28482689	Irritability is a common and impairing clinical presentation in children and adolescents. Despite its significant public health impact, irritability remains an elusive construct. Chronic and severe irritability is the primary symptom of the new DSM-5 diagnosis, disruptive mood dysregulation disorder (DMDD). However, empirical and clinical approaches to irritability are in their relative infancy, and questions regarding the validity of the DMDD diagnosis have been raised. Moreover, irritability is a trait distributed continuously in youth, thereby fitting within the National Institute of Mental Health Research Domain Criteria initiative. Thus, there are opportunities for scientific review and integration. Accordingly, the goals of this review include (a) clarifying the definitions of irritability, incorporating clinical and translational animal work; (b) reviewing the historical context surrounding the study of irritability;
28230907	Because binge eating and emotional eating vary through the menstrual cycle in human females, we investigated cyclic changes in binge-like eating in female rats and their control by estrogens. Binge-like eating was elicited by three cycles of 4 days of food restriction and 4 days of free feeding followed by a single frustrative nonreward-stress episode (15 min visual and olfactory exposure to a familiar palatable food) immediately before presentation of the palatable food. Intact rats showed binge-like eating during the diestrous and proestrous phases of the ovarian cycle, but not during the estrous (periovulatory) phase. Ovariectomized (OVX) rats not treated with estradiol (E2) displayed binge-like eating, whereas E2-treated OVX rats did not. The procedure did not increase signs of anxiety in an open-field test. OVX rats not treated with E2 that were subjected to food restriction and sacrificed immediately after frustrative nonreward had increased numbers of cells expressing phosphorylated extracellular signal-regulated kinases (ERK) in the central nucleus of the amygdala (CeA), paraventricular nucleus of hypothalamus (PVN), and dorsal and ventral bed nuclei of the stria terminalis (BNST) compared with nonrestricted or E2-treated rats. These data suggest that this female rat model is appropriate for mechanistic studies of some aspects of menstrual-cycle effects on emotional and binge eating in human females, that anxiety is not a sufficient cause of binge-like eating, and that the PVN, CeA, and BNST may contribute to information processing underlying binge-like eating.
28103715	Although irritability is among the most common reasons that children and adolescents are brought for psychiatric care, there are few effective treatments. Developmentally sensitive pathophysiological models are needed to guide treatment development. In this review, the authors present a mechanistic model of irritability that integrates clinical and translational neuroscience research. Two complementary conceptualizations of pathological irritability are proposed: 1) aberrant emotional and behavioral responding to frustrative nonreward, mediated by reward-system dysfunction; and 2) aberrant approach responding to threat, mediated by threat-system dysfunction. The authors review the pathophysiological literature, including animal studies, as well as experimental psychology and clinical studies. Data suggest that, relative to healthy children, irritable children have deficient reward learning and elevated sensitivity to reward receipt and omission. These deficits are associated with dysfunction in the prefrontal cortex, striatum, and amygdala. Youths with irritability also show maladaptive orienting to, interpreting, and labeling of potential threats, associated with prefrontal cortical and amygdalar dysfunction. Abnormalities in reward and threat processing potentiate one another. Future work should test pathophysiological hypotheses and novel interventions targeting reward- and threat-related dysfunction to improve treatment for severe irritability in youths.
27823854	In 2010, the National Institute of Mental Health (NIMH) created the Research Domain Criteria (RDoC), a research framework for integrating multiple units of information to explicate basic dimensions of functioning underlying both adaptive and maladaptive behavior. Our goal in this review is to evaluate self-report indicators of negative valence systems constructs within RDoC.We review the content and correlates of several of the most popular self-report measures currently classified within the negative valence systems in the RDoC matrix, using both our own data and previously published results. We use these data to evaluate whether these measures are appropriately placed; in addition, wherever possible, we recommend better alternatives to assess key RDoC constructs.	Our findings indicate that many of the currently listed self-report measures are misplaced. Specifically, our data reveal that some of the purported fear scales are better conceptualized as measures of anxiety and/or anxious arousal. In addition, none of the currently listed measures of frustrative nonreward is a clear, unambiguous indicator of that construct.	The RDoC matrix currently does not list any specific measures of either loss or sustained threat, which makes it difficult to identify appropriate measures of these constructs. In many cases, the specificity/discriminant validity of proposed measures remains uncertain.	Researchers wanting to include self-report measures of negative valence constructs currently receive little guidance from the RDoC matrix. Future assessment work should be oriented toward the development of measures that are explicitly designed to assess these RDoC constructs.	
25265284	Stress glucocorticoids and insulin are important endocrine regulators of energy homeostasis, but little is known about their central interaction on the reward-related processing of food cues. According to a balanced group design, healthy food deprived men received either 40IU intranasal insulin (n=13), 30mg oral cortisol (n=12), both (n=15), or placebo (n=14). Acoustic startle responsiveness was assessed during presentation of food and non-food pictures. Cortisol enhanced startle responsiveness during visual presentation of "high glycemic" food pictures, but not during presentation of neutral and pleasant non-food pictures. Insulin had no effect. Based on the "frustrative nonreward" model these results suggest that the reward value of high glycemic food items is specifically increased by cortisol.
24465595	Comparative studies are imperative for understanding the evolution of adaptive neurobiological processes such as neural plasticity, cognition, and emotion. Previously we have reported that prolonged omission of expected rewards (OER, or 'frustrative nonreward') causes increased aggression in Atlantic salmon (Salmo salar). Here we report changes in brain monoaminergic activity and relative abundance of brain derived neurotrophic factor (BDNF) and dopamine receptor mRNA transcripts in the same paradigm. Groups of fish were initially conditioned to associate a flashing light with feeding. Subsequently, the expected food reward was delayed for 30 minutes during two out of three meals per day in the OER treatment, while the previously established routine was maintained in control groups. After 8 days there was no effect of OER on baseline brain stem serotonin (5-HT) or dopamine (DA) activity. Subsequent exposure to acute confinement stress led to increased plasma cortisol and elevated turnover of brain stem DA and 5-HT in all animals. The DA response was potentiated and DA receptor 1 (D1) mRNA abundance was reduced in the OER-exposed fish, indicating a sensitization of the DA system. In addition OER suppressed abundance of BDNF in the telencephalon of non-stressed fish. Regardless of OER treatment, a strong positive correlation between BDNF and D1 mRNA abundance was seen in non-stressed fish. This correlation was disrupted by acute stress, and replaced by a negative correlation between BDNF abundance and plasma cortisol concentration. These observations indicate a conserved link between DA, neurotrophin regulation, and corticosteroid-signaling pathways. The results also emphasize how fish models can be important tools in the study of neural plasticity and responsiveness to environmental unpredictability. 
24354658	Previous research has shown that food deprivation enhances the acoustic startle reflex when it is elicited during presentation of visual food cues. Frustrative nonreward may explain this effect, since visual food cues are also rated to be more appetitive and arousing during food deprivation. However, the impact of menstrual cycle and sex on this effect remains unclear, and it is also not known whether this effect is influenced by hunger and motivation to eat. According to a within-study design, 20 healthy women in different menstrual cycle phases and 14 healthy men participated twice, in normal and food-deprived conditions. After 18  h of food deprivation, acoustic startle was attenuated by appetitive nonfood foreground pictures, but enhanced by presentation of food pictures. No differences between menstrual cycle phases and sexes appeared. The effect correlated with hunger changes, suggesting that motivational factors play a role.
22611665	We investigated the impact of food deprivation on oral and manual haptic size perception of food and non-food objects. From relevant theories (need-proportional perception, motivated perception, frustrative nonreward, perceptual defence, and sensory sensitisation) at least four completely different competing predictions can be derived. Testing these predictions, we found across four experiments that participants estimated the length of both non-food and food objects to be larger when hungry than when satiated, which was true only for oral haptic perception, while manual haptic perception was not influenced by hunger state. Subjectively reported hunger correlated positively with estimated object size in oral, but not in manual, haptic perception. The impact of food deprivation on oral perception vanished after oral stimulations even for hungry individuals. These results favour a sensory sensitisation account maintaining that hunger itself does not alter oral perception but the accompanying lack of sensory stimulation of the oral mucosa. Both oral and manual haptic perception tended to underestimate actual object size. Finally, an enhancing effect of domain-target matching was found, ie food objects were perceived larger by oral than by manual haptics, while non-food objects were perceived larger by manual than by oral haptics.
20121719	It has been suggested that alcohol use is related to sensitivity of the reward system. Although there are several studies using self-reported measures supportive of this notion, objective biological data in humans on this issue are lacking.This study is designed to test whether alcohol drinking frequency is associated with electrophysiological indices of reward processing.	In a passive gambling task, stimuli predicted the presence (reward) and absence (nonreward) of rewards resulting in P2 and medial frontal negativity (MFN) indices of reward processing. Forty-seven undergraduate students were asked about their habitual drinking frequency and the P2 and MFN to stimuli predicting reward were measured.	Most importantly, the MFN to unpredicted nonrewards at the frontal midline (Fz) location correlated significantly with drinking frequency, with frequent drinkers showing larger MFN amplitudes. The results did not show a significant association between frequency and alcohol drinking and P2.	Although several studies showing increased reward-sensitivity in addictive behaviors, the present results indicate that, in frequent alcohol drinkers, electrophysiological responsiveness is particularly activated by unpredicted nonrewards. In general, this may point to the involvement of the reward system in alcohol drinking frequency.	More specifically, the results demonstrate an increased vulnerability of high frequency drinkers to signals of (frustrative) nonrewards.	
18520959	To examine sex differences in autonomic nervous system functioning in children and adolescents with conduct problems and to evaluate the role of aggression in predicting autonomic nervous system functioning, over and above the effects of disruptive behavior. Although deficiencies in autonomic responding among boys with oppositional defiant disorder and/or conduct disorder are well documented, it remains unclear whether such findings extend to girls or apply only to children with aggressive forms of conduct problems.Electrodermal responding, cardiac pre-ejection period, and respiratory sinus arrhythmia were recorded while boys (n = 110; 53 with conduct problems, 57 controls) and girls (n = 65; 33 with conduct problems, 32 controls) between the ages of 8 and 12 sat for an extended baseline, then played a game with conditions of reward and frustrative nonreward.	Both sex effects and aggression effects were found. Aggressive boys with conduct problems demonstrated reduced autonomic functioning, consistent with previous research. In contrast, aggressive girls with conduct problems exhibited greater electrodermal responding than controls, with no differences in cardiovascular reactivity to incentives.	Observed sex differences in the autonomic correlates of conduct problems and aggression may suggest different etiological mechanisms of externalizing psychopathology for girls compared with boys.	
15053723	Does the behavioral approach system (BAS) relate to the experience of any negative affects, or are all negative affects tied to the behavioral inhibition system (BIS)? In Study 1, self-reported Fun Seeking predicted reports of greater frustration and sadness after frustrative nonreward. In Study 2, self-reported Reward Responsiveness predicted reports of greater anger in response to scenarios. In Study 3, self-reported Drive predicted reports of greater anger after the terrorist attacks of September 11, 2001. In no case did BIS sensitivity contribute uniquely to these affects, though BIS predicted nervousness in Study 2 and fear in Study 3. Discussion focuses on the role of frustration and anger in effortful pursuit of goals and depressed affect in disengagement from goals.
12937347	The surprising or unexpected omission of an appetitive reinforcer has at least two effects: An allocentric effect according to which the organism updates knowledge about the environment, and an egocentric effect that allows the organism to learn about its own emotional reaction to the change. This egocentric effect (traditionally called frustration) is correlated to activation of the hypothalamic-pituitary-adrenal axis, can be modulated by treatment with anxiolytics, and is expressed in terms of behavioral changes that have an emotional component (e.g., agonistic behavior). It is hypothesized that all vertebrates share the mechanisms underlying the allocentric effect, but only mammals possess the mechanisms underlying the egocentric effect. It is further argued that frustrative mechanisms evolved in early mammals from those underlying fear conditioning.
12148930	A discrete stimulus (flashing light) was paired with cocaine (20 mg/kg) to induce conditioned locomotion. To identify brain regions activated during this response, Fos was measured with immunohistochemistry. Although paired subjects displayed robust conditioned locomotion, Fos was not increased in any limbic brain regions analyzed. In contrast, pairing of cocaine with generalized contextual cues (whole room) produced conditioned locomotion and Fos activation in the prelimbic portion of prefrontal cortex and the nucleus accumbens core. These results suggest that the pattern of neuronal activation during cocaine-conditioned activity differs depending on whether a discrete or contextual stimulus is used as a conditioned stimulus. The possibility that expectancy and frustrative nonreward contribute to Fos expression in rats conditioned to contextual cues is discussed.
11239675	Little is known about frustration-induced changes in stress physiology in humans and nonhuman primates. Here we assess in two experiments with squirrel monkeys plasma levels of pituitary-adrenal stress hormones in conditions designed to provoke frustrative nonreward. In the first experiment 18 prepubertal monkeys were trained to feed from one of eight sites, and then tested without food at any of the sites. These monkeys responded with significant increases in cortisol and adrenocorticotropic hormone (ACTH). In the second experiment 18 adult monkeys were trained to feed from one of eight sites, and then tested after food was moved to a different foraging site. Nine monkeys found food at the relocated site, discontinued foraging at the previously baited site, and responded with decreases in cortisol. The other nine monkeys failed to find the relocated site, initially increased their visits to the previously baited site, and responded with elevations in cortisol and ACTH. In keeping with comparable findings in rats, our observations indicate that frustrative nonreward elicits ACTH-stimulated secretion of cortisol in primates.
10459405	Modulation of the startle reflex by affective foreground stimuli was investigated in a group receiving inpatient treatment for major depressive episodes (n = 14) and an age and gender matched nondepressed group (n = 14).Participants viewed 27 pleasant, neutral, and unpleasant pictures chosen from the International Affective Picture System. Acoustic startle probes were presented during picture viewing, and participants also rated the affective qualities of the pictures.	While ratings of the pictures were largely similar between the depressed and nondepressed groups, they displayed dissimilar patterns of startle modulation. In the nondepressed group, blinks elicited during unpleasant pictures were significantly larger than during pleasant pictures, whereas the depressed group failed to show this effect. Analyses, which separated the depressed participants into moderate and severe groups based on Beck Depression Inventory scores, revealed that while the moderately depressed group also showed a normal pattern of startle modulation, the severely depressed showed potentiated startles during the pleasant pictures.	These preliminary results suggest that severely depressed patients may respond to some pleasant stimuli as if they are aversive, possibly because such stimuli are seen as signals of frustrative nonreward.	
24896729	Laying hens are thought to express an expectation of a rewarding event through a specific vocalisation, the gakel-call. It has been suggested that the gakel-call is related to frustration, i.e. the thwarting of behaviour. We investigated if frustrative nonreward (nonreinforcement in a situation that previously was consistently reinforcing) in laying hens is expressed through this gakel-call. Twenty hens of two commercial strains, ten ISA White Leghorn and ten ISA Brown Warren were subjected to a classical conditioning procedure. After 23 h of food-deprivation they were trained, in automated Skinnerboxes, to use red lights as a signal (unconditioned stimulus) for a food reward. After this the hens of each strain were equally divided into two groups of five. They were subjected to a control session (light as conditioned stimulus followed by food reward) and to a frustration session (conditioned stimulus followed by nonreward). Both during the frustration and control session behaviour and vocalisations were recorded. In the White Leghorn strain high levels of alarm-calls are found as indicators of anxiety. In the Brown Warren strain more gakel-calls and an increased locomotor activity are found after frustrative nonreward. In conclusion, both findings suggest that vocalisations could serve as indicators of a laying hen's welfare. 
9460168	The current study assessed the effects of maternal, paternal, or combined parental consumption of Lake Ontario salmon in rats on the behavior of their offspring. Adult female Sprague-Dawley rats were put on a 30 day diet of either ground rat chow containing 30% Lake Ontario salmon (LAKE) or 30% Pacific Ocean salmon (OCEAN). These females were then mated with adult male rats similarly exposed (LAKE or OCEAN). An additional control group of males and females who were fed ground rat chow (MASH) only were also mated. These pairing combinations resulted in five offspring groups: LAKE-LAKE, LAKE-OCEAN, OCEAN-LAKE, OCEAN-OCEAN, MASH-MASH. When the offspring reached 80 days of age, they were tested for reactivity to frustrative nonreward using runway successive negative contrast, which has been repeatedly shown to be increased in adult rats fed Ontario salmon. Consistent with previous work, results showed that the behavior of the OCEAN-OCEAN rats did not differ from the MASH-MASH group, indicating that a salmon diet per se does not cause behavioral change. However, the offspring of dams who consumed Lake Ontario salmon (LAKE-LAKE and OCEAN-LAKE) showed an increased depression effect relative to controls. There was little evidence of a paternal effect. A follow-up experiment employed cross-fostering to determine the relative contribution of pre- and/or postnatal exposure to Lake Ontario salmon consumption on offspring behavior. Rat pups were cross-fostered to or from dams who consumed Lake Ontario salmon during gestation and parturition. Results from two separate replications indicated that prenatal (LAKE to OCEAN) exposure alone or postnatal (OCEAN to LAKE) exposure alone produced a large increase in successive negative contrast relative to controls (OCEAN to OCEAN). These data are strong evidence of behavioral changes produced by maternal consumption of Lake Ontario salmon in the offspring rat. Further, they indicate that either prenatal or postnatal exposure alone is sufficient to produce behavioral changes in the offspring.
7652024	Three experiments were carried out to investigate stress hyperthermia in prepubertal pigs. Experiment 1 examined the effect of frustrative nonreward (psychological stress) on deep body temperature in animals (n = 7) trained to make operant responses for food following a 17.5-h period of deprivation. There was no change in body temperature when the feeders were switched off whereas there was a small increase (NS) during normal operant feeding that might be attributable to physical exertion. In Experiment 2, the effects of 15-min physical restraint (snaring) were examined in the same group of animals. This procedure induced a significant (p < 0.01) rise in core temperature that was completely abolished by prior administration of a cyclooxygenase inhibitor (indomethacin, 2 mg/kg given intravenously). The final experiment investigated the effects of snaring on plasma cortisol concentrations. Blood samples were taken from indwelling catheters in pigs (n = 5) subjected to 15-min restraint with, or without, indomethacin pretreatment. Snaring produced a significant (p < 0.001) increase in cortisol release that was not affected by the administration of indomethacin. These results suggest that snaring, a physical stress that may also have energy expenditure components, induces a prostaglandin-mediated hyperthermic response in the growing pig.
24203515	In this comment, I examine Amsel's theory in the light of rats' reaction not to frustrative non-reward per se, but to the more complicated case in which frustrative nonreward is part of a rule-based sequence of reward quantities. The discussion goes beyond Amsel's emphasis on dispositional memory to consider cognitive and representational memory-the signaling properties of reinforcement and nonreinforcement. The strengths and weaknesses of Amsel's theory are discussed with the fresh perspective that this viewpoint provides, and some issues emerge that may be fruitful for further study. 
8255911	The conditioned place preference procedure was used to evaluate the reinforcing properties of drinking in water-deprived rats. Subjects were allowed to drink for 8 min and were then transferred to place preference cages. In Experiment 1, the effects of naloxone and pimozide on drinking-induced place preference were analyzed. Animals treated with naloxone, 16 mg/kg, before the conditioning sessions showed a place aversion instead of the place preference found in saline-treated animals. Naloxone also reduced drinking. It was proposed that naloxone induced a state of frustrative nonreward. Pimozide, 1 mg/kg, blocked place preference and somewhat reduced drinking. In Experiment 2, doses of 1 and 4 mg/kg naloxone were used. Both doses blocked place preference. A dose of 4 mg/kg had a marginal effect on drinking, while 1 mg/kg lacked effect on this behavior. Thus, naloxone may block the establishment of place preference without modifying drinking. The effects of the dopamine D1 antagonist SCH23390 and the D2 antagonist raclopride were studied in Experiment 3. SCH23390 blocked place preference and reduced drinking at doses of 0.25 and 0.125 mg/kg. A dose of 0.06 mg/kg did not affect drinking but inhibited place preference. Raclopride, 0.25 mg/kg, had the same effects as SCH23390 at the same dose while 0.125 mg/kg blocked place preference without affecting drinking. It appears that the effects of a D1 and a D2 antagonist are similar. Because the effects of these latter drugs also are similar to those obtained with naloxone, it is suggested that both dopamine and opioids are important for water-induced reinforcement. Possible interactions between these two neurotransmitter systems are discussed.
8475504	Prior to straight runway training two groups of rats received lead exposure (500 ppm via the drinking water) for 106 days. Two additional groups of animals received access to plain tap water. An 80-trial runway acquisition phase followed an initial 60-day fluid exposure phase. During acquisition one lead-exposed group and one water-exposed group received 50% partial reinforcement training, while the remaining animals received continuous reinforcement training. An 80-trial extinction phase immediately followed acquisition. Acquisition results were characterized by superior performance by the continuous reinforcement animals. The partial reinforcement animals took significantly longer to extinguish the alleyway response than did the continuous reinforcement animals. Moreover, the lead-exposed, partial reinforcement animals took longer to extinguish in the goal section of the runway than did the water-exposed, partial reinforcement animals. Conversely, the lead-exposed, continuously reinforced animals displayed significantly more rapid goal-measure extinction than did the water-exposed, continuously reinforced animals. When interpreted by the classic frustration theory [1,2], these latter two findings are supportive of a heightened emotional reaction being promulgated by lead exposure.
1409798	The effect of administration of diazepam on successive negative contrast in one-way avoidance learning was examined in rats. Contrast was induced by shifting rats from a large reward, 30 s spent in the safe compartment, to a small reward, 1 s spent in the safe compartment. IP administration of 2 mg/kg diazepam eliminated this negative contrast. Moreover, this effect is dose dependent, with doses of 2 and 2.5 mg/kg, but not 0.5 mg/kg, effective in reliably reducing contrast. These results suggest the existence of similar or common underlying mechanisms in both aversive and appetitive contrast effects; they are discussed in light of the current theories of frustrative nonreward and as a mean of studying the behavioral and biological mechanisms of anxiety.
1611935	Learning of a manipulative response was examined in 6-13-month-old well babies and in risk infants who, in the perinatal period, had experienced a range of respiratory interventions (low- and high-risk). 2 contingency conditions (contingent and yoked) were crossed with 2 locations of feedback (local and remote). Both well-baby and low-risk groups reliably discriminated between contingent and noncontingent feedback when it was presented locally, whereas high-risk babies failed to make this distinction in the conditioning phase. Risk status reliably predicted the learning performance. No response acquisition was obtained in the remote feedback condition. In extinction, the well-baby and low-risk groups decreased their responding, but the high-risk group showed an initial response burst. The findings are discussed in the context of risk-related differences in contingency awareness and frustrative nonreward. Overall, the results confirm that the effects of perinatal compromise involving respiratory complications influence infants' processing of contingency information during the first year of life.
2707346	We tested whether the stress of nonreward has neurochemical effects on noradrenergic neurones which resemble those reported for other forms of stress. Rats trained to run in a straight runway for food reward were subjected to either 1 or 10 extinction trials. Half the rats in each group were injected before the start of acquisition with IP 6-hydroxydopamine to deplete peripheral noradrenaline stores. All animals were killed immediately after their final test in the runway, together with untrained controls. Noradenaline depletion had no behavioural or neurochemical effects. The rate of extinction in the 10-trial group, which was indexed by the slope of the linear regression of running time on trial, correlated negatively with both alpha 2- and beta-adrenoceptor number (Bmax). There were no differences between groups in cerebral cortical noradrenaline content, or alpha 2- or beta-adrenoceptor binding. These results substantially conflict with those predicted from Stone's hypothesis relating beta-adrenoceptor sensitivity to the behavioural response to stress. A further finding was that alpha 2-, but not beta-adrenoceptor number, negatively correlated with levels of noradrenaline in the tissue, suggesting that noradrenaline is less involved in the regulation of beta- than in that of alpha 2-adrenoceptors.
2901114	Anti-anxiety drugs (including benzodiazepines, barbiturates and alcohol) have a distinctive profile of behavioural action in animal species ranging from goldfish to chimpanzee. This profile may be summarised as a blockade of three kinds of reaction (behavioural inhibition, preparation for vigorous action, and increased attention to the environment) in response to any of three kinds of stimuli (novelty, stimuli associated with punishment, or stimuli associated with frustrative nonreward). On this basis, one may postulate a 'behavioural inhibition system' in the brain, responsible for organising the above reactions in response to appropriate stimuli; activity in this system would then constitute 'anxiety.' One may attempt to describe the brain structures that constitute the behavioural inhibition system either by enquiring about the neurochemical mode of action that is common to anti-anxiety drugs, or by seeking for structures with appropriate behavioural functions. The latter approach has implicated a number of structures in the limbic system (including the hippocampal formation, the septal area, and ascending monoaminergic pathways). Possible information-processing functions of these structures are described.
3939643	The effect of local injections of 6-hydroxydopamine (6-OHDA) into the lateral septum was tested in a paradigm known to lead to an energizing behavior, through a possible frustrative effect, induced by partial or total omission of reward in hungry rats. Biochemical assays in the septum showed that 6-OHDA reduced endogenous dopamine and, to a lesser extent, noradrenaline concentrations and left intact noncatecholaminergic neurons such as serotoninergic terminals. The first behavioral experiment was conducted in a double straight alley. The animals were submitted to three phases of testing with differing degrees of reinforcement: (a) an acquisition phase, in which the reinforcement was continuously delivered in the goal box of the two alleys, (b) a partial reinforced phase, in which animals received 50% partial reinforcement in the first alley and continuous reinforcement in the second alley, and (c) an extinction phase performed in one alley without any reinforcement. Animals with lesions ran faster for food than controls in the partial reinforcement or extinction situation, although there was no difference between the two groups in the acquisition phase of the continuous schedule of reinforcement or in the 50% reinforced trials of the partial reinforcement phase. The two groups also behaved similarly after the first six trials of the extinction phase. In a second experiment, the animals were tested in a lever-press conditioning task. Animals with lesions and control animals learned this task equally well, both with respect to the number of lever presses and the time to obtain a fixed number of food pellets.(ABSTRACT TRUNCATED AT 250 WORDS)
6721007	Groups of rats received discriminative straight-alley training under 75% or 90% predeprivation body weight levels. After training, one-half of the subjects at each body weight level received extinction trials to only the stimulus associated with reward (S +), and one-half received intermixed extinction trials to S + and the stimulus associated with nonreward (S -). In extinction, rats trained under 75% body weight displayed greater persistence when alternated between S + and S - than when extinguished to S + only (positive induction). Subjects trained under 90% body weight levels failed to show evidence of positive induction. These results support an interpretation of positive induction based on deprivation-dependent frustrative reactions.

457953	Corticosterone, the principal glucocorticoid in the rat, binds selectively to the CA1 pyramidal neurons of the hippocampus where the hormone has been demonstrated to exert a moderate chronic suppression of spontaneous activity. In the first experiment of the current study, the functional behavioral significance of this hormone--brain interaction was investigated in the extinction of an appetitive runway response in normal rats and those with lesions of the hippocampus. During extinction, half of the animals in each group were given daily subcutaneous injections of corticosterone. Whie the classical retardation effect of hippocampal lesions on appetitive extinction was replicated, hormone treatment was without effect in normal or hippocampally damaged subjects. The absence of a hormone effect in normals was primarily attributed to a saturated limited-binding system operating in the normal animal. Experiment 2 tested this notion, repeating the first experiment, with adrenal-ectomized (ADX), ADX + corticosterone replacement, and normal groups of animals. Adrenalectomy produced a striking facilitation of extinction which was speculated to be the result of a hyperactive inhibitory neural organ free from an inhibitory endocrine feedback. Corticosterone treatment normalized the progress of extinction in ADX animals, providing support for the afore-mentioned speculation. In the normal animal, it appears that a stress-induced surge in hormone level interacts with a limited-capacity neural binding to produce a transient dynamic range of behavioral disinhibition, perhaps promoting persistence during initial stages of frustrative nonreward in moderate stress tasks.
755057	Lesions of the dorsal nonadrenergic bundle produced by 6-hydroxydopamine, which depleted telencephalic noradrenaline by over 95%, were found to produce resistance to extinction in animals trained on a continuously reinforced schedule for food reward but not to alter the extinction rate after partial reinforcement training. These results confirm the dorsal bundle extinction effect reported previously but suggest that it is confined to continuously reinforced situations. The pattern of results is consistent with a role for the dorsal bundle in attentional processes but appears to contradict the predictions required if the dorsal bundle were to have a role in frustrative nonreward.
409929	Recent developments in animal psychopharmacology were reviewed with special reference to our 10-year studies in confirming the disinhibitory theory of chlordiazepoxide in frustrative nonreward (rats), spontaneous alternation (rats), discrimination reversal (rats), successive discrimination (rats), go/no-go type descrimination (rats, monkeys), passive and shuttle avoidance (rats) and differential heart rate conditioning (rats). Although anticholinergics have a similar behavioral function, their sites of action seem to be different because of their effect on the hippocampal electrical activity is markedly distinct from that of chlordiazepoxide.

1129357	Rats trained to run an alley for a food reward were extinguished following injections of different antidepressants. When retested several days later, the animals extinguished following pretreatment with the NE reuptake blocker protriptyline showed faster running speeds than did the other groups. Other rats given electrical shocks following pretreatment with protriptyline avoided the compartment in which they had been shocked less than did animals shocked following pretreatment with other antidepressants. This implies an interferance with some aspect of the learning or consolidation process which is correlated with the degree of NE reuptake blockage. It is hypothesized that NE terminals are deactivated following frustrative nonreward or punishment by the conversion and reuptake of the released NE to an altered extinction molecule.







16811515	Twenty to seventy per cent of the reinforcements scheduled for pigeons' fixed-ratio 80 performances were replaced by a 4-sec timeout. Pauses after reinforced ratios were unchanged at 80% reinforcement, but were lengthened at lower reinforcement percentages. Pauses after nonreinforced ratios were shorter than post-reinforcement pauses. When 50% of the reinforcements arranged by a variable-interval 60-sec schedule were replaced by a 4-sec timeout, pauses after reinforcement omission increased. Both frustrative nonreward and reinforcement aftereffects notions can explain the fixed-ratio results; neither easily explains the variable-interval data.

4910006	The frequency of the hippocampal theta rhythm in freely moving rats varies predictably in relation to behavior in a simple learning situation. The theta rhythm may be driven by electrical stimulation of the medial septal area at frequencies within the theta range. The threshold for septal driving is lowest at that frequency which the rat displays in response to frustrative nonreward; the driving threshold is selectively raised at this frequency by sodium amobarbital. It is suggested that the behavioral effects of amobarbital are due to a disruption of the theta frequency normally displayed in response to nonreward.


5768370	Animals deprived of reward for a task previously rewarded behave differently, depending on whether the reward is food or positive brain stimulation. Unlike the relatively stable frustration effects obtained with conventional reward, frustration produced by withholding brain stimulation dissipates rapidly with time.





28578816	Few studies have investigated pediatric headaches in Japan. Thus, we examined the lifetime prevalence and characteristics of headaches among elementary and junior high school students in Japan.In this school-based study, children aged 6-15years completed a questionnaire based on the diagnostic criteria of the International Classification of Headache Disorders-3β to assess headache characteristics and related disability.	Of the 3285 respondents, 1623 (49.4%) experienced headaches. Migraine and tension-type headaches (TTH) were reported by 3.5% and 5.4% of elementary school students, respectively, and by 5.0% and 11.2% of junior high school students. Primary headaches increased with age. Compared with TTH sufferers, the dominant triggers in migraine sufferers were hunger (odds ratio=4.7), sunny weather (3.3), and katakori (neck and shoulder pain) (2.5). Compared with TTH, migraine caused higher headache-related frustration (P=0.010) as well as difficulty concentrating (P=0.017). Migraine-related disability was greater among junior high school students (feeling fed up or irritated, P=0.028; difficulty concentrating, P=0.016). TTH-related disability was also greater among junior high school students (feeling fed up or irritated, P=0.035). Approximately half of the students who complained of headache-related disability were not receiving medical treatment.	This is the first detailed study of headaches in Japanese children to include elementary school students. Nearly 50% of the school children reported headaches and the disruption of daily activities caused by migraine was higher among junior high students than elementary school students.	
28499301	Tinnitus belongs to seriously debilitating auditory conditions and is often complicated by comorbidities such as insomnia, difficulties with concentration, depression, frustration and irritability. To facilitate the grading of symptoms and the effects of therapeutic strategies, we validated a German-version Tinnitus Functional Index (TFI) in 229 subjects suffering from chronic tinnitus. Outcome validity was assessed using the Tinnitus Questionnaire (TQ, German adaptation by Goebel u. Hiller [1998]). Construct validity was assessed using the "Hamburger Allgemeine Depressionsskala" (HADS). The German TFI featured excellent internal consistency (total score Cronbach's α=0.93). Factor analysis disclosed eight TFI subscales as proposed earlier by Meikle et al. [2012]. Intercorrelations were strong both between the TFI and the TQ (r=0.83), and between the TFI and the HADS (depression r=0.49, anxiety r=0.51). The German-version TFI qualifies as a rapid and statistically robust tool for grading the impact of tinnitus on daily living and for the measurements of therapeutic effects. Regarding depressive symptomatology, sensitivity of the TFI was comparable to that of the TQ.
28032045	Dentists encounter numerous professional stressful situations, beginning from education to day-to-day practice. The resulting stress tends to have a negative impact on their personal as well as professional lives.To measure daily burnout, and to investigate the extent of expectations from dental career and the feeling of being unqualified new dental practitioner.	A close-ended questionnaire, i.e., "the Copenhagen Burnout Inventory," was utilized for evaluation. A total of 121 dentists with an experience ranging between 6 months and 5 years were included. The period was considered initiating from graduation to dental practicing in urban or rural areas. Ninety-seven dentists replied with filled questionnaires (80.16%). The multivariant analysis was done using SPSS 11.0 ver. (Chicago, USA).	Using measures analysis, the mean scores for dentists on the basis of age and sex (n = 97) were calculated. The factors most commonly considered responsible for professional burnout were emotional exhaustion (39.27%), frustrations (47.83%), feeling worn out at the end of the day (35.05%), feeling worn out at the end of the working day (46.80%), exhaustion in the morning at the thought of another day at work (35.05%), feeling that every working hour is tiring (46.80%), less energy and less time for family and friends (47.83%). The most common cause for stress was professional burnout that was recorded commonly in females in the age range of 26-28 years.	Dentists are more prone for professional burnout, anxiety, and depression. The main reason for this is the nature of their practice and their personality traits, especially while pursuing dentistry as a carrier. Stress may lead to negative impact on dentists' personal as well as professional lives.	
27021879	The purpose of this study was to identify the daily problems experienced by school-age children in remission from cancer. It also sought to assess the predictive value of these problems on the mental health of these children 1 year after the first assessment.Against this background, 50 children in remission from cancer and in mainstream education, aged 8-12 years, completed two questionnaires: the Quality of Life Systemic Inventory for Children (QLSI-C) (Missotten et al., 2007) and the Child Depression Inventory (CDI). THE QLSI-C consists of 20 life areas: Sleep, Diet, Physical pain, Health, Clothing, Physical appearance, Bedroom, Grandparents, Mother, Father, Siblings, Friends, How my friends talk about me, School, School results, Sport, Non-sporting activities, Autonomy, Obedience to authority, and Tolerance of frustration. Each of these 20 life areas was evaluated by the child by reference on each occasion to an ideal situation, first in relation to their current situation and then in relation to their personal goals, in order to measure the gap between these two evaluations. This difference was then weighted by the importance given to each life area and the dynamic situation of approximation to or distance from the goals. All the children in this study were seen in person for two interviews 1 year apart (T1 and T2).	The analyses conducted following the PLS-PM approach enabled eight of the 20 life areas evaluated to be identified as difficult to access by the children in this study. These analyses also showed that the difficulties perceived by children in remission from cancer have mainly proximal effects (i.e., short-term) on the discomfort experienced (direct effect of difficulties expressed in T1 on discomfort felt at T1; idem for T2). However, the areas perceived as difficult at T1 did not enable distal effects (i.e., effect over a year) on the discomfort expressed in T2 to be updated. Nonetheless, the conflicts at T1 fed the conflicts at T2 and, as a consequence, indirectly affected the experience of depression at T2.	The discussion examines the nature of the daily difficulties perceived by school-age children in remission from cancer and the short-term psychological distress experienced by these children. It concludes that the difficulties encountered by children in remission from cancer are not necessarily cumulative over time and that they do not inevitably result in permanent psychological suffering.	
26909725	To describe mothers' experiences with expressing breast milk for preterm or SGA infants.This is a descriptive qualitative study involving 130 mothers of preterm or SGA infants admitted to a neonatal intensive care unit. Data were collected in collaboration with two Finnish peer support associations. An Internet-based questionnaire with open-ended questions was administered to respondents. Responses were analyzed with inductive content analysis.	Mothers had to try to manage daily life and breast pumping. The combination of preterm birth and separation from the hospitalized infants served simultaneously as motivating factors and obstacles. Mothers tried to look beyond the unnatural and difficult process of milk expression, looking forward to eventual breastfeeding. Concerns about time and scheduling, equipment, environment, and sufficient milk supply were prevalent, as well as feelings of unfamiliarity, difficulty, frustration, and loneliness.	Expressing breast milk should be considered as a helpful factor for preterm or SGA infants' mothers. Separation between mother and infant should be avoided. Mothers need adequate equipment and a private space for expressing milk, in addition to assistance with their daily routines. For mothers to successfully manage expression, they also require an environment that fosters a sense of caring, normality, and hope, as well as frequent care for their emotional needs.	
26603674	Smokers with fibromyalgia have greater pain intensity and function impairment compared to nonsmokers. Patients' perceptions of interactions between smoking and fibromyalgia symptoms have not been described. The primary aim of this study was to report the perceptions of female smokers with fibromyalgia on how smoking affects symptoms.Forty-eight daily smokers with fibromyalgia enrolled in the Mayo Clinic Fibromyalgia Treatment Center completed the Fibromyalgia Impact Questionnaire, Fagerstrom Test for Nicotine Dependence, Patient Health Questionnaire-9, General Anxiety Disorder-7 and a Fibromyalgia Symptoms and Smoking Survey which queried how smoking directly affected fibromyalgia symptoms (eg, pain, tiredness/fatigue, stiffness, nervousness/anxiety, depression/blueness, irritability, concentration, and overall) or indirectly as a coping mechanism.	The majority of subjects reported smoking had no direct effect on fibromyalgia physical symptoms (pain [60% reported no effect], fatigue [56%], stiffness [81%]) but direct improvement of emotional symptoms (anxiety [62% reported improvement], irritability [64%]). The majority of subjects used smoking to cope with pain (69%) via distraction (83%) and relaxation (77%), lessening emotional distress by reducing a sense of frustration (83%) or sadness (54%) because of pain, and as a justification for resting vis-à-vis "smoke breaks" (69%). Thirty-one smokers were mildly and 17 moderately/severely dependent on tobacco, and no difference in fibromyalgia impact score (P = 0.70), pain (P = 0.39), depression (P = 0.20), and anxiety (P = 0.64) scores were detected, but more moderately/severely dependent subjects reported smoking improved pain (50% vs. 17%, P = 0.04).	Smokers with fibromyalgia reported smoking helped to cope with fibromyalgia pain but generally did not directly ameliorate fibromyalgia physical symptoms.	
26562461	Asthma is one of the most common chronic diseases in children. The unpredictability, frequency, and health risks associated with acute asthma attacks have a profound impact on the daily lives of affected children and their families. Understanding the experiences of primary caregivers may help nurses provide better care to children with asthma.This study explores the experience of primary caregivers in providing care to children with asthma.	The study used exploratory and descriptive research methods and collected data using a qualitative research interview approach. Seventeen primary caregivers of children with asthma who visited the allergy clinics of two medical centers and one regional hospital in northern Taiwan participated in the study. An interview guide with a semistructured questionnaire was used, and verbatim transcripts of the audiotape-recorded interviews were analyzed using content analysis.	The findings are described in three themes covering 10 categories. These themes and categories include feelings of uncertainty during illness (disease as perception related, lack of information), feelings of chaos and instability (worry, fear, frustration, helplessness, physical distress), and social tension and family conflict (disorientation of daily activity and burden of care, economic burden, family tensions and disagreements).	Negative experiences with asthma care and the unpredictability of the disease outcomes impair the ability of caregivers to adapt successfully to their caregiving role and encourage perceptions that they cannot cope with this illness. Better understanding the caregiver experience may assist healthcare providers to better target support to these caregivers so that they are better able to care for children with asthma.	
26486272	BACKGROUND Studies have suggested that contact precautions (CP) for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus may have risks that outweigh the benefits. These risks, coupled with more widespread use of horizontal interventions such as daily bathing with chlorhexidine gluconate, have brought into question the value of routine CP for these organisms. OBJECTIVE To assess the state of utilization of CP as well as adjunctive measures to reduce the risk of transmission in US hospitals. DESIGN Cross-sectional survey. PARTICIPANTS Total of 751 physician members of the Emerging Infections Network. METHODS An 8-question electronic survey distributed by email. RESULTS A total of 426/751 (57%) responded to the survey; 337/364 (93%) of respondents use routine CP for methicillin-resistant S. aureus and 335/364 (92%) use routine CP for vancomycin-resistant enterococcus. The most widely used trigger for initiation of CP for both pathogens was positive clinical culture. Practices for discontinuation of isolation varied widely. We found that 325/354 (92%) perform routine chlorhexidine gluconate bathing and 236/353 (67%) perform S. aureus decolonization with mupirocin for 1 or more subsets of inpatients, and 82/356 (23%) reported using either hydrogen peroxide vapor or ultraviolet-C room disinfection at discharge. Free text responses noted frustration and variation in the application, practice, and process for initiation and discontinuation of CP. CONCLUSIONS Use of CP for methicillin-resistant S. aureus and vancomycin-resistant enterococcus remains commonplace, although horizontal interventions such as chlorhexidine gluconate bathing are increasingly used. The heterogeneity of practices and policies was striking. Evidence-based guidelines regarding CP and horizontal interventions are needed. Infect. Control Hosp. Epidemiol. 2015;37(1):36-40. 
26329115	We evaluate (a) associations between marital quality (emotional support, strain, and overall appraisal) and three negative aspects of experienced well-being (frustration, sadness, and worry) among older husbands and wives and (b) the relative importance of own versus spouse's marital quality assessments for understanding experienced well-being in later life.Data are from the 2009 Disability and Use of Time daily diary supplement to the Panel Study of Income Dynamics (N = 722). We estimate actor-partner interdependence models, using seemingly unrelated regression.	Own reports of marital strain are associated with own frustration, sadness, and worry among wives and are associated with frustration only among husbands. Own reports of marital support are associated with negative emotion among husbands only: higher levels of marital support are associated with less worry. Results from partner effects analyses also are mixed. Husbands' reports of marital strain are associated with wives' elevated frustration levels, whereas wives' reports of greater marital support are associated with their husbands' higher frustration levels.	One's own and spouse's marital appraisals play a complex role in shaping negative emotions among older adults. Findings suggest that frustration is a particularly complex emotion and a promising area for further study among older married couples.	
26000827	This study analyzes the consequences of maternal death to households in Western Kenya, specifically, neonatal and infant survival, childcare and schooling, disruption of daily household activities, the emotional burden on household members, and coping mechanisms.The study is a combination of qualitative analysis with matched and unmatched quantitative analysis using surveillance and survey data. Between September 2011 and March 2013 all households in the study area with a maternal death were surveyed. Data were collected on the demographic characteristics of the deceased woman; household socio-economic status; a history of the pregnancy that led to the death; schooling experiences of surviving school-age children; and disruption to household functioning due to the maternal death. These data were supplemented by in-depth and focus group discussions. Quantitative data on neonatal and infant survival from a demographic surveillance system in the study area were also used. Descriptive and bivariate analyses were conducted with the quantitative data, and qualitative data were analyzed through text analysis using NVivo.	More than three-quarters of deceased women performed most household tasks when healthy. After the maternal death, the responsibility for these tasks fell primarily on the deceased's husbands, mothers, and mothers-in-law. Two-thirds of the individuals from households that suffered a maternal death had to shift into another household. Most children had to move away, mostly to their grandmother's home. About 37% of live births to women who died of maternal causes survived till age 1 year, compared to 65% of live births to a matched sample of women who died of non-maternal causes and 93% of live births to surviving women. Older, surviving children missed school or did not have enough time for schoolwork, because of increased housework or because the loss of household income due to the maternal death meant school fees could not be paid. Respondents expressed grief, frustration, anger and a sense of loss. Generous family and community support during the funeral and mourning periods was followed by little support thereafter.	The detrimental consequences of a maternal death ripple out from the woman's spouse and children to the entire household, and across generations.	
25875102	Asthma is one of the most common chronic diseases in children. The unpredictability, frequency, and health risks associated with acute asthma attacks have a profound impact on the daily lives of affected children and their families. Understanding the experiences of primary caregivers may help nurses provide better care to children with asthma.This study explores the experience of primary caregivers in providing care to children with asthma.	The study used exploratory and descriptive research methods and collected data using a qualitative research interview approach. Seventeen primary caregivers of children with asthma who visited the allergy clinics of two medical centers and one regional hospital in northern Taiwan participated in the study. An interview guide with a semistructured questionnaire was used, and verbatim transcripts of the audiotape-recorded interviews were analyzed using content analysis.	The findings are described in three themes covering 10 categories. These themes and categories include feelings of uncertainty during illness (disease as perception related, lack of information), feelings of chaos and instability (worry, fear, frustration, helplessness, physical distress), and social tension and family conflict (disorientation of daily activity and burden of care, economic burden, family tensions and disagreements).	Negative experiences with asthma care and the unpredictability of the disease outcomes impair the ability of caregivers to adapt successfully to their caregiving role and encourage perceptions that they cannot cope with this illness. Better understanding the caregiver experience may assist healthcare providers to better target support to these caregivers so that they are better able to care for children with asthma.	
25858054	Aspirin-exacerbated respiratory disease (AERD) is a chronic illness of progressive recurrent sinus disease with nasal polyps and asthma. No population-based comprehensive surveys of patients with AERD have been carried out to assess specific quality-of-life impact or perceptions of treatment benefit.This survey analyzed perceptions and quality of life in those living with AERD and queried patient observations of treatment effectiveness. The survey assessed whether dietary and nutritional support was used to manage AERD, and if so, whether there was a perceived benefit.	This survey was publicized through clinics that treat patients with AERD, Web sites, and online blogs.	Results are reported for 190 patients. Most subjects reported an adverse effect of AERD on quality of life. Chronic nasal symptoms followed by decreased sense of smell were reported to have the greatest impact on quality of life—in 81 (43%) and 74 (39%), respectively. Those who lost their ability to smell (n = 65; 34%) reported that they missed the enjoyment of food and eating the most. A minority indicated that a combination of medications (aspirin, leukotriene receptor antagonist, zileuton, or omalizumab) was more effective than 1 alone. Of those surveyed, 120 (63%) respondents felt that components of their diet contributed to their disease and 147 (77%) respondents reported having reactions after alcohol consumption.	Patients with AERD live with frustration and report a poor quality of life in spite of several pharmacologic treatments including aspirin desensitization followed by daily aspirin. Despite ongoing medical therapy, the burden of disease in AERD remains high.	
25720045	Adolescents affected by a severe disease who undergo high-risk treatment may experience stress, pain, extreme frustration, depression, and anger. In this large spectrum of emotions, several situations must be considered carefully. To improve coping and quality of services offered to adolescents in paediatric hospitals, we elaborated a semi-structured interview and a short questionnaire (Quality of life-adolescent-Istituto Giannina Gaslini, QoL-adol-IGG scale) to investigate the quality of life, the needs and expectations of adolescent in-patients.The study sample includes 117 in-patients aged between 10 and 20 years coming from several Italian regions who were admitted to the G. Gaslini Research Children's Hospital for a period of 10 days or more, regardless of the disease. The QoL-adol-IGG scale was administered - after obtaining informed consent from the children and their parents - in one single encounter by trained psychologist. The distribution of the answers was evaluated after stratification by patient's age, gender, area of residence, and clinical diagnosis. Continuous data were compared using the Kruskal-Wallis, while the χ2-test was used for categorical data.	Seventy-two percent had difficulty practicing normal daily activities during their stay in the hospital, not only because of the disease (40%), but also because of the poor organization within the hospital, the lack of proposals/activities and space for spare time, and the limited access to technologies. Adolescents ≥15 years were more frequently dissatisfied than youngsters concerning the access to Internet and other technologies, the possibility to make new friends and to take part in social activities.	The results of this study, which evaluated the hospital's organization, but also psychological functioning in a representative sample of patients, may contribute to optimize internal procedures of clinical departments where adolescent in-patients are present, on the basis of their requests and taking into account their age.	
25586796	To explore parents' views of the activities and participation of children with cerebral palsy (CP) with a range of communicative abilities and the factors (personal and environmental) that influenced these.Thirteen parents of children with CP aged 4-9 years participated in semi-structured individual interviews. Interviews were recorded, transcribed and analysed thematically. Identified codes and themes were mapped to the domains of the International Classification of Functioning, Disability and Health - Children and Youth Version (ICF-CY).	Parents' responses reflected all ICF-CY domains comprising activity, participation and environmental factors. Codes were primarily mapped to the domains learning and applying knowledge, communication, mobility and interpersonal interactions and relationships. Key barriers identified included aspects of parents' own interactions with their child (e.g. not offering choices), unfamiliar people and settings, negative attitudes of others and children's frustration. Facilitators included support received from the child's family and school, being amongst children, having a familiar routine and the child's positive disposition.	Despite the barriers experienced, children participated in a range of activities. Parents placed importance on communication and its influence on children's independence, behaviour and relationships. Barriers and facilitators identified highlight aspects of the environment that could be modified through intervention to enhance communication and participation.	Children's activities and participation were largely related to early learning tasks (e.g. literacy), communication, mobility and interactions. Intervention aimed at improving activities and participation may address the various child, impairment, social and environment factors identified here as impacting on activities and participation (e.g. the child's personal characteristics, communication and physical impairments, the support and attitudes of others and the familiarity of the environment). Therapists will need to consider (and manage) the potential negative impact communication deficits may have on children's behaviour, independence and social skills which may in turn detrimentally impact on activity and participation.	
25548792	The aim of this study was to assess the impact of herpes zoster (HZ) and postherpetic neuralgia (PHN) on the daily activities of patients and family members who care for them. Some former patients and family members participated in face-to-face interviews or in a T-group meeting (qualitative phase) and some participated in telephone interviews (quantitative phase). They all expressed feelings of helplessness and frustration mixed with depression, sadness, or rage. Many of the former patients said their lives stopped, in contrast to family members who said that their lives were busy and stressful. Family members caring for patients with PHN were more psychologically stressed than those caring for patients with HZ. Although former patients appreciated the psychological and emotional support given by their family members, they underestimated the impact that their disease had on them. Former patients and their family never forgot this illness and its considerable impact on their lives, particularly when PHN occurred. We need to raise the awareness of the general public about the real life impact of HZ and PHN and their often severe, debilitating consequences and the potential benefits from vaccination. 
25325598	A growing body of literature indicates that insomnia is related to suicidality. However, the mechanism through which insomnia correlates with suicide risk is unclear. The goal of the present research was to determine whether hopelessness, a robust predictor of suicidality, mediates the relation between insomnia and suicidal ideation (SI).The present study used archival data from community-dwelling adults. Participants (n = 766) completed a Health Survey, two weeks of daily sleep diaries, and five measures of daytime functioning, including the Beck Depression Inventory (BDI). BDI item 2 was used to assess hopelessness, and BDI item 9 was used to assess SI. Criteria from the DSM-5 as well as quantitative criteria were used to identify participants with insomnia (n = 135).	The analyses revealed that hopelessness is a significant mediator of the relation between insomnia and SI. After adding depression as an additional mediator, hopelessness remained a significant predictor of SI.	The present research suggests the need for clinicians to routinely screen clients who have insomnia for hopelessness and SI, and to treat hopelessness when it is present. Further research should address the limitations in this sample and should also consider other potential mediators of the insomnia-SI link.	
25207710	Little research has been conducted exploring the issues surrounding parenting with an acquired brain injury (ABI). This study aimed to explore the experiences and needs of parents who suffered an ABI in the last 2 years from their own perspectives. For individuals with an ABI who have dependent children their ABI has the potential to impact upon their parenting abilities, skills and relationships.Interpretive phenomenological analysis (IPA) was used to analyse the data. Using IPA allowed the research questions and inquiry to be positioned epistemologically and directed towards 'meaning' rather than 'difference' or 'causality'.	Five participants (two female, three male) were interviewed using a semi-structured interview schedule.	Four main themes were identified: (i) Multiple losses, (ii) A mix of resigned acceptance and uncertain future, (iii) Giving and receiving support is part of the healing process and (iv) Hopes and aspirations.	The results indicated that the participants experienced an oscillation between experiencing the multiple losses of their parental role and attempting to adapt and adjust to these changes. These findings are discussed in relation to clinical and theoretical implications for parents who are inpatients with an ABI up to 2 years post-injury.	
25066432	Emotional lability (EL), characterized by negative emotional traits and emotional instability, is frequently reported in children and adults with attention deficit hyperactivity disorder (ADHD). However, EL is primarily assessed using retrospective self-report, which is subject to reporting bias and does not consider the potential influence of positive and negative everyday experiences.Ambulatory assessment was carried out in 41 men with ADHD without co-morbidity, current medication or substance abuse, and 47 healthy control participants. Reports of negative and positive emotions (irritability, frustration, anger, happiness, excitement) and the occurrence of bad and good events were completed eight times daily during a working week. Group differences in emotional intensity and instability were investigated using multilevel models, and explored in relation to bad and good events and the Affective Lability Scale - Short Form (ALS-SF), an EL questionnaire.	The ADHD group reported significantly more frequent bad events, heightened intensity and instability of irritability and frustration, and greater intensity of anger. The results for positive emotions were equivocal or negative. Bad events significantly contributed to the intensity and instability of negative emotions, and showed a stronger influence in the ADHD group. However, covariation for their effect did not eliminate group differences. Small-to-moderate correlations were seen between intensity and instability of negative emotions and the ALS-SF.	Adults with ADHD report heightened intensity and instability of negative emotions in daily life. The results suggest two components of EL in ADHD: a reactive component responsive to bad events and an endogenous component, independent of negative everyday events.	
