD) became a core concept of sociological studies on the chronic illness experience by showing how this event can be strongly affected by ruptures in the ways of living and organizing the biographical trajectory through narratives. Critical reviews have pointed out that the widespread use of this concept was not sufficiently attentive to its analytical limits, e.g. addressing experiences of children with genetic diseases, when biographic flows (BF) rather than BD would be probably found. In this paper, we employed the concepts of BD and BF to analyze the relationships between the illness trajectories of children with cystic fibrosis (CF) and the experiences of their parents, taking into account the narratives about their histories and family contexts, drawn from semi-structured interviews with 10 children with CF and 14 family members. The results pointed to potentialities and limits of the concepts of BD and BF for the analysis undertaken in this study. We conclude that both concepts can be applied to the analysis of family experience involving child genetic diseases, provided that this occurs in a critical and sensitive way to subjects and contexts investigated, keeping in mind the more broader theoretical concerns.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Parents/psychology , Family/psychology , Cystic Fibrosis/psychology , Chronic Disease , Interviews as TopicABSTRACT
Objective To evaluate the reliability and validity of the Chinese-version of the scale for the assessment of illness behavior(SAIB) in Chinese medical college students. Methods In view of the professional and cultural basis of the translation of SAIB,723 medical students were asked to complete the SAIB and the Illness Attitude Scale. After two weeks,75 students were followed to complete the SAIB. Re-sults After the analysis of the scale project analysis and the exploratory factor analysis,23 entries were re-tained and five common factors were extracted( verification of diagnosis,expression of symptoms,medication/treatment,consequences of illness,somatic symptom scanning),and accounted for 56.14％ of the total vari-ance.The confirmatory factor analysis identified a five factors model(SRMR=0.057,χ2/df=1.80,SRMR=0.06,RMSEA=0.05,GFI=0.912,CFI=0.93,TLI=0.91,IFI=0.93,PGFI=0.72,AGFI=0.89).The correla-tion validity between SAIB scale total score and treatment experience and symptoms affected in IAS scale were -0.31,-0.36 (P<0.01).Reliability coefficients of the five dimensions and total score ranged from 0.61 to 0.88,and the test-retest reliability was 0.78. Conclusion The Chinese version of the scale for the assess-ment of illness behavior is a reliable and valid instrument in Chinese.
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ABSTRACT CONTEXT AND OBJECTIVE: Multiple sclerosis (MS) is a chronic, immune-mediated and degenerative central nervous system (CNS) disease with well-established diagnostic criteria. Treatment can modify the course of the disease. The objective of this study was to describe the initial symptoms of multiple sclerosis in a Brazilian medical center. DESIGN AND SETTING: Descriptive study, conducted in a Brazilian reference center for multiple sclerosis treatment. METHODS: Data on 299 patients with confirmed diagnoses of MS were included in the study. Their medical files were evaluated and the data were analyzed. RESULTS: The most common symptom involved the cranial nerves (50.83%) and unifocal manifestation was presented by the majority of this population (73.91%). The mean time between the first symptom and the diagnosis was 2.84 years. Unifocal symptoms correlated with longer time taken to establish the diagnosis, with an average of 3.20 years, while for multifocal symptoms the average time taken for the diagnosis was 1.85 years. Unifocal onset was related to greater diagnostic difficulty. CONCLUSIONS: MS is a heterogeneous disease and its initial clinical manifestation is very variable.
