The effects of a recalled injustice on the experience of experimentally induced pain and anxiety in relation to just-world beliefs.

BACKGROUND: A growing field of investigation into social justice cognitions and pain suggests perceived injustice has a negative impact on pain, but little is known about individual variation in the impact of a perceived injustice. One published study found that individuals with a strong rather than a weak just-world belief reported greater pain from the cold pressor task after experiencing a perceived injustice, but an overt measure of perceived unfairness is needed to investigate this relationship. METHODS: Following the completion of just-world belief and state anxiety scales, and the cold pressor task, 114 healthy participants were interviewed about either an experienced injustice or the characteristics of their home, before repeating the cold pressor task. Pain and anxiety measures were completed following each cold pressor task. RESULTS: Opposing the hypotheses, no differences were found on pain and anxiety between the two interview conditions, and individuals with a strong just-world belief did not report higher pain and anxiety levels following a recalled injustice. However, within the recalled injustice condition, unfairness ratings were associated with significantly increased pain and anxiety. CONCLUSIONS: Recalled personal injustice unrelated to one's current pain experience had a negative impact on pain and anxiety associated with the cold pressor task. These findings indicate that intervention development should be cognizant of the role of everyday injustices and not just those related to pain, on the pain experience. WHAT DOES THIS STUDY ADD?: This study shows that, independent of just-world beliefs, perceived unfairness associated with a recalled injustice unrelated to pain has a negative impact on the experience of acute pain.

Acceptability of temporary suspension of visiting during norovirus outbreaks: investigating patient, visitor and public opinion.

BACKGROUND: Noroviruses are a leading cause of outbreaks globally and the most common cause of service disruption due to ward closures. Temporary suspension of visiting (TSV) is increasingly a recommended public health measure to reduce exposure, transmission and impact during norovirus outbreaks; however, preventing patient-visitor contact may contravene the ethos of person-centred care, and public acceptability of this measure is not known. AIM: To investigate the acceptability of TSV during norovirus outbreaks from the perspectives of patients, visitors and the wider public. METHODS: Cross-sectional survey of patients (N = 153), visitors (N = 175) and the public (N = 224) in three diverse areas in Scotland. Health Belief Model constructs were applied to understand ratings of acceptability of TSV during norovirus outbreaks, and to determine associations between these levels and various predictor variables. FINDINGS: The majority (84.6%) of respondents indicated that the possible benefits of TSV are greater than the possible disadvantages. Conversely, the majority (70%) of respondents disagreed that TSV 'is wrong as it ignores people's rights to have contact with family and friends'. The majority (81.6%) of respondents agreed that TSV would be more acceptable if exceptions were made for seriously ill or dying patients. Correlational analysis demonstrated that overall acceptability was positively related to perceived severity (r = 0.65), identified benefits (r = 0.54) and implementing additional communication strategies (r = 0.60); acceptability was negatively related to potential barriers (r = -0.49). CONCLUSIONS: There is greater service user and public support for the use of TSV than concerns around impinging upon patients' rights to have visitors. TSV should be considered as an acceptable infection control measure that could be implemented consistently during norovirus outbreaks.

An experimental investigation of the role of perceived justice in acute pain.

BACKGROUND: Emerging research suggests that perceiving injustice can compound the suffering of chronic pain, while perceiving justice serves as a positive psychological resource in this context. However, little more is currently known about the function of justice beliefs, particularly in the context of acute pain. The present study undertook this investigation, using cold pressor methodology to investigate whether trusting in the fairness of the world would help someone to cope with short-term pain. METHODS: Sixty-five men and 65 women completed measures of personal and general just world beliefs and state anxiety before pain induction and measures of the intensity and quality of pain, in addition to state anxiety following pain induction. RESULTS: The personal and general beliefs in a just world were negatively correlated with pre-task anxiety but not with measures of pain induction (threshold, tolerance and sensitivity) or measures of post-task pain. Gender had a moderating role, whereby men with a stronger general just world belief reported lower post-task state anxiety and men who had a stronger personal just world belief reported lower pain intensity. However, unexpectedly, women with a stronger personal just world belief reported higher pain intensity. CONCLUSION: The observed gender differences may be attributed to gender variations in cognitive appraisals of the task. Overall, while perceived injustice may be undesirable and a potential target for intervention, perceived justice is not necessarily a desired cognition in pain. Research is needed to replicate and extend this emerging research.

Has testing been normalized? An analysis of changes in barriers to HIV testing among men who have sex with men between 2000 and 2010 in Scotland, UK.

