[Experiences and wishes of family members regarding their involvement in dealing with a psychiatric patient's request for termination of life. A checklist for physicians]. / Ervaringen en wensen van familieleden bij het omgaan met een verzoek om levensbeëindiging in de psychiatrie. Een checklist voor behandelaars.

BACKGROUND: In the Netherlands, increasing attention is being paid to psychiatric patients with a request for termination of life. One discussion related to this is the role of the family. However, the experiences and wishes of the family regarding their involvement in dealing with a psychiatric patient's request for termination of life, are not yet well documented.
AIM: To investigate the experiences and wishes of families regarding their role in dealing with the psychiatric patient's request for termination of life, and to develop a checklist for physicians to adequately involve the family in the process of dealing with such a request.
METHOD: The experiences and wishes of families regarding their role in dealing with a psychiatric patient's request for termination of life were investigated in a focus group meeting with family members. Based on the results, recommendations were formulated for physicians and their feasibility was tested in a dialogue group of family members and caregivers. Finally, the results were discussed in a focus group of family members to develop a checklist for physicians to involve the family in dealing with a psychiatric patient's request for termination of life.
RESULTS: Family members prefer that physicians: 1. involve the family in the process and understand the impact of the situation on family members; 2. discuss expectations and explore the wishes of the family; 3. make use of the knowledge and expertise of the family in order to understand the patient in the context of his/her life; 4. support the family and provide after care, and jointly evaluate the process. The recommendations were consolidated in a checklist for physicians about involving the family in dealing with a psychiatric patient's request for termination of life.
CONCLUSION: It is expected that application of the recommendations and the checklist will promote adequate involvement of the family in dealing with a psychiatric patient's request for termination of life.

Performance of aneuploid backcross hybrids between the crop Brassica napus and its wild relative B. rapa.

Crossings between the diploid wild Brassica rapa (AA, 2n = 20) and the tetraploid cultivar B. napus (AACC, 2n = 38) can readily be made. Backcrosses to the wild B. rapa (BC1 ) produce aneuploids with variable chromosome numbers between 20 and 29. How does survival and performance relate to DNA content of plants? Growth of the BC1 plants was measured in the lab. One plant in the F1 self-pollinated spontaneously and produced abundant F2 seeds that were also examined. The number of C-chromosomes was estimated from DNA values obtained with flow cytometry. Average DNA value of the BC1 was similar to that of the parents, which shows that C-chromosomes do not reduce success of pollen or embryos. The average DNA value in the F2 was 13% higher than in the F1 , suggesting that extra C-chromosomes facilitated gamete success and/or embryo survival. Under both optimal and drought stress conditions growth and survival of BC1 hybrids was similar to that of B. rapa. No significant correlations existed between growth or survival and DNA value. Aneuploid plants were not inferior under the conditions of the growth room and may persist in nature. We discuss other factors, such as herbivory, that could prevent hybrid establishment in the field.

International HIV Dementia Scale: Screening for HIV-Associated Neurocognitive Disorders in Occupational Settings

This study investigated whether the International HIV Dementia Scale (IHDS) can be used to screen for milder forms of HIV-associated neurocognitive disorder (HAND) in occupational health settings. It explored first; the effect of demographic variables on IHDS performance in a sample of HIV-negative employees and second; the extent to which the IHDS can differentiate between milder forms of HAND in HIV-infected employees. Data from 476 HIV-negativeand 90 HIV-positive individuals indicated that; although clinicians need to be sensitive to the effect of education and test-language proficiency; separate norms based on socio-demographic variables are not required in this context; and that the IHDS shows promise for identifying milder forms of HAND in this HIV-positive sample; with ?10 the recommended cut-off for further referral. In conclusion; there is support for the IHDS to screen for HAND where this may impact on safety-critical tasks in the workplace

[Defence style and therapeutic technique as predictors of the outcome of psychodynamic psychotherapy in depression]. / Afweerstijl en therapeutische techniek als voorspellers voor uitkomst van psychodynamische psychotherapie bij depressie.