24966141	Haemophilia and its treatment have a significant impact on patients' lives. The study objectives were to understand the impacts of haemophilia and its treatment from the patient perspective and to inform the development of comprehensive health-related quality-of-life (HRQL) conceptual models to illustrate these impacts.The study included two phases. Phase I involved a review of literature published from 1995 to 2010, qualitative analysis of six patient (N = 31) and three healthcare provider (N = 15) focus group transcripts, and interviews with two experts to inform draft conceptual models of mild/moderate and severe haemophilia. Phase II involved interviews with 20 haemophilia patients and qualitative analysis of transcripts to confirm the concepts and structure of the conceptual models.	The literature search resulted in 66 publications assessing HRQL, four of which were qualitative studies on the impact of haemophilia from the patient perspective. Results from Phase I indicated that acute bleeding events result in pain, swelling, bruising and restricted joint movement; repeated joint bleeds result in chronic symptoms, such as pain and arthropathy. Acute bleeds cause interruptions in daily activities and interfere with work/school. Patients have fears about having bleeds, which can affect their participation in activities, such as sports or crowded events. Patients also expressed feelings of depression, frustration, isolation and embarrassment. Results of Phase II corroborated findings from Phase I.	The conceptual models illustrate the substantial impact of haemophilia and its treatments on patients' lives and can help inform clinical study design and the selection of endpoints to assess treatment benefit.	
24784486	The purpose of the current study was to evaluate the relationship between parent-report and objective measures of executive function in children diagnosed with Fetal Alcohol Spectrum Disorder (FASD). The participants were a clinical sample of 551 children who completed 597 evaluations, including initial and re-evaluations. Participants were 6-16 years old, with a mean age of 10. Pearson correlations were used to determine the relationship between performance-based measures and parent-report measures of executive functioning. Relationships among the same types of measures, that is, performance based or parent report, were also evaluated. The data largely demonstrate low nonsignificant correlations between performance-based measures and parental report of executive function. Parent-report measures were internally consistent as were objective measures. It is possible that a third variable, for example, parental frustration, significantly influences parent reports. It is also likely that objective measures, which are administered in a controlled environment, do not fully capture children's day-to-day functioning. That is, a child may have the executive function abilities (i.e., good performance on objective measures) but may be unable to deploy the appropriate skills in their daily lives, as evidenced by parental report. Children with FASD who have executive function abilities but not implementation skills likely require different interventions than children who lack abilities and skills.
24679383	Hoarding Disorder (HD), a new diagnostic entity in DSM-5, is associated with substantial functional impairment and family frustration but data from well-characterized samples is lacking.Participants were 37 individuals meeting DSM-5 criteria for HD, 55 relatives of individuals meeting criteria for HD, and comparison groups of 51 self-identified collectors and 25 relatives of collectors. All participants completed a clinician-administered diagnostic interview for HD and an online battery of standardized measures of health, well-being, and impairment.	Substantial functional impairment was found for both HD individuals and their relatives. HD relatives reported significantly greater carer burden and accommodation of hoarding behaviors than relatives of collectors. Perceived level of squalor, co-habiting with, and increasing age of the HD individual were significant predictors of carer burden and functional impairment in the relatives.	The use of self-identified HD individuals may have produced a bias towards participants with relatively good insight. Subjective biases in self-reported symptoms cannot be ruled out, although the use of informant-report data provided some independent validation.	HD is associated with substantial functional impairment for both sufferers and their relatives. The level of carer burden experienced by HD relatives was comparable to or greater than that reported in the literature by relatives of individuals with dementia. The findings indicate that relatives of individuals with HD may benefit from increased support and suggest that it may be beneficial to involve family members in the treatment of HD.	
24598560	Patients' perspectives of posttransplant self-management tasks have not been explored.OBJECTIVE-To explore the concept and the presence of self-management tasks mastered by patients in the early phase after kidney transplant.Mixed-method study using semistructured interviews and a structured questionnaire.Setting-Outpatient Division of Nephrology at University Hospital Zurich, Switzerland.	Twelve patients (median age, 52 years, interquartile range, 42.25-65.25 years; median time after kidney transplant, 6.5 months; interquartile range, 2.25-15.75 months) were included.Analysis-Qualitative data were analyzed according to Corbin and Strauss' 3 self-management tasks with content analysis procedures. In the quantitative analysis, the presence of each self-management task is expressed as a frequency.	-The qualitative findings showed that patients were greatly challenged by the effort to manage the upcoming instability, which has a persistent broad impact on their lives. Managing emotions comprised dealing with uncertainty, disappointment, and frustration. Additionally, patients had to manage changes in self-perception. Managing life roles mainly involved an adaptation of relationships, occupational changes, and interactions with health care providers. Taking medications, managing symptoms, integrating new behaviors, and understanding one's course of disease were further tasks. Quantitatively, self-management tasks that were perceived as a challenge by at least half of the patients were primarily tasks from the questionnaire section "managing stressful emotions and self-perception." The synthesis of qualitative and quantitative findings indicates that self-management programs for kidney transplant recipients should focus on strengthening patients' self-management of emotional tasks and on regaining stability in daily life.	
24571924	The Lifetime Impairment Survey, conducted in Europe, assessed impairment and symptoms of attention-deficit/hyperactivity disorder (ADHD) in childhood, and experiences of ADHD diagnosis and treatment, as recalled by adults.Adults with ADHD and without ADHD (control group) were invited to participate in an internet-based survey and report on their childhood experiences. History of ADHD diagnosis was self-reported. Groups were compared using impairment and symptom scales.	Overall, 588 adults with ADHD and 736 without ADHD participated. Mean (standard deviation [SD]) age at diagnosis of ADHD was 20.0 (12.6) years (median 18.0) following consultation with 3.8 (5.1) doctors (median 2) over 44.6 (69.3) months (median 17.0). A total of 64.1% (377/588) of adults with ADHD reported frustration or difficulties during the diagnostic process. The ADHD group had a higher mean (SD) score versus control for general (3.3 [1.2] vs 2.1 [1.2]; p < 0.001) and school impairment (2.8 [0.7] vs 2.3 [0.6]; p < 0.001) but not home impairment (2.1 [0.5] for both groups). Discussion The survey demonstrated that ADHD had a negative impact on all aspects of childhood investigated, as recalled by adults.	These data provide insights into childhood impairments and identify areas for improvement in the management and treatment of ADHD.	
24355601	The Lifetime Impairment Survey assessed impairment and symptoms of attention-deficit/hyperactivity disorder (ADHD) in children/adolescents from six European countries. Parents/caregivers of children/adolescents aged<20 years with ADHD (ADHD group; n = 535) and without ADHD (control group; n=424) participated in an online survey. History of ADHD diagnosis was self-reported. ADHD and control groups were compared using impairment and symptom scales; higher scores indicate greater impairment. Mean (SD) age at ADHD diagnosis was 7.0 (2.8) years, following consultation of 2.7 (2.6) doctors over 20.4 (23.9) months. Parents/caregivers (64%; 344/535) reported frustration with some aspect of the diagnostic procedure; 74% (222/298) were satisfied with their child's current medication. ADHD had a negative impact on children/adolescents in all aspects of life investigated. The ADHD group had a higher mean (SD) school impairment score (2.7 [0.7]) compared with the control group (2.1 [0.7]; P<0.001) and were more likely to be in the bottom of their class (P<0.001). These data provide insights into impairments associated with ADHD in childhood/adolescence, and identify areas for improvement in its management and treatment.
24143904	Athletic training students (ATSs) are involved in various situations during the clinical experience that may cause them to express levels of frustration. Understanding levels of frustration in ATSs is important because frustration can affect student learning, and the clinical experience is critical to their development as professionals.To explore perceived levels of frustration in ATSs during clinical situations and to determine if those perceptions differ based on sex.	Cross-sectional study with a survey instrument.	A total of 14 of 19 professional, undergraduate athletic training programs accredited by the Commission on Accreditation of Athletic Training Education in Pennsylvania.	Of a possible 438 athletic training students, 318 (72.6%) completed the survey.	The Athletic Training Student Frustration Inventory was developed and administered. The survey gathered demographic information and included 24 Likert-scale items centering on situations associated with the clinical experience. Descriptive statistics were computed on all items. The Mann-Whitney U was used to evaluate differences between male and female students.	A higher level of frustration was perceived during the following clinical situations: lack of respect by student-athletes and coaching staffs, the demands of the clinical experience, inability of ATSs to perform or remember skills, and ATSs not having the opportunity to apply their skills daily. Higher levels of frustration were perceived in female than male ATSs in several areas.	Understanding student frustration during clinical situations is important to better appreciate the clinical education experience. Low levels of this emotion are expected; however, when higher levels exist, learning can be affected. Whereas we cannot eliminate student frustrations, athletic training programs and preceptors need to be aware of this emotion in order to create an environment that is more conducive to learning.	
24102896	Niacin has lipid-modifying efficacy and cardiovascular benefit, but is underutilised because of niacin-induced flushing (NIF). This real-world, prospective, observational study characterised the severity and impact of NIF symptoms among participants who were newly prescribed extended-release (ER) niacin.Participants were surveyed daily during week 1 of therapy, at weeks 5, 9, 13, and at months 7, 10 and 13. Surveys included the Flushing Symptom Questionnaire (FSQ), which includes the Global Flushing Severity Score (GFSS) question, the Flushing Impact Questionnaire (FIQ) and the Treatment Satisfaction Questionnaire for Medication (TSQM).	Overall, 306 participants were enrolled. During week 1, 30.0% of participants reported a maximum GFSS ≥ 4 (moderate or greater). Mean FIQ domain scores increased with increasing flushing severity, primarily driven by the Irritation/Frustration domain. By week 13, only 2.5% of participants had attained a 2 g ER niacin dose. By month 13, 43.5% (n = 133) had discontinued ER niacin. At discontinuation, only 3.1% of participants had attained the 2 g dose. Over half of the participants who discontinued experienced flushing symptoms: 82% reported moderate to extreme flushing (GFSS ≥ 4), and 68% reported severe to extreme flushing (GFSS ≥ 7). Participants who discontinued and had flushing side effects reported high degrees of impact in the FIQ Irritation/Frustration domain, and high dissatisfaction as a result of side effects, as measured by the TSQM.	In a real-world setting, NIF side effects were bothersome and had an impact on the continuation of therapy.	
24080080	Connect-Four, a new sensorimotor rhythm (SMR) based brain-computer interface (BCI) gaming application, was evaluated by four severely motor restricted end-users; two were in the locked-in state and had unreliable eye-movement.Following the user-centred approach, usability of the BCI prototype was evaluated in terms of effectiveness (accuracy), efficiency (information transfer rate (ITR) and subjective workload) and users' satisfaction.	Online performance varied strongly across users and sessions (median accuracy (%) of end-users: A=.65; B=.60; C=.47; D=.77). Our results thus yielded low to medium effectiveness in three end-users and high effectiveness in one end-user. Consequently, ITR was low (0.05-1.44bits/min). Only two end-users were able to play the game in free-mode. Total workload was moderate but varied strongly across sessions. Main sources of workload were mental and temporal demand. Furthermore, frustration contributed to the subjective workload of two end-users. Nevertheless, most end-users accepted the BCI application well and rated satisfaction medium to high. Sources for dissatisfaction were (1) electrode gel and cap, (2) low effectiveness, (3) time-consuming adjustment and (4) not easy-to-use BCI equipment. All four end-users indicated ease of use as being one of the most important aspect of BCI.	Effectiveness and efficiency are lower as compared to applications using the event-related potential as input channel. Nevertheless, the SMR-BCI application was satisfactorily accepted by the end-users and two of four could imagine using the BCI application in their daily life. Thus, despite moderate effectiveness and efficiency BCIs might be an option when controlling an application for entertainment.	
23978405	although maintaining activity is key to successful pain management, and important to health and wellbeing, it is known that older people in pain frequently alter or reduce activity levels. A 'fear-avoidance' model is often used to explain avoidance of activity in the face of pain. However, this model is not intended to take account of the wider context in which activity changes take place, nor older people's own explanations for their behaviour.to investigate the reasons why older people in the community adjust their activity levels when living with chronic pain.	thirty-one people aged between 67 and 92 were purposively sampled from respondents to a community-based cross-sectional survey. All participants had reported long-term pain and were interviewed about this. Data were collected and analysed using a qualitative constructivist grounded theory approach.	explanations for deliberative reduction or ceasing of activities reflected a desire to prevent pain exacerbation, thereby avoiding medical intervention. It also reflected a desire to safeguard autonomy in the face of pain in older age. Restrictions were often rationalised as normal in older age, although co-existing accounts of perseverance and frustration with limitation were also evident.	a rational desire to avoid pain exacerbation and medical intervention motivated restrictions to activity. However, deliberative limitation of activity has the potential to compromise autonomy by increasing social isolation and de-conditioning. Supporting older people with pain to be active requires sensitivity to the function of activity restriction, especially as a means of preventing deterioration.	
23769146	The Personal Mobility and Manipulation Appliance (PerMMA) is a recently developed personal assistance robot created to provide people with severe physical disabilities enhanced assistance in both mobility and manipulation. PerMMA aims to improve functional independence when a personal care attendant is not available on site. PerMMA integrates both a smart powered wheelchair and two dexterous robotic arms to assist its users in completing essential mobility and manipulation tasks during basic and instrumental activities of daily living (ADL). Two user interfaces were developed: a local control interface and a remote operator controller. This paper reports on the evaluation of PerMMA with end users completing basic ADL tasks. Participants with both lower and upper extremity impairments (N=15) were recruited to operate PerMMA and complete up to five ADL tasks in a single session of no more than two hours (to avoid fatigue or frustration of the participants). The performance of PerMMA was evaluated by participants completing ADL tasks with two different control modes: local mode and cooperative control. The users' task completion performance and answers on pre/post-evaluation questionnaires demonstrated not only the ease in learning and usefulness of PerMMA, but also their attitudes toward assistance from advanced technology like PerMMA. As a part of the iterative development process, results of this work will serve as supporting evidence to identify design criteria and other areas for improvement of PerMMA. 
23567422	While typically examined as a unitary construct, there is evidence that caregiver burden may be composed of several dimensions. The purpose of this study was to examine the factor structure of the Zarit Burden Interview (ZBI) in a sample of dementia caregivers and to explore the relationship between these factors and demographic, mood, and care recipient variables.Cross-sectional.	Academic medical center.	206 spousal or adult child caregivers for patients with mild to moderate dementia residing in the community.	Caregiver measures included the ZBI, Center for Epidemiologic Studies Depression Scale, and the Burns Relationship Satisfaction Scale. Patient measures included scores on the Dementia Rating Scale, Lawton-Brody Activities of Daily Living scale, and Revised Memory and Behavior Problems Checklist.	Factor analysis revealed three dimensions of caregiver burden: direct impact of caregiving upon caregivers' lives, guilt, and frustration/embarrassment. Caregiver depression and age emerged as unique predictors of the first two factors. Caregivers' satisfaction with their relationship with the patient and patients' functional independence also uniquely predicted the direct impact of caregiving upon caregivers' lives. Patients' behavioral problems and caregivers' level of relationship satisfaction with the care recipient served as unique predictors of frustration/embarrassment.	Findings demonstrate the multidimensionality of caregiver burden among dementia caregivers. Given the unique predictors of each dimension of burden, caregivers may benefit from different types of tailored interventions specific to the subtype of burden they are experiencing.	
23343358	The aim was to describe and understand how connecting rehabilitation experiences and everyday life was characterised in the lived experiences during the rehabilitation in women with stress-related ill health.Five women were interviewed on three occasions during a rehabilitation programme and once 3 months later. Data were analysed using the Empirical, Phenomenological and Psychological method.	The participants experienced connections between their rehabilitation and their previous, present and future everyday life influencing both rehabilitation and everyday life in a back-and-forth process. These connections were experienced in mind or in doing, mostly targeting the private arena in everyday life. Connecting rehabilitation experiences to their working situations was more challenging and feelings of frustration and being left alone were experienced.	Although the participants described constructive connections between rehabilitation experiences and the private arena in everyday life, they mostly failed to experience connections that facilitated a positive return to work. Recommended support in the return to work process in rehabilitation comprises the provision of practical work-related activities during rehabilitation; being supportive in a constructive dialogue between the participant and the workplace, and continuing this support in follow-ups after the actual rehabilitation period.	Rehabilitation for persons with stress-related ill health needs to focus on the private arena as well as the work situation in everyday life. Creative activities may enable experiences that inspire connections in mind and connections targeting the private arena in everyday life. The work situation needs to be thoroughly discussed during rehabilitation for enabling the participants to experience a support in the return to work process. Rehabilitation including practical work-related activities, support in a constructive dialogue between the participant and the manager at the workplace, and continued support in follow-ups targeting the workplace might be beneficial for successfully return to work.	
23339906	The purpose of this study was to discover the frequency and type of use of online resources for continuing professional development displayed by physiotherapists in the UK. Therapists' skills, needs and frustrations using these resources were explored. With the relatively recent release and saturated use of the internet the potential presence of a skills gap between therapists at different stages of their career was also investigated.National online survey study.	The online survey was carried out using the international online service 'Survey Monkey'.	774 physiotherapists from students to band 8c completed the survey.	The online survey was advertised through Frontline, the Interactive Chartered Society of Physiotherapy, Journal of Physiotherapy Pain Association and cascade email through research and other networks.	Most physiotherapists reported using the internet for professional purposes daily (40%) or 2 to 4 times a week (37%), with only 8% of respondents using it less than once a week. Overall the results suggest band 6 and 7 physiotherapists had the least skills and most frustrations when using online search engines.	History and the nature of rapid technological advancement, specifically of the internet, appears to have created a generational skills gap within the largest group of the physiotherapy workforce band 6 and 7 therapists. Students, band 5 and band 8a therapists appear to most successfully use online resources and the reasons for this are explored.	
22965367	Mentors have been recognized as important elements in the personal and professional development of medical students. However, few investigations have sought to understand their development, needs and difficulties. Our objective was to investigate the perceptions of a group of mentors regarding difficulties experienced over time and the resources used to face up to them.Qualitative exploratory study on mentors at Faculdade de Medicina da Universidade de São Paulo (FMUSP). In the FMUSP Mentoring Program, mentors follow and guide students throughout the course, and are responsible for heterogeneous group of students, in relation to the academic year.	Semi-structured interviews were conducted with 14 FMUSP mentors.	For many of the mentors, the difficulties related to initial doubts about the role, frustration with the students' attendance and overloading of daily tasks. To address such difficulties, these mentors used external resources and their own life experience and personal way of dealing with situations. Some mentors did not perceive difficulties for themselves or for students.	Like in other mentoring programs, many difficulties perceived by mentors seem to be derived from the context of medical education itself. However, unlike in other experiences, FMUSP mentors do not feel that there is lack of support for their role, since this is regularly provided in the structure and dynamics of the program. The "difficulty in perceiving difficulties", presented by some mentors, demands further investigation for better and greater understanding.	
22928674	Temper modulation problems are both a hallmark of early childhood and a common mental health concern. Thus, characterizing specific behavioral manifestations of temper loss along a dimension from normative misbehaviors to clinically significant problems is an important step toward identifying clinical thresholds.Parent-reported patterns of temper loss were delineated in a diverse community sample of preschoolers (n = 1,490). A developmentally sensitive questionnaire, the Multidimensional Assessment of Preschool Disruptive Behavior (MAP-DB), was used to assess temper loss in terms of tantrum features and anger regulation. Specific aims were: (a) document the normative distribution of temper loss in preschoolers from normative misbehaviors to clinically concerning temper loss behaviors, and test for sociodemographic differences; (b) use Item Response Theory (IRT) to model a Temper Loss dimension; and (c) examine associations of temper loss and concurrent emotional and behavioral problems.	Across sociodemographic subgroups, a unidimensional Temper Loss model fit the data well. Nearly all (83.7%) preschoolers had tantrums sometimes but only 8.6% had daily tantrums. Normative misbehaviors occurred more frequently than clinically concerning temper loss behaviors. Milder behaviors tended to reflect frustration in expectable contexts, whereas clinically concerning problem indicators were unpredictable, prolonged, and/or destructive. In multivariate models, Temper Loss was associated with emotional and behavioral problems.	Parent reports on a developmentally informed questionnaire, administered to a large and diverse sample, distinguished normative and problematic manifestations of preschool temper loss. A developmental, dimensional approach shows promise for elucidating the boundaries between normative early childhood temper loss and emergent psychopathology.	
22893074	To characterize the traits of low vision patients who seek outpatient low vision rehabilitation (LVR) services in the United States.In a prospective observational study, we enrolled 764 new low vision patients seeking outpatient LVR services from 28 clinical centers in the United States. Before their initial appointment, multiple questionnaires assessing daily living and vision, physical, psychological, and cognitive health states were administered by telephone. Baseline clinical visual impairment measures and disorder diagnoses were recorded.	Patients had a median age of 77 years, were primarily female (66%), and had macular disease (55%), most of which was nonneovascular age-related macular degeneration. More than one-third of the patients (37%) had mild vision impairment with habitual visual acuity (VA) of 20/60 or greater. The VA correlated well with contrast sensitivity (r = -0.52) but poorly with self-reported vision quality. The intake survey revealed self-reported physical health limitations, including decreased endurance (68%) and mobility problems (52%). Many patients reported increased levels of frustration (42%) and depressed mood (22%); memory and cognitive impairment (11%) were less frequently endorsed. Patients relied on others for daily living support (87%), but many (31%) still drove.	Most patients seeking LVR are geriatric and have macular disease with relatively preserved VA. The disparity between VA and subjective quality of vision suggests that LVR referrals are based on symptoms rather than on VA alone. Patients seen for LVR services have significant physical, psychological, and cognitive disorders that can amplify vision disabilities and decrease rehabilitation potential.	
22863790	To identify through focus groups of visually impaired children and their parents, relevant content for a vision-targeted health-related quality of life (HRQoL) questionnaire designed for children aged 6 to 12 years.Six focus groups of children with vision impairment aged 6 to 12 years and six focus groups of their parents were conducted by trained facilitators using a guided script. Sessions were recorded, transcribed, and coded as per a standardized protocol for content analysis. Comments were placed in thematic categories and each was coded as positive, negative, or neutral.	Twenty-four children (mean age: 9.4 years) with vision impairment from a variety of causes and 23 parents participated in the study. The child focus groups generated 1,163 comments, of which 52% (n = 599) were negative, 12% (n = 138) were neutral, and 37% (n = 426) were positive. The three most common topical areas among children were: glasses and adaptive equipment (18%), psychosocial (14%), and school (14%). The parent focus groups generated 1952 comments of which 46% (n = 895) were negative, 16% (n = 323) were neutral, and 38% (n = 734) were positive. The three most common topical areas among parents were: school (21%), expectations or frustrations (14%), and psychosocial (13%).	Pediatric vision impairment has significant effects on HRQoL, as reported by children with vision impairment and their parents in their own words. These findings will provide the content to guide construction of a survey instrument to assess vision-specific, HRQoL in children with vision impairment.	
22584858	To evaluate habits of sun exposure and sun protection of pregnant women in a public hospital, to assess orientation about photo protection during the prenatal care, and to detect the presence of melasma and its impact on their quality of life.A descriptive cross sectional study conducted among women of 18 years old and older, after delivery, who participated in a program of prenatal care in the South Region of Brazil. The sample was non-probabilistic by convenience. Data collection occurred from July to August 2011 through direct interview using a structured questionnaire to obtain personal information and photo protection habits during pregnancy, skin assessment and photographic record of lesions through informed consent. The skin was classified per Fitzpatrick's phototypes and the melasma was diagnosed clinically. In the patients with melasma, the MELASQoL-PB version was applied. The analysis was performed using Statistica, version 8.0, and the significance level of p<0.05.	In the sample (109 mothers) predominated white women (60.6% phototype III), young (average age 24.4 years SD=6.1) and housewives (59.6%). The majority (80%) stayed exposed to sunlight for 1-2 hours per day between 10 am and 3 pm, and from those (72%) did not apply any photoprotection due to lack of sunscreen habit. Other physical means of sun protection were used by 15% of these patients. Information during prenatal care about the risks of sun exposure was reported by 34% of the mothers interviewed. There was a trend toward a significant association between prenatal guidance and daily use of sunscreen (p=0.088). About 20% of mothers had melasma. The average score MELASQol-PB (25) showed a negative impact on quality of life of these patients.	In these women, sun exposure occurred at inappropriate times, without proper guidance and without the use of an effective sunscreen. The mothers with melasma complained about the appearance of their skin, frustration and embarrassment.	
22356720	The aim of this study was to describe how patients perceive their recovery following open tibial fractures using a qualitative approach.Following the appropriate ethical approval, adult patients with a diagnosis of open tibial fracture were recruited after completion of their surgical treatment and discharge from Morriston Hospital, a centre with orthoplastic surgical care. A purposive sampling method was employed to ensure that a range of injuries as well as clinical outcomes were included. All patients took part in an in-depth semi-structured interview, exploring aspects of their injury, treatment, rehabilitation and psychosocial and financial situations. Interviews were completed with two interviewers present and were recorded for verbatim transcription. Interview transcripts were analysed to identify items important to patients during their recovery.	Nine patients with a mean injury to interview interval of 2.3 years were interviewed. A total of 538 items were identified and subsequently mapped onto 18 categories: pain; mobility; flexibility; temperature (effects on symptoms); fear; appearance; sleep; diet/weight; employment; social; finance; impact on others; self-care; recovery (patient perceptions of recovery); frustration; goal setting (by patients and health-care providers); and adaptation (both physical and mental).	There is a wide range of factors that our cohort found important during their recovery from open tibial fracture. Despite being considered as 'healed' by the medical staff, patients did not report a corresponding full recovery and return to pre-injury normality. The categories identified will enable the development of a patient-reported recovery scale to be used in lower-limb trauma.	
21921808	Short bowel syndrome (SBS) describes the malabsorptive state seen following extensive bowel resection. Management aims to optimise nutritional intake, promote intestinal adaptation, and prevent the development of complications. Surgical options such as autologous gastrointestinal reconstruction (AGIR) attempt to restore enteral autonomy to the patient. Although the literature focuses on the objective measurements of success following AGIR techniques, subjective assessment of its effect on the quality of life (QoL) should also be sought. Because children with SBS are reliant on caregivers, caregivers' satisfaction with surgery and their perception of the effect of AGIR on their daily lives should be assessed. This is the first report of caregiver satisfaction following AGIR in children.All children with SBS who had AGIR between January 1999 and June 2010 were identified. A questionnaire was developed. Caregivers were asked to complete the questionnaire to rate their satisfaction with surgery and the pre- and postoperative daily care, medical needs, and subjective interpretation of QoL for their child. Data were analysed using SPSS version 18, using the Friedman nonparametric test and 2-way analysis of variance by rank. Statistical significance was set at ≤0.05.	Thirty-two children were identified. Seven assessments were done outside our centre (5 outside the UK) and were not included in the study. One patient moved to another city and was not contacted. Two children died. Twenty patients were contactable and were included in the present study. Parents were satisfied with the AGIR and saw improvements in their child's physical condition, bowel habit, and subjective interpretation of QoL postoperatively. Parents perceived significant improvements in the ease of caring and in aspects of their relationship with their child, including the quality of time spent, their enjoyment, and the level of their frustration with them.	The present study found that AGIR improved the physical well-being of the child and gave the impression of improvements on specific QoL aspects for both the child and the parents.	
21703111	Despite a high prevalence, internists rarely screen for at-risk drinking. A contributing factor is likely to be physicians' limited understanding of the negative effects that at-risk drinking can have on common clinical conditions managed on a daily basis.To develop and conduct a pre-post pilot evaluation of a web-based educational programme to educate and support physicians to assess alcohol use in patients with sleep disorders, depression and hypertension.	An expert panel developed a programme that addressed: 1) screening for alcohol use; 2) evidence on effect of alcohol on hypertension, sleep disorders and depression; 3) brief interventions for at-risk drinking with patient education materials; and 4) codes for payment of brief alcohol interventions. From an internist network, 17 physicians were recruited for a pilot test of the web-based educational programme. All participants were surveyed at baseline and at an end point three months after the intervention about attitudes, knowledge and beliefs about at-risk drinkers and effects of alcohol on hypertension, sleep disorders and depression.	Among the 17 study physicians: 1) most believed that at-risk drinking affected their ability to treat hypertension, sleep disorders and depression (77% at baseline and 65% at end point); 2) nearly all were aware that at-risk drinking affects hypertension, sleep disorders and depression (94% at baseline and 94% at end point); and 3) 94% rated the educational programme positively at the end point. Frustration with managing at-risk alcohol use decreased (from 71% at baseline to 53% at end point) and study physicians' self-reported screening for at-risk drinking increased for new patients (from 47% at baseline to 71% at end point) and established patients (from 35% at baseline to 47% at end point).	This pilot of a web-based educational programme for internists was well received by study physicians. The programme increased screening for at-risk drinking while reducing frustration in dealing with this condition. Future work needs to evaluate this highly accessible programme in diverse practices and assess patient-related outcomes.	
21558305	Patient satisfaction is an important measurement in healthcare for administrators, clinicians and patients.This study investigated the role of gait deviation in patient satisfaction following lower-limb amputation and prosthesis prescription.	A cross-sectional study was done.	Twenty community-based unilateral lower-limb amputees, 12 transtibial and 8 transfemoral, were recruited from support groups. Participants completed the prosthesis evaluation questionnaire (PEQ) with embedded satisfaction-related questions, the timed-up-and-go test and the six-minute walk test, and also underwent quantitative three-dimensional analysis. Kinematic deviation was summarized using the gait profile score (GPS).	Satisfaction levels were generally high (median 80 + /100). Sociodemographic variables did not correlate significantly with any of the satisfaction measures (-0.35 ≤ r ≤ 0.54). Satisfaction correlated strongly with the PEQ scales, particularly ambulation, prosthetic utility, frustration, perceived response and social burden (r ≥ 0.70). By contrast, the relationships between satisfaction and performance-based outcome measures were not significant (-0.45 ≤ r ≤ 0.43), and the GPS did not correlate with any satisfaction measures (-0.23 ≤ r ≤ 0.15).	In this study of high functioning amputees, gait deviation was unimportant to the amputee, while self-reported functional ability and attitudes toward the prosthesis were the strongest correlates of satisfaction following lower-limb amputation.	For the high functioning individuals with lower-limb amputation in this study, gait deviation was not a significant correlate of patient satisfaction. RESULTS suggest that improving self-perceived functional ability and attitudes toward the prosthesis, rather than minimizing gait deviation, will improve patient satisfaction.	
21558282	Traumatic brain injury (TBI) is associated with complaints including headaches, restlessness, memory problems, or irritability, which are assumed to be a consequence of the TBI. The current study is a first attempt to establish the prevalence of common TBI complaints reported by non-brain-injured children aged 11-13. In a 38-item self-report questionnaire, 124 children reported high base rates for symptoms over the past year, especially "grumpy/cross" (79.4%), "frustration" (74.0%), and "fatigue (mental or physical)" (72.2%). This was comparable with base rate information reported by Lees-Haley and Brown (1993) for non-brain-injured adults for a longer period (24-month period). Approximately 20% of children reported five or more symptoms on a daily or weekly basis. They were most likely to be in behavioral and emotional rather than somatic or cognitive domains. Therefore, further research is needed to establish base rate information in order to clarify the true significance of symptom reporting and caution is recommended in interpretation of these symptoms in neuropsychological assessment of TBI in children.
21371977	Kaufman's observation that the patients' reactions to their impairments and disabilities need to be addressed in stroke rehabilitation has been shown to be an accurate and perceptive statement. In this article, 3 levels of stroke rehabilitation are outlined, and the importance of focusing on the third level (the level of subjective experience) is emphasized. Identification of the patients' subjective experience allows one to understand what is most frustrating to them. After addressing those frustrations, patients are more eager to engage the rehabilitation process. Within the context of this rehabilitation process, helping patients clarify what their subjective or phenomenological state is as it relates to their stroke is crucial in having them not only engage the rehabilitation process, but ultimately find meaning in life in the face of their stroke. This can be a difficult task because patients often do not have the words to clarify what their inner psychological experiences are following a stroke. Helping to provide guidelines for this can result in a meaningful experience for both the patient and the therapists involved in their care.
21062186	Disablement theory has been characterized as the sequence of events that occurs after an injury, but little research has been conducted to establish how disablement is experienced and described by physically active persons.To describe the disablement process in physically active persons with musculoskeletal injuries.	Concurrent, embedded mixed-methods study. For the qualitative portion, interviews were conducted to create descriptive disablement themes. For the quantitative portion, frequencies analysis was used to identify common terminology.	National Collegiate Athletic Association Division I collegiate and club sports, collegiate intramural program, large high school athletics program, and outpatient orthopaedic center.	Thirty-one physically active volunteers (15 males, 16 females; mean age  =  21.2 years; range, 14-53 years) with a current injury (18 lower extremity injuries, 13 upper extremity injuries) participated in individual interviews. Six physically active volunteers (3 males, 3 females; mean age  =  22.2 years; range, 16-28 years) participated in the group interview to assess trustworthiness.	We analyzed interviews through a constant-comparison method, and data were collected until saturation occurred. Common limitations were transformed into descriptive themes and were confirmed during the group interview. Disablement descriptors were identified with frequencies and fit to the themes.	A total of 15 overall descriptive themes emerged within the 4 disablement components, and descriptive terms were identified for each theme. Impairments were marked by 4 complaints: pain, decreased motion, decreased muscle function, and instability. Functional limitations were denoted by problems with skill performance, daily actions, maintaining positions, fitness, and changing directions. Disability consisted of problems with participation in desired activities. Lastly, problems in quality of life encompassed uncertainty and fear, stress and pressure, mood and frustration, overall energy, and altered relationships. A preliminary generic outcomes instrument was generated from the findings.	Our results will help clinicians understand how disablement is described by the physically active. The findings also have implications for how disablement outcomes are measured.	
20808080	Systemic lupus erythematosus (SLE) is an autoimmune disease that requires lifelong follow-up treatment. Most SLE patients experience feelings of helplessness and frustration in the period after which the condition has been brought under control but not yet cured. Thus, to improve the SLE patient's quality of life (QOL), it is very important to assist them to adjust to face both the severity of their disease and their own feelings of limitation and uncertainty, to understand their condition and required treatments, and to adopt self-help strategies to adjust to difficulties in daily life.This study was designed to test both the hypothesized relationships in the Braden Self-help Model and the mediating effects of self-help on QOL in a sample of women with SLE.	A cross-sectional design with causal modeling approach was used to verify specified relationships in the theoretical model. SLE patients who were registered with the Rainbow SLE Association and the Lupus SLE Foundation in Taiwan were recruited as participants by convenience sampling. A total of 231 SLE patients participated in this project. Data were collected using a self-administered structured questionnaire consisting of a personal information section, the Disease Course Graphic Scale, the Mishel Uncertainty in Illness Scale, the Limitation Scale, the Self-Control Scale, the Adult Role and Behavior Scale, and the Well-Being Scale.	Path analysis found a high level of significance for the coefficient of each path. We also identified a positive correlation between the disease severity and limitations and the factor of uncertainty and a negative correlation between the limitations and uncertainty and the factors of enabling skills, self-help, and QOL. A positive correlation among enabling skills, self-help, and QOL was also evident. The Sobel analysis pointed to self-help as having the greatest impact on QOL (79.15%).	The study examined the applicability of the causal Braden Self-help Model on women with SLE and provides a basis for the design of intervention activities.	
20607307	This study aimed to analyze the impact of winter weather conditions on young children's behavior and affective states by examining a group of 61 children attending day-care centers in Florence (Italy). Participants were 33 males, 28 females and their 11 teachers. The mean age of the children at the beginning of the observation period was 24.1 months. The day-care teachers observed the children's behavioral and emotional states during the morning before their sleeping time and filled in a questionnaire for each baby five times over a winter period of 3 weeks. Air temperature, relative humidity, air pressure and solar radiation data were collected every 15 min from a weather station located in the city center of Florence. At the same time, air temperature and relative humidity data were collected in the classroom and in the garden of each day-care center. We used multilevel linear models to evaluate the extent to which children's emotional and behavioral states could be predicted by weather conditions, controlling for child characteristics (gender and age). The data showed that relative humidity and solar radiation were the main predictors of the children's emotional and behavioral states. The outdoor humidity had a significant positive effect on frustration, sadness and aggression; solar radiation had a significant negative effect only on sadness, suggesting that a sunny winter day makes children more cheerful. The results are discussed in term of implications for parents and teachers to improve children's ecological environment.
20444771	The purpose of this study was to illuminate the ethically difficult situations experienced by care providers working in a nursing home. Individual interviews using a narrative approach were conducted. A phenomenological-hermeneutic method developed for researching life experience was applied in the analysis. The findings showed that care providers experience ethical challenges in their everyday work. The informants in this study found the balance between the ideal, autonomy and dignity to be a daily problem. They defined the culture they work in as not supportive. They also thought they were not being seen and heard in situations where they disagree with the basic values of the organization. The results are discussed in terms of Habermas's understanding of modern society. Care settings for elderly people obviously present ethical challenges, particularly in the case of those suffering from dementia. The care provider participants in this study expressed frustration and feelings of powerlessness. It is possible to understand their experiences in terms of Habermas's theory of modern society and the concept of the system's colonization of the life world.
20308843	To estimate the effect of anal incontinence on postpartum quality of life (QOL).We conducted a longitudinal follow-up study of women reporting anal incontinence on a statewide postpartum survey to estimate the effect of anal incontinence on QOL up to 2 years postpartum. Quality of life was assessed every 6 months for 2 years based on the Uebersax incontinence impact questionnaire. The effect of severe anal incontinence on QOL was determined by multivariate logistic regression.	A total of 1,050 women reported persistent anal incontinence and returned at least two completed QOL surveys during the 2-year study period. Among women with anal incontinence, 51% reported frustration caused by anal incontinence, 26% reported that anal incontinence affected their emotional health, 18.5% reported anal incontinence affected their child-caring abilities, and 16.2% reported a negative effect on social activities. One in three women with anal incontinence reported severe symptoms. Compared with women with mild anal incontinence, women with severe anal incontinence were four to seven times as likely to report that anal incontinence affected emotional health and the ability to perform daily activities. However, only 10% of women sought medical help for anal incontinence at 6 months, 13.5% at 1 year, and 16.7% at 2 years.	Even 2 years after delivery, more than a quarter of women who experience a new onset of anal incontinence after childbirth report persistently negative QOL. Despite this, few women discuss anal incontinence with their medical providers.	III.	
20220670	BACKGROUND People are not expected to die from multiple sclerosis although, as the condition progresses over a period of time, some people become increasingly disabled and will require assistance with all activities of daily living. Their partners invariably carry out these tasks. OBJECTIVE To gain a deeper understanding of the experiences of the partner living with and caring for a spouse disabled by multiple sclerosis. METHODOLOGY In a qualitative study, eight partners who live and care for a person with multiple sclerosis were interviewed using a semi-structured questionnaire to explore their experience of their role. RESULTS The interview transcripts were analyzed using a thematic framework approach. Codes, themes and five categories were identified, which were worry, planning, frustrations, commitment to marriage and coping strategies. These categories were examined using quotes from the transcripts as evidence. CONCLUSION This qualitative study identified that these couples had been married for at least 20 years before disability of the spouse significantly affected their lifestyle. Partners felt obliged to continue in their caring role due to a sense of duty and commitment of marriage. Partners felt a sense of loss as they prioritized the health and needs of their spouse above their own and, finally, partners lost their identity as husband/wife as they were called 'the carer'. Partners felt out of control due to the unpredictable and progressive nature of MS and because it consumed their life 24 hours every day. Partners often felt guilty at not being satisfied with their life and wanting some independence.
20050815	To assess the current state of asthma management in Austria and evaluate improvement of symptoms and quality of life (QoL) in asthma patients by adding the controller substance montelukast to existing therapy.Office-based pneumologists across Austria were invited to participate in an open-label, multicenter observational study. Male and female patients aged from 12-50 years with mild or moderate persistent asthma according to GINA guidelines and FEV(1) > 70% predicted were included if they were on concurrent asthma treatment, but still had persistent symptoms and reduced quality of life. Asthma control was assessed at time of patient anamnesis and subsequent follow-up visits. In addition, a physical examination was performed, lung function (FEV(1)) was measured and two types of validated QoL questionnaires were used: the Juniper Asthma Control Questionnaire was evaluated and documented by the physicians at each study visit and the Asthma Quality of Life Questionnaire was completed by the patients following each visit.	A total of 851 patients (343 males, 508 females) were included and 328 patients were eligible for evaluation 3-5 months after completing at least two study visits. QoL rating by patients was available for 263 at baseline and for 216 patients after 3-5 months. The physicians' rating of asthma-related QoL showed improvements between 6.66 and 11.80% in the categories: nocturnal awakening, morning asthma symptoms, reduction of daily activities, wheezing and dyspnoea, but no reduction in the use of short acting ss(2)-agonists (SABA). The QoL judged by the patients by means of the QoL-Q showed statistically significant improvements in 13 of 15 parameters of QoL. The categories: response to cigarette smoke and response to air pollution showed positive trends (not significant) while the improvement of shortness of breath, response to dust, frustration, cough, anxiety, chest pressure, sleep quality, worries about asthma, wheezing, symptoms at heavy and moderate exercise and impairment of daily activities and activities at work reached statistical significance.	This open-label, multicenter observational study shows significant improvement in six QoL parameters evaluated by the physicians and in 13 out of 15 QoL categories judged by the patients 3-5 months after adding montelukast to the ongoing asthma treatment in patients with mild or moderate persistent asthma. Limitations to these conclusions are the lack of a placebo control group (as this was an open-label study) and the continuing basal asthma therapy, which might contribute to improvement of asthma control.	
19950254	The purpose of this paper is to analyze the social organization of caring as gendered work as it relates to meal preparation and consumption activities surrounding older adult cancer patients and their caregivers.Qualitative methods consisting of in-depth, semi-structured, face-to-face interviews with 30 older cancer patients (17 women and 13 men aged 68-90) and their caregivers were conducted separately. Participants were diagnosed with pancreatic, colon, breast, lymphoma, skin, and head and neck cancer.	Major findings were that both patients and caregivers experienced distress surrounding food preparation and mealtime activities, and these varied according to the gender of both patients and caregivers and the relationship that existed between patients and caregivers. Of particular note, female patients experienced distress over not being able to fully participate in meal planning and cooking activities that were central to their self-identity. Related to this, male spouses experienced frustration over not being able to engage in cooking activities that met their wives' expectations. Female caregivers expressed tremendous discontent that the one they were caring for did not eat like they 'should'.	Matters related to the organization of meals and food consumption activities may be a source of significant distress for patients and caregivers. Further research and greater attention from health care providers are warranted to evaluate the extent of such distress.	
19654579	Limited research has investigated the specific needs of patients with advanced incurable cancer. The aim of this study was to describe the prevalence of perceived needs among this population.Medical specialists from two regions in New South Wales, Australia, identified patients with advanced, incurable cancer, who were estimated to have a life expectancy of <2 years and were not receiving formal palliative care. Of the 418 eligible patients, 246 (59%) consented to participate. Consenting patients completed the Needs Assessment for Advanced Cancer Patients questionnaire, which has demonstrable validity and reliability. Patients' perceived needs were assessed across the seven domains of the questionnaire: psychological, daily living, medical communication and information, symptom related, social, spiritual and financial needs.	Patients identified the greatest areas of need in relation to psychological and medical communication/information domains. Patients' specific needs were highest in dealing with a lack of energy and tiredness, coping with fears about the cancer spreading, and coping with frustration at not being able to do the things they used to do.	This study indicates that patients with advanced, incurable cancer have high levels of unmet needs, especially in relation to the areas of psychological and medical communication/information needs. The data have the potential to guide the development of interventions aimed at meeting the current unmet needs of patients with advanced, incurable cancer.	
19481983	Cystic fibrosis (CF) specific patient-derived and reported symptom tools are critical steps toward evaluating the outcomes of new therapies for CF.We conducted 25 in-depth qualitative interviews using the Day Reconstruction Method and 9 cognitive interviews at two CF programs, the University of Washington and Seattle Children's Hospital and Regional Medical Center. The interviews were audio-recorded and transcribed, and then coded and analyzed for themes relating to pulmonary symptoms and related psychosocial impacts.	Six pulmonary symptoms were identified as central to CF: cough, sputum production, wheeze, chest tightness, difficulty breathing/shortness of breath, and fever. Emotional impacts included frustration, sadness/depression, irritability, worry, difficulty sleeping; while activity impacts included time spent sitting or lying down, reduction of usual activities, and missing school or work. In all, 8 symptom items, 4 emotional impacts items, and 4 activity impacts were selected for inclusion on a new daily diary. We also assessed triggers for seeking care.	Using a qualitative inductive methodology, we have obtained patient centered data regarding pulmonary symptoms and burdens and have created a novel patient reported outcome measure for CF. Future studies will assess the validity of the instruments.	
19321021	Existing measures of stress either focus on burnout or frustration and fatigue factors, often referred to as job strain. The objectives of this study were to: establish a reliable measure of distress that is sensitive enough to identify job strain at lower levels of distress and risk of burnout at higher levels of distress; and document levels of distress among the major medical specialties and across varying patterns of clinical practice.A stratified cross-sectional survey of physicians in Canada was conducted in 2004. Among the eligible population, 2810 physicians (56.7%) responded. Response bias was negligible. Responding physicians completed a 13-item measure of distress. Confirmatory factor analysis was used to establish the measure. Scheffe tests were used to document differences in the levels of distress among specializations and by clinical practice profile.	Factor analysis revealed reliable dimensions of: fatigue (alpha = 0.75) and reaction (alpha = 0.73). The distress measure was reliable (alpha = 0.82). Emergency physicians (n = 4.51), surgeons (n = 4.35), and general practitioners (n = 4.33) reported the highest levels of distress, while administrative physicians (n = 3.30), community health (n = 3.35), and clinical specialists (n = 3.46) reported the lowest levels of distress. Physicians with clinical and administrative responsibilities reported the highest levels of distress (n = 4.40), compared with purely clinical physicians (n = 3.94) and clinician-academics (n = 3.98).	Some specializations are associated with more distress than others. Administrative duties appear to add to distress for all physicians. Counterintuitively, adding academic as well as administrative responsibilities appears to add less distress than adding administrative duties alone. Academic duties are viewed as advancing medicine.	
18987515	Although much work has been done to quantify the direct and indirect costs of cancer treatment, little is known regarding how these costs impact the daily lives of persons undergoing active treatment of cancer. Content analysis performed on open-ended interviews with 22 women in 3 income categories undergoing chemotherapy for a diagnosis of breast or ovarian cancer revealed 7 themes. Most participants stated that they felt "lucky" or "thankful" that most of the treatment costs were being covered by insurance or personal income. Women also described receiving financial assistance from friends, family, and support organizations and stated that they often made trade-offs between paying for regular family expenses and paying for treatment-related expenses. Worry about future financial expenses and frustrations dealing with regulatory agencies were also pervasive in the interviews. Finally, participants described having to access retirement/savings accounts and voiced concerns regarding the impact of cancer treatment on their work income. Data from the study illuminate the personal impact of cancer costs and suggest that interventions to assist women with cancer in financial planning and negotiating with insurance companies may offset some of the financial burden of cancer treatment.
18942563	Life-long lymphedema is a common complication of cancer therapy. In this Canadian study, we adopted a phenomenological methodology to explore the experience of patients with cancer-related lymphedema, and their spouses. We conducted audio taped semistructured interviews with 11 patients and eight spouses, who were recruited through a university hospital-based lymphedema clinic and through local lymphedema therapists. We developed an analytical framework from the data themselves, and tentative hypotheses and thematic categories that represented shared case features. Participants expressed frustration because of lack of financial support from government and insurance companies, inadequate knowledge and perceived lack of interest on the part of physicians, and lack of awareness in society in general. This study suggests further investigation of the funding of lymphedema treatments, and of the effect of lymphedema on work, intimacy, and leisure activities. Our research findings will inform educational initiatives and cancer rehabilitation programs.
18925946	To develop the content for two new patient reported outcome (PRO) measures to: a) assess the severity of symptoms; and b) the impact of facial skin oiliness on emotional wellbeing using qualitative data from face to face, and internet focus groups in Germany and the US.Using input from initial treatment satisfaction focus groups (n = 42), a review of relevant literature and expert clinicians (n = 3), a discussion guide was developed to guide qualitative inquiry using Internet focus groups (IFGs). IFGs were conducted with German (n = 26) and US (n = 28) sufferers of oily skin. Questionnaire items were generated using coded transcript data from the focus groups. Cognitive debriefing was conducted online with 42 participants and face to face with an additional five participants to assess the comprehension of the items.	There were equal numbers of male and female participants; mean age was 35.4 (SD 9.3) years. On average, participants had had oily skin for 15.2 years, and 74% (n = 40) reported having mild-moderate acne. Participants reported using visual, tactile and sensory (feel without touching their face) methods to evaluate the severity of facial oiliness. Oily facial skin had both an emotional and social impact, and was associated with feelings of unattractiveness, self-consciousness, embarrassment, irritation and frustration. Items were generated for a measure of oily skin severity (Oily Skin Self-Assessment Scale) and a measure of the impact of oily skin on emotional well-being (Oily Skin Impact Scale). Cognitive debriefing resulted in minor changes to the draft items and confirmed their face and content validity.	The research provides insight into the experience of having oily skin and illustrates significant difficulties associated with the condition. Item content was developed for early versions of two PRO measures of the symptoms and emotional impact of oily facial skin. The psychometric validation of these measures reported elsewhere.	
18663740	Afghanistan provides a unique setting in which to appraise psychosocial stress, given the context of persistent insecurity and widening economic inequality. In Kabul, people experience widespread frustrations, hinging on restricted opportunities for social advancement, education, and employment. We appraised social aspirations, every-day stressors, psychosocial distress, and mental health problems for a random sample of 161 male and female students at Kabul University. The survey featured both existing and newly-developed instruments (Self-Reported Questionnaire SRQ-20; Afghan Symptom Checklist; Afghan Daily Stressor Scale; and Social Aspirations and Frustrations), implementing both internationally-used and culturally-grounded measures of mental health assessment. We also included indicators of physical health (blood pressure, immune responses to Epstein-Barr virus (EBV), C-reactive protein, and body mass index), to map physiological function with reported psychosocial distress. This young, urban elite expressed major feelings of frustrations, related to physical, economic, social, and political stressors of day-to-day life in Kabul. There were striking gender differences for psychosocial and physiological markers of wellbeing; specifically, women showed poorer mental health (SRQ-20, P = 0.01) and elevated EBV antibody titers (P = 0.003). Both diastolic blood pressure (P = 0.018) and EBV (P = 0.038) were associated with a subscale of family stressors among women, but not among men, consistent with women's social vulnerabilities to stressful family dynamics. This is the first study to integrate approaches from anthropology, cross-cultural psychiatry, and human biology to document social stressors, psychosocial distress, and physiological wellbeing in the challenging setting of present-day Afghanistan.
18392146	We undertook a qualitative e-mail survey of federally-funded principal investigators of their views of the US human subjects protection system, intended to identify the range of investigator attitudes. This was an exploratory study with a 14% response rate. Twenty-eight principal investigators responded; their comments were analyzed to show underlying themes, which are here presented along with supporting quotations.There was consensus that it is important to protect human subjects from research abuse, but disagreement over how well the IRB system is functioning. Some researchers felt that the system is effective and serves its purpose well. Of those who support the system, some endorse its methods, purpose, and daily functioning, as they experience it, without reservation. Others, while expressing some frustration, feel that the purpose is important and their local IRB does its best to make a difficult system work well.Those investigators who were more harshly critical commented on multiple flaws in the system, including (1) consent forms that are inappropriate and incomprehensible, (2) an emphasis on minutiae, and (3) concern with protecting the institution more than research subjects. Respondents told us that the IRB system is a particular burden for research in neurology, emergency medical conditions, repositories, and social sciences in general; a more comprehensive study might identify other problematic areas. Significant concern was expressed about the cost, inefficiency, and irrationality of IRB review. The IRB system works well for some researchers, but our results indicate that other investigators feel the costs outweigh the benefits.
17693115	To compare perceptions of patients with rheumatoid arthritis (RA) to those of their families and usual physicians regarding pain and subjective experience of the disease.Questionnaires were mailed to patients listed in the files of a non-profit patient organization (Association Française des Polyarthritiques). Each patient, one family member (or close friend), and the usual physician were each asked to complete a questionnaire. Concordance among replies made by patients, family/friends, and physicians was evaluated using the kappa coefficient.	Questionnaires were sent to 20,468 patients, among whom 7702 (38%) mailed back adequate data. The family member was usually the spouse (70%) and the usual physician a rheumatologist (68%). Joint pain was described by patients as variable (80%) and unpredictable (68%). Patients reported a need to push themselves (86%), frustration (86%), anxiety about possible disease progression (89%), and being prevented from making plans for the future (6%). A negative impact was reported on recreational activities (84%), work (56%), and family life and sexuality (51%). Concordance was excellent for pain severity (kappa>0.90) and good for the main joint-pain characteristics and experience of the disease (kappa>0.70), although family members tended to overestimate, and physicians to underestimate, the intensity of the pain.	We found good overall agreement between perceptions of patients, their families, and their physicians, despite differences between these last two groups. Our qualitative analysis showed not only a major physical impact of the disease, but also marked negative psychosocial effects.	