OBJECTIVES: This paper examines changes in barriers to HIV testing amongst gay men. We compared data collected in 2000 and 2010 to assess changes in HIV testing behaviours, in community-level perceptions of barriers to HIV testing, and in the relative contributions of barrier measures. METHODS: Cross-sectional surveys were conducted within the commercial gay scene in Glasgow with good response rates (78% and 62%) using a form of time and location sampling. RESULTS: Major changes in HIV testing behaviours were observed between 2000 and 2010 (30.6% increase in testing within previous year). At the community level, the perceived benefits of testing [t (1284) = -8.46; P < 0.001] and the norm for HIV testing [t (1236) = -11.62; P < 0.001] increased; however, other perceived barriers did not change (fear of a positive result, clinic-related barriers and attitudes to sex with HIV-positive men). Multinomial logistic regression showed that fear of a positive test result remained a key barrier to HIV testing; however, a significant fear × year of survey interaction indicated that fear played a lesser role in differentiating those who had never been tested from those who had been tested in 2010 than it had in 2000. CONCLUSIONS: These findings suggest the partial normalization of HIV testing. While some barriers have reduced, other key barriers remain important. Interventions should be designed and evaluated that attend to both the biomedical and the psychosocial aspects of HIV testing (e.g. the meaning of positive test results, the sexual exclusion of positive men, and HIV-related stigma).

HIV testing trends among gay men in Scotland, UK (1996-2005): implications for HIV testing policies and prevention.

OBJECTIVE: To examine trends in the HIV testing behaviour of gay men in Scotland over a 10-year period. METHODS: Seven cross-sectional surveys in commercial gay venues in Glasgow and Edinburgh (1996-2005). 9613 men completed anonymous, self-completed questionnaires (70% average response rate). RESULTS: Among 8305 respondents included in these analyses, HIV testing increased between 1996 and 2005, from 49.7% to 57.8% (p<0.001). The proportion of men who had tested recently (in the calendar year of, or immediately before, the survey) increased from 28.4% in 1996 to 33.2% in 2005, when compared with those who have tested but not recently, and those who have never tested (adjusted odds ratio 1.31, 95% CI 1.13 to 1.52). However, among ever testers, there was no increase in rates of recent testing. Recent testing decreased with age: 31.3% of the under 25, 30.3% of the 25-34, 23.2% of the 35-44 and 21.2% of the over 44 years age groups had tested recently. Among men reporting two or more unprotected anal intercourse partners in the previous year, only 41.4% had tested recently. CONCLUSIONS: HIV testing among gay men in Scotland increased between 1996 and 2005, and corresponds with the Scottish Government policy change to routine, opt-out testing in genitourinary medicine clinics. Testing rates remain low and compare unfavourably with near-universal testing levels elsewhere. The limited change and decline across age groups in recent HIV testing rates suggest few men test repeatedly or regularly. Additional, innovative efforts are required to increase the uptake of regular HIV testing among gay men.

Re-appraising HIV Testing among Scottish Gay Men: The Impact of New HIV Treatments.

This paper explores Scottish gay men's understandings of HIV testing within the context of changes stemming from the availability of new treatments for HIV. Transcripts of one-toone interviews with 18 gay men were analysed together with those from four focus groups (n= 19) concerning HIV testing, HIV status and HIV risk management. Interpretative Phenomenological Analysis was employed to identify recurrent themes. We focus upon a rise of HIV-optimism, risk-complacency and HIV fatigue and chart the apparent transformation of HIV diagnosis from 'death sentence' to 'life sentence'. In turn, we explore how these changes have impacted upon HIV testing. As HIV management becomes increasingly medicalized, we highlight the ongoing need to attend to psychological and social issues.

Measuring the stress associated with caring for clients with HIV/AIDS.

The AIDS-stress scale (Pleck et al., 1988) provides measures of the sources of stress faced by health care workers caring for people with AIDS. The aim of the study was to consider the utility of the scale as a means of identifying groups of health care workers who would benefit from intervention. Data were collected from a sample of Scottish health care workers (n = 140), all with known contact with clients with HIV or AIDS within the year prior to data collection. Three factors were derived from the AIDS-stress scale: 'lack of knowledge', 'discomfort' and 'work load'. Each showed a different pattern of association with occupational, training and attitudinal measures. The factor scores had some degree of concurrent validity and were not, in the main, associated with the desire to give socially desirable responses. The results were discussed in relation to appropriate interventions.

HIV/AIDS and health care workers: contact with patients and attitudes towards them.