BACKGROUND: In psychodynamic psychotherapy it is assumed that insight-fostering interventions lead to better results when used with patients who have relatively strong personality structures. AIM: To investigate to what extent the use of supportive or insight-fostering interventions is determined by sociodemographic variables, the severity, duration and recurrence of depression and defence style and to find out whether the type of intervention used can predict the treatment outcome of psychotherapy in depression. METHOD: The study-group consisted of 147 depressed patients with or without a comorbid personality disorder who had been treated with supportive PsychoDynamic Therapy (PDT) with or without medication and for whom the Therapist Evaluation Form (TEF) was available. On the TEF the therapist assessed the patients' defence style and the therapeutic technique that was used. The most important outcome measure was the Hamilton Depression Rating Scale (HAM-D). RESULTS: No correlation was found between technique used and sociodemographic characteristics or the severity and duration of the depression. Insight-fostering interventions were related to better treatment outcomes. Not only age and educational level but also defence style turned out to be confounding variables in the relationship between technique and outcome. We found no interaction between treatment success and insight-fostering interventions in patients who used mature defence styles. CONCLUSION: In our study it was defence style as evaluated by the therapist rather than the technique used which was the strongest independent predictor of a successful outcome. This indicates that patients with primitive defence styles may also benefit from insight-fostering interventions.

[Emergency psychiatry in Amsterdam: a historical case study]. / Spoedeisende psychiatrie in Amsterdam: een historische gevalsbeschrijving.

Over the past 25 years the system of centralised management of emergency psychiatry has disappeared and re-appeared. Since 2000 improvements have been made in the logistics, organisation and quality of emergency care. In the same period, however, there has been a horrendous increase in the number of compulsory admissions in the main Dutch cities. The authors hypothesise that this increase may be due partly to organisational changes in the psychiatric emergency services and partly to the introduction of a new mental health act and changes in society.

Protrusion method for automated estimation of polyp size on CT colonography.

OBJECTIVE: The purpose of this study was to assess the accuracy and measurement variability of automated lesion measurement on CT colonography in comparison with manual 2D and 3D techniques under varying scanning conditions. MATERIALS AND METHODS: The study included phantoms (23 phantom objects) and patients (16 polyps). Measurement with sliding calipers served as the reference for the phantom data. The mean of two independent colonoscopic measurements was the reference for the polyps. The automated measurement was developed for a computer-aided detection scheme, and the size of any detected object was obtained from measurement of its largest diameter. The automated measurement was compared with manual 2D and 3D measurements by two experienced observers. RESULTS: For phantom data, the measurement variability of the automated method was significantly less than that of the two observers (p < 0.05), except for the 3D measurement by observer 1, as follows: automated, 0.86 mm; observer 1, 1.76 mm (2D), 0.96 (3D); observer 2, 1.34 mm (2D), 1.45 mm (3D). The variability of the automated method did not differ significantly from that of manual methods in measurement with patient data. The automated method had a systematic error for phantom data (1.9 mm). CONCLUSION: For phantoms, the automated method has less measurement variability than manual 2D and 3D techniques. For true polyps, the measurement variability of the automated method is comparable with that of manual methods. The automated method does not suffer from intraobserver variability. Because systematic error can be calibrated, automated size measurement may contribute to a practical evaluation strategy.

[Breast cancer in the family: a possible contra-indication to the use of dopamine antagonists. A case study]. / Borstkanker in de familieanamnese: een mogelijke contra-indicatie voor dopamineantagonisten.

A 23-year-old woman with a family history of breast cancer suffers from a psychotic disorder and has symptoms of anxiety and depression. There are some indications in the literature that the use of dopamine antagonists can lightly increase the risk of developing breast cancer. So far there is insufficient scientific evidence to justify alterations in the standard treatment strategy simply on the grounds that a woman has a family history of breast cancer. We do however recommend that women in this risk category be tested periodically for possible breast cancer.

Segmentation and size measurement of polyps in CT colonography.

Virtual colonoscopy is a relatively new method for the detection of colonic polyps. Their size, which is measured from reformatted CT images, mainly determines diagnosis. We present an automatic method for measuring the polyp size. The method is based on a robust segmentation method that grows a surface patch over the entire polyp surface starting from a seed. Projection of the patch points along the polyp axis yields a 2D point set to which we fit an ellipse. The long axis of the ellipse denotes the size of the polyp. We evaluate our method by comparing the automated size measurement with those of two radiologists using scans of a colon phantom. We give data for inter-observer and intra-observer variability of radiologists and our method as well as the accuracy and precision.

