Learning psychology as a challenging process towards development as well as "studies as usual": a thematic analysis of medical students' reflective writing.

Reflective writing in medical training has been shown to be most effective when combined with some form of personal meeting or dialog. During a course in medical psychology for medical students, reflective texts were followed up by an individual personal talk with a teacher from the course. Thematic analysis of the texts revealed four separate sub-themes: 1) the course has enabled me and the class to develop, which is good albeit arduous; 2) understanding myself is a resource in understanding people as well as knowing psychology; 3) the course provided me with new, purely intellectual skills as well as eye-openers; and 4) the receiving teacher is an integral part of my reflective writing. The main theme, capturing the students' writing process, concluded that students perceive the course as "Learning psychology as a challenging process towards development" as well as "studies as usual". Ethical, psychological, and pedagogical aspects are discussed in the paper.

Health-care delay in malignant melanoma: various pathways to diagnosis and treatment.

We aimed to describe and compare patients diagnosed with malignant melanoma (MM), depending on their initial contact with care and with regard to age, sex, and MM type and thickness, and to explore pathways and time intervals (lead times) between clinics from the initial contact to diagnosis and treatment. The sample from northern Sweden was identified via the Swedish melanoma register. Data regarding pathways in health care were retrieved from patient records. In our unselected population of 71 people diagnosed with skin melanoma of SSM and NM types, 75% of patients were primarily treated by primary health-care centres (PHCs). The time interval (delay) from primary excision until registration of the histopathological assessment in the medical records was significantly longer in PHCs than in hospital-based and dermatological clinics (Derm). Thicker tumors were more common in the PHC group. Older patients waited longer times for wide excision. Most MM are excised rapidly at PHCs, but some patients may not be diagnosed and treated in time. Delay of registration of results from histopathological assessments within PHCs seems to be an important issue for future improvement. Exploring shortcomings in MM patients' clinical pathways is important to improve the quality of care and patient safety.

Coping styles in decision-making among men and women diagnosed with malignant melanoma.

Early care seeking is important for prognosis of malignant melanoma. Coping styles in decision-making to seek care can relate to prognosis since avoidant strategies could delay care seeking. The aim of this study was to compare self-reported coping styles in decision-making between men and women diagnosed with malignant melanoma. We used the Swedish version of the Melbourne Decision-Making Questionnaire to assess coping styles. Men generally scored higher in buck-passing while women and those living without a partner scored higher in hypervigilance. This knowledge could be used in the development of preventive programmes with intention to reach those who delay care seeking.

Distress after a single violent crime: how shame-proneness and event-related shame work together as risk factors for post-victimization symptoms.

To increase understanding of post-victimization symptom development, the present study investigated the role of shame- and guilt-proneness and event-related shame and guilt as potential risk factors. 35 individuals (M age = 31.7 yr.; 48.5% women), recently victimized by a single event of severe violent crime, were assessed regarding shame- and guilt-proneness, event-related shame and guilt, and post-victimization symptoms. The mediating role of event-related shame was investigated with structural equation modeling (SEM), using bootstrapping. The guilt measures were unrelated to each other and to post-victimization symptoms. The shame measures were highly intercorrelated and were both positively correlated to more severe post-victimization symptom levels. Event-related shame as mediator between shame-proneness and post-victimization symptoms was demonstrated by prevalent significant indirect effects. Both shame measures are potent risk factors for distress after victimization, whereby part of the effect of shame-proneness on post-victimization symptoms is explained by event-related shame.

Malignant melanoma: gender patterns in care seeking for suspect marks.