RESUMO CONTEXTO E OBJETIVO: A esclerose múltipla (EM) é uma doença crônica do sistema nervoso central (SNC) imunomediada e degenerativa, com critérios diagnósticos bem estabelecidos. O tratamento pode modificar o curso da doença. O objetivo deste estudo foi descrever os sintomas iniciais da esclerose múltipla em um centro médico brasileiro. TIPO DE ESTUDO E LOCAL: Estudo descritivo, conduzido em um centro médico de referência no tratamento de EM no Brasil. MÉTODOS: Foram incluídos no estudo dados de 299 pacientes com diagnóstico confirmado de EM. Seus prontuários foram avaliados e os dados foram analisados. RESULTADOS: O sintoma mais comum encontrado envolveu nervos cranianos (50,83%) e a manifestação unifocal foi apresentada pela maioria da população estudada (73,91%). O tempo médio entre o primeiro sintoma e o diagnóstico foi de 2,84 anos. O sintoma unifocal foi relacionado com maior tempo para o estabelecimento do diagnóstico, com uma média de 3,20 anos; enquanto para os sintomas multifocais, a média foi de 1,85 anos para o diagnóstico. O início unifocal foi relacionado a maior dificuldade de diagnóstico. CONCLUSÕES: EM é uma doença heterogênea e sua manifestação clínica inicial é muito variável.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Multiple Sclerosis/diagnosis , Multiple Sclerosis/physiopathology , Time Factors , Brazil , Cross-Sectional Studies , Age of Onset , Disease Progression , Early DiagnosisABSTRACT
Objetivo. Identificar las variables de conducta de enfermedad en una muestra de pacientes colombianos con Hemofilia A y comparar los resultados de grupos (con dolor crónico y sin dolor crónico) para un análisis de relaciones entre variables. Método. El enfoque fue cuantitativo y su diseño transversal; la metodología empleada fue ex post facto de tipo retrospectiva. Para el análisis estadístico se hizo una comparación de grupos (sin dolor crónico y con dolor crónico). El factor de conducta de enfermedad se evaluó a través del Cuestionario de Conducta de Enfermedad de Ballester y Botella del año 1993. Los resultados obtenidos mediante la prueba T, la correlación de Spearman, la prueba U de Mann-Whitney y la Curva de ROC. Resultados. Se evaluaron veintisiete sujetos con diagnóstico de Hemofilia A con un rango de edad entre 19 y 55 años. Diecisiete sujetos conformaron el grupo con dolor crónico y diez sujetos el grupo sin dolor crónico. En conclusión se hallaron asociaciones significativas entre el dolor crónico y las variables relacionadas a inestabilidad emocional, así como correlaciones positivas con resultados de investigaciones previas sobre la caracterización de la población con hemofilia.
Objective. To Identify the variables of illness behavior in a sample of Colombian patients with hemophilia A and to compare the results of groups (with chronic pain and without chronic pain chronic) for an analysis of relationships between variables. Methods. The approach was quantitative and its cross-sectional design. The methodology used was ex post facto retrospective type. A comparison groups (without chronic pain and chronic pain) was done for the statistical analysis. The disease behavior factor was evaluated through the Ballester and Botella Disease Questionnaire Conduct of 1993. The results obtained by the T-test, the Spearman correlation, the Mann-Whitney U test and the ROC curve. Results. Twenty-seven subjects diagnosed with haemophilia A diagnosed with a age range between 19 and 55 years were evaluated. Seventeen subjects formed the group with chronic pain and ten subjects the group without chronic pain. In conclusion, we found significant associations between chronic pain and variables related to emotional instability, as well as positive correlations with results of previous research on the characterization of the population with hemophilia.
Subject(s)
Humans , Hemophilia A , Acrodynia , Chronic Pain , HematologyABSTRACT
Objectives: The concept of “Abnormal illness behavior (AIB)” has been evolved to a greater extent in the last century. Henry Sigerist introduced the concept of “illness behavior” in 1929. Mechanic & Volkart defined and further conceptualized the impression on illness behavior. Talcott Parson had given the concept of “Sick role,” and Issy Pilosky had familiarized the notion of “abnormal illness behavior.” The main objective of this article is to review the conceptual evolution on “abnormal illness behavior” and to analyze its current clinical implications. Methods: Extensive search of literature was performed regarding abnormal illness behavior, illness behavior and sick role in online web searching sites like – Google Scholar, PubMed and individual journal sites as well as google books. The literature was critically reviewed with personal inputs from authors. Results: Abnormal illness behavior ranges from denial of illness in one extreme to conscious amplification of symptoms on the other. Abnormal illness behavior is noticed in various clinical conditions like stress-related disorder, stress-related disorders, factitious disorder and malingering. Conclusions: Identifying abnormal illness behavior can prevent unnecessary and excessive utilization of medical aids for the same.