Data on a range of variables associated with contact with patients with HIV/AIDS and attitudes towards them were collected from 174 Scottish health care workers. Measures of attitudes and contact (overall, social and physical) were derived from the scales devised by Pleck et al. (1988). The measure of overall contact was not significantly related to attitudes, but those with predominantly social contact with patients with HIV/AIDS had more positive attitudes towards them. This relationship was moderated by occupational characteristics, concern about working with people of unknown HIV status and neuroticism. With all these variables controlled, including social contact, those who had not received in-service training relating to HIV/AIDS had more negative attitudes. The results are discussed with regard to the measurement of social contact with patients, salient beliefs, the occupational characteristics associated with attitudes, and in-service education.

Pain memories in phantom limbs: a case study.

Pain experienced in a limb prior to amputation may influence the course of phantom limb pain many months later. Katz and Melzack (1990) found that 42% of their sample reported a 'somatosensory pain memory' which resembled the quality and location of a painful, or non-painful pre-amputation sensation. For many amputees, pain memories are vivid experiences which incorporate both emotional and sensory aspects of the pre-amputation pain (Katz 1992). Katz and Melzack (1990) suggest that sensory input will 'trigger' somatosensory pain memories while the affective component of a pain memory is generated by the intensity, quality and location of the current experience of phantom limb pain. The present case study used a diary design to examine whether 'triggers' could be identified for somatosensory pain memories. Over a 9-month period, the patient reported daily experience of ongoing phantom limb pain, generally confined to the distal part of the limb, and 5 episodes of injury-related phantom limb pain, primarily experienced in the calf of the missing limb. A 'trigger' was identified for each of the episodes of injury-related phantom limb pain, and a significant finding in this study was that two episodes of injury-related phantom limb pain were associated with cognitive and/or emotional, rather than sensory 'triggers'.

The role of coping in adjustment to phantom limb pain.

Research has indicated that the way individuals cope with pain may influence pain, and physical and psychological adjustment. The present study assessed the relationship between coping strategy use and adjustment in amputees with phantom limb pain (PLP). Coping strategies were measured using the Coping Strategies Questionnaire (CSQ) and their relationship with adjustment was examined using both composite scores and individual strategy scores. The results indicated that the relationship between coping and adjustment was primarily explained by the use of strategies within the 'Helplessness' factor of the CSQ. A clearer picture of coping strategy use was gained from examining individual strategies rather than the composite measures. Catastrophizing explained the largest proportion of variance in pain report (26%), while increasing behavioral activity and hoping or praying strategies explained a smaller proportion of the variance (3% and 1%, respectively). Catastrophizing also explained a large proportion of the variance in physical and psychosocial dysfunction (11% and 22%), while hoping or praying strategies accounted for only a small proportion of the variance in physical dysfunction (3%), and re-interpreting pain sensations accounted for a small proportion of the variance in psychosocial dysfunction (3%). The findings in this study have important clinical implications in that coping strategy use was associated with increased, rather than decreased, levels of pain and disability. However, since the reported use of coping strategies in the present study was low, further research, perhaps utilizing other measures of coping, is required to clarify these findings.

The stability of the Ways of Coping (Revised) Questionnaire over time in parents of children with Down's syndrome: a research note.

The stability of the Ways of Coping (Revised) Questionnaire over time was assessed by comparing the scores of 68 mothers and 53 fathers of school-aged children with Down's syndrome over a 3-year time interval on the five coping strategy subscales described by Knussen et al. (1992). For this analysis, mothers' and fathers' scores were analysed separately. It was shown by t tests that mothers' and fathers' scores on the coping strategy subscales had not significantly changed over the three-year period. Time 1 and Time 2 scores on all of the coping subscales were strongly positively associated, with the exception of fathers' scores on the Stoicism subscale. Test-retest reliability was adequate for all subscales except mothers' scores on the Passive Acceptance subscale and fathers' scores on the Stoicism subscale. These results, by demonstrating the stability of the Ways of Coping (Revised) Questionnaire over a 3-year time period, further illustrate the utility of this instrument for investigating coping with families with special problems.

The use of the Ways of Coping (Revised) questionnaire with parents of children with Down's syndrome.

The principal aim of this study was to assess the validity and usefulness of the Ways of Coping (Revised) questionnaire (Folkman & Lazarus, 1985) with a British sample of parents of children with Down's syndrome. Factor analysis yielded five subscales which were compared with those reported elsewhere. Other properties of the instrument were investigated. It was concluded that the instrument was potentially valuable to those investigating coping in families with special problems.

The validity and applicability of the ADIECAS classroom rating scale in a sample of children with Down's syndrome.