17591413	In Australia, more than 346,000 individuals who experience a stroke return to living in their homes with varying degrees of disability. They rely on emotional and physical support from informal carers, typically family members. Informal carers have an indispensable role in patient care poststroke, and the ability of carers to manage this role effectively is crucial for stroke survivors to be able to return home. The aim of this study was to examine the impact of the caring role on carers of stroke survivors, particularly the services provided and the levels of depression and well-being experienced. The study used a longitudinal design incorporating survey methods. Stroke survivors were assessed for functional ability, quality of life, and depression using three assessment tools: the Stroke Impact Scale, World Health Organization Quality of Life-BREF scale, and Zung Self-Rating Depression Scale. A total of 26 people were surveyed: 13 stroke survivors and their 13 carers. Carer knowledge of stroke support services was also explored. Information was collected by using survey methods and structured interviews at 3 weeks and at 3 months postdischarge. The main finding was that depression scores for carers and stroke survivors were below Australian norms at both assessment time points. The major concern identified by carers was poor follow-up procedures for initiating rehabilitation in the home. This study highlighted that a lack of appropriate discharge planning, in conjunction with early discharge of stroke survivors, can have an impact on the rehabilitation process and place increased and unrealistic demands on carers.
17364481	This study examined the overlap and validity of several measures of mother - child attachment developed for preadolescents. Validity was assessed in part by examining how attachment is related to children's mood and emotion regulation. Mother - child attachment was assessed in a sample of 9 to 11 year-old children using a story stem interview technique and questionnaires. Positive and negative mood were scored from daily logs completed by children. Emotion regulation was assessed with mothers' reports of constructive coping and teacher reports of children's ability to tolerate frustration. Interview and questionnaire measures of attachment were not consistently related to one another, although both were related to mood and emotion regulation. As expected, secure attachment and maternal secure base support were related to higher levels of positive mood, more constructive coping, and better regulation of emotion in the classroom, with effects stronger for emotion regulation than for mood. Children classified Disorganized or Ambivalent displayed the most negative mood. All effects remained significant after controlling for child temperament.
17317076	The aim of this study was to discover the ways in which a training program on intimate partner abuse affected a doctor's daily practice.Eighteen family doctors who participated in a training program on partner abuse were interviewed.	The interviewees evaluated the training program to be useful in raising their awareness and suspect criteria on partner abuse. Any questions and frustrations they had concerning the subject were resolved. They felt more confident and equipped to discuss and aid abused patients after the training.	In order to improve doctors' awareness of partner abuse in daily practice, they must need first realize the scale of the problem and then become more comfortable in their own attitude and finally more confident in their ability to aid these patients.	Training on partner abuse should be specifically tailored to change awareness, attitudes and consultation skills.	
17296290	Urinary tract infections (UTIs) are extremely prevalent and despite treatment with antibiotics, reoccurrences are common causing frustration in the patient and the potential for developing antibiotic resistance. The use of cranberry products to prevent UTIs has recently become popular and more clinical studies are needed to explore this use.This open label pilot study examined the ability of a concentrated cranberry preparation to prevent UTIs in women with a history of recurrent infections.	Women between the ages of 25 and 70 years old were included with a history of a minimum of 6 UTIs in the proceeding year.	The women took one capsule twice daily for 12 weeks containing 200 mg of a concentrated cranberry extract standardized to 30% phenolics.	A questionnaire was used initially to determine the patient's medical history and they were asked at monthly intervals if any of the information had changed. All of the women in the study had urinalysis within 24h before starting on the study preparation and once a month after that for 4 months. Subjects were followed-up approximately 2 years later.	All 12 subjects participated in the 12-week study and were available for follow up 2 years later. During the study none of the women had a UTI. No adverse events were reported. Two years later, eight of the women who continue to take cranberry, continue to be free from UTIs.	A cranberry preparation with a high phenolic content may completely prevent UTIs in women who are subject to recurrent infections.	
17270519	To evaluate differences in function, performance, and preference between mechanical and microprocessor prosthetic knee control technologies.A-B-A-B reversal design.	Home, community, and laboratory environments.	Twenty-one unilateral, transfemoral amputees.	Mechanical control prosthetic knee versus microprocessor control prosthetic knee (Otto Bock C-Leg).	Stair rating, hill rating and time, obstacle course time, divided attention task accuracy and time, Amputee Mobility Predictor score, step activity, Prosthesis Evaluation Questionnaire score, Medical Outcomes Study 36-Item Short-Form Health Survey score, self-reported frequency of stumbles and falls, and self-reported concentration required for ambulation.	Stair descent score, hill descent time, and hill sound-side step length showed significant (P<.01) improvement with the C-Leg. Users reported a significant (P<.05) decrease in frequency of stumbles and falls, frustration with falling, and difficulty in multitasking while using the microprocessor knee. Subject satisfaction with the C-Leg was significantly (P<.001) greater than the mechanical control prosthesis.	The study population showed improved performance when negotiating stairs and hills, reduced frequency of stumbling and falling, and a preference for the microprocessor control C-Leg as compared with the mechanical control prosthetic knee.	
17239066	To investigate the efficacy of acupressure in decreasing agitated behaviours associated with dementia.Agitated behaviour is found in nearly half of all patients who have dementia. The presence of these behaviours increases the likelihood of injury, weakness, dehydration and lack of sleep and contributes to caregiver frustration and fatigue.	This pilot study was designed with subjects receiving both acupressure and the control treatment. Each subject served as his or her own control. Subjects received four weeks of acupressure protocols; to avoid a carry-over effect there was a treatment-free period of one week. Subjects then were visited by one of the investigators for a six-week period.	Participants were recruited from a nursing home caring specifically for patients with dementia. Twenty of the 31 subjects (64.5 %) completed the study, while 11 were discharged or hospitalized. All the subjects were assigned to an experimental protocol and had a six-week acupressure treatment program. Baseline data were collected in the first week. Individual treatment sessions began at the second week of the study and lasted 15 minutes, twice a day, five days a week for four weeks. After a treatment-free period of one week, all the subjects served as controls undergoing a four-week control protocol consisting of companionship and conversation.	Comparison between the control and experimental phases indicated significant differences between the two groups on all outcome measures (Cohen-Mansfield Agitation Inventory, daily agitation records about physical attack, verbal and non-verbal attack and non-physical attack) with better results found during the acupressure phase.	Acupressure is recommended as an efficacious and non-intrusive method for decreasing the agitation behaviours in patients with dementia.	Conducting the acupressure treatment takes 15 minutes. It could provide caregivers with a viable alternative to deal with patients with dementia.	
17233651	This paper reports a descriptive study of how untreated patients with obstructive sleep apnoea syndrome perceived their sleep situation and how the syndrome affected their life situation.Obstructive sleep apnoea syndrome is a prevalent problem independently associated with an increased risk for hypertension, cardiovascular disease, chronic heart failure and mortality. Increased consumption of healthcare resources can often be seen among patients over a long period of time since many have been undiagnosed and untreated.	A phenomenographic approach was employed. Data were collected by interviews during 2005 with 20 purposively selected participants with untreated obstructive sleep apnoea syndrome. Findings. Participants described loud snoring, frequent awakenings, dyspnoea, frustration over nocturia, fear of dying during sleep and partners' anxiety about the apnoea, as being night-time effects of obstructive sleep apnoea syndrome. They described dry and sore throats, tiredness and daytime sleepiness, shame about falling asleep and snoring, thoughts about complications and depressed mood as daytime effects. Needs, such as increased alertness, improved ability to concentrate, improved relationship, adequate information as well as effective treatment, were described. Participants tried self-care strategies such as information-seeking about sleep disturbances and treatment, adapted sleeping routines, change of bedroom arrangements, adapted daily schedules, hyperactivity and avoidance of difficult situations.	The perceived effects and needs, as well as tried self-care actions by the patients with obstructive sleep apnoea syndrome in this study, could be used to identify and evaluate concerns of other patients with obstructive sleep apnoea syndrome waiting for treatment.	
17101624	This article reports on children's experiences of hospitalization. Data were collected via semi-structured interviews with 11 children aged between seven and 14 years from four paediatric units in England. The children identified a range of fears and concerns, which included: separation from parents and family; unfamiliar environment; investigations and treatments; and loss of self-determination. The children's loss of self-determination over personal needs exacerbated their fears and concerns. It needs to be recognized that compliance with hospital routines is a variable, which influences children's reaction to hospitalization. The findings clearly indicate that children need adequate information tailored to their needs, that their views are sought in the planning and delivery of their care and that hospital environments need to be made more child-centred. Interventions designed to reduce children's stress during hospitalization are not only likely to decrease their stress at the time, but also likely to influence how future experiences are appraised and managed.
16801223	The HIV epidemic has had a profound impact on people's everyday life in most African societies. A large proportion of all new HIV infections involves young people between 15 and 25 years. The objective of this paper is to explore local moral worlds of young people in Bobo-Dioulasso, Burkina Faso, and discuss how the HIVS epidemic affects their reflections on their everyday life and their perceptions of sexual relationships. Based on anthropological fieldwork, including focus-group discussions, in-depth interviews and participant observation, a total of 57 young people between 15 and 25 years were followed over a 3-month period. Using the notion of 'lifestyle', the paper shows how structural factors of unemployment and poverty paired with global discourse on AIDS present the young people with frustrations and quandaries in relation to their hopes and images of love, faithfulness and modern living. The data shows that the HIV epidemic contributes to and accelerates their feeling of living in a risk society and of being at risk. In order to cope with these uncertainties and contingencies, local discourses of trust and fidelity become extremely important and to most young people HIV prevention is synonymous with finding a faithful partner and/or using condoms.
16199164	This study used a descriptive qualitative design to explore emergency nurse experiences of decision making about triage in Hong Kong. Seven experienced nurses who were working in three different accident and emergency departments participated in the study. Unstructured interviews were used to provide the nurses with opportunities to describe their experiences. The findings fall into three main categories, including the experience of triage decision making, the use of information in the triage decision-making process, and the factors that influence triage decision making. Although the experience of triage was generally positive, the nurses felt frustrated and uncertain in some circumstances. In addition, triage decision making was influenced by a series of factors that occur in daily practice. The findings of this study have implications for the development of formal triage training and triage decision-making protocols in accident and emergency nursing. They also provide positive reinforcement and support to triage nurses that will enhance their ability to make decisions about triage. Avenues for further research in the area are recommended.
16109116	To assess changes in health-related quality of life (HRQoL) measures among patients receiving topiramate (TPM) 100 mg/d in two divided doses for migraine prevention in three randomized, double-blind, placebo-controlled, 26-week trials with similar protocols and study populations.Migraine substantially impairs HRQoL and work productivity before, during, and after attacks. Approximately 50% of patients with migraine could be recommended for preventive therapies, yet only 3% to 5% of patients receive them. TPM is an effective and generally well-tolerated migraine prophylactic (preventive) therapy for adults, as demonstrated in several randomized, double-blind, placebo-controlled trials. The most common adverse events in double-blind, placebo-controlled studies of TPM in migraine prevention are paresthesia, fatigue, anorexia, nausea, taste alteration, and diarrhea.	The Migraine-Specific Questionnaire (MSQ, version 2.1) was used to assess the effect of TPM 100 mg/d on the functionality and HRQoL of randomized intent-to-treat (ITT) and study-completer populations pooled from three randomized, double-blind, placebo-controlled trials. MSQ scores (0 to 100, higher score indicates better functioning) were assessed for the following three domains: role restriction (examines the degree to which performance of daily activities is limited by migraine), role prevention (examines the degree to which performance of daily activities is interrupted by migraine), and emotional function (examines feelings of frustration and helplessness due to migraine). Between-group differences from baseline in mean MSQ domain scores for TPM 100 mg/d and placebo were compared using a mixed-effects model with piecewise linear regression. Effect sizes were calculated to estimate the magnitude of change in HRQoL that can be associated with TPM therapy.	TPM 100 mg/d significantly improved all three MSQ domains compared with placebo for both the ITT (TPM, n = 372; placebo, n = 362) and study-completer (TPM, n = 220; placebo, n = 216) populations (P < .001 for all three domains, both populations). Effect sizes for TPM 100 mg/d varied from 0.40 to 0.78, indicating that the changes in MSQ scores for TPM 100 mg/d were moderate and may be clinically significant.	TPM 100 mg/d has been shown to be effective in the prevention of migraine headache in adults. As the MSQ results from the three randomized, placebo-controlled trials indicate, HRQoL is significantly improved for up to 6 months following initiation of treatment.	

15921985	This interpretive-phenomenological study examined the lived experience of being on the waiting list for arthroplastic surgery of the knee or hip. Interviews reveal that respondents experience suffering in different ways: illness-, caring- and life-suffering. Suffering leads to a struggle in order to have their caring needs met and the struggle is often fruitless-against a faceless enemy-"the system". No one is there to answer their plea or the frustration they experience. This in combination with their present life situation may lead to a disrupted self-image. Finding or creating meaning in suffering appears to be a crucial issue in the struggling process. Respondents who are able to preserve or create meaning in life are able to reformulate their life-world and live a full life, in spite of severe pain and disability.
15548488	To describe changes in personality after stroke and effects on carers.A consecutive series of patients was recruited from hospital admissions with stroke. A novel questionnaire was administered to the patients' main carer at nine months after the stroke to determine their perception of the patients' pre-stroke and post-stroke personality. Personality change was identified by changes in these ratings, and associations between personality change and the following variables explored: emotional disorder in patients and carers (measured using the hospital anxiety and depression scale and a structured psychiatric interview), stroke classification (Oxford community stroke classification), residual disability (Barthel index and Nottingham extended activities of daily living scale), and lesion characteristics on computed tomography (CT).	Carers of 35 patients with stroke took part. Reported changes in personality after stroke included: reduced patience and increased frustration (both p<0.0001, t test of difference), reduced confidence, more dissatisfaction, and a less easy going nature (all p<0.005). Occasionally, aspects of personality change were seen as positive by carers. There were relations between greater personality change and interviewer rated patient depression or anxiety (p<0.001) but not when this was self rated; and between personality change and both emotional disorder in carers (p<0.005) and greater disability (p<0.01) but not CT lesion characteristics.	Carers commonly perceive personality change in stroke patients. This is associated with self rated emotional distress in the carer. More research is needed to understand what carers mean by "personality change" and what factors contribute to the perceived change.	
15496345	The purpose of this study is to test our hypothesis that muscle relaxation is effective on the psychological well-being of juvenile delinquents. Subjects were 16 juvenile delinquents who had entered a reform school. Subjects were divided into two groups. The muscle relaxation group received muscle relaxation therapy once a week for a total of 4 times. The control group spent an ordinary daily life in the reformatory. Psychological questionnaires used were the Rosenzweig Picture Frustration Study (P-F study), the Psychological Stress Response Scale (PSRS), and the Eysenck Personality Questionnaire (EPQ). There was a significant Group Time interaction of the Group Conformity Rating (GCR) of the P-F study (F [1,14] =10.1, P=0.007). There were no significant interactions in the other psychological subscales. Thus, muscle relaxation therapy may improve frustration tolerance among juvenile delinquents.
15287280	Clinicians and researchers have become increasingly interested in the impact of chronic pain (CP) on quality of life (QoL). This report describes the qualitative stages of developing a pain and discomfort module for persons with CP to be used with the UK World Health Organisation generic measure of quality of life (WHOQOL). The aims were to investigate patients' perceptions of CP and its effect on QoL, and to generate items to be used in the development of a module appended to the UK WHOQOL-100. At the first stage (study 1), six focus groups of patients were invited to discuss how living with pain and discomfort affected QoL. At the second stage (study 2), an international web survey was conducted with English-speaking respondents. Ten new facets of QoL were identified by the focus groups: flare-ups, pain relief, anger and frustration, vulnerability/fear/worry, uncertainty, loss/loneliness/feeling alone, positive strategies, communication, guilt and burdening others, and relationship with health care providers. The web-survey confirmed and validated these new facets. Although the WHOQOL-100 is a reliable and valid measure of QoL for use in CP, this study shows that additional areas must be assessed when measuring the impact of CP on QoL.
14593937	Idiopathic intracranial hypertension (IIH) is an unusual disease, seen most often in women of childbearing age who are obese. If left untreated, IIH can cause chronic pain and blindness. Although IIH has been recognized by healthcare providers since the late 1880s, the cause is still not known and risk factors remain unclear. Treatment has not changed over the years. While professionals struggle to define, describe, and successfully treat IIH, persons with the disease are struggling to cope. Internet support group communications relate numerous personal stories of frustration, depression, pain, anxiety, and disability. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) model provides an appropriate framework through which to view what is known and what is yet to be discovered about IIH. The ICF model was designed to complement the International Statistical Classification of Diseases and Related Health Problems, looking beyond mortality and disease by describing how people live with their health conditions. Applying this framework to IIH reveals many opportunities for nursing research within the ICF domains of health condition, body function and structure, ability and participation, and environmental and personal factors.
14528541	The presence of a painful, disabling chronic disease may have implications for perceived ability to fulfill a parenting role. The purpose of this research was to examine the realities of parenting from the perspectives of mothers, fathers and grandparents with arthritis using a combination of methods: a cross sectional survey and in-depth focus group discussions. There was consensus that pain, fatigue and restricted physical functioning combined to interfere with the parenting role. Overall, approximately 35% of the sample had experienced difficulties attributed to arthritis. A gender difference emerged with women reporting more difficulties in relation to caring for babies and toddlers, whereas men reported more problems as children grew older. Key themes concerned: physical limitations; practical and caring issues; social factors; emotional response; hereditary risks and safety issues. Perceived inability to fulfill parenting roles resulted in feelings of frustration, guilt, anger and depression. A number of positive outcomes were mentioned including children's increased awareness of the needs of others. Limitations of the methodological approach adopted are discussed.
12930542	It has become clear that nursing is a high-risk occupation with regards to stress-related diseases. In this study, we were interested in nurses' experiences of stress and the emotions arising from stress at work. Results showed that nurses experienced negative stress which was apparently related to the social environment in which they worked. Four nurses were interviewed. The method used was grounded theory. Analysis of the interviews singled out absence of response as the core category. Recurring stressful situations obviously caused problems for the nurses in their daily work. Not only did they lack responses from their supervisors, they also experienced emotions of frustration, powerlessness, hopelessness and inadequacy, which increased the general stress experienced at work. Our conclusion is that the experience of absence of response leads to negative stress in nurses.
12930538	The objectives of this research were to explore and describe emerging new roles of First-Line Nurse Managers (F-LNMs i.e. individuals who oversee the daily operations of nursing units, regardless of their titles) in one Canadian province, identify their requisite knowledge, skills, competencies, and determine the training and development needs of these managers.F-LNMs, recognized as key players in health care systems, face major challenges (e.g. continuing organizational change, lack of resources) daily. These challenges affect their ability to achieve quality work experiences for their staff members and quality of nursing care for their patients and for themselves.	The research design entails a triangulation of investigators (nursing and management), methods (interviews and a Delphi Study), samples (interviews with 26 F-LNMs and a Delphi Study with 62 panelists), and data (qualitative and quantitative). Institutions were randomly selected and then F-LNMs were randomly selected to participate in personal interviews and the remaining F-LNMs, along with nominated senior administrators, were invited to participate in the Delphi Study.	Key findings relate to role changes (e.g. job enlargement and emphasis on efficiency), challenges (e.g. staffing and retention, frustrations), and recommendations for administrators (e.g. provide resources, training and development) and educators (e.g. link education to organizational needs). Ultimately, organizational changes and challenges affect how F-LNMs perceive their future professional (e.g. providing quality of patient care) and personal (e.g. high quality of life) satisfaction levels.	This research suggests that the role of F-LNMs continues to evolve, consistent with the changing health care system. F-LNMs face challenges that compromise performance of their functions as they believe their work should be completed. To enhance satisfaction in their roles, F-LNMs express a desire for balance in their professional and personal lives.	
12851097	This study aimed to get knowledge of the younger stroke patient's viewpoint and to describe how young stroke patients experience the rehabilitation process. The purpose was also to develop hypotheses about the relationship between young stroke patients and the rehabilitation process.Thematised in-depth interviews were performed with two women and three men who suffered from stroke (37 - 54 years). The analysis used was the Grounded Theory method of constant comparison.	The analyses resulted in the core category 'Frustration' which was derived from the categories labelled 'The paralysed everyday' and 'Outside and invisible'. 'The paralysed everyday' category involved different aspects of everyday life after a stroke. Because of their fatigue they were unable to work and their family and social life were negatively affected. They found it difficult to engage in daily life activities and felt indifferent. The three women expressed frustration over the demands they experienced as being mothers and housekeepers, whereas the two men emphasised economic responsibility of the family as problematic. The category 'Outside and invisible' describes the lack of participation the informants experienced regarding the rehabilitation process. The informants felt they lacked information and age-adapted interventions. Their needs were not provided for and they felt distant from the other patients. Their remaining symptoms were probably on a cognitive basis and therefore invisible. This was a source of frustration.	The hypotheses generated indicated that young stroke patients are frustrated and invisible due to the fact that the rehabilitation setting does not acknowledge the different needs of young stroke patients compared with older patients.	
12765314	To assess the prevalence of asthma symptoms, their impact on daily activities, and perceptions of disease severity among people with asthma.A telephone survey of 699 people with asthma was conducted in 1999 in metropolitan and nonmetropolitan New South Wales, Victoria, and Queensland, Australia.	Forty-two percent of adults and 26% of children reported experiencing asthma symptoms at least every 2-3 days. Thirty-seven percent of adults and 26% of children reported using a reliever more than four times in the previous week. Of those for whom preventer therapy had been prescribed (61% of respondents), 30% of children and 45% of adults did not use their preventer as instructed. A high proportion of respondents reported avoiding physical and social activities because of their asthma, while 75% said asthma generally made them feel tired. Many respondents attributed frustration (61%), irritability (57%), fear (38%), and worry (43%) to their asthma. Only 50% of respondents had been reviewed by a general practitioner for asthma in the past year. Respondents generally underestimated the severity of their asthma, compared with symptom frequencies reported.	The Living with Asthma Survey suggests that national asthma management goals are not being achieved in a high proportion of patients, with evidence for both underprescribing and underusage of preventer medication. Achieving closer alignment between medical and patient perspectives is an important goal of asthma education and management in order to help bridge the gap between current concepts of best practice and the reality of persistently poor asthma outcomes.	
12681159	To identify difficult (heartsink) patients (DP), describe their profile, and report the opinions and experiences they evoke in physicians who see them.Descriptive, cross-sectional study based on quantitative and qualitative methods.	Urban health care center.	Difficult patients were selected daily from among all patients seen in six primary care practices during the period from March to May 2001. Patients were identified according to the diagnostic criteria of Ellis (patients who cause a knot in the stomach when their name appears on the list of patients with an appointment that day) and O'Dowd (patients who cause distress or discomfort).	Information was obtained on the number of DP seen, number of visits made by DP, age, sex, type of DP, level of education, occupation, family structure and comorbidity. Type of DP was determined with a modification of the Groves classification (dependent clinger, entitled demander, manipulative help-rejecter, self-destructive denier, somatizer, emotive seducer). We analyzed the opinions DP generated by examining the discourse produced during a discussion group session with 9 physicians from the participating health center and a moderator.	A total of 82 DP were identified (prevalence.7%, i.e., 2.3% of all visits). Most (67.1%) were women. Mean age was 57.8 years (standard deviation 15.2 years). Dependent clinger patients predominated (41%). Most patients had primary-level education (62%), about one-third were retired (35%), and about one-third were married and had children (35%). Most had two or more medical diagnoses (74.4%), and many had at least one psychiatric diagnosis (40.2%).The feelings these patients evoked most often in physicians were irritability and frustration. Most physicians agreed that these patients are rare but have a severe emotional impact. Physicians believe that the skills and strategies they have to help them manage these patients are limited, and consider specific training necessary to improve them.	Although DP are not a relevant problem in quantitative terms, they cause considerable emotional distress. Specific training in clinical interviewing is felt to be necessary given the difficulties in managing these patients.	
12674289	The ABC model underlying Ellis's Rational Emotive Behavior Therapy predicts that people who think more irrationally should respond to daily stressors or hassles differently than do people who think less irrationally. This study tested this aspect of the ABC model. 192 college students were administered the Survey of Personal Beliefs and the Hassles Scale to measure irrational thinking and daily hassles, respectively. Students who scored higher on overall irrational thinking reported a significantly higher frequency of hassles than did those who scored lower on overall irrational thinking, while students who scored higher on awfulizing and low frustration tolerance reported a significantly greater intensity of hassles than did those who scored lower on awfulizing and low frustration tolerance. This indicates support for the ABC model, especially Ellis's construct of irrational beliefs central to this model.
12556824	A survey conducted by the Research Council Of Illinois ENA was intended to assess educational needs, but it revealed some very important serendipitous findings. This survey gave a voice to the frustrations of emergency nurses.A 31-question survey was distributed to 900 Illinois ENA members requesting information about their educational needs. The last question, which formed the basis of this report, asked respondents to list the 3 biggest challenges they face on a daily basis.	In addition to the information regarding educational offerings, the survey revealed that ED nurses were overburdened and frustrated in their jobs. Specifically, the nurses identified 7 areas of greatest concern: (1) insufficient and inexperienced staff; (2) increased responsibilities; (3) lack of administrative support; (4) lack of rewards or incentives to stay; (5) low morale among staff; (6) difficulty balancing work and family; and (7) increasing violence in the emergency department.	The first step toward addressing a growing crisis in emergency nursing is to listen to the voices of emergency nurses themselves and let their frustrations be heard. The spontaneous comments of emergency nurses point to serious, pervasive, systemic problems in emergency nursing. Such problems will not be solved by "quick fixes" such as sign on bonuses, but rather by listening carefully to the concerns of experienced nurses.	
12131606	The aim of this study was to assess the effect of infliximab on quality of life in patients with active Crohn's disease (CD) inadequately responsive to concomitant therapies.We examined responses to the Inflammatory Bowel Disease Questionnaire (IBDQ) from patients enrolled in a previously reported, randomized, placebo-controlled study. Patients with active CD received a single intravenous infusion of either placebo or infliximab 5, 10, or 20 mg/kg. Most patients received stable doses of mesalamine, corticosteroids, azathioprine, or 6-mercaptopurine throughout the study. Changes from baseline in overall IBDQ score and individual dimensions at 4 weeks postinfusion were compared.	Patients treated with infliximab had a significantly larger improvement in overall IBDQ score than those treated with placebo at 4 weeks (p < 0.001). Infliximab-treated patients also had larger improvements in all IBDQ dimensions: bowel (p = 0.007), social (p = 0.002), emotional (p < 0.001), and systemic (p < 0.001). A significantly larger proportion of infliximab-treated patients reported having normal or near-normal frequency of bowel movements in the past week (p < 0.001), full or a lot of energy (p = 0.019), and no or hardly any difficulty doing leisure or sports activities (p = 0.011), and being extremely or very satisfied with their personal life (p = 0.046). They also significantly differed in responses regarding fatigue, frustration, ability to work, general well-being, depression, anxiety, and anger resulting from bowel problems.	These results indicate that infliximab significantly improved quality of life in patients with active CD, increasing their ability to work and participate in leisure activities, and decreasing feelings of fatigue, depression, and anger.	
12024339	This pilot study assessed the impact of diabetes on overall quality of life (QOL) of 23 adolescents (12-16 years old). The impact of diabetes on daily life, satisfaction with life, and common worries and frustrations were explored through the Diabetes Quality of Life for Youth scale (DQOLY) and semistructured interviews. The four major themes that emerged from the interviews were (a) restrictions, (b) differentness, (c) negative emotion, and (d) adaptation. Adolescents reported being most bothered by dietary restrictions, including the regimentation/scheduling of eating and its social ramifications. Adolescents in this study worried the most about the future and, in particular, complications. Older adolescents worried less, had lower Diabetes Impact scores, and had better Quality of Life scores on the DQOLY. The theme of adaptation and the negative emotion theme were both expressed most often by participants who had had diabetes for a longer period of time.
11820540	The cuban government has placed a very high emphasis on health since 1959 and vaccination and health education campaigns, as well as access to a comprehensive free healthcare system, have contributed to dramatic improvements in the population's health status. Much that has been written about the Cuban health service has relied on published sources, but this article is based on 18 months spent carrying out ethnographic fieldwork in the country, with particular emphasis on the daily lives of women employed in the health sector. Data were collected by participant observation, interviews and life-story work. Family doctors are usually young women completing their specialist training. They work in health centres in apartment blocks in which they also live. They work closely with nurses and other health and social service workers. Health workers are expected to live and work in their own communities, to act as role models for their patients, and to be available at all times. Whilst this has led to an extremely well-informed population and accessible healthcare, it has brought costs to healthcare workers in terms of very high expectations, a feeling that they do not have a private life, and stress caused by the inability to meet patient demands in the face of shortages of medicines and other supplies as a result of the continuing US trade blockade. These pressures and frustrations for healthcare workers may have parallels in Western healthcare services which are subject to resource constraints.
11777510	To assess, from the patient's perspective, the prevalence and impact of postoperative fatigue after hysterectomy and to increase understanding of physician-patient communications before and after surgery regarding recovery and diminished postoperative energy level.We completed a telephone survey of 300 women aged 25-50 who had undergone a hysterectomy or myomectomy within the past 2 years. The patients were recruited randomly from two national, random samples of households: 1) women aged 25-50, and 2) women taking hormone replacement therapy in the target age range. Patients were asked a series of questions about their postoperative fatigue after surgery.	Overall, 74% of patients experienced moderate-to-severe fatigue within the first few weeks after surgery. Fatigue occurred more frequently and persisted twice as long as pain, the next most frequent symptom, which was experienced by 63% of patients overall. Fatigue was the symptom that most interfered with daily activities (37%) and also contributed to feelings of frustration (52%), to depression (37%), and to difficulty in concentrating (42%). Patients employed at the time of surgery missed an average of 5.8 weeks of work; 69% of those surveyed required 2 or more weeks of caregiver assistance. Postoperative fatigue was discussed by 68% of patients' physicians before surgery, and 57% of patients discussed postoperative fatigue with their physicians after surgery. Oral iron therapy and dietary supplements were the most frequently recommended treatments; 52% of patients were not offered any treatments or recommendations to alleviate their fatigue.	Fatigue is a highly prevalent posthysterectomy and myomectomy symptom and has substantial negative physical, psychosocial, and economic effects on patients during recovery.	
11332258	To gain insight into the prevalence of faecal incontinence, looking for medical attention, treatment and the impact of faecal incontinence on the quality of life in community-residing men and women of 60 years and over.Enquiry and interview.	A questionnaire about the incidence of faecal incontinence and the request for help from the family doctor was mailed in 2000 to persons aged 60 and older listed in seven general practices in and round Nijmegen. In an interview with persons with faecal incontinence questions were asked about the need for assistance and the psychosocial consequences of the incontinence.	Of the 3887 questionnaires mailed, 3345 were available for analysis, from 1536 males and 1809 females. The prevalence of faecal incontinence was 6%. The male-female distribution was equal and a rise in prevalence was seen with advancing age. One-third of the population discussed the incontinence with their physician, more women (58%) than men (42%). The faecal incontinence had hardly any impact on daily or social activities but the subjects did feel anxiety, shame or frustration. Treatment, if given (14/17), consisted of a prescription for diapers (n = 2) or of referral to an internist for examination of the intestines (n = 4).	Faecal incontinence occurred in 6% of persons aged 60 or older living independently. Explicit looking for medical attention was not common. There were hardly any male-female differences. The most impact on the quality of life concerned the emotional wellbeing. Treatment had a little effect.	
11331802	The purpose of this study was to examine the prevalence of religious coping among persons with persistent mental illness and to gain a preliminary understanding of the relationship between religious coping and symptom severity and overall functioning.A total of 406 individuals who were diagnosed as having a mental illness and who were patients at one of 13 Los Angeles County mental health facilities completed a survey consisting of the Religious Coping Index, the Symptom Checklist 90-R (SCL-90), the Global Assessment of Functioning (GAF) scale, and a 48-item demographic questionnaire.	More than 80 percent of the participants used religious beliefs or activities to cope with daily difficulties or frustrations. A majority of participants devoted as much as half of their total coping time to religious practices, with prayer being the most frequent activity. Specific religious coping strategies, such as prayer or reading the Bible, were associated with higher SCL-90 scores (indicating more severe symptoms), more reported frustration, and a lower GAF score (indicating greater impairment). The amount of time that participants devoted to religious coping was negatively related to reported levels of frustration and scores on the SCL-90 symptom subscales.	The results of the study suggest that religious activities and beliefs may be particularly compelling for persons who are experiencing more severe symptoms, and increased religious activity may be associated with reduced symptoms. Religion may serve as a pervasive and potentially effective method of coping for persons with mental illness, thus warranting its integration into psychiatric and psychological practice.	
11115010	Waiting lists for coronary artery bypass surgery (CABS) are common in many developed countries. Yet, there is limited information available regarding patients' health care needs at this time. This paper reports on a prospective study which aimed to investigate the experience of waiting for CABS from a qualitative perspective. An inductive research approach was used to conduct interviews with 70 randomly selected patients at three intervals over the first year on the waiting list - referral for surgery, again after waiting 6 months (n=49), and finally after waiting for 1 year (n=28). Attrition was mainly caused by surgery having been performed (n=36), although death (n=4) and refusal to participate (n=2) also contributed. Domicilliary interviews were taped and transcribed verbatim. Thematic content analysis identified three central themes in this experience - uncertainty, chest pain and anxiety; with six secondary themes - powerless, dissatisfaction with treatment, anger/frustration, physical incapacity, reduced self-esteem, and altered family and social relationships. The nature and meaning inherent in each theme is described using interview quotations, and a model is proposed which summarizes this data and the relationship between themes. From this analysis, uncertainty, chest pain and anxiety emerge as important indicators of a negative outcome for these patients. This report strongly suggests that patients awaiting bypass surgery require more information regarding the waiting time for such a surgery. Nurses should also offer advice regarding pain management to help improve patients' skills and decrease the fear associated with angina. Nursing intervention and support should also be directed at reducing patients' anxiety levels. This is the first known qualitative study which specifically examines patients' perception of the waiting period prior to bypass surgery. It may therefore provide new evidence on which to base practice for nurses in both hospital and community, and may also stimulate further research in this area.
11094916	In meeting national needs for our terminally ill, health care educators need to become more aware of their students' aptitudes for hospice work. For these reasons we measured hospice nurses' attitudes toward caring for the terminally ill and their views on using opioids, and compared them to those of other health care personnel and their students. Thirty-eight hospice nurses, 64 other nurses, 93 physicians, and 676 senior medical students participated in this study. Our primary measures were scales assessing thanatophobia and opiophobia and a battery of personal and professional role trait measures. Our results indicated that in providing end-of-life care, hospice nurses expressed less discomfort, helplessness, and frustration, and indicated less reluctance to use opioids than did any of the other groups surveyed. Overall, these hospice nurses had 35 percent lower opiophobia and 55 percent lower thanatophobia scores than the other health care professionals. Despite dealing with issues of death and dying on a daily basis, hospice nurses also scored lower on depressed mood. In caring for the terminally ill, hospice nurses' other personal traits were also less maladaptive than those of the other health professionals. Psychiatrists exhibited the most opiophobia, not only scoring higher than physicians practicing oncology, but also higher than senior medical students. To assure cancer patients that they can expect to live their lives free of pain, medical educators can use these thanatophobia and opiophobia scales to develop better teaching, counseling, and monitoring strategies.
10661295	The study aims at exploring the experience of the patients suffering from high blood pressure, analysing the difficulties they evoke and trying to generate similarities. It is a qualitative study, based on the phenomenological method. The interviews highlight the fact that the patients are preoccupied only by the symptoms of high blood pressure. They also show that all the patients live through the disease with a lot of emotions, with feelings of frustration, stress, anxiety and helplessness. A better understanding of the patients' experience must enable the nurses to have better targeted actions.
10601912	This study was undertaken to evaluate the anatomic, functional, and quality-of-life effects of site-specific posterior colporrhaphy in the surgical management of rectocele.In a retrospective observational study 125 patients were studied who had undergone site-specific posterior colporrhaphy between 1995 and 1996, either alone or in conjunction with other pelvic procedures. Physical examination was performed >/=6 months after the operation to assess the anatomic success of the repair. Standardized questionnaires were used to assess quality of life, sexual function, and bowel function.	Surgical correction was found at follow-up examination to have been achieved in 82% of eligible patients (73/89). All daily aspects of living improved significantly (P <.05), including ability to do housework (56% improvement or cure), travel (58% improvement or cure), and social activities (60% improvement or cure). Emotional well-being also significantly improved after the operation, as measured by thoughts of embarrassment (57% improvement or cure) or frustration (71% improvement or cure). Sexual function was not affected; however, reports of dyspareunia significantly (P <.04) improved or were cured after the operation in 73% of patients (19/26), worsened in 19% of patients (5/26), and arose de novo in 3 patients. Results showed no other significant differences in vaginal dryness, orgasm ability, sexual desire, sexual frequency, or sexual satisfaction. Bowel symptoms were assessed subjectively and were noted to have significantly improved (P <.008) after the operation. The following improvement or cure rates were obtained: stooling difficulties, 55%; pelvic pain or pressure, 73%; vaginal mass, 74%; and splinting, 65%.	This study indicates that defect-specific posterior colporrhaphy is equal to or superior to traditional posterior colporrhaphy. This type of repair provides durable anatomic support and is successful in restoring bowel function. It does not detrimentally affect sexual function, may aid in the resumption of sexual activity, and significantly improves quality of life and social aspects of daily living.	
10480462	This study assessed the diagnostic accuracy of formal diagnostic criteria for canine compulsive disorder (canine CD). Canine CD is a syndrome of abnormal behaviors that are believed to result from conflict or frustration. Differential diagnoses include normal conflict behavior and learned behavior. In studies of canine CD, confidence in the diagnosis comes with knowing the accuracy of the diagnostic method. This accuracy may be quantified as the chance-corrected agreement between the diagnostic method and a 'gold standard' diagnostic test. The present study examined the agreement between diagnoses of canine CD made by an expert (the 'gold standard') and by using formal diagnostic criteria. The owners of 84 dogs suspected of having CD received 2 telephone interviews. The first utilized a detailed, pre-tested questionnaire; a dog was then diagnosed with CD if the behavioral history met 7 diagnostic criteria. The second interview was given by a behavioral expert whose diagnosis was based on personal experience. The interviewers were blind to each other's diagnoses. The chance-corrected agreement between diagnoses was minimal (kappa = 0.02) and disagreement was associated with 3 of the formal criteria: a history of conflict or frustration, an increase in the number of contexts that elicit the behavior, and an increase in the daily frequency of the behavior. Reasons for the disagreement include the order of the interviews, response biases, the setting of the interviews, and, possibly, the diversity of the behaviors associated with canine CD. To the authors' knowledge, this type of study is the first in clinical ethology to address validation of the diagnostic method. The results indicate 3 developmental aspects of canine CD that should be examined in future work.
10434145	The purpose of this study was to detect subjective elements that came into play with the satisfaction of patients that had been undergoing total hip replacement surgery. None of the patients had ever had a psychiatric pathology or undergone orthopedic surgery before. We defined specific questionnaires in order to support this study, based upon a clinical experience very representative of daily practice. In this study, we have also included the summary of clinical notes which highlight one of the present roles of a psychiatrist in a field which is no longer strictly psychiatric disease. Working daily with surgeons gave us access to patients who do not belong to traditional psychiatry but who need carefully selected words and not only a surgical operation in order to become really relieved. This work demonstrated that the standard quality-of-life questionnaires did not allow to evaluate patients' subjective assessments. In order to take into account this subjectivity, it was necessary to combine questionnaires and open-ended interviews. The analysis of the data gathered in this study showed that half of the patients underwent, roughly 3 months after surgery, a period of temporary frustration, although the hip was already in very good condition, according to objective measures. Patients could get out of this temporary period of disappointment--which seemed to be a necessary stage of mourning of their complaint--without any specific treatment. But a good relationship between surgeon and patient was necessary; it helped the patient and the surgeon to escape a duel or a confrontation. For some patients it may have taken as long as one year to enjoy all the benefits of the operation.
10091852	The parents of children with epilepsy (PCE) face multiple psychosocial and economic problems that are often neglected. We undertook this study to ascertain these problems among the patients attending a tertiary referral center for epilepsy in India. A structured questionnaire was administrated to parents of 50 children aged between 5-10 years and having epilepsy for more than 1 year's duration. Some 52% of the children had partial epilepsy whilst the remaining had generalized epilepsy. The median seizure frequency was one per 6 months. The majority of the patients (86%) were living in villages. The family income was less than 1000 Rs per month (1 USD = 42 INR) for 66% of the patients. A decline in social activities, after the onset of epilepsy in their children, was reported by 80% of the parents. Daily routines were significantly affected in over 75% of the parents. Parents had been experiencing frustration (52%) and hopelessness (76%), whilst 60% were in financial difficulties. The most important item of expenditure was cost of drugs or cost of travel to hospital for 54% and 36% parents respectively. Impaired emotional status and poor social adaptation were co-related with the severity of epilepsy (frequent seizures/generalized seizures/attention disorder) and low economic status of the parents. These observations need to be borne in mind while organizing rehabilitation programs for epilepsy.
9917734	The purpose of this study was to evaluate participants' perceptions of the weight-loss intervention used in a hypertension prevention clinical trial.A total of 308 overweight and moderately obese subjects participated in the weight-management intervention. After the 18-month program, 281 participants completed a questionnaire designed to evaluate their perceptions of the program's effectiveness.	Adult participants (224 men and 84 women) in the weight-loss modality of the Trials of Hypertension Prevention Phase I, surveyed in 1991.	chi 2 Analyses were used to test for statistical significance of group differences.	Intervention components that were most useful are presented. Older participants (older than 50 years) were most likely to attend sessions and women were most likely to identify stress and frustration because of disappointing results. Successful participants were more likely to incorporate exercise into their daily activities, exercise regularly, and use self-monitoring strategies. Few participants found group exercise to be useful.	These findings suggest that interventionists in weight-loss programs need to find flexible and creative ways to maintain contact with participants, continue to develop better methods of self-monitoring, obtain the skills needed to recognize frustration and provide timely support, continue to couple the message of diet and exercise, and emphasize helping participants develop their problem-solving skills. This may require training outside the traditional field of dietetics.	
9864746	Children diagnosed with Developmental Dysplasia of the Hip (0.2% of live births) are often treated by splintage to hold the head of the femur in the acetabulum during early joint development. Whilst clinically effective, this can create difficulties for the parents in handling the child and affects the mobility of the family, which subsequently creates emotional and social difficulty resulting from the disruption of the family routine. To identify these problems and their order of priority, a survey of 113 recently affected families was carried out in England and Northern Ireland. Parents identified mobility, emotional and social problems. Splintage size and shape was the fundamental problem from which the other difficulties arose. Solutions to the basic difficulties of transporting and seating a child in splintage would largely alleviate the feelings of frustration felt by the families and enable more normal activities of daily living.
9832918	Individuals who have had a stroke must cope with many changes in their lives. Initially, the focus is on the physical changes and functional abilities; however, coping with the emotional and cognitive changes also requires attention. Changes in mental status can affect a person's rehabilitation outcomes. This study describes the predominant themes related by stroke survivors that affected their recovery. Eleven right-hemisphere stroke patients (6 women and 5 men) were interviewed four times (at 1 week, 1 month, 3 months, and 6 months) after their stroke. The descriptions of personal changes, feelings, and experiences were categorized and analyzed for recurrent themes. The major mental changes were in mood, judgment, memory, and personality. At 6 months, the predominant themes were depression, memory loss, nervousness, irritability, frustration, lack of energy, and decreased initiative. These mental changes are important for nurses to consider when planning rehabilitation goals.
9710165	To develop a self-report questionnaire for persons with lower limb amputations who use a prosthesis. The resulting scales were intended to be suitable to evaluate the prosthesis and life with the prosthesis. The conceptual framework was health-related quality of life.Multiple steps of scale development, terminating with test-retest of the Prosthesis Evaluation Questionnaire (PEQ) by mail. SOURCE OF SAMPLE: Records from two Seattle hospitals.	Ninety-two patients with lower limb amputations who varied by age, reason for amputation, years since amputation, and amputation level.	The 10 scales used were 4 prosthesis function scales (Usefulness, Residual Limb Health, Appearance, and Sounds), 2 mobility scales (Ambulation and Transfers), 3 psychosocial scales (Perceived Responses, Frustration, and Social Burden), and 1 Well-being scale. Validation measures were the Medical Outcomes Study Short Form-36, the Social Interaction subscale from the Sickness Impact Profile, and the Profile of Mood States-short form.	Nine PEQ scales demonstrated high internal consistency. All met test-retest criteria for comparing group results. Validity was described based on methods used to gather original items, distribution of scores, and comparison of scores with criterion variables.	The PEQ scales displayed good psychometric properties. Future work will assess responsiveness of PEQ scales to changes in prosthetic components. We conclude that they will be useful in evaluation of prosthetic care.	
9697582	A phenomenological study was conducted to answer the question, What is it like being an individual with a disability who uses a wheelchair for full-time mobility and lives in society with many potential barriers? A total of 9 people from Ohio and Pennsylvania composed the purposively selected sample. Colaizzi's method of data analysis was used to review transcriptions of interviews with those in the sample. The analysis identified a major theme: all participants had feelings of frustration concerning access. Four subtheme clusters related to this frustration emerged: issues of independence, attitudes of others toward people with disabilities, others' lack of understanding of the situations of individuals with disabilities, and lack of involvement of people with disabilities in decisions regarding the development of facilities for them. This study provides insights into the lived experience of accessibility in today's environment for people with disabilities who use a wheelchair for full-time mobility, offers direction for health professionals who work with these individuals, and serves as an impetus for further research.
9236701	Service provision for those with cerebral palsy (CP) becomes fragmented after adolescence. Young people with CP in two age groups, their carers and associates, were interviewed, and use of health and social services was investigated. Leisure activities were also compared with a matched control group of able-bodied young people. Use of health and social services decreased when the children with CP left school, thereby increasing the demands upon carers. Carers expressed anxieties about the provision of services, and frustration in obtaining information about help. Findings from the questionnaires showed the young people with CP in both age groups to be socially less active than the controls. Among the subjects, the older age group was socially less active than the younger age group. Communication is poor both between the agencies providing care and between the agencies and the young person or carer. There is a need to identify those with responsibility for coordinated-care planning for adolescents with CP.
8842826	Two separate graduate rehabilitation counselling groups from a mid-south university either did or did not take part in a wheelchair sensitivity training pilot study designed to enhance their understanding as to what life might be like for persons who use a wheelchair. Twenty students were individually accompanied on a designated route across campus by a non-disabled graduate researcher. Eighteen other graduate students formed a control group and did not participate. Both groups completed a contextually different 14-item Likert type questionnaire designed to assess their perceptions of persons with physical disabilities based on either the sensitivity exercise or their experience in the rehabilitation programme. Results from this quasi-experimental study suggested that regardless of whether they participated in the sensitivity training, both groups perceived they would become better counsellors. t-Tests revealed significant differences in the two groups' responses to questions pertaining to daily frustrations experienced by persons with physical disabilities and a pre-occupation with how accessible places are. Other differences noted were that persons with physical disabilities must feel different from being stared at and must have a harder time in society. Implications of the utility and misuses of these one-time experiences are explored.
8008309	Computerized electronic mail (E-mail) systems provide a rapid means of data sharing and are used in a variety of commercial and industrial settings for the widespread distribution of memoranda. We adapted an E-mail system to our program to determine the feasibility of incorporating such a system into didactic resident education in obstetrics and gynecology and to assess resident response to this form of computer-based learning. The system was programmed to distribute one review question per day to 24 resident physicians for 60 days. Residents were given 24 hours to respond and comment. Each question was discussed and appropriate references distributed within 48 hours of presentation. All questions and responses were then stored in an electronic file folder for later review. An examination was given at completion of the project (post-test), and these scores were compared to performance during the project (pre-test). An anonymous questionnaire was distributed upon completion of the project to assess the residents' overall satisfaction with the program. The system was well received by the residents. On a scale of 1 to 6 (1 = lowest; 6 = highest), resident satisfaction was high, with an overall average rating of 5.0. Using this scale, residents assessed their frustration level as 1.5. Average daily participation was 85%. An average of 9 minutes was required to complete each question and review prior responses and discussion; this interval was not significantly different among the postgraduate years. Scores on the examination at project completion were significantly higher than performance during the project.(ABSTRACT TRUNCATED AT 250 WORDS)
1330459	We investigated the daily life and opinions of patients after total proctocolectomy and ileal J-pouch-anal anastomosis. Eighty patients answered a questionnaire, completed Cattell's anxiety scale, and recorded bowel function for one month. Both colitis and polyposis patients defecated five times daily, had 1.6 episodes of nocturnal motions weekly, and soiled twice weekly. However, colitis patients were more satisfied with their bowel function and surgical outcome than were polyposis patients. This difference had a close relationship to the personality factors of ego strength and frustration. All patients with either disease who defecated less than three times daily, had no nocturnal motions, and had no soiling showed normal ego strength and frustration and were completely satisfied with their bowel status and operation. In contrast, patients defecating more than seven times daily or more than once per week nocturnally and soiling more than four times weekly had high frustration and were dissatisfied. Thus, satisfaction with surgery correlated not only with the objective outcome but also with personality and lifestyle.
28513276	Perhaps unlike other social roles that people may hold, caring for children offers opportunities for both immense joy and incredible frustration. Yet what predicts how parents will feel during caregiving experiences? In the current study, we examined parents' (N = 152) positive emotion, negative emotion, and felt meaning during caregiving using the Day Reconstruction Method. In addition, we tested attachment anxiety and avoidance as predictors of parents' emotion during caregiving relative to their other daily experiences. We found that attachment avoidance was associated with elevated negative emotion and reduced positive emotion and meaning in life across the entire day, whereas attachment anxiety was associated with elevated negative emotion and marginally greater meaning in life, but not positive emotion, across the entire day. Furthermore, caregiving was associated with greater positive emotion and meaning, but not negative emotion, compared to parents' other daily activities. Finally, attachment avoidance, but not anxiety, was associated with lower levels of positive emotion, negative emotion, and felt meaning during caregiving compared to other daily activities. These findings are consistent with other evidence that attachment avoidance is associated with deactivation of emotion in close relationships and suggest that attachment avoidance minimizes the joys of parenting.
28509404	Autism spectrum disorders (ASDs) are characterised by impairments in communication and reciprocal social interaction. These impairments can impact on relationships with family members, augment stress and frustration, and contribute to behaviours that can be described as challenging. Family members of individuals with ASD can experience high rates of carer stress and burden, and poor parental efficacy. While there is evidence to suggest that individuals with ASD and family members derive benefit from psychological interventions designed to reduce stress and mental health morbidity, and enhance coping, most studies to date have targeted the needs of either individuals with ASD, or family members. We wanted to examine whether family (systemic) therapy, aimed at enhancing communication, relationships or coping, is effective for individuals with ASD and their wider family network.To evaluate the clinical effectiveness and acceptability of family therapy as a treatment to enhance communication or coping for individuals with ASD and their family members. If possible, we will also seek to establish the economic costs associated with family therapy for this clinical population.	On 16 January 2017 we searched CENTRAL, MEDLINE, Embase, 10 other databases and three trials registers. We also handsearched reference lists of existing systematic reviews and contacted study authors in the field.	Randomised controlled trials (RCTs) and quasi-RCTs investigating the effectiveness of family therapy for young people or adults with ASD or family members, or both, delivered via any modality and for an unspecified duration, compared with either standard care, a wait-list control, or an active intervention such as an alternative type of psychological therapy.	Two authors independently screened each title and abstract and all full-text reports retrieved. To enhance rigour, 25% of these were independently screened by a third author.	The search yielded 4809 records. Of these, we retrieved 37 full-text reports for further scrutiny, which we subsequently excluded as they did not meet the review inclusion criteria, and identified one study awaiting classification.	Few studies have examined the effectiveness of family therapy for ASD, and none of these are RCTs. Further research studies employing methodologically robust trial designs are needed to establish whether family therapy interventions are clinically beneficial for enhancing communication, strengthening relationships, augmenting coping and reducing mental health morbidity for individuals with ASD and family members.	
28491048	This study builds on previous research combining achievement goal orientation from Achievement Goal Theory and motivational regulation from Self-Determination Theory. The aim was to assess the combination of the "what" and "why" of youth sport activity, and how it relates to the need for competence and self-esteem. Achievement goal orientation, specifically task and ego, was employed to represent the "what", whilst intrinsic and external regulation reflected the "why". Based on a sample of 496 youth sports participants, structural equation modeling with a bootstrapping procedure was used to examine whether the indirect relationship between achievement goal orientation and self-esteem was conditional to motivational regulation. The results show partial support for the conditional process models. Specifically, task orientation was indirectly linked with self-esteem through competence need, and the relationship was stronger with higher levels of intrinsic regulation for sport. Furthermore, ego orientation was negatively associated with self-esteem through a positive relationship with competence frustration. However, this relationship emerged only for those higher in intrinsic regulation. External regulation did not emerge as a moderator, but presented a positive relationship with competence frustration. Findings are discussed in light of both Achievement Goal Theory and Self-Determination Theory, and underline the importance of considering both the "what" and "why" when attempting to understand motivation in youth sport.
28422990	Previous neuroimaging studies have shown an increased sensory cortical response (i.e., heightened weight on sensory evidence) under higher levels of predictive uncertainty. The signal enhancement theory proposes that attention improves the quality of the stimulus representation, and therefore reduces uncertainty by increasing the gain of the sensory signal. The present study employed functional magnetic resonance imaging (fMRI) to investigate the neural correlates for ambiguous valence inferences signaled by auditory information within an emotion recognition paradigm. Participants categorized sound stimuli of three distinct levels of consonance/dissonance controlled by interval content. Separate behavioural and neuroscientific experiments were conducted. Behavioural results revealed that, compared with the consonance condition (perfect fourths, fifths and octaves) and the strong dissonance condition (minor/major seconds and tritones), the intermediate dissonance condition (minor thirds) was the most ambiguous, least salient and more cognitively demanding category (slowest reaction times). The neuroscientific findings were consistent with a heightened weight on sensory evidence whilst participants were evaluating intermediate dissonances, which was reflected in an increased neural response of the right Heschl's gyrus. The results support previous studies that have observed enhanced precision of sensory evidence whilst participants attempted to represent and respond to higher degrees of uncertainty, and converge with evidence showing preferential processing of complex spectral information in the right primary auditory cortex. These findings are discussed with respect to music-theoretical concepts and recent Bayesian models of perception, which have proposed that attention may heighten the weight of information coming from sensory channels to stimulate learning about unknown predictive relationships.