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In addition to damaging several target organs, arterial hypertension may negatively impact patients' activities of daily living. Biological and behavioral mechanisms underlying such limitations have yet to be clarified. The objectives of this study were to investigate whether having been previously told of a hypertension diagnosis is associated with the frequency and duration of temporary limitations in activities of daily living, and whether these relationships differ by gender, age, or socioeconomic position. We analyzed sectional data from 2,666 participants (56% women; 55% with high school or lower schooling) at the baseline phase (1999 - 2001) of a longitudinal investigation of university employees in Rio de Janeiro, Brazil (Pró-Saúde Study), asking participants whether they had ever been diagnosed with hypertension by a health professional, if they had been unable to perform any activities of daily living due to a health problem in the previous 2 weeks, and for how many days that had occurred. Multinomial logistic regression models were fitted for the overall study population and for age, gender, educational level, and per capita household income strata. Associations between hypertension diagnosis and temporary limitations were not observed in the overall study population and in gender, education and income strata. However, there were higher odds of temporary limitations among participants aged 55 years old or more with hypertension diagnosis (adjusted OR = 9.5; 95%CI 1.5 - 58.6), regardless of blood pressure levels and use of antihypertensive medication. Elderly people may keep an attitude of higher vigilance regarding conditions or events potentially worsening their health status.
Além de lesões em vários órgãos-alvo, a hipertensão arterial pode determinar outras consequências negativas no cotidiano do portador, mas os mecanismos biológicos e comportamentais possivelmente envolvidos ainda não foram esclarecidos. Os objetivos deste estudo foram investigar se o histórico autorrelatado de hipertensão associa-se com freqüência e duração de incapacidade temporária para atividades habituais, e se esta relação modifica-se de acordo com sexo, idade ou posição socioeconômica. Analisamos dados seccionais relativos a 2666 participantes (56% mulheres; 55% ensino médio ou menos) da linha de base (1999 - 2001) de uma investigação longitudinal de funcionários de universidade no Rio de Janeiro (Estudo Pró-Saúde): se o indivíduo alguma vez havia sido informado por profissional de saúde que tinha hipertensão, se nas duas semanas anteriores havia ficado impedido de realizar alguma de suas atividades habituais por problema de saúde, e por quantos dias isso ocorrera. Modelos de regressão logística multinomial foram utilizados para a população total e em estratos de sexo, idade, renda e escolaridade. Não observamos associação entre histórico autorrelatado de hipertensão e ocorrência de incapacidade temporária na população total e em estratos de sexo, escolaridade e renda. Entretanto, essa associação foi evidenciada entre os participantes com 55 ou mais anos de idade (OR ajustada = 9,5; IC95% 1,5 - 58,6), independentemente dos níveis de pressão arterial e do uso de medicação anti-hipertensiva, o que pode expressar uma atitude de maior vigilância desses indivíduos mais idosos em relação a sintomas que possam representar piora de seu estado de saúde.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Activities of Daily Living , Hypertension/psychology , Illness Behavior , Hypertension/diagnosisABSTRACT
Objective To investigate the illness-related stigma in outpatients with chronic viral hepatitis B and C and its effects on interaction anxiousness and general self-efficacy.Methods Forty-eight patients with chronic hepatitis B ( CHB),41 patients with chronic hepatitis C (CHC) and 29 healthy volunteers were enrolled.Hepatitis-related Stigma Questionnaire (HRSQ) produced by researchers was used to assess stigma in patients of both CHB and CHC.All patients and healthy volunteers were evaluated by Interaction Anxiousness Scale (IAS),General Self-efficacy Scale (GSES) and Simplified Coping Style Questionnaire (SCSQ).Results Hepatitis-related stigma was common in both CHB and CHC.The most common positive items and their percentages of CHB and CHC were rejection in job seeking (81.2％,75.6％ ), keeping conditions about hepatitis secret (72.9％,75.6％ ),feeling discrimination in society (66.7％,56.1％ ) and rejection in mate selection (60.4％,61.0％ ),and the rarest ones and percentages were feeling lowest stress together with patients with the same disease (35.4％,31.7％ ) and being understood only by patients with the same disease (33.3％,26.8％ ).Differences of positive percentages of any items between CHB and CHC were not statistically significant (P ＞0.05 ).One-way ANOVA showed that difference of IAS scores among three groups of participants was not statistically significant ;and GSES score of CHB(2.41 ± 0.45 )was not statistically different from that of CHC (2.49 ±0.60 ),but they both were lower than that of healthy control (2.78 ± 0.52) (F=4.648,P =0.011 ).The multivariate stepwise regression analysis showed that the item feeling much different from others of HRSQ entered the formula of CHB IAS score (B =4.861,adjustment R2 =0.106),and the item being understood only by patients with the same disease of HRSQ entered the formula of CHC IAS score (B =6.745,adjustment R2 =0.113);negative coping dimension score of SCSQ ( B =- 0.424),the item feeling discrimination in society ( B =-0.359) and feeling lowest stress together with patients with the same disease ( B =-0.274) entered the formula of CHB GSES score (adjustment R2 =0.280).Conclusion Illness-related stigma is common in outpatients with chronic viral hepatitis,which probably raises patients' interaction anxiousness and weakens the general selfefficacy of patients with hepatitis B and C.