Predicting medically unexplained physical symptoms and health care utilization. A symptom-perception approach.

OBJECTIVES: The present study investigated the contribution of demographic characteristics (age, gender, socioeconomic status [SES]) and symptom-perception variables to unexplained physical symptoms and health care utilization. In addition, the consequences of the use of four frequently applied symptom-detection methods for relations among study variables were examined. METHOD: A group of 101 men and women were administered a standardized interview and several questionnaires. Their general practitioners (GPs) rated (un)explained symptoms and consultations over the previous year. RESULTS: Path analyses showed that direct and indirect effects on symptoms and GP consultations depend on method of symptom detection, the largest difference being between self-reported symptoms and registered symptoms. The model including self-reported common symptoms demonstrated the direct and indirect effects of the symptom-perception variables: chronic disease, negative affectivity, selective attention to bodily sensations, and somatic attribution. In the model including registered symptoms, only chronic disease and SES showed effects on symptoms and GP consultations. CONCLUSION: This study demonstrates the usefulness of a symptom-perception approach to the experience of unexplained symptoms, the importance of selection of a symptom-detection method, and the need for different models for the explanation of daily experienced symptoms and their presentation in health care.

Levels of anxiety and hostility in South African Navy divers.

This study aimed to describe the levels of anxiety and hostility in a group of 45 SA Navy divers, by analysing their scores on an Anxiety Scale and Hostility and Directed Hostility Questionnaire. Results indicate that divers experience average anxiety compared with the norm groups. They have a higher urge for acting out their hostility, and are more critical of others than the norm group. Their overall hostility scores are higher than that of the general population. To determine if this differs from other naval personnel, the diver group was compared to a sample of 40 general navy sailors and 20 sport divers. The navy divers' scores displayed a higher urge to act out than the general navy, which in turn scored higher than the sport divers. Both the navy divers and general navy groups had higher total hostility scores than the civilian divers. It is concluded that the results are contextually appropriate, but not meaningful for selection of navy divers.

Personality characteristics of South African navy divers.

The first study aimed to determine the extent to which the 16 Personality Factor Questionnaire (16PF) can be used to describe successful divers in the South African Navy. The 16PF profiles of 100 divers were analyzed to describe the personality characteristics of naval divers. Results indicate that four personality factors were most descriptive of the sample. They were Group-orientation, Enthusiasm, Adventurousness, and Confidence. These factors seemed appropriate when discussed from an environmental demand perspective. The second study aimed to determine the extent to which the 16 PF can be used to differentiate between divers and submariners in the South African Navy. The two groups differed significantly on two factors--divers scored higher on Enthusiasm and submariners scored higher on Conservatism.

Psychological attributes of South African Navy Underwater Sabotage Device Disposal operators.

The first of two studies described here aimed to determine the extent to which psychological instruments could be used to describe the psychological profile of Underwater Sabotage Device Disposal (USDD) operators in the South African Navy. The Advanced Progressive Matrices, 16-Personality Factor Questionnaire (16PF), Self-Directed Search Questionnaire, and Rey Complex Figure Test were used. In this study, five 16PF factors appeared to be most descriptive of the sample. They were adventurous, assertive, self-assured, emotionally stable, and tough minded. These factors appeared appropriate when discussed from an environmental demand perspective. Occupational interests were realistic and social, and operators scored high on the Complex Figure Test. The second study aimed to determine the extent to which the 16PF could differentiate between USDD operators and other clearance divers. Two factors showed a significant difference between the two groups. The USDD operators were more adventurous and more assertive, which also appeared appropriate when discussed from an environmental demand perspective.

Personality characteristics of South African Navy submarine personnel.