The ADIECAS classroom behaviour rating scale (Evans & Hogg, 1984) was used with a sample of 123 children with Down's syndrome as part of a wider study of child and family adaptation. According to Evans & Hogg, the ADIECAS scale measures two types of behaviour: attentiveness-distractability, and inhibition-excitability. Such measures of behaviour style may be related to behaviour problems and child and family relationships for children with mental handicap. The factor structure of the 16 ADIECAS items was investigated by using confirmatory factor analysis within the LISREL program. Overall, the original factor structure was found to be a poor fit to the new data, in that, while the distractability factor replicated well, the excitability factor split into three. After examining the components of the four factors, two were discarded as containing unreliable items, and goodness of fit statistics on the two revised factors, using 10 of the original 16 items, gave the best results. Thus, the factors structure showed only limited replicability with a different subject group from the original Evans & Hogg study.

Factors related to stress and satisfaction with life in families of children with Down's syndrome.

In a study of families of children with Down's syndrome, measures of parent, family and child characteristics were obtained from mothers and fathers. Multivariable analyses investigated their relationships to outcome measures of psychosomatic symptoms of stress and parents' perceived satisfaction with life. Personality factors were related to outcome for both parents. For mothers, the children's levels of behaviour problems, excitability and self-sufficiency were strongly related to outcome. Coping strategies, family relationships and socio-economic factors also showed significant effects. For fathers, child characteristics were not related to outcome. The marital relationship was an important factor and there was evidence that factors external to the family acted as stressors.

Is the appearance of children with Down syndrome associated with their development and social functioning?

The appearance of 111 children with Down syndrome, aged six to 14 years, was rated by their class teachers as part of a larger study on factors associated with their development, social life-style and family functioning. There were no significant associations between measures of child development, communicative or independent functioning, social life, behaviour problems or with parental stress, parent-child relationships or quality of family life. Typical features of Down syndrome are not major correlates of development and social functioning, and no support could be found to justify routine cosmetic surgery aimed at ameliorating such features.

Factors relating to self-sufficiency in children with Down's syndrome.

An index of self-sufficiency in children with Down's syndrome was developed for use in a study of the process of adaptation in families living in the Greater Manchester area. The children were 6-14 years old, and living at home. Index scores were based on the mothers' responses to a questionnaire covering their children's personal and domestic functioning and community self-sufficiency, and were obtained from 111 of the 117 mothers who took part in the study. A wide range of child- and family-related variables were found to be significantly associated with self-sufficiency scores on a univariate level. Multiple regression analysis was used to identify those variables which best predicted the level of self-sufficiency achieved. After the child's mental age, the most significant variables were excitability, behaviour problems, the extent the mother used practical means of coping, and the level of social activity experienced by the child. Together, these five variables explained 63% of the variance in self-sufficiency scores. The dynamics by which such factors may relate to self-sufficiency in children with Down's syndrome are discussed, and intervention aimed at promoting the use of practical ways of coping by parents is suggested.

Factors related to the academic attainments of children with Down's syndrome.

The attainments in reading, number and writing skills, of 117 children with Down's syndrome, aged 6 to 14 years, were assessed using checklists completed by teachers. In a study of child and family functioning a wide range of variables was measured and the relationships of these to academic attainments were investigated using multivariable analysis. The children's mental age scores were most strongly related to academic attainments scores, but, in addition, type of school attended, gender, chronological age and fathers' scores on a measure of locus of control were significantly related. The results are discussed in terms of their implications for educational placement and curriculum, and the role of fathers in their children's education.

Social life of school children with Down's syndrome.

Frequency of participation in organized activities and informal play contacts with other children were investigated for a group of 118 children with Down's syndrome. Measures were based on mothers' reports. As part of a study of child and family functioning, a wide range of child, parent and family variables was measured and the relationships of these to the extent of the children's social contacts were investigated in multivariable analyses. Family variables of social class, parental education, marital relationship, and achievement and recreational orientation were found to be significantly related to the measures of the child's social life. In addition, children at the lower end of the IQ range in this sample were likely to have fewer informal play contacts. These results point to the influence of the family in stimulating and maintaining the children's social activities.

Health problems in children with Down's syndrome.

The health problems of 117 children with Down's syndrome were identified through a questionnaire to their mothers, as part of a wider study of the process of adaptation among families in the Manchester Down's Syndrome Cohort. At the time of the present study, the children were all of school age: mean age 9 years 2 months, range 6 to 14 years. Results from the current study are compared with that from earlier studies involving these children. Vision and hearing problems and respiratory infections were identified as the most common health problems, affecting a large percentage of the children. While a high proportion had been hospitalized and had undergone operations, the proportion of children who had missed more than 4 weeks of schooling in the previous 12 months was not high compared to the general child population. Equally, the numbers who had suffered accidents did not appear unduly high. Poor child health was found to be associated with a higher level of behaviour problems and increasing maternal stress over time. The need for health screening to continue during this period of childhood is identified.