AIMS AND OBJECTIVES: Gender patterns in self-detection of melanoma are not sufficiently highlighted in the literature. The aim of the study was to identify specific patterns in the decision-making process to seek care for suspect melanoma, as narrated by women and men. BACKGROUND: Females have a more favourable prognosis than males and also a higher level of perceived susceptibility and a higher level of knowledge about melanoma. Women are, furthermore, more prone to participate in screening. METHOD: Thirty patients (15 women and 15 men) with a mean age of 55.5 years and diagnosed with malignant melanoma were interviewed about their decisions to seek care for suspect skin marks. The interviews were transcribed and analysed with qualitative content analysis. RESULTS: Care-seeking behaviour for suspect melanoma was influenced by gender constructions. Men seldom or never acknowledged interest in attention to bodily changes, but when they became aware of changes, they often took a quick decision and sought an expert's assessment. Men were compliant with wives' and relatives' advice about seeking care. All women reported that they paid attention to bodily changes, but they often delayed care seeking, due to family responsibilities and emotional struggles. The women also attempted self-care remedies, such as applying ointment, before seeking professional care. CONCLUSIONS: There are gender-specific patterns that may influence decision making in the care-seeking process. Such patterns are important to identify, since health care professionals must take these factors into account in communicating with men and women. RELEVANCE TO CLINICAL PRACTICE: Nurses and in particular those working in telephone counselling, are often at the frontlines, deciding who can have access to health services. They are ideally placed to tackle the issue of gender constructions in the development of effective health care services.

A five-year follow-up study of Swedish adults with gender identity disorder.

This follow-up study evaluated the outcome of sex reassignment as viewed by both clinicians and patients, with an additional focus on the outcome based on sex and subgroups. Of a total of 60 patients approved for sex reassignment, 42 (25 male-to-female [MF] and 17 female-to-male [FM]) transsexuals completed a follow-up assessment after 5 or more years in the process or 2 or more years after completed sex reassignment surgery. Twenty-six (62%) patients had an early onset and 16 (38%) patients had a late onset; 29 (69%) patients had a homosexual sexual orientation and 13 (31%) patients had a non-homosexual sexual orientation (relative to biological sex). At index and follow-up, a semi-structured interview was conducted. At follow-up, 32 patients had completed sex reassignment surgery, five were still in process, and five-following their own decision-had abstained from genital surgery. No one regretted their reassignment. The clinicians rated the global outcome as favorable in 62% of the cases, compared to 95% according to the patients themselves, with no differences between the subgroups. Based on the follow-up interview, more than 90% were stable or improved as regards work situation, partner relations, and sex life, but 5-15% were dissatisfied with the hormonal treatment, results of surgery, total sex reassignment procedure, or their present general health. Most outcome measures were rated positive and substantially equal for MF and FM. Late-onset transsexuals differed from those with early onset in some respects: these were mainly MF (88 vs. 42%), older when applying for sex reassignment (42 vs. 28 years), and non-homosexually oriented (56 vs. 15%). In conclusion, almost all patients were satisfied with the sex reassignment; 86% were assessed by clinicians at follow-up as stable or improved in global functioning.

Assessment of self-conscious emotions: a Swedish psychometric and structure evaluation of the Test of Self-Conscious Affect (TOSCA).

The Test of Self-Conscious Affect (TOSCA) is a well-established scenario-based questionnaire assessing self-conscious emotions, such as shame and guilt, which have been shown to be differentially associated with a variety of functional, motivational, behavioral and health outcomes. The aim of this study was to evaluate the psychometric properties and internal structure of a Swedish version of TOSCA in a sample of 361 healthy adults. The psychometric properties and internal consistency of the Swedish version were at level with the original US TOSCA version for shame, guilt and detachment. The internal structure of the Swedish version was acceptable for shame, guilt and detachment but contained shortcomings in assessment of externalization.

Is disturbed sleep a mediator in the association between social support and myocardial infarction?