28420246	Males among many species, including humans, evaluate cues of sperm competition risk and adjust accordingly their sperm competition tactics. The number of potential sexual rivals can serve as an index of sperm competition risk. Therefore, men may adjust their in-pair copulatory interest in accordance with the presence of sexual rivals. Using self-reports from 45 married men, we test the hypotheses that the time a man's wife spends with other men-either male friends or male coworkers-will positively predict a man's copulatory interest in his wife (Hypothesis 1) and his anger (Hypothesis 2), upset (Hypothesis 3), and frustration (Hypothesis 4) in response to his wife's sexual rejection. The results show that the time wives spend with male friends (but not male coworkers) predicts their husbands' anger, upset, and frustration in response to sexual rejection, providing support for Hypotheses 2-4. Discussion highlights novel contributions of the current research and provides a potential explanation for the discrepant findings regarding male friends versus male coworkers.
28398817	This study aimed to identify childhood factors that predict later psychiatric problems in children with disruptive mood dysregulation disorder (DMDD).The sample consisted of 36 6-year-old children who met criteria for DMDD who were followed up at 9 years of age. Child psychopathology was assessed at age 6 using the Preschool Age Psychiatric Assessment (PAPA) and at age 9 using the Kiddie-Schedule for Affective Disorders and Schizophrenia. We compared children with DMDD at age 6 who continued to have a psychiatric diagnosis at age 9 (n = 17) to children with DMDD at age 6 with no psychiatric diagnosis at age 9 (n = 19) across several age 6 predictors: child psychopathology, irritability and temperament, parenting, and maternal psychopathology. In addition, we examined whether children with DMDD at age 6 and no psychiatric diagnosis at age 9 continued to experience elevated psychiatric symptoms and impairment at age 9 compared to children with a non-DMDD diagnosis at age 6 and no psychiatric diagnosis at age 9 (n = 44) and children with no psychiatric diagnosis at age 6 or 9 (n = 266).	The following variables predicted which children with DMDD at age 6 would have a psychiatric diagnosis at age 9: higher levels of externalizing symptoms, anger/frustration, headstrong/hurtful behaviors, functional impairment, and temperamental surgency and negative affect; lower levels of effortful control/executive functioning; and maternal depression. However, children with DMDD at age 6 and no psychiatric diagnosis at age 9 continued to demonstrate greater disruptive behavior disorder symptoms and impairment at age 9 compared to children with no psychiatric diagnosis at age 6 or 9.	These findings identify factors predicting later psychopathology in children with DMDD. In addition, we found that the subgroup of children with DMDD at age 6 but no psychiatric diagnosis at age 9 continued to evidence symptomatology and impairment 3 years later.	
28371225	Grounded in self-determination theory, this study tested the hypothesis that the satisfaction and frustration of the psychological needs for autonomy, competence, and relatedness would relate to fatigue and subjective and objective sleep parameters, with stress and negative sleep cognitions playing an explanatory role in these associations. During a stay at a sleep laboratory in Belgium, individuals with unexplained chronic fatigue (N = 160; 78% female) underwent polysomnography and completed a questionnaire at 3 different points in time (i.e., after arrival in the sleep lab, before bedtime, and the following morning) that assessed their need-based experiences and stress during the previous week, fatigue during the preceding day, and sleep-related cognitions and sleep during the previous night. Results indicated that need frustration related to higher stress, which in turn, related to higher evening fatigue. Need frustration also related to poorer subjective sleep quality and shorter sleep duration, as indicated by both subjective and objective shorter total sleep time and subjective (but not objective) longer sleep latency. These associations were accounted for by stress and negative sleep cognitions. These findings suggest that health care professionals working with individuals with unexplained chronic fatigue may consider focusing on basic psychological needs within their therapeutic approach.
28323159	In the present longitudinal study, we aimed to investigate video game training associated neuronal changes in reward processing using functional magnetic resonance imaging (fMRI). We recruited 48 healthy young participants which were assigned to one of 2 groups: A group in which participants were instructed to play a commercial video game ("Super Mario 64 DS") on a portable Nintendo DS handheld console at least 30minutes a day over a period of two months (video gaming group; VG) or to a matched passive control group (CG). Before and after the training phase, in both groups, fMRI imaging was conducted during passively viewing reward and punishment-related videos sequences recorded from the trained video game. The results show that video game training may lead to reward related decrease in neuronal activation in the dorsolateral prefrontal cortex (DLPFC) and increase in the hippocampus. Additionally, the decrease in DLPFC activation was associated with gaming related parameters experienced during playing. Specifically, we found that in the VG, gaming related parameters like performance, experienced fun and frustration (assessed during the training period) were correlated to decrease in reward related DLPFC activity. Thus, neuronal changes in terms of video game training seem to be highly related to the appetitive character and reinforcement schedule of the game. Those neuronal changes may also be related to the often reported video game associated improvements in cognitive functions.
28263647	It is generally assumed that drivers speed intentionally because of factors such as frustration with the speed limit or general impatience. The current study examined whether speeding following an interruption could be better explained by unintentional prospective memory (PM) failure. In these situations, interrupting drivers may create a PM task, with speeding the result of drivers forgetting their newly encoded intention to travel at a lower speed after interruption. Across 3 simulated driving experiments, corrected or uncorrected speeding in recently reduced speed zones (from 70 km/h to 40 km/h) increased on average from 8% when uninterrupted to 33% when interrupted. Conversely, the probability that participants traveled under their new speed limit in recently increased speed zones (from 40 km/h to 70 km/h) increased from 1% when uninterrupted to 23% when interrupted. Consistent with a PM explanation, this indicates that interruptions lead to a general failure to follow changed speed limits, not just to increased speeding. Further testing a PM explanation, Experiments 2 and 3 manipulated variables expected to influence the probability of PM failures and subsequent speeding after interruptions. Experiment 2 showed that performing a cognitively demanding task during the interruption, when compared with unfilled interruptions, increased the probability of initially speeding from 1% to 11%, but that participants were able to correct (reduce) their speed. In Experiment 3, providing participants with 10s longer to encode the new speed limit before interruption decreased the probability of uncorrected speeding after an unfilled interruption from 30% to 20%. Theoretical implications and implications for road design interventions are discussed. (PsycINFO Database Record
28243481	Parkinson's disease (PD) is a neurodegenerative disease characterized by motor and nonmotor symptoms. Both of them imply a negative impact on Health-Related Quality of Life. A significant one is the stigma experienced by the parkinsonian patients and their caregivers. Moreover, stigma may affect everyday life and patient's subjective and relational perception and it may lead to frustration and isolation. Aim of the present work is to qualitatively describe the stigma of PD patients stemming from literature review, in order to catch the subjective experience and the meaning of the stigma construct. Literature review was performed on PubMed database and Google Scholar (keywords: Parkinson Disease, qualitative, stigma, social problem, isolation, discrimination) and was restricted to qualitative data: 14 articles were identified to be suitable to the aim of the present overview. Results are divided into four core constructs: stigma arising from symptoms, stigma linked to relational and communication problems, social stigma arising from sharing perceptions, and caregiver's stigma. The principal relations to these constructs are deeply analyzed and described subjectively through patients' and caregiver's point of view. The qualitative research may allow a better understanding of a subjective symptom such as stigma in parkinsonian patients from an intercultural and a social point of view.
28190288	WHAT IS KNOWN ON THE SUBJECT?: Behavioural Family Therapy (BFT) has been shown to help people with some severe mental health conditions, such as schizophrenia, by reducing relapse rates and stress within families. It can be difficult to put family interventions, like BFT, into clinical practice. Families where someone has an intellectual disability can experience more stress compared to those who do not, but we know very little about using BFT with families where a member has an intellectual disability. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: We interviewed nine Community Learning Disability Nurses and Allied Health Professionals about their experiences delivering BFT to families where one member has an intellectual disability. We found that therapists' experiences of delivering BFT were broadly positive, although they found some aspects of their service frustrating. EXPLAIN THE IMPORTANCE OF THE PAPER'S FINDINGS FOR A NON-SPECIALIST AUDIENCE: The study identifies the perceived benefits of BFT as a model to work with families, where a member has an intellectual disability. The study highlights some of the challenges experienced by practitioners, notably issues with engagement and some issues specific to working with adults with an intellectual disability. The findings suggest that it needs to be clear which families would benefit most from BFT, that interventions need to be adapted for people with intellectual disabilities and that Community Learning Disability Nurses and Allied Health Professionals should have support from management to deliver these interventions.Introduction Studies have found family interventions (FIs) to be effective in reducing stress and relapse rates for a variety of mental health conditions. However, implementing FIs into clinical practice is challenging. Studies have suggested that levels of stress within some families of people with intellectual disabilities can be high. However, there is little reported about the use and implementation of FIs, such as Behavioural Family Therapy (BFT), in adult intellectual disability services. Purpose of study To explore the experiences of practitioners delivering BFT to adults with intellectual disabilities. Method A qualitative methodology was employed, using semi-structured individual interviews with BFT therapists from a health professional background (n = 9). Data were analysed thematically. Results Two overarching themes were identified: positivity and frustration. Discussion Implementation of therapy was identified as being broadly successful but with some underlying challenges, notably wider organizational issues and some issues specific to working with adults with intellectual disabilities. Implications for practice The broadly positive experiences reported provide encouragement for the delivery of FIs, such as BFT, to adults with intellectual disabilities, by professions outwith psychology. However, there is a need to provide clarity on referral processes, adapt materials accordingly for this client group and ensure that supportive management and supervision is available to therapists.	
28165409	There are concerns about mental wellbeing in later life in older people as the global population becomes older and more urbanised. Mobility in the built environment has a role to play in improving quality of life and wellbeing, as it facilitates independence and social interaction. Recent studies using neuroimaging methods in environmental psychology research have shown that different types of urban environments may be associated with distinctive patterns of brain activity, suggesting that we interact differently with varying environments. This paper reports on research that explores older people's responses to urban places and their mobility in and around the built environment. The project aim was to understand how older people experience different urban environments using a mixed methods approach including electroencephalography (EEG), self-reported measures, and interview results. We found that older participants experience changing levels of "excitement", "engagement" and "frustration" (as interpreted by proprietary EEG software) whilst walking between a busy built urban environment and an urban green space environment. These changes were further reflected in the qualitative themes that emerged from transcribed interviews undertaken one week post-walk. There has been no research to date that has directly assessed neural responses to an urban environment combined with qualitative interview analysis. A synergy of methods offers a deeper understanding of the changing moods of older people across time whilst walking in city settings.
28146596	To describe the experiences of emergency department (ED) use among a population of Rhode Island Medicaid patients with chronic pain and a recent history of frequent ED use, who were eligible to participate in the Rhode Island Medicaid Pain Management program. Qualitative interviews were conducted with twenty-four patients who were either enrolled, or eligible to be enrolled, in a pain management program that is part of a state-funded initiative to reduce ED overuse.	Four main themes describe the experiences of these patients seeking ED care: (1) patients perceive that they use the ED appropriately; (2) frustrations in communication with ED providers; (3) helplessness; (4) changes in beliefs and behaviors with care coordination.	Patients enrolled, or eligible to be enrolled, in the Rhode Island Medicaid Pain Management program believe they use the ED for true emergencies, but feel helpless and unable to communicate effectively with ED providers. [Full article available at http://rimed.org/rimedicaljournal-2017-02.asp].	
28139143	There is a growing body of evidence demonstrating that sexual activity is important to the quality of life of older adults, and that it can be influenced by physical, psychological, and social factors. However, older adults' experiences of sexual difficulties remain relatively unexplored. This article draws on qualitative data collected as part of the English Longitudinal Study of Ageing (ELSA). Participants answered a Sexual Relationships and Activities Questionnaire (SRA-Q), which included an open comment box for further details, 1,084 (1/7) of which were completed. These data were analyzed using Template Analysis, and findings on the experiences of sexual difficulties are presented in this article. Sexual difficulties were contextualized within the couple relationship and could be detrimental to the relationship, particularly if the partner would not seek professional help. Participants reported that sexual difficulties could also have a negative impact on psychological well-being, described mainly as frustration, depression, and sadness. For some participants the supportive nature of their relationship buffered these impacts. Few had sought professional help; those who had reported helpful and unhelpful experiences. These findings add to the limited evidence base and have implications for health care in the context of global aging and a growing recognition of older adults' sexual rights.
28128664	Little is known about implications of temperament for children who receive nitrous oxide inhalation sedation (N2O/O2) for dental care. The aim of this study was to investigate whether child temperament is associated with success in N2O/O2. Child-caregiver dyads were enrolled from patients aged 36-95 months receiving dental care with N2O/O2 at a university-based pediatric dental clinic. To assess child temperament, 48 caregivers completed the Children's Behavior Questionnaire Short Form. Patient behavior was abstracted from Frankl scores recorded in the patient's chart. The overall behavioral failure rate was 15% (n = 7/48). There was no significant difference in sedation outcome associated with sex, health, insurance status, or complexity of treatment provided. Sedation outcome was significantly associated with the broad temperament domain of Effortful Control and its subscales Attentional Focusing and Inhibitory Control. The Negative Affectivity subscales of Frustration, Sadness, and Soothability and the Extraversion/Surgency subscales Activity and Impulsivity were also significantly associated with sedation outcome. The results of this study suggest that Effortful Control is associated with behavior during dental treatment with N2O/O2. The subscales of Attention Focusing, Inhibitory Control, Frustration, Fear, Sadness, Soothability, Activity, and Impulsivity may also be important determinants of child behavior during dental treatment.
28103159	The current study examined the relative efficacy of behavioral sports training, medication, and their combination in improving sports competence among youth with attention deficit/hyperactivity disorder (ADHD). Participants were 73 youth (74% male; 81% Hispanic) between the ages of 5 and 12 diagnosed with Diagnostic and Statistical Manual of Mental Disorders (4th ed.) ADHD enrolled in a Summer Treatment Program (STP). The study consisted of a 2 (medication: methylphenidate, placebo) × 2 (sports training: instruction and practice, recreational play) between-groups design and was conducted over a 3-week period during the STP. Sports training was conducted with a novel sport, badminton, to limit previous sport knowledge and to differentiate it from concurrent sports training that occurred within the STP. Objective and subjective measures of sports skills, knowledge, and behavior were collected. Results indicated that, relative to recreational play, brief sports training improved observed and counselor-rated measures of sports competence including sports skills, knowledge, game awareness, effort, frustration, and enjoyment. During sports training, medication incrementally improved children's observed rule following behavior and counselor-rated sportsmanship relative to placebo. In the absence of sports training, medication improved behavior, effort, and sport knowledge. Training in sports skills and rules produced the largest magnitude effects on sports-related outcomes. Therefore, skills training, rather than medication alone, should be used in conjunction with behavioral intervention to teach sports to youth with ADHD. It is recommended that medication be used only as an adjunct to highly structured sports skills training for youth who display high rates of negative behavior during sports activities.
28080091	Self-regulation can be conceptualized in terms of dynamic tension between highly probable reactions (prepotent responses) and use of strategies that can modulate those reactions (executive processes). This study investigated the value of a dynamical systems approach to the study of early childhood self-regulation. Specifically, ordinary differential equations (ODEs) were used to model the interactive influences of 115 36-month-olds' executive processes (strategy use) and prepotent responses to waiting to open a gift (desire for the gift and frustration about waiting to open it). Using a pair of coupled second-order ODEs in a nonlinear mixed effects framework, the study tested predictions for specific within- and between-child patterns of prepotent response-executive process coupling. Dynamic modeling results articulated the limits of 36-month olds' strategic efforts. They engaged executive processes when their prepotent responding levels were high, which delayed the resurgence of prepotent responses, but ultimately did not damp prepotent responding over the course of the wait. There was, however, preliminary evidence that the effectiveness of 36-month-olds' self-regulation depended upon child characteristics. Externalizing behavior problems were associated with more regulatory interference. Temperamental negative affectivity was marginally associated with more regulatory inefficiency. Compared with conventional methods of studying self-regulation, dynamic modeling yielded complementary and unique findings, suggesting its potential. (PsycINFO Database Record
28066304	The term emotional dysregulation refers to an impaired ability to regulate unwanted emotional states. Scientific evidence supports the idea that emotional dysregulation underlies several psychological disorders as, for example: personality disorders, bipolar disorder type II, interpersonal trauma, anxiety disorders, mood disorders and post-traumatic stress disorder. Emotional dysregulation may derive from early interpersonal traumas in childhood. These early traumatic events create a persistent sensitization of the central nervous system in relation to early life stressing events. For this reason, some authors suggest a common endophenotypical origin across psychopathologies. In the last 20 years, cognitive behavioral therapy has increasingly adopted an interactive-ontogenetic view to explain the development of disorders associated to emotional dysregulation. Unfortunately, standard Cognitive Behavior Therapy (CBT) methods are not useful in treating emotional dysregulation. A CBT-derived new approach called Schema Therapy (ST), that integrates theory and techniques from psychodynamic and emotion focused therapy, holds the promise to fill this gap in cognitive literature. In this model, psychopathology is viewed as the interaction between the innate temperament of the child and the early experiences of deprivation or frustration of the subject's basic needs. This deprivation may lead to develop early maladaptive schemas (EMS), and maladaptive Modes. In the present paper we point out that EMSs and Modes are associated with either dysregulated emotions or with dysregulatory strategies that produce and maintain problematic emotional responses. Thanks to a special focus on the therapeutic relationship and emotion focused-experiential techniques, this approach successfully treats severe emotional dysregulation. In this paper, we make several comparisons between the main ideas of ST and the science of emotion regulation, and we present how to conceptualize pathological phenomena in terms of failed regulation and some of the ST strategies and techniques to foster successful regulation in patients.
28041577	The aim of this concept mapping study was to identify the structure and alleged importance of perpetuating factors of functional somatic symptoms (FSS) from the perspective of professionals. Further, we examined to which extent these factors have been addressed in scientific literature.Ninety-nine perpetuating factors were sorted with respect to content using a card-sorting task by 61 experienced clinicians (62.3% psychologists, 75.4% female, mean age: 45.7 [SD: 10.6] years, mean duration of experience in treating FSS patients: 10.5 [SD: 7.6] years). These factors had been derived from in-depth interviews with 12 clinicians, with extensive experience in treating FSS. Thirty-eight clinicians rated the importance of the 99 factors on a scale ranging from 1 ('not important at all') to 10 ('extremely important').	Hierarchical cluster analysis revealed three overarching domains of perpetuating factors: 'Hypochondria', 'Social and relational problems' and 'Symptom-related emotions and habits'. These domains comprised 16 clusters, which were rated on importance between 6.1, 'Adverse physical factors and counterproductive lifestyle', and 7.8, 'Frustration and despair regarding the symptoms'. All clusters have been addressed in scientific literature.	This study revealed an encompassing hierarchical structure of somatic, emotional, cognitive, behavioral, and social factors of importance in the perpetuation of FSS based on expert opinions. This structure will guide the development of personalized treatment of FSS.	
28038437	Appearance-related pressures have been associated with binge eating in previous studies. Yet, it is unclear if these pressures are associated with emotional eating or if specific sources of pressure are differentially associated with emotional eating. We studied the associations between multiple sources of appearance-related pressures, including pressure to be thin and pressure to increase muscularity, and emotional eating in 300 adolescents (Mage=15.3, SD=1.4, 60% female). Controlling for age, race, puberty, body mass index (BMI) z-score, and sex, both pressure to be thin and pressure to be more muscular from same-sex peers were positively associated with emotional eating in response to feeling angry/frustrated and unsettled (ps<0.05). Pressure from same-sex peers to be more muscular also was associated with eating when depressed (p<0.05), and muscularity pressure from opposite-sex peers related to eating in response to anger/frustration (p<0.05). All associations were fully mediated by internalization of appearance ideals according to Western cultural standards (ps<0.001). Associations of pressures from mothers and fathers with emotional eating were non-significant. Results considering sex as a moderator of the associations between appearance-related pressures and emotional eating were non-significant. Findings illustrate that both pressure to be thin and muscular from peers are related to more frequent emotional eating among both boys and girls, and these associations are explained through internalization of appearance-related ideals.
28013478	Previous research into scratch card gambling has highlighted the effects of these games on players' arousal and affective states. Specifically, near-miss outcomes in scratch cards (uncovering 2 of 3 needed jackpot symbols) have been associated with high levels of physiological and subjective arousal and negative emotional evaluations, including increased frustration. We sought to extend this research by examining whether near-misses prompted increases in gambling urge, and the subsequent purchasing of additional scratch cards. Participants played two scratch cards with varying outcomes with half of the sample experiencing a near-miss for the jackpot prize, and the other half experiencing a regular loss. Players rated their urge to continue gambling after each game outcome, and following the initial playing phase, were then able to use their winnings to purchase additional cards. Our results indicated that near-misses increased the urge to gamble significantly more than regular losses, and urge to gamble in the near-miss group was significantly correlated with purchasing at least one additional card. Although some players in the loss group purchased another card, there was no correlation between urge to gamble and purchasing in this group. Additionally, participants in the near-miss group who purchased additional cards reported higher levels of urge than those who did not purchase more cards. This was not true for the loss group: participants who experienced solely losing outcomes reported similar levels of urge regardless of whether or not they purchased more scratch cards. Despite near-misses' objective status as monetary losses, the increased urge that follows near-miss outcomes may translate into further scratch card gambling for a subset of individuals .
27995547	Research has demonstrated the efficacy of analgesic placebos. The manner in which they are usually delivered deceptively raises questions about their impact on recipients. However, there has been little empirical investigation into the potential harms of analgesic placebo. Moreover, the role of deception in determining the magnitude of analgesic placebo response remains poorly understood.This study aimed to investigate the consequences of deceptive placebo analgesia in terms of ethical/psychological effects and efficacy.	Healthy adults (N = 75) were randomized to a control group, deceptive placebo manipulation, or non-deceptive placebo manipulation. All participants underwent repeated pain testing using a thermal stimulus. Placebo manipulation groups underwent placebo conditioning involving a cream that was described as being either analgesic or inert. State-specific negative mood and attitudes toward research and pain treatment were assessed before and after placebo conditioning.	Deceptive and non-deceptive placebo manipulations yielded pain ratings that did not differ significantly from one another but did differ from those of the control group, which experienced a pain sensitization response across trials. Results thus indicated that both deceptive and non-deceptive placebo manipulations prevented pain sensitization. Across groups, the participants reported improved depression, anxiety, frustration, and fear. The use of placebo did not negatively impact participants' attitudes and beliefs about research or pain treatments. The participants tended to rate several parameters related to research participation more positively after participating in our study.	Our results indicate that the placebo manipulation groups experienced an anti-sensitization effect. The use of analgesic placebo did not result in any detrimental ethical or psychological effects.	
27989564	Binge eating is the most common disordered eating symptom and can lead to the development of obesity. Previous self-report research has supported the hypothesis that individuals who binge eat report greater levels of general emotion dysregulation, which may facilitate binge-eating behavior. However, to date, no study has experimentally tested the relation between binge eating history and in-vivo emotion dysregulation. To do this, a sample of female college students who either endorsed binge eating (n = 40) or denied the presence of any eating pathology (n = 47) completed the Difficulties with Emotion Regulation Scale (DERS) and a behavioral distress tolerance task (the Paced Auditory Serial Addition Task-Computer: PASAT-C) known to induce negative affect and distress. The binge eating group was 2.96 times more likely to quit the PASAT-C early (χ2 = 5.04, p = 0.025) and reported greater irritability (F(1,84) = 7.09 p = 0.009) and frustration (F(1,84) = 5.00, p = 0.028) after completing the PASAT-C than controls, controlling for initial levels of these emotions. Furthermore, across the entire sample, quitting early was associated with greater emotion dysregulation on the DERS (rpb = 0.342, p < 0.01). This study is the first to demonstrate that individuals who binge eat show in-vivo emotional dysregulation on a laboratory task. Future studies should examine the PASAT-C to determine its potential clinical utility for individuals with or at risk of developing binge eating.
27989493	There is general consensus that explicit expression of empathy in patient-GP communication is highly valued. Yet, little is known so far about patients' personal experiences with and expectations of empathy. Insight into these experiences and expectations can help to achieve more person-centeredness in GP practice care.Participants were recruited by a press report in local newspapers.	adults, a visit to the GP in the previous year. Exclusion criterion: a formal complaint procedure. Five focus groups were conducted. The discussions were analyzed using constant comparative analysis.	In total 28 participants took part in the focus group interviews. Three themes were identified: (1) Personalized care and enablement when empathy is present; (2) Frustrations when empathy is absent; (3) Potential pitfalls of empathy. Participants indicated that empathy helps build a more personal relationship and makes them feel welcome and at ease. Furthermore, empathy makes them feel supported and enabled. A lack of empathy can result in avoiding a visit to the GP.	Empathy is perceived as an important attribute of patient-GP communication. Its presence results in feelings of satisfaction, relief and trust. Furthermore, it supports patients, resulting in new coping strategies. A lack of empathy causes feelings of frustration and disappointment and can lead to patients avoiding visiting their GP.	More explicit attention should be given to empathy during medical education in general and during vocational GP-training.	
27941353	Postcancer fatigue (PCF) is a form of chronic fatigue that is very common and can persist for years among disease-free cancer survivors. Despite this, PCF remains underreported and often goes untreated.The aim of this study is to explore PCF from the perspective of cancer survivors via online blogs, with a focus on their experiences and personal explanations of PCF.	An online search identified 15 recent blogs written by cancer survivors who specifically discussed their PCF. Thematic analysis was used to analyze blog content.	Bloggers explained PCF as a severe and unpredictable symptom in their lives. They identified anxiety, emotional trauma, and cancer side effects to be the key causal factors of their PCF. Coping strategies adopted by bloggers included diet, exercise, acceptance and reducing workload to manage their fatigue.	Online blogs are a rich source of qualitative data that can give unique insight into issues faced by cancer survivors. Bloggers' accounts confirmed that PCF is a complex issue that can be a significant source of frustration in their everyday lives. This study highlighted that bloggers with PCF appear to have some coping strategies and understanding of PCF, yet these are not always consistent with current medical and psychological knowledge.	This study has demonstrated that blogs can offer valuable information to existing knowledge of cancer survivors' experiences and explanations of PCF. The findings may assist healthcare professionals with educating patients about PCF and with increasing the legitimacy, awareness, and understanding of PCF.	
27930369	Moral distress is a common experience among critical care professionals, leading to frustration, withdrawal from patient care, and job abandonment. Most of the studies on moral distress have used the Moral Distress Scale or its revised version (Moral Distress Scale-Revised). However, these scales have never been validated through factor analysis. This article aims to explore the factorial structure of the Moral Distress Scale-Revised and develop a valid and reliable scale through factor analysis.Validation study using a survey design.	Eight medical-surgical ICUs in the north of Italy.	A total of 184 clinicians (64 physicians, 94 nurses, and 14 residents).	The Moral Distress Scale-Revised was translated into Italian and administered along with a measure of depression (Beck Depression Inventory-Second Edition) to establish convergent validity. Exploratory factor analysis was conducted to explore the Moral Distress Scale-Revised factorial structure. Items with low (less than or equal to 0.350) or multiple saturations were removed. The resulting model was tested through confirmatory factor analysis.	The Italian Moral Distress Scale-Revised is composed of 14 items referring to four factors: futile care, poor teamwork, deceptive communication, and ethical misconduct. This model accounts for 59% of the total variance and presents a good fit with the data (root mean square error of approximation = 0.06; comparative fit index = 0.95; Tucker-Lewis index = 0.94; weighted root mean square residual = 0.65). The Italian Moral Distress Scale-Revised evinces good reliability (α = 0.81) and moderately correlates with Beck Depression Inventory-Second Edition (r = 0.293; p < 0.001). No significant differences were found in the moral distress total score between physicians and nurses. However, nurses scored higher on futile care than physicians (t = 2.051; p = 0.042), whereas physicians scored higher on deceptive communication than nurses (t = 3.617; p < 0.001). Moral distress was higher for those clinicians considering to give up their position (t = 2.778; p = 0.006).	The Italian Moral Distress Scale-Revised is a valid and reliable instrument to assess moral distress among critical care clinicians and develop tailored interventions addressing its different components. Further research could test the generalizability of its factorial structure in other cultures.	
27926808	The low level of patient satisfaction recorded in many studies and, at the same time, the level of frustration and burnout, disclosed by medics in the perception of the patient as a ‘problem’, incline to look for the causes of inadequate relationship between physician and patient.The aim of this study was to evaluate the level of acceptance of the patient by the medical personnel. The research problem was the acceptance level which was within the range of the communication skills of the nurses and doctors. Another aim was to discover the factors determining this level of acceptance.	Two methods were used in the research process: 1) a diagnostic survey regarding the medical, professional communication skills; 2) testing of professional self-esteem from the medical aspect. The study population consisted of a total of 1,244 respondents divided into the following groups: registered nurses and doctors (729), students of nursing and medical faculties (515).	The results of the research showed that in most cases the acceptance of the patient by the medical staff was ‘conditional’, which translated into the level of frustration or lack of satisfaction with their profession, and ultimately into the level of burnout. The level of patient acceptance by medical staff (unconditional acceptance), depended primarily on age, followed by their profession. However, the relationship between this acceptance and gender and work experience was statistically insignificant.	As the method to improve this situation, the expansion of education in the field of interpersonal communication is proposed, adding issues related with both the conditional and unconditional acceptance of the patient, as well as issues regarding how to deal with the patient from the aspect of disease and the psycho-socio-spiritual area.	
27923146	Our objective was to identify behaviors and contextual situations associated with negative affect observed in the interactions of children with and without ADHD and their real-life friends. We expected negative affect to be linked to rule violations and disagreements about the choice of games. Loss of game was associated with episodes of negative affect in a structured game. Negative appraisal of friend's ability was most frequently associated with negative affect during unstructured free play. Comparison children expressed greater frustration regarding their own abilities, whereas children with ADHD commented more frequently about the inabilities of their friends.
27885691	Unfulfilled basic psychological needs have been associated with disordered eating behaviours, but the mechanisms underlying that associations are not well understood. This study examined a two-stage path model linking basic psychological need satisfaction to disordered eating behaviours via issues of control.Female university students (N = 323; Mage  = 19.61), community participants (N = 371; Mage  = 29.75), and women who self-reported having been diagnosed with an eating disorder (ED; N = 41; Mage  = 23.88) completed measures of psychological need satisfaction (i.e., autonomy and competence), issues of control (i.e., feelings of ineffectiveness and fear of losing self-control [FLC]), and ED pathology.	Path analysis revealed that unsatisfied needs of autonomy and competence were indirectly related to disordered eating behaviours through feelings of ineffectiveness and FLC.	The results indicate that issues of control might be one of the mechanisms through which lack of psychological need satisfaction is associated with disordered eating. Although the model was constructed using cross-sectional data, these findings suggest potential targets for prevention and treatment efforts aimed at reducing disordered eating in young females.	Our results indicate that young women with chronically unfulfilled basic psychological needs might be vulnerable to developing disordered eating behaviours. The observed patterns suggest that persistent experience of need frustration may engender an internal sense of ineffectiveness and lack of control, which then compels individuals to engage in disordered eating behaviours in an attempt to regain autonomy and competence. Interventions for eating disorders may be most effective when emphasizing the promotion of people's needs for autonomy and competence. Limitations The model was constructed using cross-sectional data. Future experimental and longitudinal studies are needed to confirm the temporal sequence from basic psychological needs to issues of control. The sample only consisted of young women. Further research should explore how thwarting of psychological need satisfaction functions in men. Our clinical sample was small and diagnosis was not confirmed through clinical interview; therefore, those data should be interpreted with caution.	
27836242	Etiological models of trichotillomania (TTM) conceptualize hair pulling as a dysfunctional emotion regulation strategy; accordingly, some research has found that affective states change differentially across the hair pulling cycle. We explored emotional changes in a sample of Italian individuals reporting TTM. Eighty-nine participants reporting TTM completed a 12-item section of the Italian Hair Pulling Questionnaire online and rated the extent to which they had experienced 12 affective states before, during, and after hair pulling. Overall, participants reported increased levels of shame, sadness, and frustration from pre- to post-pulling, and decreased levels of calmness after hair pulling episodes. Moreover, participants reported increased pleasure and relief across the pulling cycle, and variations in the direction of change for anger and anxiety depending on the hair pulling phase. Lastly, reported boredom decreased across the hair pulling cycle. These findings highlight the importance of considering emotional changes experienced across the pulling cycle in Italian hair pullers.
27835044	The recovery process after autologous chondrocyte implantation (ACI) can be challenging for patients and clinicians alike due to significant functional limitations and a lengthy healing time. Understanding patients' experiences during the recovery process may assist clinicians in providing more individualized care.To explore and describe patients' experiences during the recovery process after ACI.	Qualitative study.	Orthopaedic clinic.	Participants from a single orthopaedic practice who had undergone ACI within the previous 12 months were purposefully selected.	Volunteers participated in 1-on-1 semistructured interviews to describe their recovery experiences after ACI. Data were analyzed using the process of horizontalization.	Seven patients (2 men, 5 women; age = 40.7 ± 7.5 years, time from surgery = 8.7 ± 4.2 months) participated. Four themes and 6 subthemes emerged from the data and suggested that the recovery process is a lengthy and emotional experience. Therapy provides optimism for the future but requires a collaborative effort among the patient, surgeon, rehabilitation provider, and patient's caregiver(s). Furthermore, patients expressed frustration that their expectations for recovery did not match the reality of the process, including greater dependence on caregivers than expected.	Patients' expectations should be elicited before surgery and managed throughout the recovery process. Providing preoperative patient and caregiver education and encouraging preoperative rehabilitation can assist in managing expectations. Establishing realistic goals and expectations may improve rehabilitation adherence, encourage optimism for recovery, and improve outcomes in the long term.	
27803024	Handoff protocols are often developed by brainstorming and consensus, and few are directly compared. We hypothesized that a handoff protocol (Flex 11) developed using a rigorous methodology would be more favorable in terms of clinicians' attitudes, behaviors, cognitions, or time-on-task when performing handoffs compared with a prevalent protocol (Situation Background Assessment Recommendation [SBAR]).Using a between-groups, randomized control trial design (Flex 11 versus SBAR) during a pilot study in a simulated environment, 20 clinicians (13 attending physicians and 7 residents) received 3 patient handoffs from a standardized physician, managed the patients, and handed off the patients to the same standardized physician. Participants completed surveys assessing their attitudes and cognitions, and behaviors and handoff duration were assessed through observations.	All data were analyzed using independent samples t tests. For attitudes, "ease of use" ratings were lower for SBAR participants than Flex 11 participants (P < .01), and "being helpful" ratings were lower for SBAR participants than Flex 11 participants (P = .02). For behaviors, results indicate no significant difference in the information acquired between the SBAR and Flex 11 protocols. However, SBAR participants gave significantly less information than Flex 11 participants (P < .01). For cognitions, SBAR and Flex 11 participants reported similar workload except for frustration. For handoff duration, there were no significant differences between the protocols (P = .36).	The results suggest that Flex 11 is an efficient, beneficial tool in a simulated environment with pediatric clinicians. Future studies should evaluate this protocol in the inpatient setting.	
27736100	This study examined the unique relations between multiple sources (i.e., mothers, teachers, and siblings) of perceived daily autonomy support and psychological control and children's basic psychological needs and well-being. During 5 consecutive days, 2 children from 154 families (Mage youngest child = 8.54 years; SD = .89 and Mage oldest child = 10.38 years; SD = .87) provided daily ratings of the study variables. Multilevel analyses showed that each of the sources of perceived autonomy support and psychological control related uniquely to changes in daily well-being and ill-being. These associations were mediated by experienced psychological need satisfaction and frustration, respectively. Overall, the findings testify to the dynamic role of autonomy support and psychological control in children's development. Implications for future research are discussed. (PsycINFO Database Record
27709976	Boredom research is booming. Nonetheless, a comprehensive understanding of boredom in relation to other negative emotions is lacking. This ambiguity impedes accurate interpretation of boredom's causes and consequences. To gain more insights into boredom, we examined in detail how it differs from a range of other negative experiences, namely sadness, anger, frustration, fear, disgust, depression, guilt, shame, regret, and disappointment. Our research indicates that the appraisals associated with boredom distinguish it clearly from other negative emotions; conceptually (Study 1), in terms of state experiences (Study 2), and in terms of individual differences in these experiences (Study 3). Our findings suggest that boredom is mild in negative valence, low in arousal, is associated with low perceived challenge and low perceived meaningfulness, and has low relevance to moral judgment and behavior. Boredom also involves low attention given to situations and tasks, and the lack of perceived meaningfulness and attention associated with boredom emerged as particularly distinctive characteristics. The findings underscore the importance of carefully discriminating boredom from other emotions in experimental induction, psychometric assessment, and conceptual discussion. (PsycINFO Database Record
26387568	Evidence suggests that binge eating may be caused by a unique interaction between dieting and stress. We developed a binge-eating model in which female rats with a history of intermittent food restriction show binge-like palatable food consumption after a 15-minute exposure to the sight of the palatable food (frustration stress). The aim of the present study was to investigate the regulation of the stress neurohormone corticotropin-releasing factor (CRF) system and of the nociceptin/orphanin FQ (N/OFQ) system genes in selective rat brain regions, using our animal model. Food restriction by itself seems to be responsible in the hypothalamus for the downregulation on messenger RNA levels of CRF-1 receptor, N/OFQ and its receptor (NOP). For the latter, this alteration might be due to selective histone modification changes. Instead, CRF gene appears to be upregulated in the hypothalamus as well as in the ventral tegmental area only when rats are food restricted and exposed to frustration stress, and, of relevance, these changes appear to be due to a reduction in DNA methylation at gene promoters. Moreover, also CRF-1 receptor gene resulted to be differentially regulated in these two brain regions. Epigenetic changes may be viewed as adaptive mechanisms to environmental perturbations concurring to facilitate food consumption in adverse conditions, that is, in this study, under food restriction and stressful conditions. Our data on N/OFQ and CRF signaling provide insight on the use of this binge-eating model for the study of epigenetic modifications in controlled genetic and environmental backgrounds.
26308239	Infants harm others at higher rates than older children and adults. A common explanation is that infants fail to regulate their frustration, becoming aggressive when they do not get what they want. The present research investigated whether infants also use force against others without provocation, for instance because they seek to explore the consequences of hitting or try to pet someone using too much force. Two studies with infants aged 11 to 24 months investigated infants' use of force against others in everyday life using maternal report (Study 1) and direct observation (Study 2). In both studies, a large proportion of infants' acts of force were unprovoked and occurred without signs of infant distress. Unlike provoked acts, unprovoked acts showed a decrease late in the second year and were positively associated with reports of infant pleasure-proneness. The presence of unprovoked acts of harm may reflect that infants' actions are not reliably guided by an aversion for harming others and may provide unique opportunities for early moral development.
27385730	Intervention-induced gains in need satisfaction decrease PE students' amotivation. The present study adopted a dual-process model to test whether an intervention could also decrease need frustration and hence provide a second supplemental source to further decrease students' PE amotivation. Using an experimental, longitudinal research design, 19 experienced PE teachers (9 experimental, 10 control) and their 1,017 students participated in an intervention program to help teachers become both more autonomy supportive and less controlling. Multilevel repeated measures analyses showed that students of teachers in the experimental group reported greater T2, T3, and T4 perceived autonomy support, need satisfaction, and engagement and lesser T2, T3, and T4 perceived teacher control, need frustration, and amotivation than did students of teachers in the control group. Multilevel structural equation modeling analyses confirmed the hypothesized dual-process model in which both intervention-induced increases in need satisfaction and intervention-induced decreases need frustration decreased students' end-of-semester amotivation. We discuss the theoretical and practical implications of this new finding on the dual antecedents of diminished amotivation.
27753195	In Australia and around the world, people with disability and their carers living in rural areas face additional challenges compared to their urban-dwelling counterparts. This cross-sectional study explored current access to therapy services for people with disability living in western New South Wales as reported by their primary carers. Data were collected using an online and paper survey distributed to carers, from December 2012 until June 2013. Information was sought about the carers, the person they care for, access to physiotherapy, speech pathology, occupational therapy and psychology services. A total of 166 carers participated. Respondents were mostly the carers of a son or daughter (83.6%) , the person they care for had an average age of 17.6 years (range 1-69 years) and more than half were males (56%). The majority of people with disability (73.5%) had received therapy services in the last 2 years. Waiting time and distance travelled to access physiotherapy, speech and occupational therapy services varied. People with disability had to wait an average of 6.6 months to receive speech pathology and had to travel an average of 2.6 hours to receive physiotherapy. The main provider of all services was the specialist disability government department, except for psychology, which is mainly provided in the private sector. From the carers' perspective, availability and accessibility to services are limited. Carers noted that availability of services was more restricted once people with disability reached adulthood. Lack of choice and frustration with the lack of availability of specialist disability services was reported frequently. Carers believed that timely allied health intervention prevented the development of more severe or complicated conditions that had a greater impact on carers, families, communities and the person with disabilities.
27682225	We examined five dimensions of distress tolerance (i.e. uncertainty, ambiguity, frustration, negative emotion, physical discomfort) as prospective predictors of perceived stress. Undergraduate students (N = 135) completed self-report questionnaires over the course of two assessment sessions (T1 and T2). Results of a linear regression in which the five dimensions of distress tolerance and covariates (i.e. T1 perceived stress, duration between T1 and T2) served as predictor variables and T2 perceived stress served as the outcome variable showed that intolerance of uncertainty was the only dimension of distress tolerance to predict T2 perceived stress. To better understand this prospective association, we conducted a post hoc analysis simultaneously regressing two subdimensions of intolerance of uncertainty on T2 perceived stress. The subdimension representing beliefs that "uncertainty has negative behavioral and self-referent implications" significantly predicted T2 perceived stress, while the subdimension indicating that "uncertainty is unfair and spoils everything" did not. Results support a growing body of research suggesting intolerance of uncertainty as a risk factor for a wide variety of maladaptive psychological outcomes. Clinical implications will be discussed.
27669361	A new suicide-specific diagnostic entity, acute suicidal affective disturbance (ASAD), was recently proposed to fill a void in the nomenclature. Although several studies have examined the reliability, validity, and potential clinical utility of ASAD, no studies have examined personality indicators of ASAD. This study sought to examine the association between personality and psychopathology factors, as assessed by the Minnesota Multiphasic Personality Inventory-2-Revised Form (MMPI-2-RF), and constructs that comprise ASAD in a sample of 554 psychiatric outpatients who completed all measures prior to their intake appointments. A smaller subset of patients (N = 58) also completed a measure designed to assess lifetime ASAD symptoms. Results indicated that ASAD symptoms were associated with traits characterized by emotional turmoil and atypical cognitive processes. Further, suicide-related criteria that comprise ASAD were related to low positive emotionality and hopelessness, whereas the overarousal criteria were associated with somatic symptoms and an inability to tolerate frustration and stress. These findings expand on previous research that examines the convergent and discriminant validity of ASAD and could inform clinical treatment by providing insight into personality traits that might be associated with acute suicide risk.
27663113	We examined (a) the demographic and clinical correlates of worries about hypoglycemia in adult family members of adults with diabetes, and (b) the association of these worries with measures of diabetes support.The second multinational Diabetes Attitudes, Wishes and Needs (DAWN2) study cross-sectionally surveyed 2057 family members from 17 countries. Participants completed questions about demographics, diabetes, and psychosocial functioning, including worry about overall and nocturnal hypoglycemia. Analyses included hierarchical ordinal and linear regression.	Eighty-five percent of family members (n=1661) were at least occasionally very worried about the risk of hypoglycemic events overall. Correlates of worries about hypoglycemia included female gender, higher age and lower education in the family member, younger age of the person with diabetes and this person being a parent or another adult (versus spouse or partner), insulin or non-insulin injectable treatment, severe or non-severe hypoglycemia in the past 12months, and family member recognition of hypoglycemia. Elevated worries about hypoglycemia had a significant independent association with increased odds of diabetes-related family arguments and family member frustration in providing helpful support (OR range 1.60-3.72). High levels of worries about hypoglycemia were associated with increased odds of attending diabetes-related health-care visits. Worries about hypoglycemia were not associated with family member involvement in diabetes care. Similar results were found for worries about nocturnal events.	Worries about hypoglycemia were common in family members and were associated with suboptimal diabetes support. This issue therefore deserves increased clinician attention.	
27633218	This study investigated whether multimodal redundant warnings presented by advanced assistance systems reduce brake response times. Warnings presented by assistance systems are designed to assist drivers by informing them that evasive driving maneuvers are needed in order to avoid a potential accident. If these warnings are poorly designed, they may distract drivers, slow their responses, and reduce road safety. In two experiments, participants drove a simulated vehicle equipped with a forward collision avoidance system. Auditory, vibrotactile, and multimodal warnings were presented when the time to collision was shorter than five seconds. The effects of these warnings were investigated with participants performing a concurrent cell phone conversation (Exp. 1) or driving in high-density traffic (Exp. 2). Braking times and subjective workload were measured. Multimodal redundant warnings elicited faster braking reaction times. These warnings were found to be effective even when talking on a cell phone (Exp. 1) or driving in dense traffic (Exp. 2). Multimodal warnings produced higher ratings of urgency, but ratings of frustration did not increase compared to other warnings. Findings obtained in these two experiments are important given that faster braking responses may reduce the potential for a collision. 
27627485	Nontuberculous mycobacteria (NTM) cause an increasingly important chronic and debilitating lung disease in older adults. Diagnosis is often delayed, although awareness among clinicians and patients is increasing. When necessary, treatment often lasts 18-24 months and consists of three or four antibiotics that can have serious side effects. Relapses are common and commonly require resumption of prolonged therapy. Given the need for improved diagnostic techniques and clinical trials to identify new therapies or to improve existing therapies, a group of North American clinicians and researchers formed the NTM Research Consortium (NTMRC) in 2014. The NTMRC recognized the importance of including the patient voice in determining research priorities for NTM. In November 2015, patients, caregivers, patient advocates, clinical experts, and researchers gathered for a 1-day meeting in Portland, Oregon funded by the Patient-Centered Outcomes Research Institute. The meeting goal was to define patient-centered research priorities for NTM lung infections. Patients expressed frustration with the number of people who have endured years of missed diagnoses or inadequate treatment of NTM. Participants identified as top research priorities the prevention of NTM infection; approval of more effective treatments with fewer side effects and easier administration; understanding the best chest physiotherapy methods; validating and using tools to measure quality of life; and developing a disease-specific activity and severity assessment tool. Workshop participants agreed that two complementary objectives are critical to ensure the best achievable outcomes for patients: (1) additional clinician education to improve screening and diagnosis of NTM infections; and (2) development of a geographically distributed network of experts in NTM disease to offer consultation or direct therapy after a diagnosis is made. 
27596921	Few studies have utilised observation to investigate retained awareness when individuals with severe dementia interact with family members. Seeking evidence of retained awareness in those with severe dementia, interactive family visits in care homes were observed and analysed.Five family groups (14 individuals) completed 10/15-minute video recorded family interactions. Speech and non-speech interactions were analysed using Thematic Analysis.	One superordinate theme: Distinctive family bonds; overarched two subthemes, in-step and out-of-step describing positive and negative familial interactions. In-step interactions revealed family groups reciprocating social support, having fun together, and willing to go on the ride together. Out-of-step interactions characterised social frustration, non-reciprocity, and sidelining of members with dementia. Although awareness fluctuated, complex awareness was observed in the speech/non-speech expressions of those with dementia. In response, visitors appeared to treat those expressions and behaviours as understandable. Observed outcomes were out-of-step when visitors sought to retain the familiar and in-step when visitors sought to optimise all communication possibilities.	Video recorded family interactions and analysis revealed: (a) awareness was retained in the participants with severe dementia beyond assessed levels; and (b) Relational Social Engagement (RSE) occurred within family groups despite positive or negative interactions. Implications are discussed.	
27581053	To examine whether perceived weight discrimination is associated with change in health markers over time and whether it is associated with daily stressors, physical symptoms, and affect.Participants were selected from the Midlife in the United States (MIDUS) study if they had data on perceived weight discrimination and health markers at MIDUS II (2004-2006), health markers at MIDUS III (2013-2014), and a body mass index ≥25 kg/m(2) (N = 1,841). A subset of these participants (N = 1,153) reported on their experiences daily for 8 days as part of the second National Study of Daily Experiences.	Perceived weight discrimination was associated with declines in mental and physical health over time (median β = 0.06). Participants who reported weight discrimination experienced more daily stressors (β = 0.13), physical symptoms (β = 0.13), and negative affect (β = 0.13) and less positive affect (β = -0.12) over the 8 days of the second National Study of Daily Experiences. Weight discrimination was most strongly associated with interpersonal stressors (median β = 0.14), feelings of anger (β = 0.16) and frustration (β = 0.14), lower attention (β = -0.14) and activity (β = -0.16), and more nonspecific physical symptoms (e.g., fatigue; β = 0.10).	This research replicates the association between perceived weight discrimination and worse health over time and extends this literature to show that people who experience weight discrimination have more daily stressors, physical symptoms, and negative emotions.	

27544259	Acquisition of resources and opportunity to engage in natural behaviors has been shown to reduce frustration-related behaviors and enhance health in nondomestic felids kept in zoos, but little is known about whether there are similar effects in domestic cats living in confinement in animal shelters. Fifteen cats rated as Frustrated during the first hour of confinement to a cage at an animal shelter were assigned to either a Treatment (n=7) or Control (n=8) group. Treatment cats were taken from their cages to a separate room four times daily for 10min each time over a 10 d period, where they took part in training sessions to learn a novel behavior (paw-hand contact with a researcher). Changes in emotional states and mucosal immune response were evaluated over 10days. Infectious status was determined upon admission and incidence of upper respiratory was determined up to day 40 based on clinical signs. Treated cats were more likely to be rated as Content than Control cats and had greater concentrations of S-IgA (537μg/g) in feces than Control cats (101μg/g). Within the Treatment group, cats that responded positively had greater concentrations of S-IgA (925μg/g) than those that responded negatively (399μg/g). Control cats were more likely to develop respiratory disease over time compared to cats that received treatment (Hazard Ratio: 2.37, Confidence Interval: 1.35-4.15). It is concluded that there is prima facie evidence that cognitive enrichment of cats exhibiting frustration-related behaviors can elicit positive affect (contentment), stimulate secretion of IgA and reduce incidence of respiratory disease, which is worthy of further study. 
27543942	This study examined the association between fetal tobacco exposure (FTE) and focused attention at 9 months of child age, and the role of child sex and infant behavioral reactivity as potential moderators of this association. Data were obtained from 203 mothers and their infants (105 fetally exposed and 98 non-exposed) on infant focused attention and behavioral reactivity to a frustration task. FTE was ascertained via nicotine metabolites in infant meconium, reflecting primarily third trimester fetal exposure. Results demonstrated a main effect of FTE on focused attention, such that exposed infants exhibited lower levels of focused attention than non-exposed infants. Behavioral reactivity, but not infant sex, moderated the relationship between FTE and focused attention, such that exposed infants who were highly reactive to frustration had the lowest levels of focused attention. Results suggest that smoking interventions, even in the third trimester, may have a positive impact on attentional outcomes for infants.
27504662	In this article, the authors integrate the theory of work adjustment (Dawis, England, & Lofquist, 1964) and the stressor emotion model of counterproductive work behaviors (CWBs; Spector & Fox, 2005) to examine workplace frustration as an intervening mechanism that mediates relations between person-environment (P-E) fit and CWBs. Moreover, we adopt a multifoci perspective to estimate effects for multiple fit, frustration, and CWB foci. We examine the nature of relations between fit, frustration, and CWB for like foci (target similar effects), as well as cross-foci effects. Study 1 examines proposed effects in a sample of 447 employee-coworker dyads. Study 2 uses a 3-wave survey design and tests effects in a sample of 669 employees. Results from both studies suggest that (a) frustration mediates the effects of P-E fit on CWBs and (b) the most consistent effects were observed among the variables with matching foci. Implications for research and practice are discussed. (PsycINFO Database Record
27497449	Shortly after I received my first R01 grant to study the health effects of caregiving, my sister and I became caregivers to our father. For the next 13 years, we helped him with activities of daily living (ADLs), accompanied him to doctors' appointments, arranged for home health care, and finally for home hospice. At first, I was able to connect our assistance with ADLs, frustration with coordinating his care, and our psychological stress with my epidemiologic studies. My familiarity with the language of caregiving and long-term care helped us to navigate the medical and home care systems, and to be advocates for my father. However, as my father's health declined, I felt an increasing disconnect between my research and my experience: communicating with physicians and other care providers, responding to crises and conversations with my sister about placing our father in a nursing home were greater sources of stress than my father's dementia. These discrepancies made me realize that I could help caregivers more by helping them to negotiate these challenges than through performing quantitative research. So I enrolled in a counseling psychology program. My manuscript will chronicle the ways that caregiving changed me; how my professional work did and did not help me as a caregiver; how the developmental and family theories that I am learning in my psychology classes have expanded my understanding of stressors facing adult child caregivers, and how this entire experience ties into generativity and Third Chapter careers that build on midlife experiences.
27494531	A very low calorie diet improves the metabolic regulation of obesity related type 2 diabetes, but not for all patients, which leads to frustration in patients and professionals alike. The aim of this study was to develop a prediction model of diet-induced weight loss in type 2 diabetes.192 patients with type 2 diabetes and BMI>27 kg/m2 from the outpatient diabetes clinic of the Erasmus Medical Center underwent an 8-week very low calorie diet. Baseline demographic, psychological and physiological parameters were measured and the C-index was calculated of the model with the largest explained variance of relative weight loss using backward linear regression analysis. The model was internally validated using bootstrapping techniques.	Weight loss after the diet was 7.8±4.6 kg (95%CI 7.2-8.5; p<0.001) and was independently associated with the baseline variables fasting glucose (B = -0.33 (95%CI -0.49, -0.18), p = 0.001), anxiety (HADS; B = -0.22 (95%CI -0.34, -0.11), p = 0.001), numb feeling in extremities (B = 1.86 (95%CI 0.85, 2.87), p = 0.002), insulin dose (B = 0.01 (95%CI 0.00, 0.02), p = 0.014) and waist-to-hip ratio (B = 6.79 (95%CI 2.10, 11.78), p = 0.003). This model explained 25% of the variance in weight loss. The C-index of this model to predict successful (≥5%) weight loss was 0.74 (95%CI 0.67-0.82), with a sensitivity of 0.93 (95% CI 0.89-0.97) and specificity of 0.29 (95% CI 0.16-0.42). When only the obese T2D patients (BMI≥30 kg/m2; n = 181) were considered, age also contributed to the model (B = 0.06 (95%CI 0.02, 0.11), p = 0.008), whereas waist-to-hip ratio did not.	Diet-induced weight loss in overweight adults with T2D was predicted by five baseline parameters, which were predominantly diabetes related. However, failure seems difficult to predict. We propose to test this prediction model in future prospective diet intervention studies in patients with type 2 diabetes.	