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The objective of this study was to estimate the evolution of the burden of disease in Cuba for 20 major causes at five year intervals from 1990 to 2005, in terms of mortality and years of life lost due to premature death (YLL), using national mortality registries. Six summary measures were computed for each of the 20 major causes of death which characterized the evolution of the disease burden over the period studied. The 20 causes were then grouped according to their behaviour in these summary measures; hierarchical cluster analysis was used to support this grouping process. We compute YLL results with and without age-weighting and time discounting (3 percent). The 20 major causes were grouped into 12 subgroups, each with a particular pattern. The burden of disease in Cuba during the period 1990-2005 has a peculiar pattern that does not reproduce the one characteristic of other low- and middle-income countries. The approach used in this study supports a better description of mortality and YLL trends for major causes, for identifying possible explanations, and for supporting public health policy making. It seems convenient to reproduce this analysis using shorter time intervals, e.g. annually.
El objetivo fue estimar la evolución de la carga de enfermedades en Cuba para 20 enfermedades a intervalos de 5 años desde 1990 al 2005, en términos de años de vida perdidos por muerte prematura (YLL), usando los registros de mortalidad nacionales. Se obtuvieron seis indicadores resúmenes para cada enfermedad, que caracterizaban su evolución en el periodo de estudio 1990-2005. Las 20 enfermedades se agruparon según su comportamiento en estos seis indicadores, usando un análisis de conglomerados jerárquico. Los YLL se obtuvieron con y sin descuento en el tiempo (3 por ciento) y ponderación por edad. Se agruparon las 20 enfermedades en 12 subgrupos, cada uno con un patrón particular. El patrón de evolución observado es peculiar y no reproduce el patrón típico de los países de medio y bajo ingreso en el mundo. El enfoque adoptado en este trabajo permite una mejor descripción de la evolución de la carga por mortalidad para un grupo grande de enfermedades, desarrollar posibles explicaciones para el comportamiento identificado, y apoyar la toma de decisiones en salud pública. Sería conveniente reproducir este análisis para periodos de tiempo más cortos, por ejemplo, anualmente.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Cause of Death/trends , Life Expectancy/trends , Cluster Analysis , Cuba/epidemiologyABSTRACT
BACKGROUND: The North Korean defectors are suffering from multiple psychologic and physical health problems. However, because of their emotional maladaptation, noncooperation and suspiciousness and distrust toward others, it is difficult for South Korean doctors to build effective therapeutic relationships with them. Therefore, we made efforts to clarify the characteristics of North Korean defectors in symptom expressions and illness behaviors which would help South Korean doctors to gain rapport. METHODS: We performed qualitative study with focus group interview. Three focus groups were composed of 14 North Korean defectors and group interviews were performed twice for each group. The contents of each interview were analyzed and conclusions were drawn by extracting and arranging significant findings. RESULTS: The North Korean defectors showed psychologic symptoms such as anxiety, depression and various somatic symptoms. Among them, 'Laeng-Dol ('cold mass) and 'Jeog' mean subjective mass-feeling, such as globus sensation. And 'Tag-Gi-Byeong ('chicken heart disease')' means recurrent chest pain. These expressions reflect their anxious, depressive, and somatizing tendency. Among illness concept, 'Laeng-Byeong' ('cold related disease') means that they consider the cold weather to be the cause of various somatic symptoms. Characteristic illness behaviors include continuous complaining of recurrent symptoms, distrusting medical staffs and institutions, self-diagnosis, self- prescription, and reliance upon folk remedies. These illness behaviors were precipitated by the current breakdown of health-care system and economic crisis of the North Korea. CONCLUSION: South Korean doctors should be able to understand these characteristics of the North Korean defectors in order to build effective therapeutic relationship with them.