This study aimed to determine the extent to which the Institute of Personality and Ability Testing Anxiety Scale and the 16 Personality Factor Questionnaire can be used to describe successful submariners in the South African Navy. The Anxiety Scale scores were within normal limits when the profiles of 85 submariners were analyzed to describe the personality characteristics of submarine personnel. Although no significant factors were found, the results indicate that four personality factors appeared to be most descriptive of the sample. They were adventurousness, confidence, group orientation, and self-sentiment. These factors appeared appropriate when discussed from an environmental demand perspective.

Gender differences in physical symptoms and illness behavior. A health diary study.

Recent studies on symptom perception have highlighted the role of psychological factors, such as mood states and external involvement, in physical symptom reporting. To date, the consistently found higher physical symptom reports in women have not been studied from this perspective. The present study aimed to investigate the psychological determinants of gender differences in physical symptoms and illness behavior on a daily basis. During four adjacent weeks, a healthy primary care sample of 92 women and 61 men kept health diaries, containing scales for physical symptoms, illness behavior, external information and positive and negative mood. The daily health records showed the typical gender difference in physical symptoms, but not in illness behavior. Negative mood was found to be the strongest predictor of physical symptoms. Physical symptoms in turn were the strongest predictor of illness behavior. The modest gender difference in physical symptoms disappeared after controlling for positive and negative mood. Thus, mood states seem to mediate gender differences in symptom reporting.

Submarine escape: the effect of training on anxiety.

Student submariners in the South African Navy often report increased anxiety when confronted with the complicated nature of the submarine escape equipment and procedures. It was hypothesized that training should reduce this anxiety. This report describes part of the training process of the South African Navy, as well as a short investigation of the effect of training on anxiety. The investigation focused on state and trait anxiety, as well as overt and covert anxiety. Student submariners in the South African Navy were evaluated with the IPAT Anxiety Scale and the State-Trait Anxiety Inventory before their submarine escape training. On the completion of their training, these instruments were again administered. Results suggested a decrease in overt and covert anxiety as well as trait anxiety. Although the first two results can be attributed to the effect of training, the change in subjects' trait anxiety remains unexplained.

Criteria for successful sanitation programmes in low income countries.

In the International Drinking Water Supply and Sanitation Decade (1981-90), the development of a consensus on the concept of sanitation and the planning and implementation of effective and efficient sanitation programmes was not emphasized. Yet lack of good sanitation is a growing burden and environmental threat. Significant improvement of human health cannot be achieved without good environmental sanitation conditions and practices. A consensus on what makes a sanitation programme successful can help to conserve limited funds and spend those available more wisely. It will also help to reduce the increasing flows of waste poisoning precious sources of drinking water. This article was written to stimulate discussion on what attributes can be taken as characteristic of good environmental sanitation programmes, and on which indicators can be used to assess those attributes in actual sanitation programmes.

Factors influencing burnout and job stress among military nurses.

Burnout among military nurses has been found to lead to job absenteeism, staff conflicts, and a high turnover of personnel. Factors influencing nurses working in smaller and often isolated military installations of the South African National Defence Force were investigated using a job-stress and burnout questionnaire and a semi-structured interview. Investigation focused on registration categories, geographic location, and age. It was found that the senior registration categories experienced more burnout, and nurses in isolated areas reported almost double the number of cases of burnout than nurses in larger centers. Age played a role in the very young (19-25 years) and older (40-50 years) nurses. The lack of support from supervisors, high responsibility, long working hours, and task overload were the four most common stressors reported. Some suggestions are forwarded to manage the risk of burnout among military nurses in similar situations.

Sex differences in physical symptoms: the contribution of symptom perception theory.

Health surveys, studies on physical symptom reporting, and medical registration of physical complaints find consistent sex differences in symptom reporting, with women having the higher rates. By and large, this female excess of physical symptoms is independent from the symptom measure, response format and time frame used, and the population under study. As most studies concern healthy individuals, the sex difference can not simply be attributed to a greater physical morbidity in women. In this paper we propose a number of explanations for this phenomenon, based on a biopsychosocial perspective on symptom perception. We discuss a symptom perception model that brings together factors and processes from the extant literature which are thought to affect symptom reporting, such as somatic information, selection of information through attention and distraction, attribution of somatic sensations, and the personality factors somatisation and negative affectivity. Finally, we discuss the explanations for sex differences in physical symptoms that arise from the model.