27462978	People living with amyotrophic lateral sclerosis (ALS) are now more proactive in making decisions about their treatment options, in particular with increased awareness through social media and the Internet. Together with increased awareness about the disease comes increased frustration that there is still only one Food and Drug Administration (FDA)-approved drug that modestly improves survival.While efforts are underway to improve clinical trial design, patient involvement in trial design, clinical outcomes, and risk/benefit evaluations have become more recognized and will play a major role in the future success of clinical trials. This chapter addresses the perspective of people living with ALS and their perceptions of clinical trials. We describe various organizations and programs available that provide increased education and patient involvement.	Stronger partnerships between those living with ALS, clinicians, government, nonprofit organizations, and regulatory agencies will significantly impact treatment development.	
27448030	Measurement instruments assessing multiple emotions during epistemic activities are largely lacking. We describe the construction and validation of the Epistemically-Related Emotion Scales, which measure surprise, curiosity, enjoyment, confusion, anxiety, frustration, and boredom occurring during epistemic cognitive activities. The instrument was tested in a multinational study of emotions during learning from conflicting texts (N = 438 university students from the United States, Canada, and Germany). The findings document the reliability, internal validity, and external validity of the instrument. A seven-factor model best fit the data, suggesting that epistemically-related emotions should be conceptualised in terms of discrete emotion categories, and the scales showed metric invariance across the North American and German samples. Furthermore, emotion scores changed over time as a function of conflicting task information and related significantly to perceived task value and use of cognitive and metacognitive learning strategies.
27445928	In individuals with chronic pain (ICPs), controlling pain often is a salient goal, despite the difficulty to achieve it. This situation may bring along frustration and distress. Yet much remains unknown about the content, appraisal, and structure of goals that ICPs pursue. Here, we explore these goals, and specifically focus upon possible differences and interrelations between pain control goals (e.g., "to control my pain") and non-pain goals (e.g., "to go to work")."Personal Project Analysis" was used in 73 ICPs (48 females; 25 males; M age = 49.85 years; SD = 9.72) to elicit goals and goal appraisals. Interrelations between pain and non-pain goals, namely interference (i.e., negative influence), facilitation (i.e., positive influence), and necessary condition (i.e., conditional relation between pain control goal and non-pain goals) were measured with three items. Self-report measures of pain intensity, pain catastrophizing, problem solving and acceptance were completed.	Participants reported a variety of goals. Appraisals of pain control goals were less favorable than appraisals of non-pain goals. ICPs with higher acceptance and meaningfulness of life reported more control over pain goals, and more progress in reaching pain control goals. These individuals also reported an overall much more positive appraisal of non-pain goals (i.e., less stress, difficulty, more progress, control). In contrast, high catastrophizing and the need to solve pain were negatively related to goal appraisals. Importantly, ICP's with high perceived meaningfulness of life despite pain experienced less necessity to achieve pain control goals in order to achieve non-pain goals. This was opposite for individuals with high levels of catastrophizing.	An understanding of why ICPs may become stuck in attempts to control their pain does not only require an understanding of how individuals appraise their pain, but also requires an understanding of how pain and non-pain goals interrelate. In particular, the view that controlling pain is necessary in order to be able to achieve other goals seems detrimental.	
27438176	In laparoscopy, contamination of the distal lens is problematic. Not only a cause of frustration, repeatedly cleaning the laparoscope takes up significant time and disrupts the operative flow. Our study aims to explore and describe quantitatively this particular issue within the operating theaters of a major teaching hospital.We recorded data assessing the occurrence of impaired vision on the screen display and quantified the occurrence, duration, and modality of cleaning events. Data were recorded on a time-line sheet and collected for basic quantitative analysis as reported below. A brief interview with the surgeons was carried out at the end of each procedure.	A total of 64 hours of laparoscopy covering 25 procedures in 4 surgical disciplines were observed. The study found that 56% of the operation was performed with a clear display, while 37% of the time was spent impaired vision. Seven percent of the operation was spent cleaning the distal lens. The interviews recorded a unison sense of frustration and safety concerns regarding lens contamination.	Our observational study demonstrates that one third of the duration of a laparoscopic procedure is performed without perfectly clear display. The suboptimal display during an operation is similar to that of driving with a dirty windshield and having to step out of the car to clean it before continuing with the journey. The disruption to operative flow is transcribed as frustration felt by surgeons when display is compromised and having to clean the lens. However, the economical impact of cleaning the lens during the operation remains to be demonstrated.	
27434614	To adapt the National Aeronautics and Space Administration Task Load Index scale into Turkish, to determine the nurses' mental workload using subjective methods and to identify the factors affecting the mental workloads of nurses.As the concept of safety gains prominence in healthcare services, the determination of employees' mental workloads using subjective methods is considered important in preventing errors caused by employees.	Methodological and descriptive design.	The population of the study consisted of a total of 1900 nurses working at three hospitals and a dentistry faculty hospital affiliated with a public university in Istanbul. The sample of the study consisted of 1266 nurses who agreed to participate in the study (the rate of return was 66·6%). Language and content validity and reliability measurements were performed to adapt the National Aeronautics and Space Administration Task Load Index into Turkish, which was used as the data collection tool.	It was found that the mean total mental workload score of the nurses was 80·48 (SD 11·76), and the weighted score of mental workload was 83·7. While the highest mean score was obtained on the subscale of mental demand (88·08, SD 16·12), the lowest mean score was obtained on the subscale of frustration (54·52, SD 29·96). The mean total mental workload score of the nurses showed a significant difference according to the units in which the nurses worked.	The mean mental workload scores of nurses working at hospitals within the scope of the study were higher than the results of other studies.	It is recommended that nurse managers perform mental workload measurements of nurses and compare the results with the quality indicators observed in units to determine and employ a labour force that is qualified for the profession and that may benefit more effectively from human resources.	
27428104	low- and middle-income countries still have a long way to go to reach the fifth Millennium Development Goal of reducing maternal mortality. Mozambique has accomplished a reduction of maternal mortality since the 1990s, but still has among the highest in the world. A key strategy in reducing maternal mortality is to invest in midwifery.the objective was to explore midwives' perspectives of their working conditions, their professional role, and perceptions of attitudes towards mothers in a low-resource setting.	midwives in urban, suburban, village and remote areas; working in central, general and rural hospitals as well as health centres and health posts were interviewed in Maputo City, Maputo Province and Gaza Province in Mozambique.	the study had a qualitative research design. Nine semi-structured interviews and one follow-up interview were conducted and analysed with qualitative content analysis.	two main themes were found; commitment/devotion and lack of resources. All informants described empathic care-giving, with deep engagement with the mothers and highly valued working in teams. Lack of resources prevented the midwives from providing care and created frustration and feelings of insufficiency.	the midwives perceptions were that they tried to provide empathic, responsive care on their own within a weak health system which created many difficulties. The great potential the midwives possess of providing quality care must be valued and nurtured for their competency to be used more effectively.	
27399995	Patients affected with persistent genital arousal disorder report unprovoked, excessive, and unremitting genital arousal unrelated to sexual desire. Those afflicted experience severe physical and psychological distress with significant feelings of shame, guilt, and frustration. Definitive treatment options for this disorder are limited.We present the case of a 32-year-old woman, gravida 1 para 1, with persistent genital arousal disorder after treatment of an uncomplicated urinary tract infection while in a military-deployed environment. After numerous treatment modalities failed, she responded to an implanted sacral neuromodulator.	Persistent genital arousal disorder may be the result of upregulated sacral nerve pathways. We report the use of sacral neuromodulation using unique program settings, which may be an effective alternative in the treatment of this distressing disorder.	
27399174	Bidirectional associations between child temperament (fear, frustration, positive affect, effortful control) and parenting behaviors (warmth, negativity, limit setting, scaffolding, responsiveness) were examined as predictors of preschool-age children's adjustment problems and social competence. Participants were a community sample of children (N = 306; 50% female, 64% European American) and their mothers. Observational measures of child temperament and parenting were obtained using laboratory tasks at two time points (children's ages 36 and 54 months). Teacher-reported adjustment measures were collected at the first and third time points (children's ages 36 and 63 months). Cross-lagged analyses were performed to examine whether child temperament and parenting predict changes in one another, whether they each contribute independently to children's adjustment, and whether these transactional relations account for adjustment outcomes. Maternal negativity at 36 months predicted increases in child frustration at 54 months. Maternal negativity and child effortful control predicted decreases in each other from 36 to 54 months. Maternal warmth predicted increases in child effortful control over time. Child frustration, child effortful control, maternal warmth, and maternal negativity at 54 months each independently predicted child adjustment problems at 63 months, controlling for problems at 36 months. Child executive control at 54 months predicted increases in child social competence at 63 months. The findings suggest that temperament and parenting have independent and additive effects on preschool-age child adjustment, with some support for a bidirectional relation.
27325314	Perceptions of pain as unfair are a significant risk factor for poorer physical and psychological outcomes in acute injury and chronic pain. Chief among the negative emotions associated with perceived injustice is anger, arising through frustration of personal goals and unmet expectations regarding others' behavior. However, despite a theoretical connection with anger, the social mediators of perceived injustice have not been demonstrated in chronic pain.The current study examined two socially based variables and a broader measure of pain interference as mediators of the relationships between perceived injustice and both anger and pain intensity in a sample of 302 patients in a tertiary care pain clinic setting.	Data from the Collaborative Health Outcomes Information Registry (CHOIR) were analyzed using cross-sectional path modeling analyses to examine social isolation, satisfaction with social roles and activities, and pain-related interference as potential mediators of the relationships between perceived injustice and both anger and pain intensity.	When modeled simultaneously, ratings of social isolation mediated the relationship between perceived injustice and anger, while pain-related interference and social satisfaction did not. Neither social variable was found to mediate the relationship between perceived injustice and pain intensity, however.	The current findings highlight the strongly interpersonal nature of perceived injustice and anger in chronic pain, though these effects do not appear to extend to the intensity of pain itself. Nevertheless, the results highlight the need for interventions that ameliorate both maladaptive cognitive appraisal of pain and pain-related disruptions in social relationships.	
27322590	To identify and examine existing research exploring how people with dementia and nurses view acute hospital care.Admission to hospital can be traumatic for a person with dementia due to an inability to cope with unfamiliar environments, faces and routines. Adverse behavioural and health outcomes can result. Dementia adds complexity to patient care. Inability to deliver appropriate care is a source of stress and frustration for nurses.	Integrative review of the literature 2005-2015 reporting the experience of people with dementia and nurses caring for them in an acute hospital setting (n = 24).	Hospitals focus on acute medical care; consequently people with dementia are considered low priority and a disruption to normal routine. Risk management often takes priority over patient dignity. People with dementia are stigmatised. Families have significant roles to play in the care of a person with dementia in hospital but are often excluded. Nurses struggle to complete even basic patient care, and focus on tasks often at the expense of specific patient needs. Support for nurses is lacking. The job satisfaction of nurses caring for people with dementia is poor.	Nurses require improved education and support to care for patients with dementia. Hospitals must focus on genuine caring concurrently with rapid discharge requirements, risk mitigation and fiscal restraint. More research is needed to inform the development of appropriate care for people with dementia in hospitals.	Nurses must understand the complex needs of people with dementia in hospital. Nurse education about dementia, practical support, strong clinical leadership and role-modelling is needed. Empathy for patients regardless of diagnosis must remain a core attribute of nurses. Current hospital culture requires wider system review to mitigate against stigmatisation of patients with dementia.	
27309492	International stroke care guidelines recommend the routine assessment and management of psychological and emotional problems post-stroke. Understanding the experiences of those delivering and receiving these services is vital to improving the provision of psychological support post-stroke.To explore patients', carers', and health professionals' experiences of psychological need, assessment, and support post-stroke while in hospital and immediately post-discharge.	Participants were recruited from seven specialist stroke services in the north of England. Qualitative semi-structured interviews and focus groups were conducted with 31 stroke patients, 28 carers, and 66 health professionals. The interviews were recorded and transcribed verbatim and analyzed using thematic analysis.	Two central themes emerged minding the gap: psychological expertise, and protective factors perceived to reduce the need for formal psychological support. The lack of psychological expertise among healthcare professionals working on stroke units was a source of frustration and resulted in other disciplines assuming the role of a psychologist without the required skills and training. Multiple stakeholders discussed the importance of protective factors, including downward social comparison, social support, peer support, communication, and information provision, that were perceived to reduce the need for formal psychological support.	Stroke patients need better access to psychological support, including information, advice, and peer or social support. More research is required to establish the effectiveness of alternative options to formal psychological support.	
27295387	This article examines the facilitators and the barriers to couple relationships in families in the UK with dependent children after a diagnosis of maternal breast cancer. Qualitative data were collected through in-depth semi-structured interviews with 23 participants, including 10 couples and three women whose partners did not take part. Recorded interviews were analyzed using a thematic approach identifying themes and patterns in the interview transcripts and categorizing them using a framework. Key individual and contextual factors perceived as barriers or facilitators to couple relationships included: being a "young" family with young children, frustration and resentment from male partners, women's reactions to the illness, individual communication styles, differing needs for "personal space," body image concerns, and social support. Findings indicated the need for strengthening "family focus" in services with adequate support for male partners. Health and family services should consider variability in the experiences of couples with dependent children and be sensitive to the needs of partners alongside the women. 
27284280	Visual impairment tends to evoke more discomfiture than any other disability. Primarily, the biggest issue may be that blindness is visible. Furthermore, visual impairment develops serious medical, psychological, social and economic problems.The focus of the current study was to investigate the psychological and psycho physiological problems of visually impaired adolescent students.	Purposive sampling was adopted to select 150 visually impaired students (71 males and 72 females) from five schools in Coimbatore city of the Tamil Nadu state, India. Anxiety, frustration, aggression and social and personal adjustment levels of the visually impaired students were measured in this study using Taylor's manifest anxiety scale, frustration test, aggression scale and the adolescent adjustment inventory, respectively.	Anxiety (χ(2) = 185.66, P = 0 at P < 0.01), frustration (χ(2) = 167.23, P = 0 at P < 0.01) and aggression (χ(2) = 57.66, P = 0 at P < 0.01) were significantly related to adjustment among visually impaired students. The adjustment score had a significant positive correlation with anxiety (r = 0.919, P = 0 at P < 0.01), frustration (r = 0.887, P = 0 at P < 0.01) and aggression levels (r = 0.664, P = 0 at P < 0.01), anxiety was significantly correlated with frustration (r = 0. 961, P = 0 at P < 0.01) and aggression levels (r = 0.727, P < 0.01) and frustration was significantly correlated with aggression level (r = 0. 637, P = 0 at P < 0.01) of visually impaired adolescents. There was a positive relationship between psycho-physiological disorders and anxiety frustration, aggression and adjustment among visually impaired students.	Visually impaired students exhibited significant levels of psychological and psycho-physiological problems.	
27275626	Chronic spontaneous urticaria (CSU) is perceived as a difficult to manage disease with negative impact on quality of life. The aim of this study was to highlight how to improve the care of people with CSU, using the methodology of narrative medicine. From June 2014 to March 2015, CSU-diagnosed patients and their physicians were asked to record their experiences of the condition in writing. Fourteen healthcare teams participated: 41% considered CSU as a challenge to overcome, while 22% experienced CSU as a big commitment. The number of professional involved was evaluated as insufficient in 11 hospitals. Seventy-five percent of the 190 Italian patients had visited 3 or more physicians before receiving a final diagnosis, with a perceived waste of time and resources. The therapeutic pathways were described as unsatisfactory in 83% of cases. As a result, anger and frustration were life-dominant emotions in 92% of patients. The critical points of the care pathway are related to organizational issues and lack of awareness.
27263203	This study's main objective was to examine care transition experiences of older veterans and their caregivers. Fifty patients age 65 years and older, discharged from a Veterans Affairs Medical Center hospital, completed the Care Transitions Measure-15 survey three to four weeks postdischarge. Seven patients and six caregivers participated in semistructured interviews. Overall, the quality of care transitions was rated as good; however, some items were indicated as problematic for veterans. Themes that emerged included agreeableness, frustration with complex information, caregiver education, and the timing and methods of information delivery. These findings have implications for all clinical staff working with veterans, and particularly for social workers facilitating care transitions for veterans and their caregivers.
27234189	The authors assessed clinical symptoms and self-reported shopping and spending behavior in people diagnosed with compulsive shopping (CS) at a 5-year follow-up interview.All met the criteria of McElroy et al. for lifetime CS and had the disorder for >1year. Structured and semistructured instruments and self-report questionnaires were used to collect data.	Of the original 26 subjects, 17 (65%) were interviewed and are the focus of this report. At follow-up, their ages ranged from 23 to 67years (mean=44years). Lifetime psychiatric comorbidity was common, but few had current psychiatric disorders at follow-up. Interest in shopping and spending decreased for eight (47%), stayed the same for five (29%), and increased for four (24%) subjects. Eleven subjects (65%) reported having attempted to quit their CS and three (18%) reported successfully doing so. Triggers for returning to CS included feelings of pressure/excitement/tension to shop; boredom; negative feelings such as sadness, depression, frustration, or anger; and the desire for positive feelings like happiness, power, or elation. Mean scores on the Compulsive Buying Scale (CBS) and the shopping version of the Yale-Brown Obsessive-Compulsive Scale showed overall improvement in CS symptoms (d=1.16 and d=-1.19, respectively); subjects were also less impulsive (d=-0.48). At baseline and follow-up, those with a lifetime mood disorder tended to have greater CS severity.	While the subjects showed overall improvement, most had ongoing symptoms of CS. The implications of the findings are discussed.	
27220192	Wound represents a disruption of anathomic and physiologic continuity of the skin. Regarding to the healing process, wounds can be classified as acute or chronic wounds. Quality of life is primarily concerned with the impact of chronic wounds. A wound is considered chronic if healing does not occur within expected period of time regarding to its etiology and localization. Chronic wounds can be classified as typical and atypical. The majority of wounds (95 percent) are typical ones which include ischaemic, neurotrophic and hypostatic ulcer and two separate entities: diabetic foot and decubital ulcers. An 80 percent of chronic wounds localized on lower leg are result of chronic venous insufficiency, in 5-10 percent cause is of arterial etiology, whereas the remainder is mostly neuropathic ulcer. Chronic wounds represent a significant burden to patients, health care professionals and the entire health care system. Chronic wounds affect the elderly population and it is estimated that 1-2 percent of western population suffer from it. This estimate is expected to rise due to an increasing population of the elderly and the diabetic and obesity epidemic. The WHO definition of health is "A state of complite physical, mental and social well-being and not merely the absence of disease or infirmity". Based on this definition, quality of life in relation to health may be defined as "the functional effect of an illness and it's consequent therapy upon a patient, as perceived by the patient". The domains that contribute to this effect are physical, psychological and social functioning. The patient's own perceptions of an illness were found to play an important role in explainig quality of life. Chronic wounds significantly decrease the quality of life in a number of ways such as reduced mobility, pain, unpleasant odor, sleep disturbances, social isolation and frustration, and inability to perform everyday duties. Among the most common psychological reactions to chronic diseases, including chronic wounds, are depression, anxiety, aggression and frustration. Psychological factors may not only be a consequence of delayed healing, but may also impact on wound healing. Anxiety and depression have direct influences on endocrine and immune function. About the impact of disease on quality of life and individuals' perceptions of illness, there are questionnaires and methods to analyze this, but the challenge is to move from a focus on wound management to understanding the specific needs of each individual within the context of their life.
27207884	Supportive care is a critical issue especially for patients with cancer of unknown primary since they often face serious situations, continuing to seek for relevant diagnosis and treatment with the primary sites unknown. However, there are only few research reports on this subject. The aim of this study was to clarify the experience on patients with cancer of unknown primary until they have their initial treatment and to obtain suggestions of supportive care for them.A qualitative study using semi-structured interviews regarding the experience on patients with cancer of unknown primary was conducted.	Data of the experience of the nine patients with cancer of unknown primary until their initial treatment were collected by semi-structured interviews. Patients' speech at interviews recorded in verbatim reports was assigned with 545 codes, 102 subcategories and 38 categories. Experience of the patients with cancer of unknown primary was categorized into five phases: Phase 1: period of making self-judgment on symptoms; Phase 2: period of suspecting serious disease, and seeking for appropriate medical treatment; Phase 3: period of searching for cause of disease while having painful symptoms and anxiety; Phase 4: period of having fear for death, frustration with unknown cause and denial of unknown state; Phase 5: period of struggling but being determined to face disease.	Experience of patients with cancer of unknown primary from onset of symptoms to their initial treatment was categorized into five phases, mainly manifesting their psychological burden. These findings will warrant for the future study of supportive care for patients with cancer of unknown primary.	
27193297	Many countries belonging to the Organisation for Economic Co-operation and Development (OECD) have seen a considerable increase in the number of disability benefits recipients (DBRs), in addition to an increase in the proportion of people with mental illness. As in other countries, changes to the welfare benefits system in England were made in order to reduce the number of DBRs. Many people lost their benefit payments, although a considerable number had them reinstated after appeal. Our aim was to investigate the impact of the process on DBRs whose disability was related to mental health and who won their appeal. Seventeen DBRs were interviewed. The participants reported three main types of impact. Beyond the practical reduction of income and the related anxiety, interviewees reported considerable stress when coping with the 'never-ending' cycle of bureaucracy. They also expressed anger, frustration and demoralisation at mistrust on the part of the authorities partly due to the 'invisibility' of their disability. 
27191157	To analyze the relations between the meanings of working and the levels of doctors work well-being in the context of their working conditions.The research combined the qualitative methodology of textual analysis and the quantitative one of correspondence factor analysis. A convenience, intentional, and stratified sample composed of 305 Spanish and Latin American doctors completed an extensive questionnaire on the topics of the research.	The general meaning of working for the group located in the quartile of malaise included perceptions of discomfort, frustration, and exhaustion. However, those showing higher levels of well-being, located on the opposite quartile, associated their working experience with good conditions and the development of their professional and personal competences.	The study provides empirical evidence of the relationship between contextual factors and the meanings of working for participants with higher levels of malaise, and of the importance granted both to intrinsic and extrinsic factors by those who scored highest on well-being.	
27178111	Reducing violence against women is a national public health priority in Australia. Routine antenatal intimate partner violence screening by a skilled midwife is essential for assessment, support and appropriate referral, but can be challenging to implement.To explore midwives' experiences of routine enquiry, perceptions of facilitators and barriers, and suggested strategies to improve practice.	A qualitative descriptive design was used. Participants were recruited from an e-mail bulletin by the Australian College of Midwives. In-depth telephone interviews were conducted with 21 midwives. Data were analysed using an inductive thematic analysis approach.	Three themes were identified: The first theme; Asking the Question incorporated the belief that whilst asking women about intimate partner violence were within the role of the midwife, participants felt unsupported and unprepared. The second theme; The big fear factor represented concerns around positive disclosures of intimate partner violence, including a sense of responsibility, worries about encouraging women to disclose without clear processes and resources to support them. The third theme; Building a relationship incorporated the importance of continuity of care, trust and rapport-building. Continuity of care was identified as a positive enabler for routine enquiry. A perceived lack of support, time pressures, and presence of a partner at appointments were all considered barriers to routine enquiry.	Routine enquiry about IPV is a valuable and important midwifery role. Midwives described frustration and fear when women disclosed violence. The perceived level of support from health services varied according to practice contexts and needs to be improved.	
27177789	The analytic and family therapeutic theories connected to the topic of stutter have to be actualized.The aim of this work was to point out connections which originate from the instinct of frustrated clinging, however, these can be interpretated in new ways these days.	Two questionnaires in 48 subjects suffering from stutter were used; Rosenberg's Self-Esteem Scale measured the children's self representation, while the Multidimensional Anxiety Scale for Children measured the degree of their anxiety. At first the subjects had to anwser the questions as themselves, for the second time they had to anwser as an ordinary person without a speech disorder.	The hypothesis of the authors was verified: stutterers attributed a significant role to the speech disorder of the subjects in connection with their self-esteem. According to this a significant amount of their anxiety is based on their deficit. An unexpected result was that girls and boys estimated ordinary people's level of anxiety similarly. There was no significant difference between boys and girls regarding the level of other's self-esteem.	Based on the thesis of evolutionary psychology, the adequate use of speech is more important to women who have a connecting role in the family. This results that they see stutter as a major problem.	
27157564	Nurses are practising in a work environment which is sometimes difficult and which can affect their capacity to supervise students. They may sometimes find themselves taking out their frustration on these students. By being better trained in the specificities of adult learning, frontline professionals and tutors could find it easier to adopt a compassionate care attitude towards nursing students, an essential condition for the development of their skills. 

27152687	There is tremendous interpatient variability in the response to analgesic therapy (even for efficacious treatments), which can be the source of great frustration in clinical practice. This has led to calls for "precision medicine" or personalized pain therapeutics (ie, empirically based algorithms that determine the optimal treatments, or treatment combinations, for individual patients) that would presumably improve both the clinical care of patients with pain and the success rates for putative analgesic drugs in phase 2 and 3 clinical trials. However, before implementing this approach, the characteristics of individual patients or subgroups of patients that increase or decrease the response to a specific treatment need to be identified. The challenge is to identify the measurable phenotypic characteristics of patients that are most predictive of individual variation in analgesic treatment outcomes, and the measurement tools that are best suited to evaluate these characteristics. In this article, we present evidence on the most promising of these phenotypic characteristics for use in future research, including psychosocial factors, symptom characteristics, sleep patterns, responses to noxious stimulation, endogenous pain-modulatory processes, and response to pharmacologic challenge. We provide evidence-based recommendations for core phenotyping domains and recommend measures of each domain. 
27140170	To investigate the levels and causes of work-related frustration among senior nurses.Role changes and the associated expectations and setbacks faced by senior middle-aged nurses can easily result in low morale. Therefore, working setbacks experienced by senior nurses must be investigated.	A cross-sectional questionnaire study.	Purposive sampling was used to select questionnaire recipients. In total, 482 senior nurses completed and returned a structured questionnaire.	The predictive factors for frustration at work among senior nurses included age, service unit, and the impact of sleep disorders, which jointly explained 54% of the variance. In particular, age and service unit were important predictive factors for frustration at work.	Senior nurses had medium-to-low scores for frustration at work and did not perceive a high level of frustration.	The outpatient departments and other medical departments in this sector should provide a reasonable system of incentives and promotion opportunities if they are to retain their most senior and experienced nurses. The results of this study could serve as a reference for hospital administrations.	

27091566	Scratch card games are incredibly popular in the Canadian marketplace. However, only recently have researchers started to systematically analyze their structural characteristics and how these in turn affect the gambler. We present two studies designed to further understand the underlying physiological and psychological effects that scratch cards have on gamblers. We had gamblers (63 in Experiment 1, 68 in Experiment 2) play custom made scratch cards involving a small win, a regular loss and a near-miss-where they uncovered two out of the three symbols needed to win the top prize. Our predictions were that despite near-misses and losses being objectively equivalent (the gambler wins nothing) gamblers' reactions to these outcomes would differ dramatically. During game play, skin conductance levels and heart rate were recorded, as well as how long gamblers paused between each game. Gamblers' subjective reactions to the different outcomes were then assessed. In both studies, near-misses triggered higher levels of physiological arousal (skin conductance levels and heart rates) than losses. Gamblers paused significantly longer following small wins than other outcomes, and reported high arousal, positive affect and urge to gamble-a constellation of results consistent with their rewarding properties. Importantly near-miss outcomes were rated as highly arousing, negative in emotional tone, and the most frustrating of all three outcome types examined. In Experiment 2, when we measured subjective urge to gamble immediately after each outcome, urge to gamble was significantly higher following near-misses than regular losses. Thus, despite not rewarding the gambler with any monetary gain, these outcomes nevertheless triggered higher arousal and larger urges to gamble than regular losses, a finding that may explain in part, the allure of scratch cards as a gambling activity.
27089522	The outcome of treatment with antidepressants varies markedly across people with the same diagnosis. A clinically significant prediction of outcomes could spare the frustration of trial and error approach and improve the outcomes of major depressive disorder through individualized treatment selection. It is likely that a combination of multiple predictors is needed to achieve such prediction. We used elastic net regularized regression to optimize prediction of symptom improvement and remission during treatment with escitalopram or nortriptyline and to identify contributing predictors from a range of demographic and clinical variables in 793 adults with major depressive disorder. A combination of demographic and clinical variables, with strong contributions from symptoms of depressed mood, reduced interest, decreased activity, indecisiveness, pessimism and anxiety significantly predicted treatment outcomes, explaining 5-10% of variance in symptom improvement with escitalopram. Similar combinations of variables predicted remission with area under the curve 0.72, explaining approximately 15% of variance (pseudo R(2)) in who achieves remission, with strong contributions from body mass index, appetite, interest-activity symptom dimension and anxious-somatizing depression subtype. Escitalopram-specific outcome prediction was more accurate than generic outcome prediction, and reached effect sizes that were near or above a previously established benchmark for clinical significance. Outcome prediction on the nortriptyline arm did not significantly differ from chance. These results suggest that easily obtained demographic and clinical variables can predict therapeutic response to escitalopram with clinically meaningful accuracy, suggesting a potential for individualized prescription of this antidepressant drug. 
27078081	Under natural conditions, wild animals encounter situations where previously rewarded actions do not lead to reinforcement. In the laboratory, a surprising omission of reinforcement induces behavioral and emotional responses described as frustration. Frustration can lead to aggressive behaviors and to the persistence of noneffective responses, but it may also lead to new behavioral responses to a problem, a potential adaptation. We assessed the responses to inaccessible reinforcement in free-ranging fox squirrels (Sciurus niger). We trained squirrels to open a box to obtain food reinforcement, a piece of walnut. After 9 training trials, squirrels were tested in 1 of 4 conditions: a control condition with the expected reward, an alternative reinforcement (a piece of dried corn), an empty box, or a locked box. We measured the presence of signals suggesting arousal (e.g., tail flags and tail twitches) and found that squirrels performed fewer of these behaviors in the control condition and increased certain behaviors (tail flags, biting box) in the locked box condition, compared to other experimental conditions. When faced with nonreinforcement, that is, frustration, squirrels increased the number of interactions with the apparatus and spent more time interacting with the apparatus. This study of frustration responses in a free-ranging animal extends the conclusions of captive studies to the field and demonstrates that fox squirrels show short-term negatively valenced responses to the inaccessibility, omission, and change of reinforcement. (PsycINFO Database Record 
27054496	Postnatal mother-infant bonding refers to the early emotional bond between mothers and infants. Although some factors, such as maternal mental health, especially postnatal depression, have been considered in relation to mother-infant bonding, few studies have investigated the role of infant temperament traits in early bonding. In this study, the effects of maternal postnatal depressive and anxiety symptoms and infant temperament traits on mother-infant bonding were examined using both mother and father reports of infant temperament. Data for this study came from the first phase of the FinnBrain Birth Cohort Study (n=102, father reports n=62). After controlling for maternal symptoms of depression and anxiety, mother-reported infant positive emotionality, measured by infant smiling was related to better mother-infant bonding. In contrast, infant negative emotionality, measured by infant distress to limitations was related to lower quality of bonding. In regards to father-report infant temperament, only infant distress to limitations (i.e., frustration/anger) was associated with lower quality of mother-infant bonding. These findings underline the importance of infant temperament as one factor contributing to early parent-infant relationships, and counseling parents in understanding and caring for infants with different temperament traits. 
27027908	This study introduces an intervention that enabled a man (LH) with acquired topographical disorientation (TD) to travel independently without fear of getting lost. Adapting an errorless method, LH learned to use a smartphone to find his routes accurately and reliably. A time-series design (A1-B1-A2-B2) was used: In all phases, LH was given a printed map on which city locations were indicated. He had to walk to the indicated locations while naturalistic outcomes were recorded. In Phases A, he navigated without his smartphone, and in Phases B, with it. In Phases A, LH made numerous surplus direction changes, and openly expressed his frustration. In Phases B, he did not have surplus direction changes and could calmly find his routes. Before intervention, LH and his wife were frustrated and worried about his way-finding. They rated their confidence in his navigational ability and his actual ability in way-finding to various locations as low. After intervention, they were more confident that LH could travel by himself without getting lost and rated his ability as much higher for various scenarios. As a consequence of intervention LH gained greater independence and quality of life.
27021879	The purpose of this study was to identify the daily problems experienced by school-age children in remission from cancer. It also sought to assess the predictive value of these problems on the mental health of these children 1 year after the first assessment.Against this background, 50 children in remission from cancer and in mainstream education, aged 8-12 years, completed two questionnaires: the Quality of Life Systemic Inventory for Children (QLSI-C) (Missotten et al., 2007) and the Child Depression Inventory (CDI). THE QLSI-C consists of 20 life areas: Sleep, Diet, Physical pain, Health, Clothing, Physical appearance, Bedroom, Grandparents, Mother, Father, Siblings, Friends, How my friends talk about me, School, School results, Sport, Non-sporting activities, Autonomy, Obedience to authority, and Tolerance of frustration. Each of these 20 life areas was evaluated by the child by reference on each occasion to an ideal situation, first in relation to their current situation and then in relation to their personal goals, in order to measure the gap between these two evaluations. This difference was then weighted by the importance given to each life area and the dynamic situation of approximation to or distance from the goals. All the children in this study were seen in person for two interviews 1 year apart (T1 and T2).	The analyses conducted following the PLS-PM approach enabled eight of the 20 life areas evaluated to be identified as difficult to access by the children in this study. These analyses also showed that the difficulties perceived by children in remission from cancer have mainly proximal effects (i.e., short-term) on the discomfort experienced (direct effect of difficulties expressed in T1 on discomfort felt at T1; idem for T2). However, the areas perceived as difficult at T1 did not enable distal effects (i.e., effect over a year) on the discomfort expressed in T2 to be updated. Nonetheless, the conflicts at T1 fed the conflicts at T2 and, as a consequence, indirectly affected the experience of depression at T2.	The discussion examines the nature of the daily difficulties perceived by school-age children in remission from cancer and the short-term psychological distress experienced by these children. It concludes that the difficulties encountered by children in remission from cancer are not necessarily cumulative over time and that they do not inevitably result in permanent psychological suffering.	
27018555	Research adopting self-determination theory (SDT) supports a mediation model whereby coach motivational styles (autonomy support and interpersonal control) predict athletes' engagement and disaffection in youth sport via the satisfaction and frustration of psychological needs (autonomy, competence, and relatedness). Our study extends this research by examining SDT's mediation model longitudinally with three waves of data. Two hundred fifty-two youth sports participants (Mage = 12.98; SD = 1.84; range = 11-17; female n = 67) completed measures of study variables at the start, middle, and end of a competitive soccer season. Cross-lagged path analyses revealed that associations between the two coach motivational styles and athletes' engagement were mediated by psychological need satisfaction. Furthermore, a positive reciprocal association between psychological need satisfaction and engagement emerged over time. This study therefore supports the temporal assumptions underpinning SDT's mediation model but, importantly, evidences a mutually reinforcing interplay between athletes' psychological needs and their engaged behavior. 
27018533	Becoming a refugee is a potent risk factor for indicators of psychological distress such as depression, generalized stress, and posttraumatic stress disorder (PTSD), though research into this vulnerable population has been scant, with even less work focusing on interventions. The current study applied principles from self-determination theory (SDT; Ryan & Deci, 2000) to develop and test an intervention aimed at increasing need-satisfying experiences in refugees of Syrian civil unrest.Forty-one refugees who fled Syria during the past 24 months and resettled in Jordan participated in the study and were randomly assigned to receive the intervention or a neutral comparison.	The 1-week-long intervention alleviated some of the need frustration likely associated with refugee status, a major aim of the intervention, and also lowered refugees' self-reported symptoms of depression and generalized stress as compared to the comparison condition, though it did not reduce symptoms of PTSD.	Discussion focuses on how these findings speak to the universal importance of need satisfaction for mental health, and how need-satisfying experiences can help buffer against the profound stress of being a refugee. Avenues for longer-term or more intensive interventions that may target more severe outcomes of refugee experiences, such as PTSD symptoms, are also discussed. (PsycINFO Database Record	
26995738	Among the potential range of irrational beliefs that could be used as predictors of physical and mental health, catastrophizing is the process that has received most attention in chronic pain research. Other irrational processes such as demandingness, low frustration tolerance, and self-downing have rarely been studied. The goal of this study was to explore whether this wider range of beliefs is associated with health in chronic pain patients beyond catastrophizing. A total of 492 chronic pain patients completed a measure of irrational beliefs, a measure of physical and mental health, and a numerical rating scale designed to assess pain intensity and interference. Irrational processes were more strongly associated with mental than with physical health. Low frustration tolerance and self-downing were found to be significantly related to mental health even after controlling for the effect of catastrophizing. Processes other than catastrophizing appear to have potentially important relationships with the mental health of people with chronic pain. These results may offer new intervention targets for practitioners. 
26994991	To explore the experiences of Korean patients with end-stage renal disease awaiting kidney transplantation.The need for kidney transplantation has increased worldwide, while the number of kidney donors has not increased commensurately. This mismatch is a serious issue in South Korea. Prolonged waits for transplantation may cause physical and psychosocial issues and lead to poor outcomes. Nevertheless, the experience of waiting for kidney transplantation in South Korea has never been explored in depth.	A qualitative descriptive design was used.	The participants were eight patients diagnosed with end-stage renal disease on the waiting list for kidney transplantation in South Korea. Data were collected through individual in-depth interviews. All conversations during interviews were recorded and transcribed verbatim. Transcribed data were analysed using conventional content analysis.	The experience of waiting for kidney transplantation consisted of six categories: (1) the light at the end of the tunnel, (2) being on call without any promise, (3) a tough tug of war between excitement and frustration, (4) doubts in the complexity, (5) A companion on the hard journey and (6) getting ready for D-day.	Kidney transplantation candidates experience psychosocial difficulties and concerns while waiting for long periods of time without any assurance of resolution. Systematic education and psychosocial support from health care professionals and family members help patients get through what they describe as a difficult journey. Comprehensive management programs for kidney transplantation candidates are needed.	Health care professionals need to recognise the psychosocial concerns of patients awaiting kidney transplantation. Clinicians should provide patients with information and support throughout the waiting period.	
26984995	The aim of this study was to survey GPs and community pharmacists (CPs) in Ireland regarding current practices of medication management, specifically medication reconciliation, communication between health care providers and medication errors as patients transition in care.A national cross-sectional survey was distributed electronically to 2364 GPs, 311 GP Registrars and 2382 CPs. Multivariable associations comparing GPs to CPs were generated and content analysis of free text responses was undertaken.	There was an overall response rate of 17.7% (897 respondents-554 GPs/Registrars and 343 CPs). More than 90% of GPs and CPs were positive about the effects of medication reconciliation on medication safety and adherence. Sixty per cent of GPs reported having no formal system of medication reconciliation. Communication between GPs and CPs was identified as good/very good by >90% of GPs and CPs. The majority (>80%) of both groups could clearly recall prescribing errors, following a transition of care, they had witnessed in the previous 6 months. Free text content analysis corroborated the positive relationship between GPs and CPs, a frustration with secondary care communication, with many examples given of prescribing errors.	While there is enthusiasm for the benefits of medication reconciliation there are limited formal structures in primary care to support it. Challenges in relation to systems that support inter-professional communication and reduce medication errors are features of the primary/secondary care transition. There is a need for an improved medication management system. Future research should focus on the identified barriers in implementing medication reconciliation and systems that can improve it.	
26983171	This study is based on ethnographic fieldwork at a plastic surgery clinic in Seoul, South Korea. Examining the three phases of plastic--consultation, operation and recovery--I show how surgeons work to shape not only patients' bodies but also expectations and satisfaction. Surgeons do so in part to assuage their own anxieties, which arise from the possibility of misaligned beauty standards and unforeseen anatomies, as well as the possible dissatisfaction of the patient. I offer the concept of 'surgical anxiety', which occurs in relation to inherently unruly patient bodies in which worries, fear, frustration, self-pity, cynicism, anger and even loneliness are symptomatic. The unpredictability and uncontrollability of patients' bodies, which generates anxiety for both patients and surgeons, work to constrain the power of plastic surgery and making it inherently vulnerable. This study also pays attention to the invisible work of taking care of surgical anxiety, as practised by female staff members, and surgeons' dependence on these workers. My focus on anxiety is a kind of remedy for the predominant concern with 'ambivalence' in constructivist science and technology studies; rather than continue to highlight the power differentials between experts/practitioners and lay people/patients, this study illuminates surgical anxiety as their shared vulnerability. Thus, this study proposes a new politics of care in technoscience and medicine, which begins with anxiety.
26977459	Improving your understanding of these disorders will help you identify specific diagnoses, ensure appropriate treatment, and reduce frustration during office visits.
26966012	Attention deficit hyperactivity disorder (ADHD) is thought to involve an executive inhibitory control (IC) deficit, yet it is not clear if this is a general deficit affecting both cold and hot EC, and if methylphenidate (MPH) affects both systems in treated children. We explored this by using a Stroop-like task in children with ADHD as compared to controls, containing different types of emotional stimuli (six levels), and we investigated the role of intervention with MPH on IC as compared to placebo. Children with ADHD and controls (N = 40; 7-13 years old) were tested with a hot and cold Stroop-like task. This was followed by a double-blind placebo-controlled crossover trial of the effect of MPH on these skills. Children with ADHD showed a specific difficulty inhibiting their responses, particularly to hot, angry and frustration-inducing stimuli. Further, treatment with MPH was effective in reducing errors toward frustration-inducing stimuli as compared to placebo (p < .05, η 2 = .347), particularly with repeated exposure to the stimuli. Results indicate that children with ADHD experience executive control difficulties, particularly in hot negative emotional contexts. These emotion regulation difficulties are amenable to stimulant intervention.
26961237	Despite the wealth of clinical research carried out in children with juvenile idiopathic arthritis (JIA), little is known about the emotional experiences of their parents. This article describes the predominant emotional experiences reported by parents of children with JIA in two Canadian cities.Research participants included 15 experienced parents and 8 novice parents (<6 months since children's JIA diagnosis). Their children were 2 to 16 years old with various JIA categories. A qualitative dataset including audio recordings and verbatim transcripts of three focus groups, and written reports of 59 reciprocal interviews (parents interviewing each other) were examined by a multidisciplinary research team following a four-step qualitative analytical process.	Parents of children with JIA experienced recurrent mixed negative and positive emotions that varied over time. Between disease onset and diagnosis, mounting anxiety, fear and confusion were the predominant emotions. Shortly after diagnosis there were shock, disbelief, and fear, with a sense of having being blindsided by the disease. At times of disease quiescence there was hope and gratitude, but also fatigue and frustration with ongoing treatment and fear of flares. During periods of increasing or ongoing symptoms there was admiration and sympathy for the courageous way children coped with JIA, as well as sorrow and frustration for ongoing pain and limitations. There were at times, frustration and indignation with peers and teachers unable to understand the child's fluctuations in physical activity and schoolwork. Throughout the disease, parents felt an underlying anxiety and powerlessness.	Parents of children with JIA described complex emotional journeys akin to the recurring ups and downs of rollercoaster rides, instead of ordered emotional phases ending in resolution. This has implications for healthcare providers who need to be aware of the complexity of these emotional journeys to support parents more effectively, thereby helping improve patient outcomes.	

26956370	This study tested the hypothesis that maternal physiological and psychological variables during pregnancy discriminate between theoretically informed infant stress reactivity profiles.The sample comprised 254 women and their infants. Maternal mood, salivary cortisol, respiratory sinus arrhythmia (RSA), and salivary α-amylase (sAA) were assessed at 15 and 32 weeks gestational age. Infant salivary cortisol, RSA, and sAA reactivity were assessed in response to a structured laboratory frustration task at 6 months of age. Infant responses were used to classify them into stress reactivity profiles using three different classification schemes: hypothalamic-pituitary-adrenal (HPA)-axis, autonomic, and multi-system. Discriminant function analyses evaluated the prenatal variables that best discriminated infant reactivity profiles within each classification scheme.	Maternal stress biomarkers, along with self-reported psychological distress during pregnancy, discriminated between infant stress reactivity profiles.	These results suggest that maternal psychological and physiological states during pregnancy have broad effects on the development of the infant stress response systems. © 2016 Wiley Periodicals, Inc. Dev Psychobiol 58: 578-599, 2016.	
26927143	Despite high smoking prevalence and excessive smoking-related morbidity and mortality among people with mental disorder compared to the general population, smoking treatment is often neglected in mental health settings. The UK National Institute of Health and Clinical Excellence (NICE) recently issued public health guidance stipulating completely smoke-free mental health settings. This project evaluated existing smoking-related practices in preparation for guidance implementation. The objectives were to: audit the recording of smoking-related information and treatment provision; explore current arrangements relating to the facilitation of patient smoking; measure staff time spent and identify costs of facilitating smoking; and explore the role of smoking in smoking-related incidents.A mixed-methods study was conducted across four acute adult mental health wards, accommodating 16 patients each, over six months. It included a case-note audit, on-site observations, and a qualitative content analysis of incident reports.	Smoking status was recorded for less than half of the 290 patients admitted (138, 48%). Of those, 98 (71%) were recorded as current smokers, of whom 72 (74%) had received brief smoking cessation advice. Staff spent 6028 h facilitating smoking, representing an annual cost of £ 131,040 across four wards. Incident reports demonstrated that smoking facilitation was often central to the cause of incidences, triggered frustration in patients, and strained staff resources.	The findings highlight the importance and potential of implementing completely smoke-free policies using comprehensive pathways.	
26916153	This study examines experiences of individual patients and psychiatrists in the Henry Phipps Psychiatric Clinic at Johns Hopkins between 1913 and 1917. The dynamics of these patient-psychiatrist interactions elucidate the well-known conceptual shift in explanations of mental illness during the twentieth century, from somatic models rooted in the logic of "neurasthenia" and damaged nerves to psychodynamic models based on the notion of "subconscious conflict." A qualitative analysis of 336 cases categorized as functional disorders (a catchall term in this period for illnesses that could not be confirmed as organic diseases), shows that patients explained their symptoms and suffering in terms of bodily malfunctions, and, particularly, as a "breakdown" of their nervous apparatus. Psychiatrists at the Phipps Clinic, on the other hand, working under the direction of its prominent director, Adolf Meyer, did not focus their examinations and therapies on the body's nervous system, as patients expected. They theorized that the characteristic symptoms of functional disorders-chronic exhaustion, indigestion, headaches and pain, as well as strange obsessive and compulsive behaviors-resulted from a distinct pathological mechanism: a subconscious conflict between powerful primal and social impulses. Phipps patients were often perplexed when told their physical symptoms were byproducts of an inner psychological struggle; some rejected the notion, while others integrated it with older explanations to reconceptualize their experiences of illness. The new concept also had the potential to alter psychiatrists' perceptions of disorders commonly diagnosed as hysteria, neurasthenia, or psychoneuroses. The Phipps records contain examples of Meyer and his staff transcending the frustration experienced by many doctors who had observed troubling but common behaviors in such cases: morbid introspection, hypochondria, emotionalism, pity-seeking, or malingering. Subconscious conflict recast these behaviors as products of "self-deception," which both absolved the sufferer and established an objective clinical marker by which a trained specialist could recognize functional disorder. Using individual case studies to elucidate the disjunction between patients' and psychiatrists' perspectives on what all agreed were debilitating illnesses, this analysis helps to illuminate the origins of a radical transformation in psychiatric knowledge and popular culture in the twentieth century-from somatic to psychodynamic explanations of mental illness.
26909725	To describe mothers' experiences with expressing breast milk for preterm or SGA infants.This is a descriptive qualitative study involving 130 mothers of preterm or SGA infants admitted to a neonatal intensive care unit. Data were collected in collaboration with two Finnish peer support associations. An Internet-based questionnaire with open-ended questions was administered to respondents. Responses were analyzed with inductive content analysis.	Mothers had to try to manage daily life and breast pumping. The combination of preterm birth and separation from the hospitalized infants served simultaneously as motivating factors and obstacles. Mothers tried to look beyond the unnatural and difficult process of milk expression, looking forward to eventual breastfeeding. Concerns about time and scheduling, equipment, environment, and sufficient milk supply were prevalent, as well as feelings of unfamiliarity, difficulty, frustration, and loneliness.	Expressing breast milk should be considered as a helpful factor for preterm or SGA infants' mothers. Separation between mother and infant should be avoided. Mothers need adequate equipment and a private space for expressing milk, in addition to assistance with their daily routines. For mothers to successfully manage expression, they also require an environment that fosters a sense of caring, normality, and hope, as well as frequent care for their emotional needs.	
26908469	Pediatric primary care providers (PCPs) caring for patients with autism spectrum disorder (ASD) often encounter irritability (vocal or motoric outbursts expressive of anger, frustration, or distress) and problem behavior (directed acts of aggression toward other people, self, or property). The Autism Intervention Research Network on Physical Health and Autism Speaks Autism Treatment Network charged a multidisciplinary workgroup with developing a practice pathway to assist PCPs in the evaluation and treatment of irritability and problem behavior (I/PB).The workgroup reviewed the literature on the evaluation and treatment of contributory factors for I/PB in ASD. The workgroup then achieved consensus on the content and sequence of each step in the pathway.	The practice pathway is designed to help the PCP generate individualized treatment plans based on contributing factors identified in each patient. These factors may include medical conditions, which the PCP is in a key position to address; functional communication challenges that can be addressed at school or at home; psychosocial stressors that may be ameliorated; inadvertent reinforcement of I/PB; and co-occurring psychiatric conditions that can be treated. The pathway provides guidance on psychotropic medication use, when indicated, within an individualized treatment plan. In addition to guidance on assessment, referral, and initial treatment, the pathway includes monitoring of treatment response and periodic reassessment.	The pediatric PCP caring for the patient with ASD is in a unique position to help generate an individualized treatment plan that targets factors contributing to I/PB and to implement this plan in collaboration with parents, schools, and other providers.	
26907864	The IIFF Model (Information, Immediate and Complete Registration Mechanism, Focused Engagement, Favorable Activation) offers a checklist of considerations for interventions seeking to influence organ donor registration behavior. One aspect of the model, favorable activation, recommends considering the emotional and motivational state of a potential donor registrant. Given that most donor registrations occur at the Department of Motor Vehicles (DMV), we considered whether emotions experienced while at the DMV could influence registration rates.The current research effort investigated the emotions people experience while visiting the DMV, explored whether these emotions are associated with donor registration intentions, and experimentally assessed whether DMV experiences influence donor registration.	Three studies were conducted through Amazon's Mechanical Turk. In Study 1, we randomly assigned participants to either recall a prior DMV experience or to a comparison condition. Emotions associated with the recalled experiences were the dependent variable. Study 2 assessed the correlations between nine different emotions and donor registration intentions. Study 3 randomly assigned participants to recall a prior frustrating DMV experience or to a comparison condition. Intention to register to donate was the dependent variable.	Study 1 found that recalling a prior DMV experience was associated with more negative and less positive emotions than the comparison condition. Study 2 found that increased levels of negative emotion could be problematic, as negative emotions were associated with decreased donor intentions. Study 3 found that recalling a frustrating DMV experience resulted in significantly lower intentions to register as an organ donor (vs. a control condition).	Although not all DMV experiences are negative, these data indicated a relationship between the DMV and negative emotions; an association between negative emotions and lower donor registration intentions; and, a causal relationship between negative DMV experiences and decreased registration intentions.	
26906518	The purpose of this study was to understand nurses' perceptions of a newly adopted electronic health record (EHR).As use of EHRs in hospital settings increases, leaders prepare staff members for change. There is limited information about impacts of EHR adoption on RNs using EHRs at the point of care.	Clinical RNs were surveyed about 3 domains (ease of use, usefulness, and attitude) before and after implementation of an EHR. A small subset of nurses was interviewed for a deeper understanding of perceptions associated with this change.	One year after adoption, nurses believed that the EHR did not improve patient care, the learning curve was steep, and they had lower confidence using the EHR than anticipated. Nurses commented on both their frustration and optimism about EHRs.	This study provides insight into RNs' perceptions of an EHR, providing important information for nursing administrators.	
26895452	In the experiments presented here, we examined the impact of intervening tasks on the vigilance decrement. In Experiment 1 participants either (a) continuously performed a visuospatial vigilance task, (b) received a rest break, or (c) temporarily performed a different, demanding visuospatial task in the middle of the vigil. Both taking a rest break and performing the intervening task were found to alleviate the vigilance decrement in response times. Target detection accuracy was equivalent across groups. In Experiment 2 we obtained subjective ratings of task demand, boredom, motivation, and mind wandering for both the vigilance task and intervening task administered in Experiment 1. The intervening task was rated as more demanding in terms of mental demand, physical demand, temporal demand, own performance, effort, and frustration. In addition, participants also reported being more bored, less motivated, and reported mind wandering more frequently when completing the vigil. Disruptions to task monotony (even if cognitively demanding), can alleviate the vigilance decrement. The implications of this finding with respect to current theoretical accounts of the vigilance decrement are discussed.