Subject(s)
Humans , Anxiety , Chest Pain , Democratic People's Republic of Korea , Depression , Focus Groups , Heart , Illness Behavior , Interviews as Topic , Medical Staff , Medicine, Traditional , Prescriptions , Sensation , WeatherABSTRACT
BACKGROUND: The North Korean defectors are suffering from multiple psychologic and physical health problems. However, because of their emotional maladaptation, noncooperation and suspiciousness and distrust toward others, it is difficult for South Korean doctors to build effective therapeutic relationships with them. Therefore, we made efforts to clarify the characteristics of North Korean defectors in symptom expressions and illness behaviors which would help South Korean doctors to gain rapport. METHODS: We performed qualitative study with focus group interview. Three focus groups were composed of 14 North Korean defectors and group interviews were performed twice for each group. The contents of each interview were analyzed and conclusions were drawn by extracting and arranging significant findings. RESULTS: The North Korean defectors showed psychologic symptoms such as anxiety, depression and various somatic symptoms. Among them, 'Laeng-Dol ('cold mass) and 'Jeog' mean subjective mass-feeling, such as globus sensation. And 'Tag-Gi-Byeong ('chicken heart disease')' means recurrent chest pain. These expressions reflect their anxious, depressive, and somatizing tendency. Among illness concept, 'Laeng-Byeong' ('cold related disease') means that they consider the cold weather to be the cause of various somatic symptoms. Characteristic illness behaviors include continuous complaining of recurrent symptoms, distrusting medical staffs and institutions, self-diagnosis, self- prescription, and reliance upon folk remedies. These illness behaviors were precipitated by the current breakdown of health-care system and economic crisis of the North Korea. CONCLUSION: South Korean doctors should be able to understand these characteristics of the North Korean defectors in order to build effective therapeutic relationship with them.
Subject(s)
Humans , Anxiety , Chest Pain , Democratic People's Republic of Korea , Depression , Focus Groups , Heart , Illness Behavior , Interviews as Topic , Medical Staff , Medicine, Traditional , Prescriptions , Sensation , WeatherABSTRACT
OBJECTIVES: This subjects investigated the psychological characteristics of patients with functional dyspepsia. METHODS: The subjects included ninety patients with functional dyspepsia and sixty four psychiatric out-patients. We administered Minnesota Multiphasic Personality Inventory (MMPI) and Illness Behavior Questionnaire(IBQ). RESULTS: There were no significant differences between the patients with functional dyspepsia and the psychiatric out-patients by MMPI. Two groups both showed a higher distribution in hypochondriasis, depression, hysteria subscales than in any other subscales. The patients with functional dyspepsia showed lower scores in disease conviction and affective disturbance subscales in IBQ subscales were similar between the patients with functional dyspepsia and the psychiatric out-patients. The patients with functional dyspepsia were divided into three groups for the Multivariate cluster analysis: normal(group 1), similar to psychiatric out-patient(group 2), and severe neurotic(group 3). The severe neurotic group showed higher scores in hypochondriasis, depression, hysteria, psychathenia, and schizophrenia subscales in MMPI and showed significant different scores in affective disturbance, disease conviction, psychological and somatic concerns, affective disturbance, denial, and irritability subscales in IBQ. CONCLUSION: If patients with functional dyspepsia show severe neurotic behavior, such as those in(group 3), they would need appropriate psychiatric intervention.