The objective of this study was to investigate a mediating relationship between social support and disturbed sleep in cases surviving myocardial infarction. The case-referent studies, Stockholm Heart Epidemiological Program (SHEEP) and Västernorrland Heart Epidemiological Program (VHEEP) were used comprising 6231 participants (2046 women). Referents were randomly selected. Disturbed sleep was operationalized by the Karolinska Sleep Questionnaire, network support by the Availability of Social Integration Index and emotional support by the Availability of Attachment Index. Mediating associations were tested with logistic regression. The results show that disturbed sleep may act as a mediator between low network support and myocardial infarction in women.

A longitudinal study of perfectionism in adolescent onset anorexia nervosa-restricting type.

This longitudinal study analyses self-reported perfectionism, eating disorders and psychiatric symptoms during recovery from anorexia nervosa (AN). With a recovered design, a group of 68 previous patients with AN was studied in two follow-up studies, 8 and 16 years after 1st admission to Child and Adolescent Psychiatry (CAP). Levels of perfectionism stayed the same while eating disorder symptoms and psychiatric symptoms decreased during recovery. Levels of perfectionism were inversely related to duration of remission so that individuals that had short illness duration had lower levels of perfectionism at both follow-ups. Patients with initial high levels of perfectionism may be at risk for a long illness duration which we recommend clinicians to acknowledge.

Psychosocial factors, gender, and sleep.

Low social support may contribute to poor sleep, more so than adverse aspects of demand and control and more so for women than men. This study on 1,179 working individuals, 623 women and 556 men, from the Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study investigated the association between sleep and psychosocial factors. Chi-square analyses investigated the associations among sleep and demand, control, social networks, and emotional support. A logit log-linear model analyzed interactions. More women reported poorer sleep when perceiving adverse psychosocial factors. Interactive effects were found between adverse scores on demand, control, and emotional support. A multivariate partial least square analysis showed that poorer health, pain, and adverse aspects of emotional support and social networks contributed significantly to the pattern of poor sleep.

Cognitive abilities related to post-traumatic symptoms among refugees from the former Yugoslavia in psychiatric treatment.

The overall aim was to study the relationship between post-traumatic symptoms and cognitive abilities among traumatized refugees from the former Yugoslavia, in psychiatric treatment. The results showed that a diagnosis of post-traumatic stress disorder (PTSD), as well as a higher level of post-traumatic symptoms, was significantly associated with poorer average cognitive performance. Three of four tests of fluid intelligence, and the Benton Visual Retention Test, assessing episodic memory, were the most discriminating. A specific constellation of PTSD symptoms, dominated by arousal and intrusive symptoms, had a significant overall correlation with intellectual performance. One implication of the study is that assessment of cognitive abilities might be advisable in this patient group, in particular when arousal and re-experiencing symptoms are frequent.

Possible influence of defenses and negative life events on patients with chronic fatigue syndrome: a pilot study.

13 patients with a diagnosis of chronic fatigue syndrome and two contrast groups of conversion disorder patients (n = 19) and healthy controls (n = 13) were assessed using the projective perceptual Defense Mechanism Test to investigate if specific defense patterns are associated with chronic fatigue syndrome. Another objective was to assess the possible influence of perceived negative life events prior the onset of the illness. The overall results showed significant differences in defensive strategies among groups represented by two significant dimensions in a Partial Least Squares analysis. Compared to the contrast groups the patients with chronic fatigue syndrome were distinguished by a defense pattern of different distortions of aggressive affect, induced by an interpersonal anxiety-provoking stimulus picture with short exposures. Their responses suggested the conversion group was characterized by a nonemotionally adapted pattern and specific constellations of defenses, associated with interior reality orientation compared to the patients with chronic fatigue syndrome and the healthy controls. Rated retrospectively, the group with chronic fatigue syndrome reported significantly more negative life events prior to the onset of their illness than healthy controls. For instance, 5 of the 13 patients reported sexual assault or physical battery as children or teenagers compared to none of the healthy controls. A significant association was found between defense pattern and frequency of reported negative life events. However, these retrospective reports might be confounded to some extent by the experience of the patients' illness; for example, the reports may be interpreted in terms of present negative affect.