26892161	Acetaminophen has recently been recognized as having impacts that extend into the affective domain. In particular, double blind placebo controlled trials have revealed that acetaminophen reduces the magnitude of reactivity to social rejection, frustration, dissonance and to both negatively and positively valenced attitude objects. Given this diversity of consequences, it has been proposed that the psychological effects of acetaminophen may reflect a widespread blunting of evaluative processing. We tested this hypothesis using event-related potentials (ERPs). Sixty-two participants received acetaminophen or a placebo in a double-blind protocol and completed the Go/NoGo task. Participants' ERPs were observed following errors on the Go/NoGo task, in particular the error-related negativity (ERN; measured at FCz) and error-related positivity (Pe; measured at Pz and CPz). Results show that acetaminophen inhibits the Pe, but not the ERN, and the magnitude of an individual's Pe correlates positively with omission errors, partially mediating the effects of acetaminophen on the error rate. These results suggest that recently documented affective blunting caused by acetaminophen may best be described as an inhibition of evaluative processing. They also contribute to the growing work suggesting that the Pe is more strongly associated with conscious awareness of errors relative to the ERN.
26891641	After a stroke many patients have muscle weakness, spasticity and compromised sensation leading to decreased postural stability. Basic Body Awareness Therapy includes slow movements that challenge postural control.The aim was to describe experiences of 8 weeks of Basic Body Awareness Therapy from the perspective of both patients with stroke and physiotherapists.	This study had a qualitative design. Twenty-one patients and four physiotherapists were interviewed. The interviews were analysed using manifest and latent content analysis.	One overall theme emerged "Simple yet challenging" which was based on six categories: "Facing one's limitations", "Individualized movements", "A feeling of harmony", "Improved balance", "Integrated knowledge" and "Frustration and doubt". The patients described improvement in balance and stability, as well as increased wellbeing.	The patients and physiotherapists related that Basic Body Awareness Therapy challenges balance but also provides an opportunity to reflect on the body.	
26867041	The present study examined the within-day relationship between fatigue and positive and negative mood among adults with rheumatoid arthritis (RA) or osteoarthritis (OA).A sample of 142 adults-70 with RA and 72 with OA (67.6% women, 32.4% men)-completed daily diaries during 4 fixed time windows per day for 7 days. In each diary, participants reported fatigue, pain, happiness, and frustration. Multilevel modeling tested the temporal patterns in fatigue across the day and the lagged associations between fatigue and subsequent mood (and vice versa).	Fatigue showed a midmorning dip followed by a linear rise in the afternoon and evening. Higher fatigue earlier in the day predicted subsequently lower happiness and higher frustration. Higher frustration-but not happiness-predicted subsequently worse fatigue. These within-day patterns were significant even when controlling for daily sleep quality, daily physical activity, diagnosis, age, gender, anxiety, depression, and disability.	There was a unidirectional effect of fatigue on subsequent happiness and a bidirectional relationship between fatigue and frustration within the same-day for adults with RA or OA. These findings inform interventions for the management of mood and fatigue throughout the day and suggest that addressing fatigue could improve mood, and that addressing sources of frustration could improve fatigue among people with arthritis.	
26854505	Research examining factors linking early temperament and later attention-deficit/ hyperactivity disorder (ADHD) is limited by cross-sectional approaches and having the same informant rate both temperament and psychopathology. The authors used multiinformant/multimethod longitudinal data to test the hypothesis that negative emotionality during preschool is positively associated with ADHD symptom severity in middle childhood, but developing executive control mediates this relation. Children (N = 161) with and without ADHD were evaluated 3 times: parent and teacher temperament ratings and NEPSY visual attention at ages 3-4 years; Wechsler Intelligence Scale for Children-4th edition Working Memory Index and NEPSY Response Set at age 6 years; and ADHD symptoms using the Kiddie-SADS at age 7 years. Parent and teacher ratings of preschoolers' temperament were combined to form an anger/frustration composite. Similarly, an executive functioning composite was derived from age 6 measures. Bootstrapping was used to determine whether age 6 executive functioning mediated the relation between early anger/frustration and later ADHD symptom severity, while controlling for early executive functioning. Preschoolers' anger/frustration was significantly associated with later ADHD symptoms, with this relation partially mediated by age 6 executive functioning. Developing executive control mediates the relation between early anger/frustration and later ADHD symptom severity, suggesting that anger/frustration influences ADHD symptom severity through its impact on developing executive control. Early interventions targeting the harmful influences of negative emotionality or enhancing executive functioning may diminish later ADHD severity.
26842085	Most nurse educators regard students who enter postgraduate studies as adult learners capable of self-direction and independent learner behaviour. Therefore, a mismatch between the nurse educator's expectation of adult learners and actual adult learner conduct may result in disappointment and even frustration for both educator and learner.This article is a report of a secondary analysis of data that were collected to explore the high-fidelity simulation learning experiences of a group of postgraduate nursing students.The secondary analysis was done to determine whether adult learners who bring professional knowledge and experience to a postgraduate learning environment displayed adult learner conduct as proposed by educational theorist Malcolm Knowles.	Using a qualitative descriptive research design, data were gathered from 18 postgraduate nursing students who participated in high-fidelity simulation in a nursing school at a higher education institution in South Africa. The nominal group technique was used to collect the students' ideas about improving their simulation learning experiences. A secondary qualitative analysis of the primary nominal group data was done.	Data either confirmed or belied adult learner behaviour. Although the findings suggested self-directed and independent learner behaviour, they also revealed behaviour evident of dependence on the educator.	Mature students have well established ways of thinking and doing that may hinder learning. Educators have to support adult learners in developing effective learning techniques in order to maximise the benefits of their experience and knowledge by fostering independence and self-direction.	
26844238	Research on the hypothalamic pituitary adrenal (HPA) axis has involved a proliferation of cortisol indices. We surveyed recently published HPA-related articles and identified 15 such indices. We sought to clarify their biometric properties, specifically, how they interrelate and what they mean, because such information is rarely offered in the articles themselves. In the present article, the primary samples consist of community mothers and their infants (N = 297), who participated in two challenges, the Toy Frustration Paradigm and the Strange Situation Procedure. We sought to cross-validate findings from each of these samples against the other, and also against a clinically depressed sample (N = 48) and a sample of healthy older adults (N = 51) who participated in the Trier Social Stress Test. Cortisol was collected from all participants once before and twice after the challenges. These heterogenous samples were chosen to obtain the greatest possible range in cortisol levels and stress response regulation. Using these data, we computed the 15 summary cortisol indices identified in our literature survey. We assessed inter-relations amongst indices and determined their underlying dimensions via principal component analysis (PCA). The PCAs consistently extracted two components, accounting for 79%-93% of the variance. These components represent "total cortisol production" and "change in cortisol levels." The components were highly congruent across challenge, time, and sample. High variable loadings and explained factor variance suggest that all indices represent their underlying dimensions very well. Thus the abundance of summary cortisol indices currently represented in the literature appears superfluous. 
26837082	Provider burnout can impact efficiency, empathy, and medical errors. Our study examines burnout in a military medical center during a period of war.A survey including the Maslach Burnout Inventory (MBI), deployment history, and work variables was distributed to health care providers. MBI subscale means were calculated and associations between variables were analyzed.	Approximately 60% of 523 respondents were active duty and 34% had deployed. MBI subscale means were 19.99 emotional exhaustion, 4.84 depersonalization, and 40.56 personal accomplishment. Frustration over administrative support was associated with high emotional exhaustion and depersonalization; frustration over life/work balance was associated with high emotional exhaustion.	Levels of burnout in our sample were similar to civilian medical centers. Sources of frustration were related to administrative support and life/work balance. Deployment had no effect on burnout levels.	
26830544	Cultural portrayals of physicians suggest an unclear and even contradictory role for humility in the physician-patient relationship. Despite the social importance of humility, however, little empirical research has linked humility in physicians with patient outcomes or the characteristics of the doctor-patient visit. The present study investigated the relationship between physician humility, physician-patient communication, and patients' perceptions of their health during a planned medical visit.Primary care physician-patient interactions (297 patients across 100 physicians) were rated for the physician's humility and the effectiveness of the physician-patient communication. Additionally, patients reported their overall health and physicians and patients reported their satisfaction with the interaction.	Within-physician fluctuations in physician humility and self-reported patient health positively predicted one another, and mean-level differences in physician humility predicted effective physician-patient communication, even when controlling for the patient's and physician's satisfaction with the visit and the physician's frustration with the patient.	The results suggest that humble, rather than paternalistic or arrogant, physicians are most effective at working with their patients.	Interventions to improve physician humility may promote better communication between health care providers and patients, and, in turn, better patient outcomes.	
26829348	The purpose of this study was to compare catheter-related pain and quality-of-life scores between 2 catheters used after failed voiding trials following urogynecologic surgery.Women failing an inpatient voiding trial requiring short-term catheterization after urogynecologic surgery were randomized to receive either a standard FC or a patient-controlled VC. Subjects completed a 6-item, visual analog scale-based postoperative questionnaire (POQ) and an outpatient voiding trial 3 to 7 days after surgery. Baseline demographic, surgical data, and results of the outpatient voiding trial were recorded. The primary outcome was the difference in mean score for catheter-related pain on the POQ, based on intent to treat. Secondary outcomes included between-group differences in means for individual POQ items and a calculated composite satisfaction score. The statistician was blinded to group assignment.	Forty-nine subjects were randomized to FC (n = 24) and VC (n = 25). Two subjects, one in each group, were excluded from the primary analysis because of missing data. Mean age was 60.6 (SD, 12.5) years. Baseline characteristics were similar. Valve catheter users had a lower median catheter-related pain score (1.25 vs 2.3), but not significantly (P = 0.153). Valve catheter users had significantly lower median scores for frustration (1.2 vs 3.8; P = 0.018) and limitation on social activities (0 vs 7.6; P < 0.001). Mean composite satisfaction score was statistically significantly lower for the VC group (2.23 [SD, 1.83] vs 3.62 [SD, 1.95]; P < 0.01), suggesting greater satisfaction.	Valve catheter and FC users report similar catheter-related pain. Valve catheter users scored better in overall satisfaction, frustration, and limitations on social activities.	
26818374	To describe and understand the experiences and perceptions of women who undergo hysterosalpingography as part of the infertility process.Nurses and midwives should conduct research into the emotional aspects of caring for patients undergoing infertility treatment. The hysterosalpingography is considered to be the most feared test in the infertility process and the one about which very little is known.	A phenomenological qualitative study.	Ten Spanish women who had undergone hysterosalpingography participated in this study. In-depth interviews were carried out between October 2012-May 2013. Data analysis was performed with the help of atlas.ti software to identify emerging themes.	The experience of the participants who underwent hysterosalpingography during the infertility process is represented by the following three themes: (1) becoming a mother to feel complete as a person and as a woman, with the subthemes 'maternity as a life objective' and 'maternity in terms of gender identity'; (2) infertility--an intimate experience which provokes negative feelings, with the subthemes 'negative feelings regarding own infertility' and 'infertility as an experience that is little shared with others'; (3) Undergoing hysterosalpingography, with the subthemes 'feelings regarding hysterosalpingography', 'treatment by medical providers' and 'areas for improvement regarding the service given by the providers'.	For women who undergo hysterosalpingography, maternity may be seen as a life objective that could identify them as women. Results suggest that although infertility is experienced with negative feelings such as anxiety, frustration and sadness, hysterosalpingography seems to be related with both hope and fear when facing the test.	Knowing the experiences of these women could help nurses, midwives and physicians to provide better patient-centred care.	
26810389	Much of a General Practitioner's (GP) workload consists of managing patients with medically unexplained symptoms (MUS). GP trainees are often taking responsibility for looking after people with MUS for the first time and so are well placed to reflect on this and the preparation they have had for it; their views have not been documented in detail in the literature. This study aimed to explore GP trainees' clinical and educational experiences of managing people presenting with MUS.A mixed methods approach was adopted. All trainees from four London GP vocational training schemes were invited to take part in a questionnaire and in-depth semi-structured interviews. The questionnaire explored educational and clinical experiences and attitudes towards MUS using Likert scales and free text responses. The interviews explored the origins of these views and experiences in more detail and documented ideas about optimising training about MUS. Interviews were analysed using the framework analysis approach.	Eighty questionnaires out of 120 (67%) were returned and a purposive sample of 15 trainees interviewed. Results suggested most trainees struggled to manage the uncertainty inherent in MUS consultations, feeling they often over-investigated or referred for their own reassurance. They described difficulty in broaching possible psychological aspects and/or providing appropriate explanations to patients for their symptoms. They thought that more preparation was needed throughout their training. Some had more positive experiences and found such consultations rewarding, usually after several consultations and developing a relationship with the patient.	Managing MUS is a common problem for GP trainees and results in a disproportionate amount of anxiety, frustration and uncertainty. Their training needs to better reflect their clinical experience to prepare them for managing such scenarios, which should also improve patient care.	
26808052	This review will discuss erectile dysfunction in prostate cancer patients following radical prostatectomy . It will focus on the prevalence and current treatments for erectile dysfunction as well as the emotional impact of erectile dysfunction and the current psychosocial interventions designed to help patients cope with this side effect.Although there is a large discrepancy in prevalence rates of erectile dysfunction after radical prostatectomy, several recent studies have cited rates as high as 85%. The concept of 'penile rehabilitation' is now the standard of practice to treat erectile dysfunction following radical prostatectomy. However, many men avoid seeking help or utilizing erectile dysfunction treatments. This avoidance is related to the shame, frustration, and distress many men with erectile dysfunction and their partners experience. Recent psychosocial interventions have been developed to facilitate the use of treatments and help men cope with erectile dysfunction. These interventions have shown initial promise, however, continued intervention development is needed to reduce distress and improve long-term erectile function outcomes.	Erectile dysfunction is a significant problem following prostate cancer surgery. Although there are effective medical treatments, the development of psychosocial interventions should continue to evolve to maximize the assistance we can give to men and their partners.	
26793136	In spite of the prevalence of frustration in everyday life, very few neuroimaging studies were focused on this emotional state. In the current study we aimed to examine effects of frustration on brain activity while performing a well-learned task in participants with low and high tolerance for arousal. Prior to the functional magnetic resonance imaging session, the subjects underwent 2 weeks of Braille reading training. Frustration induction was obtained by using a novel highly difficult tactile task based on discrimination of Braille-like raised dots patterns and negative feedback. Effectiveness of this procedure has been confirmed in a pilot study using galvanic skin response and questionnaires. Brain activation pattern during tactile discrimination task before and after frustration were compared directly. Results revealed changes in brain activity in structures mostly reported in acute stress studies: striatum, cingulate cortex, insula, middle frontal gyrus and precuneus and in structures engaged in tactile Braille discrimination: SI and SII. Temperament type affected activation pattern. Subjects with low tolerance for arousal showed higher activation in the posterior cingulate gyrus, precuneus, and inferior parietal lobule than high reactivity group. Even though performance in the discrimination trials following frustration was unaltered, we observed increased activity of primary and secondary somatosensory cortex processing the tactile information. We interpret this effect as an indicator of additional involvement required to counteract the effects of frustration. 
26790235	There are presently few data on chronic heart failure (CHF) and its consequences on the partner relationship. The aim of our study was to assess how patients with severe CHF and their female partners were affected in their relationship. First, there was a need to address the issue of sexuality with the doctor because of fear of the occurrence of a cardiac event or an implantable cardioverter defibrillator shock. Second, there was often a significant decrease in libido and erectile dysfunction associated with general depressive symptoms. Finally, the female partners in several couples developed an overprotective behavior leading to resentment and frustration in patients towards them.
26788861	Reward-dependent instrumental behavior must continuously be re-adjusted according to environmental conditions. Failure to adapt to changes in reward contingencies may incur psychiatric disorders like anxiety and depression. When an expected reward is omitted, behavior undergoes extinction. While extinction involves active re-learning, it is also accompanied by emotional behaviors indicative of frustration, anxiety, and despair (extinction-induced depression). Here, we report evidence for a sphingolipid mechanism in the extinction of behavior. Rapid extinction, indicating efficient re-learning, coincided with a decrease in the activity of the enzyme acid sphingomyelinase (ASM), which catalyzes turnover of sphingomyelin to ceramide, in the dorsal hippocampus of rats. The stronger the decline in ASM activity, the more rapid was the extinction. Sphingolipid-focused lipidomic analysis showed that this results in a decline of local ceramide species in the dorsal hippocampus. Ceramides shape the fluidity of lipid rafts in synaptic membranes and by that way can control neural plasticity. We also found that aging modifies activity of enzymes and ceramide levels in selective brain regions. Aging also changed how the chronic treatment with corticosterone (stress) or intranasal dopamine modified regional enzyme activity and ceramide levels, coinciding with rate of extinction. These data provide first evidence for a functional ASM-ceramide pathway in the brain involved in the extinction of learned behavior. This finding extends the known cellular mechanisms underlying behavioral plasticity to a new class of membrane-located molecules, the sphingolipids, and their regulatory enzymes, and may offer new treatment targets for extinction- and learning-related psychopathological conditions. Sphingolipids are common lipids in the brain which form lipid domains at pre- and postsynaptic membrane compartments. Here we show a decline in dorsal hippocampus ceramide species together with a reduction of acid sphingomyelinase activity during extinction of conditioned behavior in rats. This reduction was associated with expression of re-learning-related behavior, but not with emotional behaviors. Read the Editorial Highlight for this article on page 485. 
26784537	We present the rationale and design of a randomized controlled trial of cognitive-behavioral therapy (CBT) for aggression in children and adolescents, which is conducted in response to the National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) approach initiative. Specifically, the study is focused on the brain-behavior associations within the RDoC construct of frustrative non-reward. On the behavioral level, this construct is defined by reactions elicited in response to withdrawal or prevention of reward, most notably reactive aggression. This study is designed to test the functional magnetic resonance (fMRI) and electrophysiological (EEG) correlates of aggression and its reduction after CBT.Eighty children and adolescents with high levels of aggression across multiple traditional diagnostic categories, ages 8-16, will be randomly assigned to receive 12 sessions of CBT or 12 sessions of supportive psychotherapy. Clinical outcomes will be measured by the ratings of aggressive behavior collected at baseline, midpoint, and endpoint evaluations, and by the Improvement Score of the Clinical Global Impressions Scale assigned by an independent evaluator (blinded rater). Subjects will also perform a frustration-induction Go-NoGo task and a task of emotional face perception during fMRI scanning and EEG recording at baseline and endpoint.	Consistent with the NIMH strategic research priorities, if functional neuroimaging and EEG variables can identify subjects who respond to CBT for aggression, this can provide a neuroscience-based classification scheme that will improve treatment outcomes for children and adolescents with aggressive behavior.	Demonstrating that a change in the key nodes of the emotion regulation circuitry is associated with a reduction of reactive aggression will provide evidence to support the validity of the frustrative non-reward construct.	
26772613	In Sweden, migrants from countries considered to have a high burden of certain infectious diseases are offered health screening to prevent the spread of these diseases, but also identify their health needs. However, very little is known about their experiences and perceptions about the screening process. This study aimed at exploring these perceptions and experiences in order to inform policy and clinical practice.Using an interpretive description framework, 26 new migrants were interviewed between April and June 2013 in four Swedish counties. Thematic analysis was used to analyze data.	The three themes developed include: new country, new practices; new requirements in the new country; and unmet needs and expectations. Participants described what it meant for them to come to a new country with a foreign language, new ways of communicating with caregivers/authorities and being offered health screening without clarification. Participants perceived health screening as a requirement from the authorities to be fulfilled by all newcomers but conceded that it benefits equally the host society and themselves. However, they also expressed concern over the involvement of the Migration Board staff and feared possible collaboration with health service to their detriment. They further stated that the screening program fell short of their expectations as it mainly focused on identifying infectious diseases and overlooked their actual health needs. Finally, they expressed frustration over delay in screening, poor living conditions in reception centers and the restrictive entitlement to care.	Migrants are aware of their vulnerability and the need to undergo health screening though they view it as an official requirement. Thus, those who underwent the screening were more concerned about residency rather than the actual benefits of screening. The issues highlighted in this study may limit access to and uptake of the screening service, and compromise its effectiveness. To maximize the uptake: (1) linguistically and culturally adapted information is needed, (2) other screening approaches should be tried, (3) trained medical interpreters should be used, (4) a holistic and human right approach should be applied, (5) the involvement of migration staff should be reconsidered to avoid confusion and worries. Finally, to improve the effectiveness, (6) all migrants from targeted countries should be offered screening and efforts should be taken to improve the health literacy of migrants and the living conditions in reception centers.	
26767097	Infertility, as a global phenomenon and one of the most important issues of reproductive health, affects women more often than men, even when the infertility is due to a male factor. The purpose of this study was to explore the cognitive emotional experiences of women faced with male infertility.This qualitative study was conducted in 2014-2015 in Mashhad, Iran. The perceptions and experiences of healthy women whose husbands were diagnosed with primary male factor infertility were investigated using a qualitative content analysis approach. Participants were selected through purposeful sampling, and data collection was conducted using in-depth semistructured interviews. Data were analyzed using conventional content analysis with MAXqda software. Study rigor was verified via criteria proposed by Lincoln and Guba.	One main theme emerged through analysis entitled "cognitive emotional reactions confronting infertility diagnosis" with sub-themes of cognitive emotional reactions when confronted with male infertility diagnosis with subthemes of disbelief and denial, fear and apprehension, suffering and emotional distress, disappointment, frustration, confusion, and joy.	The diagnosis of male infertility was associated with important emotional cognitive consequences for their female partners. Emotional support, providing new insights into how to treat the issue, and trying to shorten the process of diagnosis are necessary for these women. This kind of support could reduce the psychological effects of confrontation with the diagnosis of male infertility, including social insecurity for women.	
26759618	Pharmacists and medical doctors are two professional groups that very often receive their education and practice in the same environment. However, their approach to patient care and collaboration tends to be different and this may lead to both frustration and conflict which may adversely affect patient care. Personality has been identified as a psychological issue that could contribute to conflict in a work situation.To study the personality traits of a cohort of students studying pharmacy and medicine at the University of Malta in their first and final year.	The Gordon Personal Profile - Inventory was administered to a cohort of pharmacy and medical students in their first year and once again administered to the same cohort who completed their course of study in their final year. Basic demographic data was also collected.	In first year the most pronounced traits for both student groups were those of Emotional Stability and Personal Relations. Over a period of five years, there were shifts in personality traits. In their final year pharmacy students were characterized by high scores for Cautiousness and Personal Relations while medical students exhibited medium scores in Cautiousness and Emotional Stability.	The changes in personality traits over the duration of the course were not radical changes but rather that of traits becoming more pronounced.	
26737113	Autism Spectrum Disorder (ASD) is a prevalent and costly neurodevelopmental disorder. Individuals with ASD often have deficits in social communication skills as well as adaptive behavior skills related to daily activities. We have recently designed a novel virtual reality (VR) based driving simulator for driving skill training for individuals with ASD. In this paper, we explored the feasibility of detecting engagement level, emotional states, and mental workload during VR-based driving using EEG as a first step towards a potential EEG-based Brain Computer Interface (BCI) for assisting autism intervention. We used spectral features of EEG signals from a 14-channel EEG neuroheadset, together with therapist ratings of behavioral engagement, enjoyment, frustration, boredom, and difficulty to train a group of classification models. Seven classification methods were applied and compared including Bayes network, naïve Bayes, Support Vector Machine (SVM), multilayer perceptron, K-nearest neighbors (KNN), random forest, and J48. The classification results were promising, with over 80% accuracy in classifying engagement and mental workload, and over 75% accuracy in classifying emotional states. Such results may lead to an adaptive closed-loop VR-based skill training system for use in autism intervention. 
26735388	This study aimed to analyze the experience of working women suffering from chronic musculoskeletal pain, using a qualitative design with a phenomenological approach. The technique drew on in-depth interviews with five working women that presented to the orthopedics and neurosurgery departments of a hospital in Guadalajara, Mexico, with a complaint of musculoskeletal pain for more than six months. The study showed that the women felt rejection, segregation, discrimination, lack of support at the workplace, and feelings of frustration and powerlessness related to their health condition. The women also perceived as a barrier the lack of efficiency in disability proceedings and job reintegration or relocation. Financial and family responsibilities were their main reason for continuing to work despite their chronic musculoskeletal pain. 
26718822	Early thrombosis (ET) contributes to autogenous arteriovenous fistula (AVF) failure. We studied patients undergoing AVF placement in the Hemodialysis Fistula Maturation Study, a prospective, observational cohort study, using a nested case-control analysis to identify preoperative and intraoperative predictors of ET.ET cases were compared with controls, who were matched for gender, age, diabetes, dialysis status, and surgeon fistula volume. ET was defined as thrombosis diagnosed by physical examination or ultrasound within 18 days of AVF creation. Conditional logistic regression models were fit to identify risk factors for ET.	Thirty-two ET cases (5.3%) occurred among 602 study participants; 198 controls were matched. ET was associated with female gender (odds ratio [OR], 2.75; 95% confidence interval [CI], 1.19-6.38; P = .018), fistula location (forearm vs upper arm; OR, 2.76; 95% CI, 1.05-7.23; P = .039), feeding artery (radial vs brachial; OR, 2.64; 95% CI, 1.03-6.77; P = .043) and arterial diameter (OR, 1.52; 95% CI, 1.02-2.26; P = .039, per mm smaller). The draining vein diameter was nonlinearly associated with ET, with highest risk in 2- to 3-mm veins. Surprisingly, ET risk was lower in diabetics (OR, 0.19; 95% CI, 0.07-0.47; P = .0004), lower with less nitroglycerin-mediated brachial artery dilation (OR, 0.42; 95% CI, 0.20-1.92; P = .029 for each 10% lower) and higher with lower carotid-femoral pulse wave velocity (OR, 1.49; 95% CI, 1.02-2.20; P = .041, for each m/s lower). Intraoperative protamine use was associated with a higher ET risk (OR, 3.26; 95% CI, 1.28-∞; P = .038). Surgeon's intraoperative perceptions were associated with ET: surgeons' greater concern about maturation success (likely, marginal, unlikely) was associated with higher thrombosis risk (OR, 8.09; 95% CI, 4.03-∞; P < .0001, per category change), as were absence vs presence of intraoperative thrill (OR, 21.0; 95% CI, 5.07-∞; P = .0001) and surgeons' reported frustration during surgery (OR, 6.85; 95% CI, 2.70-∞; P = .0004). Decreased extent of intraoperative thrill (proximal, mid or distal third of the forearm or upper arm, based on AVF placement) was also associated with ET (OR, 2.91; 95% CI, 1.31-∞; P = .007, per diminished level). Oral antithrombotic medication use was not significantly associated with ET.	ET was found to be associated with female gender, forearm AVF, smaller arterial size, draining vein diameter of 2 to 3 mm, and protamine use. Paradoxically, diabetes and stiff, noncompliant feeding arteries were associated with a lower frequency of ET. Absent or attenuated intraoperative thrill, and both surgeon frustration and concern about successful maturation during surgery, were correlated strongly with ET.	
28321279	Job satisfaction is a major determinant of performance at the workplace. Studies have shown that job dissatisfaction can intensify emotional exhaustion, and this can influence nurses to perceive their work as tiresome and repetitive, leading to frustration and discouragement. The purpose of this study was to investigate the relationship between job satisfaction and attitude towards nursing care at Mzuzu Central Hospital in Mzuzu, Malawi.This was a descriptive correlational study. Eighty-nine nurses were selected using simple random sampling. A self-administered questionnaire was used to collect data. Data were analysed using Stata (version 12). Frequencies, means, and standard deviations were used to summarise sociodemographic data and also to determine job satisfaction and attitudes towards nursing care among the participants. Independent t-tests were used to determine if differences in professional qualifications, job title, work experience, or the clinical setting in which the nurses worked were associated with differences in job satisfaction and attitude. Pearson's product-moment correlation was used to determine the relationship between job satisfaction and attitude in the study sample.	The nurses who participated in this study generally had positive attitudes towards nursing care and were moderately satisfied with their jobs. There was a significant variation in attitude depending on the amount of time a nurse worked at a particular post (P = 0.0308), as well as the amount of time a nurse had worked at the hospital (P = 0.0012). There was a significant positive relationship between job satisfaction and attitude (r = 0.226, P = 0.033).	The nurses in the study sample were moderately satisified with their work and generally had positive attitudes towards nursing care. There was a positive correlation between attitude towards nursing care and job satisfaction. Addressing factors which dissatisfy nurses can promote nurses' attitudes and likely improve performance and patient care.	
26713624	To understand the emotional difficulties associated with living with the ocular condition Retinitis Pigmentosa, and to examine the functioning of a self-report instrument used to assess this construct.The difficulty of goals and tasks in the emotional health domain of the Dutch ICF Activity Inventory were rated by 166 people with Retinitis Pigmentosa in a cross-sectional study. Demographic factors were also assessed.	Responses to the 23 emotional health tasks were Rasch analysed and could be used to form either one 20 item overview scale with some multidimensionality, or three unidimensional subscales addressing feelings (4 items), communicating visual loss (5 items) and fatigue (7 items). The most difficult individual tasks related to communicating visual loss to other people, and dealing with feelings such as frustration, anxiety and stress. The use of mobility aids and female gender were associated with increased difficulty with emotional health, explaining 19% of the variance in the overview scale.	The emotional health domain of the Dutch ICF Activity Inventory is a valid tool to assess emotional difficulties arising from visual loss. Interventions to aid people with Retinitis Pigmentosa deal with emotional difficulties should particularly address communicating vision loss effectively to others and coping with negative feelings.	
26665476	Due to a variety of impingements on their clinical decision-making and overall practice autonomy, many physicians are expressing frustration with the current medical practice environment and are disengaging from patient care roles as a result. In this article, we trace the causes of physician dissatisfaction and the ways in which physicians are seeking alternative practice styles. We then outline steps medical practices can take to keep physicians engaged in patient care and productive in their practices.
26656770	Dual-tasking, the need to divide attention between concurrent tasks, causes a severe increase in workload in emergency situations and yet there is no standardised training simulation scenario for this key difficulty.We introduced and validated a quantifiable source of divided attention and investigated its effects on performance and workload in airway management.	A randomised, crossover, interventional simulation study.	Center for Training and Simulation, Department of Anaesthesiology, Erlangen University Hospital, Germany.	One hundred and fifty volunteer medical students, paramedics and anaesthesiologists of all levels of training.	Participants secured the airway of a manikin using a supraglottic airway, conventional endotracheal intubation and video-assisted endotracheal intubation with and without the Paced Auditory Serial Addition Test (PASAT), which served as a quantifiable source of divided attention.	Primary endpoint was the time for the completion of each airway task. Secondary endpoints were the number of procedural mistakes made and the perceived workload as measured by the National Aeronautics and Space Administration's task load index (NASA-TLX). This is a six-dimensional questionnaire, which assesses the perception of demands, performance and frustration with respect to a task on a scale of 0 to 100.	All 150 participants completed the tests. Volunteers perceived our test to be challenging (99%) and the experience of stress and distraction true to an emergency situation (80%), but still fair (98%) and entertaining (95%). The negative effects of divided attention were reproducible in participants of all levels of expertise. Time consumption and perceived workload increased and almost half the participants make procedural mistakes under divided attention. The supraglottic airway technique was least affected by divided attention.	The scenario was effective for simulation training involving divided attention in acute care medicine. The significant effects on performance and perceived workload demonstrate the validity of the model, which was also characterised by high acceptability, technical simplicity and a novel degree of standardisation.	
26653135	The present study tested specific hypotheses advanced by the developmental propensity model of the etiology of conduct problems in the Colorado Longitudinal Twin Study, a prospective, longitudinal, genetically informative sample. High negative emotionality, low behavioral inhibition, low concern and high disregard for others, and low cognitive ability assessed during toddlerhood (age 14 to 36 months) were examined as predictors of conduct problems in later childhood and adolescence (age 4 to 17 years). Each hypothesized antisocial propensity dimension predicted conduct problems, but some predictions may be context specific or due to method covariance. The most robust predictors were observed disregard for others (i.e., responding to others' distress with active, negative responses such as anger and hostility), general cognitive ability, and language ability, which were associated with conduct problems reported by parents, teachers, and adolescents, and change in observed negative emotionality (i.e., frustration tolerance), which was associated with conduct problems reported by teachers and adolescents. Furthermore, associations between the most robust early predictors and later conduct problems were influenced by the shared environment rather than genes. We conclude that shared environmental influences that promote disregard for others and detract from cognitive and language development during toddlerhood also predispose individuals to conduct problems in later childhood and adolescence. The identification of those shared environmental influences common to early antisocial propensity and later conduct problems is an important future direction, and additional developmental behavior genetic studies examining the interaction between children's characteristics and socializing influences on conduct problems are needed. (PsycINFO Database Record
26628528	To explore junior doctors' knowledge about and experiences of managing patients with medically unexplained symptoms (MUS) and to seek their recommendations for improved future training on this important topic about which they currently receive little education.Qualitative study using in-depth interviews analysed using the framework method.	Participants were recruited from three North Thames London hospitals within the UK.	Twenty-two junior doctors undertaking the UK foundation two-year training programme (FY1/FY2).	The junior doctors interviewed identified a significant gap in their training on the topic of MUS, particularly in relation to their awareness of the topic, the appropriate level of investigations, possible psychological comorbidities, the formulation of suitable explanations for patients' symptoms and longer term management strategies. Many junior doctors expressed feelings of anxiety, frustration and a self-perceived lack of competency in this area, and spoke of over-investigating patients or avoiding patient contact altogether due to the challenging nature of MUS and a difficulty in managing the accompanying uncertainty. They also identified the negative attitudes of some senior clinicians and potential role models towards patients with MUS as a factor contributing to their own attitudes and management choices. Most reported a need for more training during the foundation years, and recommended interactive case-based group discussions with a focus on providing meaningful explanations to patients for their symptoms.	There is an urgent need to improve postgraduate training about the topics of MUS and avoiding over-investigation, as current training does not equip junior doctors with the necessary knowledge and skills to effectively and confidently manage patients in these areas. Training needs to focus on practical skill development to increase clinical knowledge in areas such as delivering suitable explanations, and to incorporate individual management strategies to help junior doctors tolerate the uncertainty associated with MUS.	
26625511	Ms B's in United Kingdom and Ms P's in Finland choices in life when dealing with acute ventilator-assisted tetraplegia were analyzed by means of Viktor E. Frankl's existential analysis/logotherapy. The freedom of will to existential meaning and to worth in one's suffering realizes in the attitudinal change the person chooses or is forced to adopt when subject to severe circumstances. Life becomes existentially meaningful relative to inescapable suffering by the completion of three values: creative, experiential, and attitudinal values. If the search for meaning on these paths is frustrated or obstructed, a person's will to meaning transforms into existential frustration along with an existential vacuum and feelings of despair emerge and harm the person's will to survive. However, a person's frustrated meaning in life, when subject to unavoidable severe conditions, can be averted and redirected by applying the basic tenets in an existential analytic/logotherapeutic approach to the extreme situation.
26621061	Workers' experience of violence and perceived unsafety can have a profound impact on job satisfaction, job performance, and workers' decision to leave.The aim of the study was to assess the prevalence of physical and non-physical violence among hospital workers, explore the complaints and reactions of victims, assess the relationship between violence and psychosocial/work factors and analyze the levels of perceived unsafety.	A cross-sectional study was conducted, via a structured self-administered questionnaire given to all the employees of a major hospital in Italy. Cronbach's alpha coefficient was used to assess the internal consistency of the questionnaire. A logistic regression model was used for data analysis.	903 questionnaires out of 1853 (48.7%) were correctly returned; 11.5% had experience of physical violence and 40.2% had been victims of verbal violence in the previous 12 months. The most common consequences were fear, anger, frustration, and anxiety. Verbal violence was influenced by age, role, department, night/holiday shift work and experience in the current ward. Experiences of physical violence were related to gender, role, and department; 469 responders (51.9%) reported feelings of unsafety, which were related to their professional role, department, shift work, experience of physical or psychological violence, having seen episodes of violence and having received specific training.	Our findings suggest that several factors are associated with workplace violence in health care settings and some of these also influenced the levels of perceived unsafety.	
26617536	Testing mediation models is critical for identifying potential variables that need to be targeted to effectively change one or more outcome variables. In addition, it is now common practice for clinicians to use multiple informant (MI) data in studies of statistical mediation. By coupling the use of MI data with statistical mediation analysis, clinical researchers can combine the benefits of both techniques. Integrating the information from MIs into a statistical mediation model creates various methodological and practical challenges. The authors review prior methodological approaches to MI mediation analysis in clinical research and propose a new latent variable approach that overcomes some limitations of prior approaches. An application of the new approach to mother, father, and child reports of impulsivity, frustration tolerance, and externalizing problems (N = 454) is presented. The results showed that frustration tolerance mediated the relationship between impulsivity and externalizing problems. The new approach allows for a more comprehensive and effective use of MI data when testing mediation models. 
26613944	Occupational medicine has shifted emphasis from disease treatment to disability rehabilitation and management. Hence, newly developed occupational rehabilitation programs are often generic and multicomponent, aiming to influence the sick-listed persons' perception on return to work, and thereby support the return to work process. The aim of this study was to explore sick-listed persons' experiences with taking part in an in-patient occupational rehabilitation program based on Acceptance and Commitment Therapy.Twenty-nine adults on sickness benefit or work assessment allowance due to musculoskeletal and/or common mental health disorders participated in this study. They were interviewed in focus groups at the beginning and at the end of a 3.5 week inpatient group-based occupational rehabilitation program in Central Norway. Key elements in the program were Acceptance and Commitment Therapy (ACT), physical exercise and creating a work-participation plan. The program was mainly group-based including participants with different diagnoses. Data was analyzed according to a phenomenological approach.	At the start of the program most participants expressed frustration regarding being sick-listed, external anticipations as well as hindrances towards returning to work, and described hope that the program would provide them with the skills and techniques necessary to cope with health problems and being able to return to work. At the end of the program the participants described that they had embarked upon a long process of increased awareness. This process encompassed four areas; an increased awareness of what was important in life, realizing the strain from external expectations and demands, a need to balance different aspects of life, and return to work as part of a long and complex process.	The occupational rehabilitation program induced a perceived meaningful reorientation encompassing several aspects of life. However, the return to work process was described as diffuse and uncertain for most participants. The providers of occupational rehabilitation program should balance this reorientation with specific steps towards return to work. Effect studies and long-term qualitative studies evaluating how this affects long-term work- and health outcomes are underway.	
26612113	Guided by emotional security theory, this study examined the temperamental precursors of distinctive profiles of children's responses to interparental conflict. Participants included 243 children (M = 4.6 years) and their parents across two annual measurement occasions. Temperamental constructs of frustration proneness, approach, positive affect, activity level, and effortful control were assessed through multiple methods, informants, and contexts. Behavioral observations of children's responses to interparental conflict at each wave yielded four profiles: secure (i.e., efficiently address direct threat), mobilizing (i.e., vigilance to potential threat and social opportunities), dominant (i.e., directly defeat threat), and demobilizing (i.e., reduce salience as a target of hostility). Results supported hypotheses on the distinct constellations of temperament in predicting subsequent change in the four security profiles. 
26610187	Acquired brain injury (ABI) not only has an impact on the survivor, but also on the partner and personal relationships as a whole. The present study aimed to investigate the male partner experience of living with a female with an ABI; exploring role change, intimacy and future expectations. Semi-structured interviews were conducted with six male partners of five females with a subarachnoid haemorrhage and one female with a traumatic brain injury. Interviews were transcribed verbatim and analysed in depth using Interpretative Phenomenological Analysis (IPA). Four main themes captured the male partner's lived experience; "Entering the unknown world of ABI", "Imprisoned by the ABI", "Compassion without self-compassion", and "Holding on to hope". The accounts uncovered the male partner's journey following ABI; the unpredictability, sorrow, frustration, and finally acceptance and commitment to their partner. They identified the limited support available for partners following ABI; the sense of feeling forgotten by services and the need for information and support in the acute stages. Rehabilitation needs to take a systemic and longer-term focus, supporting both the survivor and their partner through the journey of ABI.
26608700	The deterioration of a couple's relationship has been previously associated with impairment in male sexual function. Besides a couple's dystonic relationship, other stressors can unfavorably influence dyadic intimacy. A largely neglected etiopathogenetic factor affecting couple sexuality is the frustration caused by conflicts within the family.To evaluate the possible associations between male sexual dysfunction (SD) and conflictual relationships within the couple or the family.	A consecutive series of 3,975 men, attending the Outpatient Clinic for SD for the first time, was retrospectively studied. Conflicts within the family and within the couple were assessed using two standard questions: "Are there any conflicts at home," and "Do you have a difficult relationship with your partner?" respectively, rating 0 = normal relationships, 1 = occasional quarrels, and 2 = frequent quarrels or always.	Several clinical, biochemical, and psychological (Middlesex Hospital Questionnaire) parameters were studied.	Among the 3,975 patients studied, we observed a high prevalence of conflicts within the family and within the couple (32% vs. 21.2%). When compared with the rest of the sample, subjects reporting both type of conflicts showed a higher prevalence of psychiatric comorbidities. Hence, all data were adjusted for this parameter and for age. Family and couple conflicts were significantly associated with free floating anxiety, depression symptoms, and with a higher risk of subjective (self-reported) and objective (peak systolic velocity at the penile color Doppler ultrasound <35 mm/sec2) erectile dysfunction and hypoactive sexual desire. Female sexual function parameters, as reported by the patient, retained a significant association with both type of conflicts.	This study indicates that the presence of often unexplored issues, like conflicts within the family or within the couple, can represent an important contextual factor in the determinism of male SD.	
26603895	Internationally, the workload of emergency departments (ED) has increased, resulting in overcrowding and frequent delays in the offloading of patients arriving via ambulance--referred to in Australia as 'ambulance ramping'.Using interpretive phenomenology, this study sought to understand the experience of ambulance ramping from the perspective of patients. Semi-structured interviews were undertaken with seven patients who presented to a regional Queensland ED via ambulance, and experienced an ambulance offload delay of >30 min.	Ambulance ramping in the ED was described as 'Being a patient, patient', and three major themes emerged: Understanding the emergency healthcare system; Making do within the emergency healthcare system; and Being 'in the dark' during ambulance ramping. Most participants did not understand the antecedents to ambulance ramping, but understood some of the consequences. Most were happy to wait with paramedics for a bed and, although without privacy, felt safe. However, most participants felt 'in the dark' during ambulance ramping, due to communication difficulties regarding bed availability, and this led to frustration.	In light of the Australian Charter of Healthcare Rights, service improvement opportunities exist for patients arriving to the ED by ambulance to ensure delays are minimised and quality care is delivered.	
26589300	Infants' temperamental anger or frustration reactions are highly stable, but are also influenced by maturation and experience. It is yet unclear why some infants high in anger or frustration reactions develop disruptive behavior problems whereas others do not. We examined family regularity, conceptualized as the consistency of mealtime and bedtime routines, as a protective factor against the development of oppositional and aggressive behavior. This study used prospectively collected data from 3136 families participating in the Generation R Study. Infant anger or frustration reactions and family regularity were reported by mothers when children were ages 6 months and 2-4 years, respectively. Multiple informants (parents, teachers, and children) and methods (questionnaire and interview) were used in the assessment of children's oppositional and aggressive behavior at age 6. Higher levels of family regularity were associated with lower levels of child aggression independent of temperamental anger or frustration reactions (β = -0.05, p = 0.003). The association between child oppositional behavior and temperamental anger or frustration reactions was moderated by family regularity and child gender (β = 0.11, p = 0.046): family regularity reduced the risk for oppositional behavior among those boys who showed anger or frustration reactions in infancy. In conclusion, family regularity reduced the risk for child aggression and showed a gender-specific protective effect against child oppositional behavior associated with anger or frustration reactions. Families that ensured regularity of mealtime and bedtime routines buffered their infant sons high in anger or frustration reactions from developing oppositional behavior. 
26587688	This study aimed to understand the symptomatic impact of amyloid light-chain (AL) amyloidosis from the patient's perspective.Four data sources were included: a literature review, review of online patient blogs, expert clinician interviews and patient interviews. Patients were recruited through the Amyloidosis Foundation and physician referral. Phone interviews were conducted and included open-ended concept elicitation questions. Thematic analysis was performed to identify symptoms and impacts. Descriptive statistics were used to characterize the sample. A conceptual model was developed depicting the impact of disease and treatment.	Two hundred seventy abstracts were identified; 10 articles were deemed relevant. No qualitative studies were identified, and only three studies included patient-reported measures. Ten patients completed interviews (mean age 61 [±8]; 7 male). Over 25 signs/symptoms were identified, including fatigue, weakness, dyspnea, neuropathy, edema, dizziness/lightheadedness, anorexia, diarrhea and constipation. Impacts included reduced physical and social functioning, and emotional impacts, including frustration, anxiety and depression. Findings from the blogs and expert interviews were consistent with patient reports.	Symptoms can vary widely, but a core set of symptoms were common across patients. The conceptual model derived from this study can be used to ensure a patient-centered approach to drug development.	
26577554	Nurses experience feelings of frustration, anger and fear when caring for patients who self-harm. Training programmes were developed that aimed to positively influence nurses' knowledge, attitudes and skills. The aim of this study was to investigate professional behavior of mental health nurses with positively changed attitudes after following a training program. Using grounded theory, semi-structured interviews were conducted with 11 mental health nurses. Participants reported using less restrictive interventions, being more patient oriented, and choosing a more empathic and exploratory approach after the training. A work environment conductive to making autonomous professional decisions with supportive colleagues enabled these changes. 
26568229	Loneliness and depression are serious mental health concerns across the spectrum of residential care, from nursing homes to assisted and retirement living. Psychosocial care provided to residents to address these concerns is typically based on a long-standing tradition of 'light' social events, such as games, trips, and social gatherings, planned and implemented by staff. Although these activities provide enjoyment for some, loneliness and depression persist and the lack of resident input perpetuates the stereotype of residents as passive recipients of care. Residents continue to report lack of meaning in their lives, limited opportunities for contribution and frustration with paternalistic communication with staff. Those living with dementia face additional discrimination resulting in a range of unmet needs including lack of autonomy and belonging-both of which are linked with interpersonal violence. Research suggests, however, that programs fostering engagement and peer support provide opportunities for residents to be socially productive and to develop a valued social identity. The purpose of this paper is to offer a re-conceptualization of current practices. We argue that residents represent a largely untapped resource in our attempts to advance the quality of psychosocial care. We propose overturning practices that focus on entertainment and distraction by introducing a new approach that centers on resident contributions and peer support. We offer a model-Resident Engagement and Peer Support (REAP)-for designing interventions that advance residents' social identity, enhance reciprocal relationships and increase social productivity. This model has the potential to revolutionize current psychosocial practice by moving from resident care to resident engagement.
26562461	Asthma is one of the most common chronic diseases in children. The unpredictability, frequency, and health risks associated with acute asthma attacks have a profound impact on the daily lives of affected children and their families. Understanding the experiences of primary caregivers may help nurses provide better care to children with asthma.This study explores the experience of primary caregivers in providing care to children with asthma.	The study used exploratory and descriptive research methods and collected data using a qualitative research interview approach. Seventeen primary caregivers of children with asthma who visited the allergy clinics of two medical centers and one regional hospital in northern Taiwan participated in the study. An interview guide with a semistructured questionnaire was used, and verbatim transcripts of the audiotape-recorded interviews were analyzed using content analysis.	The findings are described in three themes covering 10 categories. These themes and categories include feelings of uncertainty during illness (disease as perception related, lack of information), feelings of chaos and instability (worry, fear, frustration, helplessness, physical distress), and social tension and family conflict (disorientation of daily activity and burden of care, economic burden, family tensions and disagreements).	Negative experiences with asthma care and the unpredictability of the disease outcomes impair the ability of caregivers to adapt successfully to their caregiving role and encourage perceptions that they cannot cope with this illness. Better understanding the caregiver experience may assist healthcare providers to better target support to these caregivers so that they are better able to care for children with asthma.	
26561887	Music represents a considerable challenge for many adult users of cochlear implants (CIs). Around half of adult CI users report that they do not find music enjoyable, and, in some cases, despite enhanced speech perception skills, this leads to considerable frustration and disappointment for the CI user. This paper presents suggestions to improve the musical experiences of deafened adults with CIs. Interviews with a number of adult CI users revealed that there were a number of factors which could lead to enhanced music experiences. The acronym FAVORS (familiar music, auditory-visual access, open-mindedness, and simple arrangements) summarizes the factors that have been identified, which can help CI users in their early music listening experiences. Each of these factors is discussed in detail, along with suggestions for how they can be used in therapy sessions. The use of a group approach (music focus groups) is also discussed and an overview of the approach and exercises used is presented. The importance of live music experiences is also discussed. 
26561588	The lack of specific prosthetic-related outcome instruments for Spanish amputees must be addressed.To elaborate a culturally equivalent version of the Prosthesis Evaluation Questionnaire in the Spanish language.	Cross-cultural questionnaire validation.	Two-step process for cultural adaptation: forward and backward translations of English original and Spanish translated versions; assessment of both construct and criterion validity and reliability in a group of vascular amputees.	A total of 61 patients were recruited, 44 men (72.1%) and 17 women (27.9%), with a median age of 71.1 years (standard deviation: 7.7 years; range: 51-87 years). In the Prosthesis Evaluation Questionnaire-Spanish, the lowest scores were for gait and frustration, and the highest scores were for noise and stump health. Internal consistency of the questionnaire was acceptable (>0.70) for four of the scales used in the Prosthesis Evaluation Questionnaire but poor (<0.50) for the scales relating to appearance and stump health. Correlations with the quality-of-life levels as measured by the Short Form-36 were positive and mostly significant.	Prosthesis Evaluation Questionnaire-Spanish could assess the quality of life in patients who have undergone vascular amputations and then been fitted with a prosthetic limb. The questionnaire shows adequate criteria validity when compared with other instruments for measuring quality of life.	The Prosthesis Evaluation Questionnaire-Spanish could be a valid and reliable instrument for assessing adaptation to prostheses in vascular amputees. The questionnaire adds information relevant to the patient and the physician and may identify cases with poor expected adaptation to the prosthesis.	
26553899	My fellow physician and friend died from a rare type of cancer. She was a model for me in many respects. She showed me how to cope with a chronic disease together with a demanding professional life, yet she left me without any comfort or guidelines on how to contend with a terminal disease. This story is a reflection on my frustration and disappointment with my friend's final choices that prevented us from processing our feelings and sharing our deepest thoughts. The story includes reflections and insights about our ability to understand and accept the preferences of patients and others close to us.
26543068	To identify the categories of problems with information technology (IT), which affect patient safety in general practice.General practitioners (GPs) reported incidents online or by telephone between May 2012 and November 2013. Incidents were reviewed against an existing classification for problems associated with IT and the clinical process impacted.	87 GPs across Australia.	Types of problems, consequences and clinical processes.	GPs reported 90 incidents involving IT which had an observable impact on the delivery of care, including actual patient harm as well as near miss events. Practice systems and medications were the most affected clinical processes. Problems with IT disrupted clinical workflow, wasted time and caused frustration. Issues with user interfaces, routine updates to software packages and drug databases, and the migration of records from one package to another generated clinical errors that were unique to IT; some could affect many patients at once. Human factors issues gave rise to some errors that have always existed with paper records but are more likely to occur and cause harm with IT. Such errors were linked to slips in concentration, multitasking, distractions and interruptions. Problems with patient identification and hybrid records generated errors that were in principle no different to paper records.	Problems associated with IT include perennial risks with paper records, but additional disruptions in workflow and hazards for patients unique to IT, occasionally affecting multiple patients. Surveillance for such hazards may have general utility, but particularly in the context of migrating historical records to new systems and software updates to existing systems.	
26528948	Spinal cord injury (SCI) is a catastrophe that causes disabilities and permanently changes people's lives. The people have to adapt to the loss of self-care ability and may need long-term rehabilitation. The recovery can be problematic, affecting physiological, psychological, and financial aspects of life. The purpose of this study was to explore the lived experiences of persons with SCI living in Taiwan.In 2009, we conducted a qualitative study on 10 participants with SCI recruited from the Association of Spinal Cord Injury Persons in Taiwan. Open-ended interviews were conducted using a guide and tape recorder for subsequent transcription. A phenomenological method was used to collect data by interviews.	The core experience of persons with SCI was "finding a way to cope," which was a process from despair to self-acceptance and composed of four categories: (a) shock and unpreparedness for the injury: the catastrophe of the injury itself and the underrecognition of physiological disabilities; (b) panic and fear: denying the injury and yearning for a miracle; (c) abyss of despair: imprinting of life, bearing the agony alone, and chaos of life; and (d) reflection on the meaning of life: adaptation to physical disabilities, self-acceptance, and growth.	Our research was descriptive and focused on the structure of the lived experiences of persons with SCI. Many issues of inequality also revealed physical disabilities, such as difficulty looking professional, resulting in burden of stress and frustration. These results highlight persons with SCI should be classified as case management and integration of social welfare resources to facilitate care for persons with SCI after discharge.	
26518626	Assisted living (AL) is a growing option for housing for older adults with dementia in the United States. Typically, nurses are not employed in AL in California. The purpose of this paper is to describe the health care incidents and experiences of residents and their family members who are transferred from AL to an (emergency department) ED. Data were collected from two dementia-only AL communities in California over a period of six months. In this study, only 32% of ED visits resulted in admission to acute care. Of the 71 residents, eight (11%) were responsible for 47% of the ED visits. Qualitative interviews with 3 employees and 9 family members and focus groups with 11 employee caregivers were conducted to augment the quantitative data. The qualitative theme of frustration and helplessness by family and staff to prevent repeated falling and ED transfers was identified, which complemented the quantitative findings. 
26509684	Moderate to severe traumatic brain injuries can negatively influence health-related quality of life (HRQOL) in adolescent patients. The effect of sport-related concussion on adolescent HRQOL remains unclear.To investigate the perceptions of adolescent student-athletes and their parents regarding the adolescents' HRQOL 1 year after sport-related concussion.	Qualitative study.	Secondary school.	Seven adolescent student-athletes (age range, 12-16 years) who sustained a sport-related concussion at least 1 year (15.3 ± 2.8 months) before the study participated along with their primary care-giving parents (n = 7).	Fourteen semistructured face-to-face interviews (7 adolescents, 7 parents) were completed. Interviews were transcribed and inductively analyzed by a team of 3 athletic trainers with 32 combined years of professional experience. Themes were negotiated through a consensual review process. Participant checks were completed to ensure trustworthiness of the results.	Four major themes emerged from the interviews: (1) significant effect of symptoms, (2) feelings of frustration, (3) influence on school attendance and activities, and (4) nature of interpersonal and team relationships. Participants indicated that the physical symptoms of the concussion substantially affected their emotional and academic function. The influence of the concussion on social interactions seemed to depend on the nature of interpersonal relationships.	Sport-related concussion can negatively influence physical and emotional function, academics, and interpersonal interactions as perceived by adolescent student-athletes and their parents. Education of parents and their children, school professionals, coaches, and teammates remains critical to effectively recognize and manage sport-related concussion. Secondary school districts also play a critical role in the concussion-management process by establishing and implementing accommodation policies that alleviate student concerns about falling behind while ensuring a healthy return to normal school routines. Furthermore, adolescent support systems must be considered throughout the recovery process.	
26508397	In 2012, the Boston Housing Authority (BHA) in Massachusetts implemented a smoke-free policy prohibiting smoking within its residences. We sought to characterize BHA resident experiences before and after the smoke-free policy implementation, and compare them to that of nearby residents of the Cambridge Housing Authority, which had no such policy.We recruited a convenience sample of nonsmoking residents from the BHA and Cambridge Housing Authority. We measured residents' awareness and support of their local smoking policies before and 9-12 months after the BHA's policy implementation, as well as BHA respondents' attitudes towards the smoke-free policy. We assessed tobacco smoke exposure via saliva cotinine, airborne apartment nicotine, and self-reported number of days smelling smoke in the home. We evaluated predictors of general satisfaction at follow-up using linear regression.	At follow-up, 91% of BHA respondents knew that smoking was not allowed in apartments and 82% were supportive of such a policy in their building. BHA residents believed enforcement of the smoke-free policy was low. Fifty-one percent of BHA respondents indicated that other residents "never" or "rarely" followed the new smoke-free rule and 41% of respondents were dissatisfied with policy enforcement. Dissatisfaction with enforcement was the strongest predictor of general housing satisfaction, while objective and self-reported measures of tobacco smoke exposure were not predictive of satisfaction. At follow-up, 24% of BHA participants had complained to someone in charge about policy violations.	Resident support for smoke-free policies is high. However, lack of enforcement of smoke-free policies may cause frustration and resentment among residents, potentially leading to a decrease in housing satisfaction.	Smoke-free housing laws are becoming increasingly prevalent, yet little is known about satisfaction and compliance with such policies post-implementation. We evaluated nonsmoking residents' attitudes about smoke-free rules and their satisfaction with enforcement 1 year after the BHA implemented its comprehensive smoke-free policy. We found that while residents were supportive of the policy, they believed enforcement was low, a perception that was associated with a drop in housing satisfaction. Our findings point to a desire for smoke-free housing among public housing residents, and the importance of establishing systems and guidelines to help landlords monitor and enforce these policies effectively.	
26506161	We aimed to qualitatively describe the emotional burden experienced by women seeking treatment for prolapse. We hypothesized that the condition of prolapse would have an impact on women's emotional well-being.Women with stage II or greater symptomatic prolapse participated in focus groups or individual phone interviews. A trained facilitator conducted semi-structured focus groups and interviews. These were audio-taped and transcribed. Two authors coded transcripts and identified themes using an "editing" approach. The codebook was amended until no new major themes emerged from the data.	Forty-four women participated (25 in focus groups and 19 in phone interviews). Mean (SD) age of women was 60 (10) years and mean (SD) prolapse leading edge was 3 (2) cm. Analysis revealed the following 3 main themes: (1) emotions associated with the condition of prolapse (minimal emotions, annoyance, irritation, frustration, anger, sadness, anxiety, depression), (2) communicating emotions related to prolapse (to friends, family, healthcare providers), and (3) emotions relating to treatment (both positive and negative effects).	Prolapse significantly impacts women's emotional health and subjective well-being. An improved understanding of women's emotional experiences of prolapse may help providers better meet patients' needs.	
26503069	Fetal alcohol spectrum disorders (FASD) are often characterized by disruptive behavior problems and there are few effective interventions available. GoFAR is a novel, 3-part intervention designed to improve self-regulation and adaptive living skills of children with FASD by improving metacognitive control of emotions and arousal.The intervention has 3 components: (i) GoFAR: a "serious game" designed to teach a metacognitive control strategy in a computer game environment; (ii) parent training on child behavioral regulation; and (iii) Behavior Analog Therapy (BAT) sessions, a practical application of the metacognitive learning methodology by parent and child in the context of learning adaptive skills. The learning strategy (FAR) teaches the child to Focus and make a plan, Act out the plan, and Reflect back on the plan. Thirty families were randomized to 3 groups: (i) GoFAR (n = 10); (ii) FACELAND (n = 10); or (iii) CONTROL (n = 10). The 2 intervention groups, GoFAR and FACELAND, used computer games to instruct children. Both groups also received 5 sessions of parent training followed by 5 sessions of joint parent/child therapy (BAT). Assessment of disruptive behavior, including frequency of temper tantrums, frustration tolerance, impulsivity, destructiveness, aggression, and maintaining attention were carried out before enrollment at Mid-Treatment, when game play and parent training were completed, and finally, after completing the BAT sessions.	Parental report of disruptive behavior overall was significantly reduced in the GoFAR group after the first components, game play and parent training, and after the BAT sessions in the FACELAND group with no changes in the CONTROL group over time.	The GoFAR(®) game was well received by children and effective in teaching the required skills. Mastering the FAR metacognitive strategy was associated with a reduction in disruptive behaviors in children with FASD suggesting that effective interventions can improve outcomes for this high-risk group.	
26490011	Previous gastroschisis specific neurodevelopmental studies have focused on the first 3years of life. The aim of this study was to assess the intellectual, behavioral and neurological outcomes of older children and adolescents born with gastroschisis.Of 99 gastroschisis survivors born in Western Australia, 1992 to 2005, and who were at least 5years old, 42 agreed to take part in this study. The study assessed: intellectual ability, with age appropriate Wechsler intelligence scales; neurological status; hearing; vision; behavioral status with the Strengths and Difficulties Questionnaire (SDQ); and parenting style with the Parenting Relationship Questionnaire (PRQ). All results were compared to normative means.	Median age at follow-up was 10years (range 5-17). No child had evidence of cerebral palsy or hearing loss; 1 child had amblyopia. Psychometric tests were completed in 39 children: mean full scale IQ was 98.2 (standard deviation [SD] 10.7); the working memory index was the only subscale to show a significant decrease from the normative mean (mean 95.5, SD 12.4, p=0.038). The mean SDQ behavioral scores were significantly lower for 3 of 5 domains and the Total Difficulties score. PRQ scores were significantly abnormal for 4 of 7 domains: Communication, Discipline, Satisfaction with School and Relational Frustration.	Overall intellectual abilities were within a normal range. The decrease in working memory index and the behavioral and parenting relationship impairments could be an effect of perinatal factors, gastroschisis management and complications or the complexity of the socio-economic environment.	
26482431	Prenatal stress negatively affects fetal development, which in turn may affect infant hypothalamic-pituitary-adrenal (HPA) axis regulation and behavioral functioning. We examined effects of exposure to a traumatic stressor in families [intimate partner violence (IPV)] on both infants' HPA axis reactivity to stress and their internalizing and externalizing behaviors. Infants (n = 182, 50% girls, x age = 11.77 months) were exposed to a laboratory challenge task designed to induce frustration and anger (i.e. arm restraint). Saliva samples were taken pre-task and 20 and 40 min post-task and then assayed for cortisol. Mothers reported on their pregnancy and postpartum IPV history, current mental health, substance use and their infants' behaviors. Structural equation modeling revealed that prenatal, but not postnatal, IPV was independently associated with infant cortisol reactivity and problem behavior. Maternal mental health predicted infant behavioral functioning but not infant HPA axis reactivity. These findings are consistent with the prenatal programing hypothesis; that is, early life stress affects later risk and vulnerability for altered physiological and behavioral regulation. 
26467258	To investigate the perceived experiences and considerations among potential kidney transplantation donors in relation to acceptance or rejection as donors.Kidney transplantations are successfully performed in all Western countries, but the prevalence of patients waiting for organs from deceased donors far exceeds the number of organs available. This shortfall has promoted donation by living donors, who enter the donation process with feelings of hope, concern and patience to be accepted or rejected for donation.	A phenomenological-hermeneutic approach was applied in the study.	Semi-structured interviews were conducted with 16 participants. Data were interpreted and discussed in accordance with Ricoeur's theory of interpretation involving: naïve reading, structural analysis, critical interpretation and discussion.	Accepted donors experienced relief and delight. Reflections were made on being prepared for donation and on the risks involved. Relationships between donors and recipients became closer. Rejected donors experienced frustration and disappointment, including anxiety about the recipient's prospects. Rejected donors reflected on the reason for rejection, and this could include considerations about changes to their own lifestyle. Reactions from relatives had an impact on donors.	The study concluded that both the accepted and rejected donors were vulnerable and in need of attention, engagement, support and care. The study draws attention to the need for healthcare professionals to be open and sensitive to the donors' descriptions of their unique experiences of being accepted or rejected for kidney donation.	Nurses should be aware that dialogue with donors, including reflections on experiences, is important to reduce and alleviate vulnerability and to give the best possible support and attention, including the opportunity to promote optimal postdonation outcomes.	
26444514	In 2010, our comprehensive cancer center developed a professional practice model where the clinical nurse specialist role was transformed to proactively plan and facilitate evidence-based best practices in collaboration with a transdisciplinary, population-focused team that manages the patient across the cancer care continuum.Prior to this transition, practice was unit based, focused on nursing staff education, skills, and competencies, and practice varied widely based on the needs of the unit. This lack of role consistency resulted in decreased autonomy and collaboration and frustration with not consistently impacting positive outcomes.	Nursing leadership worked with the clinical nurse specialists to develop and transition to a population-focused model. Some responsibilities in the unit-based model were retained, whereas others were transitioned to different roles. The reporting structure was centralized, and the role was realigned to focus on a specific patient population encompassing care from diagnosis throughout survivorship.	Baseline job satisfaction data were collected prior to the transition and repeated at 6 and 12 months, then 2, 3, and 4 years after implementation. Over time, there was significant improvement in participation in decision making, support of leadership, and positive contributions to patients and staff, resulting in improved nursing-sensitive patient outcomes, an increase in evidence-based practice initiatives and nursing research projects, and substantial professional growth of clinical staff.	With this practice model, clinical nurse specialists consistently and proactively plan and facilitate evidence-based best practice in collaboration with a transdisciplinary team that manages the patient from diagnosis through the cancer trajectory. Results of outcome measurement report job satisfaction at an all-time high. Significant impact is demonstrated for patients and families, the nursing staff, and the organization.	Healthcare organizations should evaluate current roles and practice models for opportunities to incorporate innovations that will result in improved patient care and satisfaction.	
26431929	Chronic low back pain (LBP) has an important impact on quality of life, through pain and functional incapacity, but also psychosocial distress. The social participation consequences of LBP have been less explored. The objective was to better understand experiences of patients living with chronic LBP, with a focus on impact on relationships with family, friends and work colleagues.Monocentric qualitative study in a tertiary-referral centre in Paris, France. Participants had chronic mechanical LBP. Semi-structured interviews were conducted during 4 focus groups discussions focusing on living with LBP. Verbatim was categorized and coded using thematic content analysis.	Twenty-five persons (11 men, 14 women) participated; ages ranged 25-81 years. Participants often reported a negative self-perception in social interactions, with shame and frustration regarding their difficulties to perform activities of daily living. They often felt misunderstood and unsupported, partly due to the absence of visible signs of the condition. Participants suffered from the negative collective image attached to LBP ("benign/psychological disease"). LBP resulted in some patients in a significant loss of social identity with perceived impossibility to perform one's social role at home and at work. In contrast, family and friends were sometimes a support and helped in pain management.	A systematic assessment of social role is needed in LBP care.	
26415822	Rehabilitation in adults with acquired brain injury is often hampered by a lack of client engagement with the rehabilitation process, leading to frustration, withdrawal of services and poorer recovery. Motivation, apathy and awareness are potential mechanisms underlying engagement, but few studies have suggested potential intervention techniques. A systematic review of the literature was carried out to identify and evaluate interventions designed to increase rehabilitation engagement in adults with acquired brain injury. Database searches used the following terms: rehabilitation, brain injury, and compliance/engagement/adherence in PsychInfo, Medline, Cinahl, Embase, AMED, Web of Knowledge, PsycBite, Cochrane clinical trials, and clinicaltrials.org. Hand searches were conducted of reference lists and relevant journals. Fifteen studies were included in the review. Intervention techniques fell into two broad categories: behavioural modification techniques and cognitive/meta-cognitive skills. Contingent reward techniques were most effective at increasing adherence and compliance, while interventions enabling clients' active participation in rehabilitation appeared to increase engagement and motivation. The review highlighted methodological and measurement inconsistencies in the field and suggested that interventions should be tailored to clients' abilities and circumstances.
26413277	Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary renal disorder; however, at the time this research was conducted, no disease-modifying treatment was currently available. Medical texts often describe early-stage disease (Stages 1 and 2) as asymptomatic, but there is evidence from patients of considerable physical and emotional effects.In-depth interviews were conducted with 80 ADPKD patients, 72 nephrologists and 85 primary care physicians (PCPs) from nine European countries to explore the experience and impact of early-stage ADPKD. Interviews were transcribed, translated and analysed centrally using thematic analysis. An additional 600 physicians completed standardised online questionnaires to investigate perceptions of symptom severity and management of early-stage ADPKD.	Eighty-eight per cent of patients with early-stage disease reported physical symptoms including pain, fatigue, breathlessness, weakness and a general malaise. However, 24% of nephrologists and 16% of PCPs perceived that the patients with early-stage disease did not experience any physical symptoms at all. There was a greater awareness of the emotional impact of disease, but this was still underestimated when compared with patient-reported experiences, which highlighted widespread feelings of loss, uncertainty and fear. Patients and physicians experienced frustration due to the lack of treatment options, especially in the long latent period. For many patients, the inability to affect their disease course whilst living with a diagnosis resulted in feelings of hopelessness, helplessness and depression. Physicians identified a need for improved cooperation between health-care professionals, and increased psychological support for patients.	Early-stage ADPKD can have a significant physical and emotional impact on patients. Whilst some physicians have an awareness of patient experience during early-stage disease, most underestimate the impact of ADPKD. Both patients and physicians are negatively affected by their inability to alter disease progression.	
26410607	Events that induce emotional stress and frustration in a large number of subjects under specific circumstances, such as earthquakes, war conditions, and sporting occasions, may increase the incidence of cardiovascular events, such as acute myocardial infarction, arrhythmias, and sudden cardiac death. This report describes a married couple who expressed an apparently passionate interest in football with hazardous consequences after a tense football match during the FIFA 2014 World Championships. A series of emotional stressors initiated by defeat in this football game lead to cardiac arrest in a 58-year-old man caused by a thrombotic occlusion of the left anterior descending artery and ending in the death of the patient. An hour and 15 minutes after the onset of cardiac arrest of the patient, his 64-year-old wife also had chest pain caused by an acute midventricular takotsubo syndrome. She survived the acute stage of the disease, and there was complete resolution of the left ventricular dysfunction.
26404495	Losing a job or significant other are examples of incentive loss that result in negative emotional reactions. The occurrence of negative life events is associated with increased drinking (Keyes, Hatzenbuehler, & Hasin, 2011). Further, certain genotypes are more likely to drink alcohol in response to stressful negative life events (Blomeyer et al., 2008; Covault et al., 2007). Shared genetic factors may contribute to alcohol drinking and emotional reactivity, but this relationship is not currently well understood. We used an incentive downshift paradigm to address whether emotional reactivity is elevated in mice predisposed to drink alcohol. We also investigated if ethanol drinking is influenced in High Alcohol Preferring mice that had been exposed to an incentive downshift. Incentive downshift procedures have been widely utilized to model emotional reactivity, and involve shifting a high reward group to a low reward and comparing the shifted group to a consistently rewarded control group. Here, we show that replicate lines of selectively bred High Alcohol Preferring mice exhibited larger successive negative contrast effects than their corresponding replicate Low Alcohol Preferring lines, providing strong evidence for a genetic association between alcohol drinking and susceptibility to the emotional effects of negative contrast. These mice can be used to study the shared neurological and genetic underpinnings of emotional reactivity and alcohol preference. Unexpectedly, an incentive downshift suppressed ethanol drinking immediately following an incentive downshift. This could be due to a specific effect of negative contrast on ethanol consumption or a suppressive effect on consummatory behavior in general. These data suggest that either alcohol intake does not provide the anticipated negative reinforcement, or that a single test was insufficient for animals to learn to drink following incentive downshift. However, the emotional intensity following incentive downshift provides initial evidence that this type of emotional reactivity may be a predisposing factor in alcoholism. 
26401762	Preclinical studies are essential for translation to disease treatments and effective use in clinical practice. An undue emphasis on single approaches to Alzheimer's disease (AD) appears to have retarded the pace of translation in the field, and there is much frustration in the public about the lack of an effective treatment. We critically reviewed past literature (1990-2014), analyzed numerous data, and discussed key issues at a consensus conference on Brain Ageing and Dementia to identify and overcome roadblocks in studies intended for translation. We highlight various factors that influence the translation of preclinical research and highlight specific preclinical strategies that have failed to demonstrate efficacy in clinical trials. The field has been hindered by the domination of the amyloid hypothesis in AD pathogenesis while the causative pathways in disease pathology are widely considered to be multifactorial. Understanding the causative events and mechanisms in the pathogenesis are equally important for translation. Greater efforts are necessary to fill in the gaps and overcome a variety of confounds in the generation, study design, testing, and evaluation of animal models and the application to future novel anti-dementia drug trials. A greater variety of potential disease mechanisms must be entertained to enhance progress. 

26391947	Although nonphysician reentry transitions have been characterized in literature, little is known about the reentry physicians in general, or residents in particular. We conducted a qualitative study to explore pediatric residents' reentry, using reverse culture shock as a conceptual framework.Eighteen pediatric residents who completed global health experiences in Africa (9 categorical residents with 1-month elective, 9 global child health residents with 12-month training) participated in interviews that included a card-sort to solicit emotional responses consistent with the conceptual framework. Data in the form of interview transcripts were coded and analyzed according to principles of grounded theory.	All pediatric residents, despite variable time abroad, reported a range of emotional responses on reentry to residency. Global child health residents felt disconnection and frustration more intensely than categorical residents, whereas categorical residents felt invigoration more intensely than global child health residents. Although residents met with program leadership after their return, no resident described these meetings as a formal debriefing, and few described a deliberate strategy for processing emotions on reentry.	Consistent with reverse culture shock, pediatric residents felt a range of emotions as they move toward a steady state of acculturating back into their residency program. Residency programs might consider creating safety nets to help cultivate support for residents when they reenter training.	
26385996	Is forgetting mostly a positive force in human life? On the surface, this seems to not be the case, and people often associate memory loss with frustration in their everyday lives. Yet, forgetting does not have exclusively negative consequences; it also serves valuable, indeed vital, functions. In this article, I review and reflect on evidence from various areas of research, and I argue that forgetting serves at least three broad purposes. First, it is part of emotion regulation, and it promotes subjective well-being by limiting access to negative memories and by reducing unpleasant affect. Forgetting thereby allows for positivity and painlessness. Second, it is involved in knowledge acquisition, and it provides a basis for obtaining semantic and procedural knowledge by allowing for abstraction and automatization. Third, forgetting is part of context attunement, and it orients information processing for the present and the future by facilitating environmental sensitivity and by ensuring that knowledge is current, which enables timeliness and updating. Overall, I suggest that forgetting helps people to be happy, well-structured, and context sensitive, and thereby that it serves fundamentally adaptive functions. 
26381926	Current theoretical conceptualizations of regulatory development suggest that attention processes and emotion regulation processes share common neurophysiological underpinnings and behavioral antecedents such that emotion regulation abilities may build on early attentional skills. To further elucidate this proposed relationship, we tested whether early neurophysiological processes measured during an attention task in infancy predicted in-task attention behavior and whether infants' attention behavior was subsequently associated with their ability to regulate emotion during early childhood (N=388). Results indicated that greater electroencephalogram (EEG) power change (from baseline to task) at medial frontal locations (F3 and F4) during an attention task at 10months of age was associated with concurrent observed behavioral attention. Specifically, greater change in EEG power at the right frontal location (F4) was associated with more attention and greater EEG power at the left frontal location (F3) was associated with less attention, indicating a potential right hemisphere specialization for attention processes already present during the first year of life. In addition, after controlling for 5-month attention behavior, increased behavioral attention at 10months was negatively associated with children's observed frustration to emotional challenge at 3years of age. Finally, the indirect effects from 10-month EEG power change at F3 and F4 to 3-year emotion regulation via infants' 10-month behavioral attention were significant, suggesting that infants' attention behavior is one mechanism through which early neurophysiological activity is related to emotion regulation abilities during childhood. 
26369922	Despite a lack of consensus regarding prevalence rates of substance abuse, people with intellectual disabilities (ID) on average use substances slightly less often than their non-disabled peers. However, their use of substances is more often problematic. Avoidance of treatment is a crucial problem among substance-abusing people with ID. This study tested a motivational intervention to facilitate autonomous motivation (i.e. wanting to change substance abuse because of a sense of free choice and volition) for engaging with a subsequent addiction treatment.A multiple-case experimental design (N = 6) was conducted to measure day-to-day motivation to change substance abuse among individuals with mild ID (N = 3) and borderline level of intellectual functioning (N = 3) in the Netherlands. The participants (five men, one woman) lived in the community (except one, he lived in a residential facility) and abused cannabis, alcohol or hashish. During the intervention phase, the 10-session treatment programme 'Beat the kick' was delivered by an experienced psychologist, based on motivational interviewing techniques adapted for people with mild to borderline ID. Participants completed an adaptive self-reported inventory based on self-determination theory (SDT) two to three times a week during baseline, intervention and 1-month follow-up.	The results of five of the six participants (one dropped out) showed that the type of motivation changed from more controlled types of motivation (i.e. external motivation and introjected motivation) at baseline to more autonomous types of motivation after completion of the intervention. In addition, the participants reported a significant increase in overall need satisfaction and autonomy satisfaction and a significant decrease of overall need frustration.	The implementation of SDT and motivational interviewing principles in the treatment programme 'Beat the kick' reliably changed the type of motivation. In addition, the experimental effects provide initial proof of the use and applicability of SDT among people with ID.	
26369363	This study aimed to illustrate the characteristics of suicide attempters treated in the Emergency Departments of 7 general hospitals in Xi'an and to provide relevant data for early psychological treatment.Between October 2010 and September 2014, 155 suicide attempters were treated in the Emergency Departments. Data were collected using a semi-structured questionnaire. Descriptive statistics, chi-square tests, and multivariate analyses were used to identify the factors associated with suicidal behaviors.	Females outnumbered males at a ratio of 3.7 to 1. The greatest proportion of cases was in the age group of 21 to 30 years (52.9%). Patients who finished middle school or high school accounted for most of the suicide attempters (50.3%). The most common method used for attempted suicide was drug ingestion (86.5%). The majority of cases attempted suicide at home (74.8%) during the night. Marriage frustration, work and study problems, family fanaticism and conflict, somatic disease, and history of mental disorders were all significantly associated with suicide attempts. The ratio of patients to be discharged or to die were similar in occupation, marital status, and the place of suicide attempt; however, the results were different in gender, age, educational level, methods used for suicide, time of day, and reason.	Suicide is an important public health problem and is multidimensional in nature. Future studies with larger samples are expected to provide more specific knowledge of the effect of each social factor on the suicide risk in Chinese in order to improve the prevention of suicides.	
26361514	The stress a patient is subjected to during dialysis treatment can be reduced by using a synergetic approach by the medical team. The integration into therapy of the positive psychical resources such as: active positive coping mechanisms, individual or family mental resilience, improvement of the image and self-esteem, better tolerance to frustration can represent an important part in the improvement of the patient's quality of life, determination of a positive approach of the situations both for him and close friends and relatives. 
26350919	This study examined dimensions of crying and its relations with ocular dryness and mental well-being in patients with Sjögren's syndrome, a systemic autoimmune disease with dryness as primary symptom. Three-hundred patients with Sjögren's syndrome completed questionnaires on crying, dryness, and well-being. The crying questionnaire revealed four dimensions: "Cryability" (comprising both crying sensibility and ability to cry), Somatic consequences, Frustration, and Suppression. Compared to 100 demographically-matched control participants from the general population, patients scored low on Cryability and high on Somatic consequences and Frustration. The crying dimensions generally showed significant but weak associations with ocular dryness and mental well-being in patients. This is the first quantitative study indicating that crying problems are more common in patients with Sjögren's syndrome than in the general population. Perhaps, patients who experience problems with crying could be helped to rely on other ways of expressing emotions than crying in tear-inducing situations. 
26342565	Both maternal depressive symptoms and infants' dopamine-related genetic characteristics have been linked to infants' hypothalamic-pituitary-adrenal (HPA) functioning. This study investigated the interactive influence of maternal depressive symptoms and infant DRD2 and SLC6A3 genotypes on infant cortisol reactivity; whether this interaction reflects diathesis-stress or differential susceptibility; and whether this interaction influences the flexibility of the infant cortisol response across challenges known to exert differential effects on infant cortisol reactivity. A community sample of 314 mother-infant dyads participated in toy frustration (age 16 months) and maternal separation (age 17 months) challenges, and salivary cortisol was collected at baseline, +20, and +40min. Maternal depressive symptoms were assessed with the Beck Depression Inventory-II at infant age 16 months. Infant buccal cells were collected at both time points for genotyping. DRD2 and SLC6A3 genotypes moderated the relation between maternal depressive symptomatology and infant cortisol reactivity in a diathesis-stress manner in the context of toy frustration, and in a differential susceptibility manner in the context of maternal separation. Higher levels of maternal depressive symptoms predicted reduced cortisol flexibility across challenges for infants with at least one A1 allele of DRD2 and infants with the 10/10 genotype of SLC6A3. Results suggest that maternal depressive symptomatology is related to infants' cortisol reactivity and to the flexibility of that reactivity across psychosocial challenges, but this relation is dependent on the infant's genetic characteristics. 
26334658	Poverty is linked to poorer health outcomes across the life span. Nurses must understand how poverty impacts health and the ability to achieve social mobility. This article describes a poverty simulation exercise, In Their Shoes.Scenarios of clients in need of community resources were developed. Using public transportation, students travelled to agencies to collect information about accessing resources. Students were introduced to content about poverty, income inequality, social mobility, and critical social theory prior to the simulation exercise. After the simulation, students returned to the classroom and reflected on the experience.	In Their Shoes received positive feedback. Students expressed surprise at the number of community resources, frustration by the challenges encountered, and dedication to being aware and compassionate advocates for underserved clients.	Nursing programs should develop and evaluate similar activities to expose students to the challenges of living in poverty, and how this affects health and nursing practice.	
26334416	To describe the social representations of illness among people with chronic kidney disease undergoing haemodialysis.Descriptive, qualitative research, anchored on the social representations theory. This study was conducted in the municipality of Ponta Grossa, Paraná State, Brazil, with 23 adults with chronic kidney disease. Data were collection between February and November 2012 by means of a semi-structured interview, and analyzed using Content Analysis.	The interviews led to the categories "the meaning of kidney disease": awareness of finitude, and "survival": the visible with chronic kidney disease. The representation of illness unveiled a difference and interruption in life projects, and haemodialysis meant loss of freedom, imprisonment and stigma.	Family ties and the individuals´ social role are determining representations for healthcare.	
26331863	This article examines the role of microaggressions in the interactions between biomedical personnel and marginalized patients to addresses the constitutive property of medical interactions and their contribution to a class-differentiated and discriminatory local social world. Based on ethnographic fieldwork over the course of three months (2008-2011) the study examined the clinical relationships between obstetric patients and clinicians in a public hospital in the city of Puebla, Mexico. It reveals four factors present in the social hierarchies in Mexico that predispose clinicians to callous interactions toward "problematic others" in society, resulting in microaggressions within clinical encounters: (a) perceptions of suitability for good motherhood; (b) moralized versions of modern motherhood inscribed on patient bodies; (c) a priori assumptions about the hypersexuality of low-income women; and (d) clinician frustration exacerbated by overwork resulting in corporeal violence. This work concludes by questioning the efforts for universal health rights that do not address underlying social and economic inequities. 
26329115	We evaluate (a) associations between marital quality (emotional support, strain, and overall appraisal) and three negative aspects of experienced well-being (frustration, sadness, and worry) among older husbands and wives and (b) the relative importance of own versus spouse's marital quality assessments for understanding experienced well-being in later life.Data are from the 2009 Disability and Use of Time daily diary supplement to the Panel Study of Income Dynamics (N = 722). We estimate actor-partner interdependence models, using seemingly unrelated regression.	Own reports of marital strain are associated with own frustration, sadness, and worry among wives and are associated with frustration only among husbands. Own reports of marital support are associated with negative emotion among husbands only: higher levels of marital support are associated with less worry. Results from partner effects analyses also are mixed. Husbands' reports of marital strain are associated with wives' elevated frustration levels, whereas wives' reports of greater marital support are associated with their husbands' higher frustration levels.	One's own and spouse's marital appraisals play a complex role in shaping negative emotions among older adults. Findings suggest that frustration is a particularly complex emotion and a promising area for further study among older married couples.	
26314587	This systematic review was conducted to provide rich and deep evidence of the perceived determinants and consequences of physical activity and exercise based on qualitative research in multiple sclerosis (MS).Electronic databases and article reference lists were searched to identify qualitative studies of physical activity and exercise in MS. Studies were included if they were written in English and examined consequences/determinants of physical activity in persons with MS. Content analysis of perceived determinants and consequences of physical activity and exercise was undertaken using an inductive analysis guided by the Physical Activity for people with Disabilities framework and Social Cognitive Theory, respectively.	Nineteen articles were reviewed. The most commonly identified perceived barriers of physical activity and exercise were related to the environmental (i.e. minimal or no disabled facilities, and minimal or conflicting advice from healthcare professionals) and related to personal barriers (i.e. fatigue, and fear and apprehension). The most commonly identified perceived facilitators of physical activity were related to the environment (i.e. the type of exercise modality and peer support) and related to personal facilitators (i.e. appropriate exercise and feelings of accomplishment). The most commonly identified perceived beneficial consequences of physical activity and exercise were maintaining physical functions, increased social participation and feelings of self-management and control. The most commonly identified perceived adverse consequences were increased fatigue and feelings of frustration and lost control.	Results will inform future research on the perceived determinants and consequences of physical activity and exercise in those with MS and can be adopted for developing professional education and interventions for physical activity and exercise in MS.	Physical activity and exercise behaviour in people with multiple sclerosis (MS) is subject to a number of modifiable determinants. Healthcare professionals working to promote physical activity and exercise in those with MS should choose to endorse the positive benefits of participation. Future physical activity interventions for those with MS may be improved by incorporating behavioural management strategies.	
26312186	Background. A person-centered approach focusing on the interaction of an individual's temperament-character-life events is essential in the path of individuals' well-being. In this context, three character traits, Self-directedness (e.g., self-acceptance, self-control, goal-directed behavior), Cooperativeness (e.g., social affiliation, social tolerance, empathy and helpfulness) and Self-transcendence (e.g., spiritual acceptance, transpersonal identification), measured using Cloninger's model of personality are suggested to help the individual to regulate and resolve the conflicts derived from her/his temperament combinations as a reaction to life events. However, if character is related to the individual's cognitive ability, then this association might limit any intervention that focuses on character development. We used data from the Child and Adolescent Twin Study in Sweden (CATSS) to investigate the relationship between personality and cognitive ability. Method. The sample consisted of 370 15-year-old twins (159 girls/211 boys), 192 of whom screen-positive with various types of mental health problems. We used the Temperament and Character Inventory to measure personality and the Wechsler Intelligence Scales for Children (WISC-IV) to measure intelligence. The relationship was investigated using correlation analyses using random-selected twins from each dyad and separately for monozygotic and dizygotic twins. Additional analyses investigated the genetic and environmental effects on personality and cognitive ability in this specific sample. Results. There were no significant correlations between the WISC-IV indices and any of the character traits (i.e., Self-directedness, Cooperativeness, and Self-transcendence). Persistence was significantly related, if weak, to four WISC-IV indices: Verbal Comprehension, Perceptual Reasoning, Working Memory, and the Full WISC-IV Scale. Post-hoc cross-twin/cross-trait analyses showed that the Persistence-cognitive ability correlation might depend on common genetic effects. The WISC-IV indices showed a relatively large genetic influence, while earlier findings about the etiology of temperament and character traits using the whole CATSS sample were replicated in this sub-sample of twins. Conclusions. The results indicate that what individuals make of themselves intentionally (i.e., their character) was not associated to intelligence. Persistence, a temperament dimension that measures heritable individual differences in eagerness of effort, ambition, perfectionism, and resistance to discouragement despite frustration and fatigue, was weakly linked to intelligence. Suggesting that, at least during adolescence, interventions targeting character development are not limited by the individual's intelligence. 
26311004	There are no longitudinal studies that assess the impact of traumatic dental injury (TDI) on the oral health-related quality of life (OHRQoL) of preschool children. To investigate the impact of TDI on OHRQoL among preschool children, a population-based case-control study was carried out with a representative sample of 335 children, 3-5 years of age, enrolled at public and private preschools in the city of Campina Grande, Brazil. The case group and the control group were matched for age, gender, type of preschool and monthly household income at a ratio of 1:4 (67 cases and 286 controls). Impact on the OHRQoL of children was assessed through administration of the Early Childhood Oral Health Impact Scale (ECOHIS). The occurrence of TDI was determined through clinical examinations performed by three calibrated dentists. Data analysis involved descriptive statistics, McNemar's test, the chi-square test with linear trend and conditional logistic regression analysis [P≤0.05; 95% confidence interval (95% CI)]. The most frequent responses were 'felt pain' (19.4%) and 'difficulty eating' (16.4%). The prevalence of TDI was 37.3% in the case group and 33.9% in the control group. No statistically significant differences were found between case and control groups regarding the presence of TDI (odds ratio=1.16; 95% CI: 0.66-2.02). TDI had no impact on the quality of life of preschool children.
26294309	W ostatnich latach nasilają się dyskusje na temat zbyt dużego obciążenia pracą na stanowiskach pielęgniarskich. Żeby odpowiedzieć na pytanie, czy wynika to z rzeczywistego przeciążenia pracą w tej grupie zawodowej, czy powszechnie przypisywanej jej frustracji, za cel poniższego opracowania przyjęto analizę czasu pracy na stanowiskach pielęgniarskich w odniesieniu do wymiaru czasu poświęcanego na przerwy w codziennych czynnościach zawodowych.Materiał badawczy stanowiła dokumentacja pomiarów czasu pracy na wybranych pielęgniarskich stanowiskach pracy. Pomiary wykonano w latach 2007–2012 w ramach zajęć dydaktycznych na kierunku pielęgniarskim na Pomorskim Uniwersytecie Medycznym w Szczecinie. Zostały przeprowadzone w placówkach znajdujących się na terenie 6 polskich województw. Jako metodę pomiarów przyjęto fotografię dnia pracy.	Uzyskane wyniki wskazują, że jedynie 6,5% badanych pielęgniarek przeznacza na przerwy odpowiedni czas w ciągu dnia roboczego, tzn. zgodny z przyjętymi normami.	Skala problemu świadczy o nadmiernym obciążeniu pracą na stanowiskach pielęgniarskich. W przyszłości może to skutkować spadkiem efektywności wykonywanej pracy i jakości świadczonych usług. Med. Pr. 2015;66(2):165–172.	For the last few years a topic of overwork on nursing posts has given rise to strong discussions. The author has set, herself a goal of answering the question if it is a result of real overwork of this particular profession or rather commonly assumed frustration of this professional group. The aim of this paper is to conduct the analysis of working time on chosen nursing positions in relation to measures of time being used as intervals in the course of conducting standard professional activities during one working day.	Research material consisted of documentation of work time on chosen nursing workplaces, compiled between 2007-2012 within the framework of a nursing course at the Pomeranian Medical University in Szczecin. As a method of measurement a photograph of a working day has been used. Measurements were performed in institutions located in 6 voivodeships in Poland.	Results suggest that only 6.5% of total of surveyed representatives of nurse profession spends proper amount of time (meaning: a time set by the applicable standards) on work intervals during a working day.	The scale of the phenomenon indicates excessive workload for nursing positions, which along with a longer periodof time, longer working hours may cause decrease in efficiency of work and cause a drop in quality of provided services.	
26291848	There are over 243,800 female sexual assaults in the United States annually. Of those who seek healthcare services after being sexually assaulted, 90% present to hospitals. Unfortunately, care and services for women who have been sexually assaulted are inconsistent. Increased burnout, frustration, and feelings of inadequacy can lead healthcare providers to exhibit personal biases or negative attitudes toward their patients. The Joint Commission, responsible for accreditation of healthcare organizations, has stated that nurses must provide competent care to all patients. Therefore, Sexual Assault Nurse Examiner (SANE) training needs to be available for emergency department (ED) nurses who care for patients who have been sexually assaulted. A survey using the Attitude Toward Rape Victims Scale was sent to 1503 ED nurses throughout the United States, from the Emergency Nursing Association's mailing list. The results of the survey showed that there was a significant difference in attitudes toward the patients between SANE-trained emergency nurses and those without training. This study also showed that 35.5% of hospitals represented by the respondents did not have SANE services available for adult patients who had been sexually assaulted, and furthermore, 85.5% of the respondents who cared for adult patients who had been sexually assaulted were not SANE trained. The negative attitudes held toward such patients as found in this study, coupled with a lack of training provides evidence that ED nurses may benefit from education related to appropriate treatment for patients who have been sexually assaulted. As evidence-based practice becomes the gold standard of care, ensuring that nurses are properly trained to care for all patients must be the goal. 
26288866	A new survey from The Commonwealth Fund and The Kaiser Family Foundation asked primary care providers--physicians, nurse practitioners, and physician assistants--about their experiences with and reactions to recent changes in health care delivery and payment. Providers' views are generally positive regarding the impact of health information technology on quality of care, but they are more divided on the increased use of medical homes and accountable care organizations. Overall, providers are more negative about the increased reliance on quality metrics to assess their performance and about financial penalties. Many physicians expressed frustration with the speed and administrative burden of Medicaid and Medicare payments. An earlier brief focused on providers' experiences under the ACA's coverage expansions and their opinions about the law.
26283304	Psychogenic nonepileptic spells (PNESs) are often very difficult to treat, which may be, in part, related to the limited information known about what a person experiences while having PNESs. For this retrospective study, thoughts, emotions, and dissociative features during a spell were evaluated in 351 patients diagnosed with PNESs (N=223) or epilepsy (N=128). We found that a statistically higher number of thoughts, emotions, and dissociative symptoms were endorsed by patients with PNESs versus patients with epilepsy. Patients with PNESs reported significantly more anxiety and frustration, but not depression, compared with those with epilepsy. Emotions and dissociations, but not thoughts, and a history of any type of abuse were endorsed significantly more often by patients with PNESs. Patients with PNESs are prone to having poor outcomes, and interventions focusing on their actual experiences may be helpful for treatment planning. 
26282058	Chronic non-specific musculoskeletal pain is a common problem among adolescents. This study investigates the importance of future goals and goal frustration for adolescents and young adults with chronic musculoskeletal pain compared to healthy adolescents. It also explores the impact that pain intensity, pain catastrophizing and depressive symptoms have on goal frustration for adolescents with chronic pain.Using a cross-sectional design, we compared the importance and frustration of future goals for 42 adolescents and young adults with chronic musculoskeletal pain (41 women, 1 man) to those of 42 adolescents without pain (35 women, 7 men). For the adolescents with chronic pain, we also examined levels of pain intensity, pain catastrophizing and depressive symptoms to assess their ability to explain goal frustration levels. Statistics included t-tests, Mann-Whitney test and multivariate regression analysis.	We found no differences in the importance of future goals, except for goals related to health, which were more important for adolescents with chronic pain (p = 0.03). Furthermore, adolescents with chronic pain perceived higher levels of goal frustration in all domains, except that related to school (p = 0.16). Depression explained goal frustration related to personal values (p = 0.02), social acceptance (p < 0.01), self-acceptance (p < 0.01) and health (p < 0.01).	Dealing with chronic pain in adolescence and early adulthood does not seem to change future goals, but is associated with perceiving barriers to achieving them. The level of depressive symptoms seems to influence this relationship. Some caution is required in generalizing the results due to the relatively low number of male participants.	
26278724	Scale-up of viral load (VL) monitoring for HIV-infected patients on antiretroviral therapy (ART) is a priority in many resource-limited settings, and ART providers are critical to effective program implementation. We explored provider-perceived barriers and facilitators of VL monitoring. We interviewed all providers (n = 17) engaged in a public health evaluation of dried blood spots for VL monitoring at five ART clinics in Malawi. All ART clinics were housed within district hospitals. We grouped themes at patient, provider, facility, system, and policy levels. Providers emphasized their desire for improved ART monitoring strategies, and frustration in response to restrictive policies for determining which patients were eligible to receive VL monitoring. Although many providers pled for expansion of monitoring to include all persons on ART, regardless of time on ART, the most salient provider-perceived barrier to VL monitoring implementation was the pressure of work associated with monitoring activities. The work burden was exacerbated by inefficient data management systems, highlighting a critical interaction between provider-, facility-, and system-level factors. Lack of integration between laboratory and clinical systems complicated the process for alerting providers when results were available, and these communication gaps were intensified by poor facility connectivity. Centralized second-line ART distribution was also noted as a barrier: providers reported that the time and expenses required for patients to collect second-line ART frequently obstructed referral. However, provider empowerment emerged as an unexpected facilitator of VL monitoring. For many providers, this was the first time they used an objective marker of ART response to guide clinical management. Providers' knowledge of a patient's virological status increased confidence in adherence counseling and clinical decision-making. Results from our study provide unique insight into provider perceptions of VL monitoring and indicate the importance of policies responsive to individual and environmental challenges of VL monitoring program implementation. Findings may inform scale-up by helping policy-makers identify strategies to improve feasibility and sustainability of VL monitoring. 
26277283	To examine the most commonly reported emotions encountered among healthcare practitioners when holding difficult conversations, including frequency and impact on care delivery.Interprofessional learners from a range of experience levels and specialties completed self-report questionnaires prior to simulation-based communication workshops. Clinicians were asked to describe up to three emotions they experienced when having difficult healthcare conversations; subsequent questions used Likert-scales to measure frequency of each emotion, and whether care was affected.	152 participants completed questionnaires, including physicians, nurses, and psychosocial professionals. Most commonly reported emotions were anxiety, sadness, empathy, frustration, and insecurity. There were significant differences in how clinicians perceived these different emotions affecting care. Empathy and anxiety were emotions perceived to influence care more than sadness, frustration, and insecurity.	Most clinicians, regardless of clinical experience and discipline, find their emotional state influences the quality of their care delivery. Most clinicians rate themselves as somewhat to quite capable of recognizing and managing their emotions, acknowledging significant room to grow.	Further education designed to increase clinicians' recognition of, reflection on, and management of emotion would likely prove helpful in improving their ability to navigate difficult healthcare conversations. Interventions aimed at anxiety management are particularly needed.	
26267739	Attention-deficit/hyperactivity disorder (ADHD) is a neurobehavioral disorder defined by persistent inattention and/or hyperactivity and impulsivity. These symptoms occur more frequently and are more severe in individuals with ADHD compared with those at a similar developmental level without ADHD, and can be conceptualized as deficits in executive functioning (EF). EF includes domains of metacognition and inhibition, which influence the ability to regulate responses elicited by emotional stimuli. EF deficits can lead to emotional lability (EL), which is characterized by sudden changes in emotion and behaviors of inappropriately high intensity that may include sudden bouts of anger, dysphoria, sadness, or euphoria. EL is common and estimated to occur in about 3.3-10% of the population. Recent estimates of EL prevalence in children and adolescents with ADHD range from 38 to 75%. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition does not include EL in diagnostic criteria for ADHD, but does include ADHD-associated features of low frustration tolerance, irritability, or mood lability. The neurobiological basis of EL is not well understood, but brain imaging studies support dividing EF into "cool" cognitive networks encompassing attention and planning activities, and "hot" motivational networks involved in temporal discounting, reward processing, and reward anticipation. Dysfunction in "hot" networks is thought to be related to EL. EL symptoms are associated with more severe ADHD and co-morbidities, have significant impact on functioning, and may respond to treatment with medications frequently used to treat ADHD. Treatment outcomes and areas for future research are discussed.
26259569	Hypertension and diabetes, key risk factors for cardiovascular disease, are significant health problems globally. As cardiovascular disease is one of the leading causes of mortality in Mongolia since 2000, clinical guidelines on arterial hypertension and diabetes were developed and implemented in 2011. This paper explores the barriers and enablers influencing the implementation of these guidelines in the primary care setting.A phenomenological qualitative study with semi-structured interviews was conducted to explore the implementation of the diabetes and hypertension guidelines at the primary care level, as well as to gain insight into how practitioners view the usability and practicality of the guidelines. Ten family health centres were randomly chosen from a list of all the family health centres (n = 136) located in Ulaanbaatar City. In each centre, a focus group discussion with nurses (n = 20) and individual interviews with practice doctors (n = 10) and practice managers (n = 10) were conducted. Data was analysed using a thematic approach utilising the Theoretical Domains Framework.	The majority of the study participants reported being aware of the guidelines and that they had incorporated them into their daily practice. They also reported having attended guideline training sessions which were focused on practice skill development. The majority of participants expressed satisfaction with the wide range of resources that had been supplied to them by the Mongolian Government to assist with the implementation of the guidelines. The resources, supplied from 2011 onwards, included screening devices, equipment for blood tests, medications and educational materials. Other enablers were the participants' commitment and passion for guideline implementation and their belief in the simplicity and practicality of the guidelines. Primary care providers reported a number of challenges in implementing the guidelines, including frustration caused by increased workload and long waiting times, time constraints, difficulties with conflicting tasks and low patient health literacy.	This study provides evidence that comprehensive and rigorous dissemination and implementation strategies increase the likelihood of successful implementation of new guidelines in low resource primary care settings. It also offers some key lessons that might be carefully considered when other evidence-based clinical guidelines are to be put into effect in low resource settings and elsewhere.	
26259530	Advances in genome-based microarray and sequencing technologies hold tremendous promise for understanding, better-managing and/or preventing disease and disease-related risk. Chromosome microarray technology (array based comparative genomic hybridization [aCGH]) is widely utilized in pediatric care to inform diagnostic etiology and medical management. Less clear is how parents experience and perceive the value of this technology. This study explored parents' experiences with aCGH in the pediatric setting, focusing on how they make meaning of various types of test results. We conducted in-person or telephone-based semi-structured interviews with parents of 21 children who underwent aCGH testing in 2010. Transcripts were coded and analyzed thematically according to the principles of interpretive description. We learned that parents expect genomic tests to be of personal use; their experiences with aCGH results characterize this use as intrinsic in the test's ability to provide a much sought-after answer for their child's condition, and instrumental in its ability to guide care, access to services, and family planning. In addition, parents experience uncertainty regardless of whether aCGH results are of pathogenic, uncertain, or benign significance; this triggers frustration, fear, and hope. Findings reported herein better characterize the notion of personal utility and highlight the pervasive nature of uncertainty in the context of genomic testing. Empiric research that links pre-test counseling content and psychosocial outcomes is warranted to optimize patient care.
26244244	Coronary artery bypass graft surgery is the most frequently performed heart surgery on adults in the United States and often results in increased anxiety in patients and their caregivers as they attempt to cope with the process of open heart surgery.This article is a comprehensive literature review examining the current information available to health care professionals about the relationship between preoperative anxiety and postoperative surgical outcomes in patients who underwent coronary artery bypass graft surgery.	Research articles from peer-reviewed sources from 2000 to present were retrieved from CINAHL Plus, EBSCOhost, and Internet search engine Google Scholar, as well as from the Centers for Disease Control and Prevention and the National Heart, Lung and Blood Institute databases. Articles dating back to 2000 were included because of specificity of the topic.	Research related to this particular situation supports the relationship between preoperative anxiety and negative postoperative outcomes for patients and their caregivers. However, limitations were identified during the course of the review, and further research on this particular relationship is warranted.	The review of literature identified that preoperative anxiety increased the risk of poor postoperative outcomes including atrial fibrillation, acute myocardial infarction, increased risk of readmission, increased morbidity and mortality, increased health care utilization, and increased anxiety in caregivers resulting in role strain and frustration.	
26243722	To observe the extent and the detail with which playing music can impact on communication in the operating theatre.According to the cited sources, music is played in 53-72% of surgical operations performed. Noise levels in the operating theatre already exceed World Health Organisation recommendations. There is currently a divide in opinions on the playing of music in operating theatres, with few studies conducted and no policies or guidance provided.	An ethnographic observational study of teamwork in operating theatres through video recordings. Quantitative and qualitative data analysis approaches were used.	This study was conducted between 2012-2013 in the UK. Video recordings of 20 operations over six months in two operating theatres were captured. The recordings were divided into music and non-music playing cases. Each case was logged using a request/response sequence identified through interactional analysis. Statistical analysis, using a χ(2) , explored the difference between the proportion of request repetitions and whether music was playing or not. Further interactional analysis was conducted for each request repetition.	Request/response observations (N = 5203) were documented. A chi-square test revealed that repeated requests were five times more likely to occur in cases that played music than those that did not. A repeated request can add 4-68 seconds each to operation time and increased tensions due to frustration at ineffective communication.	Music played in the operating theatre can interfere with team communication, yet is seldom recognized as a potential safety hazard. Decisions around whether music is played and around the choice of music and its volume, are determined largely by surgeons. Frank discussions between clinicians, managers, patients and governing bodies should be encouraged for recommendations and guidance to be developed.	
26234330	This study evaluated financial challenges, satisfaction with financial-management supports, and interest in additional or alternative supports among clients of a mental health center.Six focus groups were held with 39 clients of an urban community mental health center who reported having difficulty with their finances. Five focus groups were held with direct-care staff who provided services to the clients. Investigators used an inductive analytical approach to distill themes from notes taken during the focus groups.	Clients emphasized the challenges of living in poverty and described using complex strategies to sustain themselves, including negotiating benefits systems, carefully planning purchases, and developing and relying on social relationships. They spoke of having uneven access to tools and services for managing their money, such as advice from direct-care staff, representative payees, and bank accounts, and had varying opinions about their value. Noting concerns similar to those of clients, direct-care staff expressed frustration at the lack of support services for helping clients manage their finances. Both clients and staff expressed the need for more services to help clients with their finances.	Findings suggest a need for more services to support people with mental illness to manage their finances, particularly a more flexible and broader range of options than are provided by current representative-payee mechanisms.	
26233804	In this paper, we present the results of research conducted on the psychological distress of lysosomal-disease-affected children. Lysosomal diseases are rare genetic diseases most often leading to severe disabilities, both psychological and physiological. As frequently reported by their relatives, affected children experience nervous breakdowns, which are sometimes treated with antidepressant prescriptions. However, mental impairment as well physical disabilities can prevent children from making their pain noticed and identified by their relatives. This raises a new research question: when disabilities are severe, how should the psychological distress of affected children be identified?Recent studies on the care of children with multiple disabilities (San Salavadour 2000; Scelles 2003; Camelio 2006; Pautrel, 2009) have used the children's family and caregivers to access their feelings, considered to be translators of children's feelings because they understand their nonverbal language (Camelio, 2006). Using this methodology, four parents from the French not-for-profit association called "VML" (Vaincre les maladies lysosomales) and four professionals were involved in semi-structured interviews. The goal of these interviews was to identify signs of possible psychological suffering, the context in which those signs were expressed, the meaning and the value attributed to it by the family and caregivers, and the reaction as well as an evaluation of that reaction. Thirteen children were involved, 12 of whom were described as having shown signs of psychological distress. Six lysosomal diseases were represented.	Two types of signs were reported: active signs (e.g., agitation, screaming, crying) and passive signs (e.g., no communication, withdrawal, lack of facial expression). Most of the time, passive signs were interpreted by the family and caregivers as evidence of deep psychological distress. The meanings of both types of sign were the following: fear, anxiety, distress, sadness, depression, stress, anger, and frustration. The family and caregivers responded by socializing with the child, providing him with comfort, assisting him in meeting his basic needs, administering medication, etc. Loneliness, disease-progression-related loss of abilities, physical pain, and epilepsy were the main factors of psychological distress. Three children were prescribed an antidepressant, two with an anticonvulsive effect.	The results of this research depend on the difficulty making a distinction between physical and psychological pain and the interpretation of the child's relatives remains an imperfect translation of what the child feels. Further research to overcome these shortcomings is currently under consideration. Moreover, quantitative analysis is needed to make this research more robust.	
26216345	Little is known about the impact of cognitive impairments on driving in adults with ADHD. The present study compared the performance of adults with and without ADHD in a driving simulator on two different routes: an urban route which we hypothesised would exacerbate weak impulse control in ADHD and a motorway route, to challenge deficits in sustained attention.Adults with (n = 22, 16 males) and without (n = 21, 18 males) ADHD completed a simulated driving session while eye movement data were recorded simultaneously. Participants also completed the Manchester Driving Behaviour Questionnaire (DBQ) and the Conners Adult ADHD Rating Scale (CAARS). Measures of driving performance included average speed, proportion distance travelled over speed limit (speeding) and lane deviation. These variables and the eye movement measures (spread of fixations, mean fixation duration) were compared between groups and routes. Also, driving behaviours, including responses to programmed events, were categorised and the frequencies within categories were compared between groups. Finally, speech analysis was performed to compare emotional verbal expressions during driving between groups.	ADHD participants reported significantly more Violations and Lapses on the DBQ than control participants and significantly more accidents. Average speed and speeding were also higher but did not interact with route type. ADHD participants showed poorer vehicle control, greater levels of frustration with other road users (including greater frequencies of negative comments) and a trend for less safe driving when changing lanes/overtaking on the motorway. These effects were predicted by hyperactive/impulsive CAARS scores. They were also more likely to cause a crash/near miss when an event occurred on the urban route.	The results suggest that difficulty regulating and controlling impulsive behavior, reflected in speeding, frustration with other road users, less safety when changing lanes on the motorway and a greater likelihood of an accident following an unexpected event, underlie impaired driving in ADHD. Hyperactivity/impulsivity symptoms correlated with these indices. Deficits in sustained attention seemed to play a lesser role in this particular study, although further research is needed to determine whether effects on attention emerge over longer periods of time and/or are influenced by the novelty of the simulator environment.	
26202906	The purpose of this study is to describe how a parent's partnership with professionals progresses and evolves throughout the service provisioning process. Using a phenomenological ethnographic approach, the lived reality of a family is depicted as the parent walks through different stages of the Individualized Family Service Plan process over a 6-month period. Data concerning parent-professional interactions were obtained via observation notes and document reviews whereas data regarding parent perceptions were collected through multiple individual interviews. Overall, the parent conveyed her satisfaction with actual services especially regarding the professionals' knowledge and parental advocacy. However, the parent also indicated frustration with the early intervention planning process and "obligated" partnerships with providers. In particular, the providers' lack of sensitivity was noted, and greater emotional and psychological support was suggested. The overall process of developing partnerships with professionals can be excessively intrusive to the family's lives. Future research directions are offered as a contribution for the development of improved policies for early intervention programs regarding family-centered practice, utilizing the perspectives of families. 
26202620	The Psychiatric Institutes have supported the different forms of self-expression from the very beginning, sometimes realizing therapeutic goals as well. Under this point theatrical phenomenon was held too. Physicians often created such scenic actions themselves. The visual, pictorial expressions have begun to be shown parallel to the representation of such scenic world. That was the context to create a number of psychiatric art collections. By this kind of theatre based on esthetical judgment visual creations have been shown to the greater public promoting the representation of integral, intact and differing body image. The exotic, the bizarre, differing from the expected, the different was in the focus. It is always a question who is inside and who is outside, who can see and who can know the secret and who cannot. Starting from space - and from a psychic point of view - the perspective and the focus are also important attitudes. It is important from where we look at things, are we included in the studied area or are we watching it from outside? Are we the ones to study something or are we being watched? Only the stability of our identity enables us to play different roles. I find it important how the ability to accept one's own body limits, the formation of body image influences one's visual expression in the mirror of the surrounding society and how it appears in the creative process. Being traumatized may lead to dissociation, post-traumatic disorder or some other psychosomatic complaints. People who endure some trauma diverge from the real situation that makes them suffer if they feel that their state is hopeless, if they cannot see any way out. One possible way to come to grips with some trauma is to create, to frame, which can be either negative or positive. In the negative sense it leads to remembrance, trace-leaving, the process of grief, frustration, mutilation and sacrifice. On the other hand, in the positive sense one is able to build up something through all these. We can also look at this process from the male or female viewpoint. Through such approach and with such questions in mind, I analyze a group of graphic objects of the Psychiatric Art Collection of the Hungarian Academy of Sciences.
26194969	Graduate nurse transition from college to professional practice is an important matter in a nurse's professional life. In many cases, this period is characterized by unhealthy physical and mental reactions, loss of interest in one's profession, and unacceptable caregiving. By examining the phenomenon from the point of view of experienced nurses, we can recognize the major factors in a successful transition from college life to professional life. This is a qualitative study and was conducted based on conventional qualitative content analysis method; 14 nurses were selected through purposive sampling, and the data were collected using semistructured interviews in teaching hospitals in Iran. Eight subthemes emerged from the analysis of the interviews: lack of practical skills, limited academic knowledge, inadequate social skills, poor self-confidence, lack of independence, frustration, stress, and loneliness. These items, in turn, fall under 3 themes: poor efficiency, low self-assurance, and unhealthy emotional reactions. The findings of this study indicate that the participants were not well prepared to assume their clinical roles, which in turn gives rise to other problems; to eliminate this defect, the curriculum needs to be revised, proper training programs should accompany the students' studies, and management in clinical environments recommended should be improved in order to facilitate nurses' transition from college to practice. 

26182215	Videogaming platforms such as the Microsoft (Redmond, WA) Kinect(®) are increasingly being used in rehabilitation to improve balance performance and mobility. These gaming platforms do not have built-in clinical measures that offer clinically meaningful data. We have now developed software that will enable the Kinect sensor to assess a patient's balance using an interactive functional reach test (I-FRT). The aim of the study was to test the concurrent validity of the I-FRT and to establish the feasibility of implementing the I-FRT in a clinical setting.The concurrent validity of the I-FRT was tested among 20 healthy adults (mean age, 25.8±3.4 years; 14 women). The Functional Reach Test (FRT) was measured simultaneously by both the Kinect sensor using the I-FRT software and the Optotrak Certus(®) 3D motion-capture system (Northern Digital Inc., Waterloo, ON, Canada). The feasibility of implementing the I-FRT in a clinical setting was assessed by performing the I-FRT in 10 participants with mild balance impairments recruited from the outpatient physical therapy clinic (mean age, 55.8±13.5 years; four women) and obtaining their feedback using a NASA Task Load Index (NASA-TLX) questionnaire.	There was moderate to good agreement between FRT measures made by the two measurement systems. The greatest agreement between the two measurement system was found with the Kinect sensor placed at a distance of 2.5 m [intraclass correlation coefficient (2,k)=0.786; P<0.001] from the participant. Participants with mild balance impairments whose balance was assessed using the I-FRT software scored their experience favorably by assigning lower scores for the Frustration, Mental Demand, and Temporal Demand subscales on the NASA/TLX questionnaire.	FRT measures made using the Kinect sensor I-FRT software provides a valid clinical measure that can be used with the gaming platforms.	
26181679	Almost 60 percent of Americans play videogames, which is a significant opportunity for health professionals to reach mass audiences. But although legions of fans spend countless hours playing entertainment games, player interest in health videogames quickly wanes. A good question to ask is, "Why?" A game developer with 20 years of experience offers his perspective on what may be limiting health games' appeal and what can be done about it. 
26177229	Patients who experience their nonmalignant chronic pain as intolerable sometimes present at Emergency Departments (EDs). However, as emergency medical services are set up to provide rapid treatment for acute injury or illness; there is potential for misunderstanding and disappointment. Literature on the topic of ED staff attitudes toward chronic pain patients is minimal, USA-based and methodologically unsatisfying. We carried out an in-depth, qualitative study identifying the attitudes and narratives of ED staff around people in chronic pain.Focus groups with ED staff; qualitative analysis of the group transcripts.	Regional trauma centre in the UK.	Three focus groups, 20 ED clinicians, mean ED experience 8.1 years.	The clinical challenge of treating patients in the ED stemmed from a mismatch between patients' needs and what the setting can deliver. Participants reported frustration with the system and with chronic pain patients' perceived inconsistencies and requirements. However, they also highlighted good practice and acknowledged their frustration around not being able to help this group.	ED staff found people presenting at ED with chronic pain to be a challenging and frustrating population to treat. Staff was constrained by the fast-paced nature of their jobs as well as the need to prioritise emergency cases, and so were unable to spend the time needed by chronic pain patients. This was seen as being bad for staff, and for the patient experience. Staff suggested that care could be improved by appropriate information, signposting and with time invested in communication with the patient.	
26169071	Little is known about substance use among resettled refugee populations. This study aimed to describe motivations for drinking, experiences of alcohol-related problems and strategies for managing drinking among marginalised African refugee young people in Melbourne, Australia.Face-to-face interviews were conducted with 16 self-identified African refugees recruited from street-based settings in 2012-2013. Interview transcripts were analysed inductively to identify key themes.	Participants gathered in public spaces to consume alcohol on a daily or near-daily basis. Three key motivations for heavy alcohol consumption were identified: drinking to cope with trauma, drinking to cope with boredom and frustration and drinking as a social experience. Participants reported experiencing a range of health and social consequences of their alcohol consumption, including breakdown of family relationships, homelessness, interpersonal violence, contact with the justice system and poor health. Strategies for managing drinking included attending counselling or residential detoxification programmes, self-imposed physical isolation and intentionally committing crime in order to be incarcerated.	These findings highlight the urgent need for targeted harm reduction education for African young people who consume alcohol. Given the importance of social relationships within this community, use of peer-based strategies are likely to be particularly effective. Development and implementation of programmes that address the underlying health and psychosocial causes and consequences of heavy alcohol use are also needed.	
26162206	This is a report of a short-term, pastoral counselling group conducted with Jewish internees in a high security prison in Israel. It was held as an adjunct to daily secular individual and group counselling and rehabilitation run by the Department of Social Work. Pastoral counselling employed spiritual and psychosocial methodologies to reduce anger, improve prisoner frustration tolerance, and develop a sense of self-efficacy and communal identity. It combined semi-didactic scriptural input with Pierre Janet's personality model, Fritz Perls' gestalt therapy, and analysis of the group process. 
26158228	Studies of trauma commonly concentrate on the psychological and physiological effects of recent violent events. Although today connections are becoming more explicitly drawn, early studies of the aftermath of amputation serve to shed light on modern understanding of the interaction of the physical and emotional. The study of combat amputation, dissociation, and related posttraumatic stress largely began with the work of 19th-century Philadelphia physician Silas Weir Mitchell, who brought attention to the phenomenon of phantom limb pain. Less known, however, are the data he and his son, John K. Mitchell, also collected on the mental outcomes of trauma. Using an archived collection of original surveys of double-amputee patients dating largely from 1893 housed at the Historical Medical Library at the College of Physicians of Philadelphia, an interdisciplinary team explored the historical, anthropological, and psychological background of the study of combat trauma. Almost 30 years following the end of hostilities, the majority of the sample of U.S. Civil War veterans indicated that their general disposition, general health, and sleeping or eating patterns had changed following limb amputation. More telling, possibly, are the written comments on the surveys and letters that indicate frustration with the continuous suffering and the knowledge of their mental and physical changes. These data illustrate the value of historical archives in documenting the development of the study of trauma and modern concepts of combat experiences. 
26156827	This study among 51 parents of young children under age four investigated how parents that report marginal, low and very low food security characterize how trade-offs associated with food insecurity affect parents' mental health and child well-being.We carried out 51 semi-structured audio-recorded interviews after participants responded to a survey regarding food security status and maternal depressive symptoms. Each interview was transcribed. Through a content analysis, we coded "meaning units" in each manuscript and organized them by themes in ATLAS.ti. Among participants reporting both food insecurity and depressive symptoms, we identified three primary areas of concern: trade-offs, mental health, and child well-being.	Parents described how trade-offs associated with food insecurity have a profound relationship with their mental health and home environment that strongly affects young children. Descriptions of hardships include anxiety and depression related to overdue bills and shut-off notices, strains with housing costs, and safety. Parents described how their own frustration, anxiety, and depression related to economic hardship have a negative impact on their children's physical health, and their social and emotional development.	Parents in food insecure households recognize that trade-offs between food and other basic necessities are associated with their personal stress and poor mental health that, in turn, affects their children's health and development. Partnerships between healthcare providers, policymakers, and parents are essential to successfully address and prevent the poor child health outcomes of toxic stress associated with food insecurity and poverty.	
26153787	Although researchers have examined issues related to partners providing care for a person with Parkinson disease (PWP), few have explored partners' broader psychosocial experiences. To investigate this underexplored area, individual, in-depth interviews with 23 partners of PWPs were conducted. Participants reported significant psychosocial challenges, including having the PWP withdraw from communication, being unable to "rescue" the PWP, being the recipient of the PWP's frustration, expressing impatience with the PWP, shouldering increased responsibility, being confronted with possibly losing the PWP, losing valued activities, feeling housebound, being unable to predict the PWP's daily well-being, and experiencing uncertainty about future caregiving and disease progression. These results indicate that being the partner of a PWP involves serious, complex psychosocial challenges related to both caregiving and noncaregiving issues. This research highlights the need for a family-centered approach to Parkinson care and provides valuable insight that can inform interventions and nursing practice for this population. 
26138148	This study investigated the effect of multimodal (visual and auditory) continuous feedback with information about the uncertainty of the input signal on motor imagery based BCI performance. A liquid floating through a visualization of a funnel (funnel feedback) provided enriched visual or enriched multimodal feedback.In a between subject design 30 healthy SMR-BCI naive participants were provided with either conventional bar feedback (CB), or visual funnel feedback (UF), or multimodal (visual and auditory) funnel feedback (MF). Subjects were required to imagine left and right hand movement and were trained to control the SMR based BCI for five sessions on separate days.	Feedback accuracy varied largely between participants. The MF feedback lead to a significantly better performance in session 1 as compared to the CB feedback and could significantly enhance motivation and minimize frustration in BCI use across the five training sessions.	The present study demonstrates that the BCI funnel feedback allows participants to modulate sensorimotor EEG rhythms. Participants were able to control the BCI with the funnel feedback with better performance during the initial session and less frustration compared to the CB feedback.	The multimodal funnel feedback provides an alternative to the conventional cursorbar feedback for training subjects to modulate their sensorimotor rhythms.	
26122594	Strategies within the public health system to curtail costs, increase efficiency and service utilisation have resulted in reduced hospital stays following elective orthopaedic procedures. Although there are advantages that support the concept of early discharge from hospital, very little is known about how patients manage the transition from hospital to home.The aim of this qualitative study was to describe the post-discharge experience of elderly patients following primary total hip replacement (THR).	Ten patients, six women and four men, provided descriptions of their experience. Data were collected by face-to-face interviews and the analysis process was based on Giorgi's phenomenological scientific methodology (Giorgi, 1994, 1997, 2000).	The analysis of the data resulted in four themes, namely; an inadequate assessment of suitable adaptive aids and personal needs; personal frustration; coping with the physical and mobility and limited social interaction.	Findings from this study demonstrated a need to review the discharge process and implement strategies to prepare patients for the stressors that the participants in this study encountered as a result of their early discharge.	
26117826	Previous studies indicate that emotion regulation may occur unconsciously, without the cost of cognitive effort, while conscious acceptance may enhance negative experiences despite having potential long-term health benefits. Thus, it is important to overcome this weakness to boost the efficacy of the acceptance strategy in negative emotion regulation. As unconscious regulation occurs with little cost of cognitive resources, the current study hypothesizes that unconscious acceptance regulates the emotional consequence of negative events more effectively than does conscious acceptance. Subjects were randomly assigned to conscious acceptance, unconscious acceptance and no-regulation conditions. A frustrating arithmetic task was used to induce negative emotion. Emotional experiences were assessed on the Positive Affect and Negative Affect Scale while emotion- related physiological activation was assessed by heart-rate reactivity. Results showed that conscious acceptance had a significant negative affective consequence, which was absent during unconscious acceptance. That is, unconscious acceptance was linked with little reduction of positive affect during the experience of frustration, while this reduction was prominent in the control and conscious acceptance groups. Instructed, conscious acceptance resulted in a greater reduction of positive affect than found for the control group. In addition, both conscious and unconscious acceptance strategies significantly decreased emotion-related heart-rate activity (to a similar extent) in comparison with the control condition. Moreover, heart-rate reactivity was positively correlated with negative affect and negatively correlated with positive affect during the frustration phase relative to the baseline phase, in both the control and unconscious acceptance groups. Thus, unconscious acceptance not only reduces emotion-related physiological activity but also better protects mood stability compared with conscious acceptance. This suggests that the clinical practice of acceptance therapy may need to consider using the unconscious priming of an accepting attitude, instead of intentionally instructing people to implement such a strategy, to boost the efficacy of acceptance in emotion regulation. 
26103717	The greatest threat to human well-being in this century is climate change and related global issues.We examined the effectiveness of the Modified Instrumentalism in Occupational Therapy model as a framework for facilitating occupational behaviour change to address climate change and related issues.	Eleven individuals participated in this mixed-methods single-subject-design study. Data were gathered using the Modified Assessment and Intervention Instrument for Instrumentalism in Occupational Therapy and Daily Occupational Inventories. Quantitative data were analyzed using two- and three-standard deviation band methods. Qualitative data were analyzed using heuristic phenomenological procedures.	Occupational performance changed for five participants. Participants' feelings shifted from frustration and helplessness to empowerment and a desire for action. They felt empowered to find occupation-based solutions to the global issues.	Occupation-based interventions that increase personal awareness of the connection between occupational performance and global issues could empower people to be agents for action to ameliorate the issues.	
26083719	The aim of the study was to describe third-party disability experienced by adult-children as a result of hearing impairment (HI) in a parent.Using semi-structured interviews, participants were asked to describe the impact of a parent's HI on their relationship and communication. Interpretative phenomenological analysis, a qualitative method to explore participant's perceptions and viewpoints, was used as the method of analysis.	Twelve participants between the ages of 22 and 58 who each had a parent with confirmed HI who owned hearing aids.	Within the contextual factors of family relationships, communication situations, and the parent's personality, adult-children considered their coping strategies and feelings that arose as a result of the HI. Coping strategies included putting forth effort in communication, yelling as an ineffective communication strategy, and providing support to the parent with HI. The described feelings included frustration, uncertainty, and loss surrounding their communication and relationship with their parent with HI. These feelings arose as a result of implementing coping strategies, plus these feelings drove the employment of coping strategies.	Adult-children of parents with HI experience third-party disability, however, the participation restrictions and activity limitations experienced by children appear less than experienced by spouses.	
26072283	This study examined differences in offending behavior and psychosocial problems between juvenile offenders who have been sexually abused (n=231), physically abused (n=1,568), neglected (n=1,555), exposed to multiple forms of maltreatment (n=1,767), and non-victims (n=8,492). In addition, the moderating effect of gender in the association between type of maltreatment and offending behavior/psychosocial problems was examined. Results showed that violent offenses were more common in victims of physical abuse and victims of multiple forms of abuse than in non-victims, both in boys and girls. In boys, sexual offenses were far more common in victims of sexual abuse than in victims of other or multiple forms of maltreatment or in non-victims. In girls, no group differences were found in sexual offending behavior. For both boys and girls, externalizing problems were relatively common in victims of physical abuse and neglect whereas internalizing problems were relatively common in victims of sexual abuse. In victims of multiple forms of maltreatment, both internalizing and externalizing problems were relatively common. Implications for clinical practice are discussed. 
26066306	Healthcare information technology systems are considered the ideal tool to inculcate evidence-based nursing practices. The wound clinical decision support system was built locally to support nurses to manage pressure ulcer wounds in their daily practice. However, its adoption rate is not optimal. The study's objective was to discover the concepts that informed the RNs' decisions to adopt the wound clinical decision support system as an evidence-based technology in their nursing practice. This was an exploratory, descriptive, and qualitative design using face-to-face interviews, individual interviews, and active participatory observation. A purposive, theoretical sample of 14 RNs was recruited from one of the largest public tertiary hospitals in Singapore after obtaining ethics approval. After consenting, the nurses were interviewed and observed separately. Recruitment stopped when data saturation was reached. All transcribed interview data underwent a concurrent thematic analysis, whereas observational data were content analyzed independently and subsequently triangulated with the interview data. Eight emerging themes were identified, namely, use of the wound clinical decision support system, beliefs in the wound clinical decision support system, influences of the workplace culture, extent of the benefits, professional control over nursing practices, use of knowledge, gut feelings, and emotions (fear, doubt, and frustration). These themes represented the nurses' mental outlook as they made decisions on adopting the wound clinical decision support system in light of the complexities of their roles and workloads. This research has provided insight on the nurses' thoughts regarding their decision to interact with the computer environment in a Singapore context. It captured the nurses' complex thoughts when deciding whether to adopt or reject information technology as they practice in a clinical setting. 
26059389	Previous research has shown that performance on cognitive tasks administered in the scanner can be altered by the scanner environment. There are no previous studies that have investigated the impact of scanner noise using a well-validated measure of affective change. The goal of this study was to determine whether performance on an affective attentional task or emotional response to the task would change in the presence of distracting acoustic noise, such as that encountered in a magnetic resonance imaging (MRI) environment.Thirty-four young adults with no self-reported history of neurologic disorder or mental illness completed three blocks of the affective Posner task outside of the scanner. The task was meant to induce frustration through monetary contingencies and rigged feedback. Participants completed a Self-Assessment Manikin at the end of each block to rate their mood, arousal level, and sense of dominance. During the task, half of the participants heard noise (recorded from a 4T MRI system), and half heard no noise.	The affective Posner task led to significant reductions in mood and increases in arousal in healthy participants. The presence of scanner noise did not impact task performance; however, individuals in the noise group did report significantly poorer mood throughout the task.	The results of the present study suggest that the acoustic qualities of MRI enhance frustration effects on an affective attentional task and that scanner noise may influence mood during similar functional magnetic resonance imaging (fMRI) tasks.	
26058241	This study examined how motor limitations in terms of reduced possibilities to move influence aggression, starting from the fact that motor skills and movement have an important place in the expression of aggression, as well as the tendency of adolescents to "body language". Adolescent with motor deficit is hindered in gaining experience of one's own body, which is reflected in the formation of complete experience of himself, or constitution of the self. In many of the functions of motor skills and movement aggression has a significant place that we wanted to determine without deeper analysis of whether the origin of aggression is instinctive or it is always just the result of frustration. The sample on which testing was performed consisted of 100 randomly selected subjects of both genders aged 16-18 years. Fifty subjects had motor limitations due to illness or injury, and another fifty subjects had intact motor functions. The study used three instruments: 1) A-87 questionnaire for aggressiveness examination; 2) structured interview; and 3) protocol for observation under natural conditions. Results of the analysis of data obtained in total score, as well as in all five subscales of the A-87 questionnaire for aggressiveness examination showed that the two groups were not significantly different. The results obtained by structured interview showed the adolescents with motor limitations to demonstrate greater verbal aggressiveness, then latent physical aggressiveness. A statistically significant between-group difference was obtained on the factor of self-destructiveness, which implies that adolescents with motor limitations are somewhat more self-destructive compared to those in control group. From the results obtained by the protocol for systematic observation in natural conditions, it was evident that there were significant differences on most of perceptual conducts between control and experimental group, whereby adolescents with motor limitations were more aggressive than control group subjects, especially in behaviors that apply to all forms of verbal aggressiveness. All examined adolescents in which some apparent forms of aggressive behavior were noticed in the observation protocol showed comparable expression of aggressiveness according to the results obtained on the subscales of the A-87 aggressiveness questionnaire, which connects these two measuring instruments and justifies their use in the study of aggressiveness regardless of the understanding of the origin of aggression.
26041054	Cognitive control is accompanied by observable negative affect. But how is this negative affect experienced subjectively, and are these feelings related to variation in cognitive control? To address these questions, 42 participants performed a punished inhibitory control task while periodically reporting their subjective experience. We found that within-subject variation in subjective experience predicted control implementation, but not neural monitoring (i.e., the error-related negativity, ERN). Specifically, anxiety and frustration predicted increased and decreased response caution, respectively, while hopelessness accompanied reduced inhibitory control, and subjective effort coincided with the increased ability to inhibit prepotent responses. Clarifying the nature of these phenomenological results, the effects of frustration, effort, and hopelessness-but not anxiety-were statistically independent from the punishment manipulation. Conversely, while the ERN was increased by punishment, the lack of association between this component and phenomenology suggests that early monitoring signals might precede the development of control-related subjective experience. Our results indicate that the types of feelings experienced during cognitively demanding tasks are related to different aspects of controlled performance, critically suggesting that the relationship between emotion and cognitive control extends beyond the dimension of valence. 
26018845	The purpose of the present study was to evaluate the development of the near miss effect in slot machine gambling as a product of stimulus generalization from total wins. The study was conducted across two experiments. Twelve college students participated in the first experiment, which demonstrated that greater post-reinforcement pauses followed losing outcomes that were formally similar to total wins, relative to losing outcomes that were formally dissimilar [F (5, 7) = 5.24, p = .025] along a generalization gradient (R (2) = .96). Additionally, 11 out of 12 participants showed greater response latencies following near-misses than following total wins. Thirteen college students participated in the second experiment, which demonstrated that symbols that more saliently indicated a loss resulted in lower response latencies than functionally equivalent but visually dissimilar losing symbols [F (3, 10) = 15.50, p = .01]. A generalization gradient was observed across winning symbols (R (2) = .98), and an inverse of the gradient observed across winning symbols was observed across symbols that were the least formally similar (R (2) = .69). The present study replicates and extends previous research on near misses in slot machine gambling, and provides discussion around the clinical utility of such findings on the prevention of problem gambling. 
26014830	Seclusion in psychiatric inpatient care means confining service users in a locked room. Service users and staff seem to have different opinions on the usefulness of seclusion. This is possibly the first time when two mental health nurses went voluntarily into seclusion and reported their experiences. The nurses felt that the seclusion room was inhumane and proposed improvements to seclusion in general and to the seclusion facilities in particular. Seclusion in psychiatric hospital care refers to isolating a service user from other service users and staff, most often in a locked and unfurnished room. Service users' experiences of seclusion are mostly negative, and although some have seen a rationale for its use, mental health nurses should be encouraged to evaluate current seclusion practices from the service user's perspective. In this small-scale experiment, two mental health nurses were voluntarily secluded for 24 h. The aim was to explore the experience of being secluded, to understand and evaluate the impact of seclusion in greater detail, and to encourage discussion on one of the controversies in mental health nursing. To the best of our knowledge, this is the first attempt to evaluate the impact of seclusion based on mental health nurses' firsthand experiences. The nurses received usual seclusion treatment and described their experiences of this every 6 h. Based on the nurses' experiences, seclusion, even in voluntary, safe and planned circumstances, may increase anxiety and frustration. Seclusion was viewed negatively and the physical environment was considered inhumane. The nurses offered some practical suggestions for updating seclusion practices and re-designing seclusion facilities. Mental health nurses, who frequently decide on and invariably implement seclusion, are key to improving seclusion practices.
26013683	In May 2013, a measles outbreak began in the Netherlands among Orthodox Protestants who often refuse vaccination for religious reasons.Our aim was to compare the number of messages expressed on Twitter and other social media during the measles outbreak with the number of online news articles and the number of reported measles cases to answer the question if and when social media reflect public opinion patterns versus disease patterns.	We analyzed measles-related tweets, other social media messages, and online newspaper articles over a 7-month period (April 15 to November 11, 2013) with regard to topic and sentiment. Thematic analysis was used to structure and analyze the topics.	There was a stronger correlation between the weekly number of social media messages and the weekly number of online news articles (P<.001 for both tweets and other social media messages) than between the weekly number of social media messages and the weekly number of reported measles cases (P=.003 and P=.048 for tweets and other social media messages, respectively), especially after the summer break. All data sources showed 3 large peaks, possibly triggered by announcements about the measles outbreak by the Dutch National Institute for Public Health and the Environment and statements made by well-known politicians. Most messages informed the public about the measles outbreak (ie, about the number of measles cases) (93/165, 56.4%) followed by messages about preventive measures taken to control the measles spread (47/132, 35.6%). The leading opinion expressed was frustration regarding people who do not vaccinate because of religious reasons (42/88, 48%).	The monitoring of online (social) media might be useful for improving communication policies aiming to preserve vaccination acceptability among the general public. Data extracted from online (social) media provide insight into the opinions that are at a certain moment salient among the public, which enables public health institutes to respond immediately and appropriately to those public concerns. More research is required to develop an automatic coding system that captures content and user's characteristics that are most relevant to the diseases within the National Immunization Program and related public health events and can inform official responses.	
26000827	This study analyzes the consequences of maternal death to households in Western Kenya, specifically, neonatal and infant survival, childcare and schooling, disruption of daily household activities, the emotional burden on household members, and coping mechanisms.The study is a combination of qualitative analysis with matched and unmatched quantitative analysis using surveillance and survey data. Between September 2011 and March 2013 all households in the study area with a maternal death were surveyed. Data were collected on the demographic characteristics of the deceased woman; household socio-economic status; a history of the pregnancy that led to the death; schooling experiences of surviving school-age children; and disruption to household functioning due to the maternal death. These data were supplemented by in-depth and focus group discussions. Quantitative data on neonatal and infant survival from a demographic surveillance system in the study area were also used. Descriptive and bivariate analyses were conducted with the quantitative data, and qualitative data were analyzed through text analysis using NVivo.	More than three-quarters of deceased women performed most household tasks when healthy. After the maternal death, the responsibility for these tasks fell primarily on the deceased's husbands, mothers, and mothers-in-law. Two-thirds of the individuals from households that suffered a maternal death had to shift into another household. Most children had to move away, mostly to their grandmother's home. About 37% of live births to women who died of maternal causes survived till age 1 year, compared to 65% of live births to a matched sample of women who died of non-maternal causes and 93% of live births to surviving women. Older, surviving children missed school or did not have enough time for schoolwork, because of increased housework or because the loss of household income due to the maternal death meant school fees could not be paid. Respondents expressed grief, frustration, anger and a sense of loss. Generous family and community support during the funeral and mourning periods was followed by little support thereafter.	The detrimental consequences of a maternal death ripple out from the woman's spouse and children to the entire household, and across generations.	
25994498	Caregivers of persons living with dementia (PWD) taking cholinesterase inhibitors, who care 3 + h over three days/week, were interviewed. This study uses thematic content analysis to compare responses to the open-ended question " What do you believe getting involved in activities outside the home means for someone with dementia?" in spouse ( n = 613) and adult-children ( n = 260) caregivers, and across mild ( n = 314) and moderate-severe stages ( n = 280). For adult-children caregivers, activity participation promotes independence in their parents. Spouses describe activity in the context of their relationship with the PWD, and the experience is framed around their continued social roles as a couple. Mild-stage caregivers report the difficulty and negative outcomes (e.g. frustration, stigma) of engaging in activity, while moderate-severe caregivers discuss activity as preserving abilities in PWD and providing connection to cohort. This may indicate areas for improved activity provision and support for spouse (i.e. emotional) and adult-children (i.e. resources) caregivers across dementia stages.
25979082	Childhood trauma is associated with hypertension in adults. It is unknown whether childhood trauma predicts elevated blood pressure earlier in development. We investigated whether the trauma of child abuse was associated with blood pressure in adolescents.The sample included 145 adolescents aged 13-17 years, 40% with exposure to child abuse. The mean age of participants was 14.93 years (SD = 1.33); 58% were female. The majority self-identified as non-Hispanic White (43%), with the remainder identifying as non-Hispanic Black (17%), Hispanic (17%), or other/mixed race (23%). We used established age/sex/height-specific cutoffs to determine the prevalence of prehypertension and hypertension in the sample. We used two-sample t tests to examine associations of abuse with resting systolic blood pressure (SBP) and diastolic blood pressure (DBP) and blood pressure reactivity to the Trier Social Stress Test and a frustration task. We used linear regression to adjust for potential confounders including sociodemographic variables, body mass index, smoking, and psychopathology.	Mean resting SBP and DBP were 114.07 mmHg and 61.35 mmHg in those with a history of abuse and 111.39 mmHg and 56.89 mmHg in those without a history of abuse. This difference was significant for DBP only. Twelve percent of participants met criteria for prehypertension or hypertension based on resting blood pressure values; this did not differ between those with and without an abuse history. Child abuse was associated with lower DBP and SBP reactivity to laboratory stress tasks and reduced DBP reactivity to frustration. These associations were robust to adjustment for potential confounders.	Child abuse is associated with higher resting DBP and blunted DBP and SBP reactivity to laboratory stress in adolescence. These findings suggest a potential pathway by which child abuse leads to hypertension.	
25976025	Mandatory predonation reading materials inform donors about risk factors for transmissible disease, possible complications of donation and changes to the donation process. We aimed to assess the attention to predonation reading materials and factors which may affect attention.A national survey in 2008 of 18,108 blood donors asked about self-assessed attention to reading the materials. In face-to-face interviews, 441 donors completed additional questions about reading the materials and a literacy test. Qualitative interviews of 27 donors assessed their approach to reading.	In the national survey, most of the first-time donors said they read all or most of the materials (90.9% first-time vs. 57.6% repeat donors, P < 0.001) and 66% vs. 23.1% reported reading them carefully (P < 0.001). In face-to-face interviews comparing those who read materials carefully, skimmed or did not read, most knew that donors are informed of positive transmissible disease test results (97.1%, 95.5, 98.0 P > 0.05), but fewer recalled seeing the definition of sex (77.2%, 56.9, 24.2 P < 0.001). Literacy was poor (30.5% frustration level, 60.3% instructional, 9.2% independent) but similar when those who read materials carefully, skimmed or did not read were compared (P > 0.05). Qualitative interviews showed that donors are reluctant to read any more than necessary and decide based on perceived importance or relevance.	Attention to predonation reading materials tends to be better among first-time donors. The effectiveness is limited by low motivation to read, especially for repeat donors, as well as poor literacy.	
25970530	PURPOSE - The purpose of this paper is to examine the personal views and experiences of Foundation Year 2 doctors operating under the European Working Time Directive (EWTD). DESIGN/METHODOLOGY/APPROACH - In total, 36 Foundation Year 2 doctors from a single UK-based Deanery participated in this semistructured interview study. FINDINGS - Findings indicated that Foundation doctors typically welcomed a regulation of working hours, but reported frustration at the manner in which the Directive had been implemented. Participants reported concerns at reducing hours by removing out-of-hours working in order to meet EWTD requirements. Out-of-hours shifts were highly valued owing to their increased opportunities for autonomous clinical decision making. By contrast, day-shifts were regarded as heavily administrative in nature and were perceived as service provision. Foundation doctors discussed the unique nature of the out-of-hours working period which appeared to provide specific learning opportunities as doctors draw on time management and prioritisation skills. ORIGINALITY/VALUE - Given the challenges the EWTD presents, careful rota planning is essential. First, the authors would encourage the restructuring of day-shift work to provide a greater emphasis on hands-on skills experience in a supportive, supervised environment. Second, where possible, Foundation doctors might benefit from the opportunity to engage in some out-of-hours working, such as with multi-professional "Hospital at Night" teams. Third, the authors would encourage junior doctor involvement in rota design and planning which may increase their perceived autonomy and therefore buy-in of working practices.
25957364	Primary care physicians face cognitive overload daily, perhaps exacerbated by the form of electronic health record documentation. We examined physician information needs to prepare for clinic visits, focusing on past clinic progress notes.This study used cognitive task analysis with 16 primary care physicians in the scenario of preparing for office visits. Physicians reviewed simulated acute and chronic care visit notes. We collected field notes and document highlighting and review, and we audio-recorded cognitive interview while on task, with subsequent thematic qualitative analysis. Member checks included the presentation of findings to the interviewed physicians and their faculty peers.	The Assessment and Plan section was most important and usually reviewed first. The History of the Present Illness section could provide supporting information, especially if in narrative form. Physicians expressed frustration with the Review of Systems section, lamenting that the forces driving note construction did not match their information needs. Repetition of information contained in other parts of the chart (eg, medication lists) was identified as a source of note clutter. A workflow that included a patient summary dashboard made some elements of past notes redundant and therefore a source of clutter.	Current ambulatory progress notes present more information to the physician than necessary and in an antiquated format. It is time to reengineer the clinic progress note to match the workflow and information needs of its primary consumer.	
25948469	The article is devoted to the subjective reaction of patients at different stages of disabling disease, in the context of the formation of a specific cognitive-emotional and motivational model of "internal picture of disability", depending on the severity of social frustration as the most important deconditioning factor. We wanted to identify psychological determinant of the specificity of adaptive activity of the patient to the situation disabling disease, depending on the level of increase social frustration. Nature of adaptation to the disabling disease depending on the level of increase social frustration expressed by: 1) decrease in self-esteem of patient self-efficacy with an increase in subjective experience of disability; 2) the growing tension of personal protective mechanisms; 3) reductions coping competence, which, depending on the rise of frustration, becomes effective instead of the rational-intelligent, more maladaptive emotional. 
25945698	Prenatal maternal distress is associated with an at-risk developmental profile, yet there is little fetal evidence of this putative in utero process. Moreover, the biological transmission for these maternal effects remains uncertain. In a study of n = 125 pregnant adolescents (ages 14-19), ambulatory assessments of daily negative mood (anger, frustration, irritation, stress), physical activity, blood pressure, heart rate (every 30 min over 24 hr), and salivary cortisol (six samples) were collected at 13-16, 24-27, 34-37 gestational weeks. Corticotropin-releasing hormone, C-reactive protein, and interleukin 6 from blood draws and 20 min assessments of fetal heart rate (FHR) and movement were acquired at the latter two sessions. On average, fetuses showed development in the expected direction (decrease in FHR, increase in SD of FHR and in the correlation of movement and FHR ("coupling")). Maternal distress characteristics were associated with variations in the level and trajectory of fetal measures, and results often differed by sex. For males, greater maternal 1st and 2nd session negative mood and 2nd session physical activity were associated with lower overall FHR (p < .01), while 1st session cortisol was associated with a smaller increase in coupling (p < .01), and overall higher levels (p = .05)-findings suggesting accelerated development. For females, negative mood, cortisol, and diastolic blood pressure were associated with indications of relatively less advanced and accelerated outcomes. There were no associations between negative mood and biological variables. These data indicate that maternal psychobiological status influences fetal development, with females possibly more variously responsive to different exposures.
25944402	No research has been conducted into the experience of peer support in improving adherence with oral antipsychotic medication for consumers with schizophrenia. Altruism influences peers to participate in peer support. Engagement in peer support can be challenging and rewarding for peers, and helps improve their own confidence and well-being.Many consumers with schizophrenia are reluctant to take their prescribed antipsychotic medications; however, non-adherence can lead to relapse. The aim of this study was to evaluate peers' perspectives of their participation in a problem-solving peer support programme to enhance adherence in consumers who are reluctant to take antipsychotic medication. Peers contacted consumers by a weekly telephone call for 8 weeks, and used a problem-solving approach to inform their discussion about medication adherence. Semi-structured qualitative interviews were used to evaluate peers' perspectives of their involvement in the programme. Three main themes were abstracted from the data: motivation to participate in the study, experience of peer support programme, and rewards and challenges of the peer experience. Helping others was an important motivator for peers in agreeing to participate in the study. Telephone delivery was a convenient way to deliver the peer support programme. However, at times, it was difficult to contact consumers by telephone and this caused some frustration. Despite these difficulties, peers recognized that being involved in the programme increased their confidence and made them feel worthwhile. The findings have implications for the use of peer support as an adjunct intervention to promote medication adherence in consumers with schizophrenia.	
25935745	Few studies have investigated absconding from forensic hospitals and there are no published studies of interventions aimed at reducing these incidents in forensic settings. We present a study of the impact of a new policy using structured professional judgment and an interdisciplinary team-based approach to granting privileges to forensic patients. We assess the impact of this policy on the rate and type of absconding from a metropolitan forensic facility.Following concern about the rate of absconding at our hospital, a new policy was implemented to guide the process of granting hospital grounds and community access privileges. Employing an A-B design, we investigated the rate, characteristics, and motivations of absconding events in the 18 months prior to, and 18 months following, implementation of this policy to assess its effectiveness.	Eighty-six patients were responsible for 188 incidents of absconding during the 42-month study window. The rate of absconding decreased progressively from 17.8% of all patients at risk prior to implementation of the new policy, to 13.8% during implementation, and further to 12.0% following implementation. There was a differential impact of the policy on absconding events, in that the greatest reduction was witnessed in absconsions occurring from unaccompanied passes; this was offset, to some extent, by an increase in absconding occurring from within hospital units or from staff accompanied outings. Seven of the absconding events included incidents of minor violence, and two included the commission of other illegal behaviors. The most common reported motive for absconding across the time periods studied was a sense of boredom or frustration. Discharge rate from hospital was 22.9% prior to the implementation of the policy to 22.7% after its introduction, indicating no change in the rate of patients' eventual community reintegration.	A structured and team-based approach to decision making regarding hospital grounds and community access privileges appeared to reduce the overall rate of absconding without slowing community reintegration of forensic patients.	
25929535	Pelvic girdle pain (PGP) is common during pregnancy and negatively affects women's lives. When PGP persists after the birth, the way it affects women's lives may change, particularly for first-time mothers as they adjust to motherhood, yet the experiences of women with persistent PGP remain largely unexplored.The objective of this study was to explore primiparous women's experiences of persistent PGP and its impact on their lives postpartum, including caring for their infant and their parental role.	This was a descriptive qualitative study.	Following institution ethical approval, 23 consenting primiparous women with PGP that had started during pregnancy and persisted for at least 3 months postpartum participated in individual interviews. These interviews were recorded, transcribed, and analyzed using thematic analysis.	Four themes emerged: (1) "Putting up with the pain: coping with everyday life," in which women put up with the pain but had to balance activities and were grateful for support from family and friends to face everyday challenges; (2) "I don't feel back to normal," in which women's feelings of physical limitations, frustration, and a negative impact on their mood were described; (3) "Unexpected," in which persistent symptoms were unexpected for women due to a lack of information given about PGP; and (4) "What next?," in which the future of women's symptoms was met with great uncertainty, and they expressed worry about having another baby.	For first-time mothers, having persistent PGP postpartum affects their daily lives in many ways. These findings provide important information for health care providers, which will improve their understanding of these women's experiences, will enhance rapport, and can be used to provide information and address concerns to optimize maternity care during pregnancy and beyond.	
25927425	Illness attributions, particularly for those living with life limiting illnesses, are associated with emotional adjustment or psychological distress. Few studies have examined attributions among people severely affected by multiple sclerosis (PwMS), and specifically among from diverse communities. This study aimed to explore and compare the presence and construction of meanings among Black Caribbean and White British PwMS.Cross sectional qualitative interviews were conducted among Black Caribbean (BC) and White British (WB) PwMS with an EDSS of ≥6.0 (severe disease). Data were analysed using the framework approach.	15 BC and 15 WB PwMS were interviewed. Attributions were complex with most PwMS reporting multiple explanations. Uncertainty, represents the first theme surrounding the aetiology of MS where participants constantly rehearsed the "why me?" question in relation to their illness, a number expressing considerable frustration. The second theme, 'logical and scientific', was voiced more often by WB PwMS and accounts for a range of genetic/viral influences, stress, environmental and lifestyle factors. Third, the 'supernatural' illness attribution theme departs from a biomedical perspective and was reported often among BC PwMS. This theme included the sub-categories of tests of faith and divine punishment, a view although exclusive to BC participants but was sometimes in conflict with notions of modernity.	Our findings identify evidence of cross-cultural and intra-group diversity in relation to MS causation. A greater professional awareness of the processes used by PwMS from diverse communities to make sense of their situation will enable health care professionals to facilitate effective support for those in their care and channel relevant psychosocial resources to them. This requires heightened skills in communication and cultural competency.	
25914101	Fever in children is common and mostly caused by self-limiting infections. However, parents of febrile children often consult in general practice, in particular during out-of-hours care. To improve management, it is important to understand experiences of GPs managing these consultations.To describe GPs' experiences regarding management of childhood fever during out-of-hours care.	A descriptive qualitative study using purposeful sampling, five focus group discussions were held among 37 GPs. Analysis was based on constant comparative technique using open and axial coding.	Main categories were: (i) Workload and general experience; (ii) GPs' perceptions of determinants of consulting behaviour; (iii) Parents' expectations from the GP's point of view; (iv) Antibiotic prescribing decisions; (v) Uncertainty of GPs versus uncertainty of parents and (vi) Information exchange during the consultation. GPs felt management of childhood fever imposes a considerable workload. They perceived a mismatch between parental concerns and their own impression of illness severity, which combined with time-pressure can lead to frustration. Diagnostic uncertainty is driven by low incidences of serious infections and dealing with parental demand for antibiotics is still challenging.	Children with a fever account for a high workload during out-of-hours GP care which provides a diagnostic challenge due to the low incidence of serious illnesses and lacking long-term relationship. This can lead to frustration and drives antibiotics prescription rates. Improving information exchange during consultations and in the general public to young parents, could help provide a safety net thereby enhancing self-management, reducing consultations and workload, and subsequent antibiotic prescriptions.	
25913053	Robotic assistance may provide for distinct technical advantages over conventional laparoscopic technique. The goals of this study were (1) to objectively evaluate the difference in the learning curves by novice and expert surgeons in performing fundamental laparoscopic skills using conventional laparoscopic surgery (CLS) and robotic-assisted laparoscopic surgery (RALS) and (2) to evaluate the surgeons' frustration level in performing these tasks.Twelve experienced and 31 novices in laparoscopy were prospectively evaluated in performing three standardized laparoscopic tasks in five consecutive, weekly training sessions. Analysis of the learning curves was based on the magnitude, rate, and quickness in performance improvement. The participant's frustration and mood were also evaluated during and after every session.	For the novice participants, RALS allowed for shorter time to task completion and greater accuracy. However, significant and rapid improvement in performance as measured by magnitude, rate, and quickness at each session was also seen with CLS. For the experienced surgeons, RALS only provided a slight improvement in performance. For all participants, the use of RALS was associated with less number of sessions in which they felt frustrated, less number of frustration episodes during a session, lower frustration score during and after the session, and higher good mood score.	The advantages of RALS may be of most benefit when doing more complex tasks and by less experienced surgeons. RALS should not be used as a replacement for CLS but rather in specific situations in which it has the greatest advantages.	
25904673	Our earlier research demonstrated that participation in four sessions of motivational interviewing (MI) early post-stroke has a positive impact on stroke survivors' mood. However, the theoretical underpinnings of MI in supporting adjustment (rather than its traditional use in supporting behavior change) require clarification. This article describes a content analysis of MI transcripts for 10 participants in our previous study, to identify the focus of discussions (patient "concerns") and potential effective components of our MI approach. Patients' post-stroke concerns were shown in 16 categories, including frustration, family impact, and getting well. There was a pattern of change discourse across sessions: "Sustain talk" (reasons for not changing) reduced from Session 1 onward, "change talk" (intent to change) increased then reduced, and "change expressed" (changes achieved) increased from Sessions 1 to 4. MI facilitates healthy adjustment post-stroke in some patients, in turn affecting mood, but clarification of how this effect is achieved requires further exploration. 
25899741	Persistent pain in the face, mouth, and jaws is a common presentation to dental and medical services. The aetiology remains unclear, but a growing evidence base recognizes the effectiveness of psychological rather than biomedical interventions. To understand how this approach might be implemented into clinical practice, knowledge is needed of patients' and clinicians' experience of chronic orofacial pain (COFP). The aim of this study was to explore the experience and understanding of COFP by patients and primary and secondary care medical and dental practitioners.Qualitative interview study.	Audio-recorded semi-structured interviews with a purposive sample of 12 dentists, 11 general practitioners, and seven patients were thematically analysed.	Clinicians and patients recognized the role that psychological factors could play in the development and maintenance of COFP, yet management and self-management strategies were largely limited to biomedical interventions. Achieving a diagnosis proved problematic but largely functional for both parties. GPs and dentists viewed COFP as a non-dental problem and felt inadequately equipped to manage the condition. GPs, unlike dentists, felt obligated to support patients using techniques for managing patients with other long-term conditions. Frustration at the current inadequacy of COFP management often led to conflict with (or disengagement from) the clinician-patient relationship.	Current management of COFP is ineffective and unsatisfactory for patients and practitioners, which impacts on their relationship. Fundamental barriers to accessing and implementing psychological interventions for COFP arise from ineffective communication between physicians and patients, and between medical and dental practitioners. Statement of contribution What is already known on this subject? COFP is characterized by persistent pain in the face, mouth, or jaws that are not the result of organic disease or physical trauma. Patients with COFP present to both medical and dental services and receive sub-optimal care. No studies have examined the experiences of managing this problem from the perspectives of dentists, general practitioners and patients. What does this study add? Patients, dentists, and GPs recognize the role that psychological factors have in maintaining and addressing facial pain symptoms, yet principally manage it through biomedical interventions. Challenges exist over arriving at a diagnosis and managing the problem, and challenges are exacerbated by poor communication between doctors and medical services. Improvements are needed in liaison between medical and dental services and further training to support primary care clinicians to facilitate a stepped care approach to managing COFP.	
25895693	Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) is a relatively new but controversial diagnosis affecting hundreds of children and their families. It is generally thought to be an autoimmune disorder resulting from a streptococcal infection that causes significant and bizarre behavioral changes in children. Currently no definitive diagnostic or treatment modalities exist, which has led to misdiagnoses, ineffective treatments, and delayed care.A qualitative study was conducted that included 60 families with at least one child diagnosed with PANDAS. The purpose was to explore how families experience the disorder and what nurses can do to provide effective care.	Using paradigmatic analysis of transcribed interviews, three themes were identified: fear, frustration, and not being heard.	Results from this study suggest that more information is needed to better understand this challenging phenomenon from both medical and nursing perspectives. The study also reaffirms the importance of practicing the art of nursing, especially when the science is not yet established.	
25895537	Palliative care professionals are exposed daily to high levels of suffering. This makes them particularly vulnerable to suffering from stress, which can lead to burnout and/or compassion fatigue.To analyse the professional trajectory of palliative care workers over time and the factors which influence this trajectory.	A qualitative study was designed based on the Grounded Theory approach, using semi-structured individual interviews. Interviews were recorded audio-visually and transcribed verbatim for subsequent analysis using the procedure described by Miles and Huberman. This process was supported using ATLAS.ti 6 software.	A total of 10 palliative care professionals from Extremadura (Spain) took part in the study.	The analysis revealed a common trajectory followed by participants in their working lives: pre-palliative care/honeymoon/frustration/maturation. In addition, factors which influence this trajectory were identified. Details of the self-care strategies that these professionals have developed are described. The result of this process, which we have metaphorically termed 'metamorphosis', is the formation of a professional who can work satisfactorily within a palliative care context.	During their professional activity, palliative care professionals go through a series of phases, depending on the relationship between the cost of caring and the satisfaction of caring, which can influence both the care provided to patients and families and their own personal circumstances. Being aware of this risk, and implementing self-care strategies, can protect professionals and enable them to conduct their work in an optimal manner. Reflecting on the experiences of these professionals could be useful for other health professionals.	
25885443	Previous research on cancer and sexuality has focused on physical aspects of sexual dysfunction, neglecting the subjective meaning and consequences of sexual changes. This has led to calls for research on cancer and sexuality to adopt an "integrative" approach, and to examine the ways in which individuals interpret sexual changes, and the subjective consequences of sexual changes.This study examined the nature and subjective experience and consequences of changes to sexual well-being after cancer, using a combination of quantitative and qualitative analysis. Six hundred and fifty seven people with cancer (535 women, 122 men), across a range of reproductive and non-reproductive cancer types completed a survey and 44 (23 women, 21 men) took part in an in-depth interview.	Sexual frequency, sexual satisfaction and engagement in a range of penetrative and non-penetrative sexual activities were reported to have reduced after cancer, for both women and men, across reproductive and non-reproductive cancer types. Perceived causes of such changes were physical consequences of cancer treatment, psychological factors, body image concerns and relationship factors. Sex specific difficulties (vaginal dryness and erectile dysfunction) were the most commonly reported explanation for both women and men, followed by tiredness and feeling unattractive for women, and surgery and getting older for men. Psychological and relationship factors were also identified as consequence of changes to sexuality. This included disappointment at loss of sexual intimacy, frustration and anger, sadness, feelings of inadequacy and changes to sense of masculinity of femininity, as well as increased confidence and self-comfort; and relationship strain, relationship ending and difficulties forming a new relationship. Conversely, a number of participants reported increased confidence, re-prioritisation of sex, sexual re-negotiation, as well as a strengthened relationship, after cancer.	The findings of this study confirm the importance of health professionals and support workers acknowledging sexual changes when providing health information and developing supportive interventions, across the whole spectrum of cancer care. Psychological interventions aimed at reducing distress and improving quality of life after cancer should include a component on sexual well-being, and sexual interventions should incorporate components on psychological and relational functioning.	
25862018	While scratch cards are a popular, accessible, and inexpensive form of gambling, very little is known about how they affect and influence the player. This study sought to understand the physiological and subjective experience of scratch card play, with special emphasis on the effect of near-miss outcomes (i.e. uncovering two out of three "grand prize" symbols needed to win said prize), which are remarkably prevalent in scratch card games. Thirty-eight undergraduate students from the University of Waterloo each played two custom scratch card games and experienced three types of outcomes (losses, wins and near-misses) while their skin conductance levels (SCLs) and post-reinforcement pauses were recorded. Each participant also rated each outcome in terms of its subjective level of arousal, valence, and frustration. Our results indicate that players interpreted near-misses as negatively valenced, highly arousing, frustrating losses, and were faster to move onto the next game following this type of outcome than following winning outcomes. Additionally, near-miss outcomes were associated with the largest amount of change in SCLs as the outcome was revealed. This work has implications for the problem gambling literature as it provides evidence of the frustration hypothesis of near-misses in scratch cards, and is the first study to examine the physiological and psychological experiences of scratch card players. 
25852041	To identify common catalysts of worker-to-worker violence and incivility in hospital settings.Worker-to-worker violence and incivility are prevalent forms of mistreatment in healthcare workplaces. These are forms of counterproductive work behaviour that can lead to negative outcomes for employees, patients and the organisation overall. Identifying the factors that lead to co-worker mistreatment is a critical first step in the development of interventions targeting these behaviours.	Retrospective descriptive study.	Qualitative content analysis was conducted on the total sample (n = 141) of employee incident reports of worker-to-worker violence and incivility that were documented in 2011 at a large American hospital system.	More than 50% of the incidents involved nurses, and the majority of incidents did not involve physical violence. Two primary themes emerged from the analysis: Work Behaviour and Work Organisation. Incidents in the Work Behaviour category were often sparked by unprofessional behaviour, disagreement over responsibilities for work tasks or methods of patient care, and dissatisfaction with a co-worker's performance. Incidents in the Work Organisation category involved conflicts or aggression arising from failure to following protocol, patient assignments, limited resources and high workload.	Incidents of worker-to-worker violence and incivility stemmed from dissatisfaction with employee behaviour or from organisational practices or work constraints. These incident descriptions reflect worker dissatisfaction and frustration, resulting from poor communication and collaboration between employees, all of which threaten work productivity.	Violence and incivility between hospital employees can contribute to turnover of top performers, hinder effective teamwork and jeopardise the quality of patient care. Identification of common catalysts for worker-to-worker violence and incivility informs the development of mistreatment prevention programmes that can be used to educate hospital staff.	
25847387	To report and synthesize the perspectives, experiences, and preferences of stroke survivors undertaking inpatient physical rehabilitation through a systematic review of qualitative studies.MEDLINE, CINAHL, Embase, and PsycINFO were searched from database inception to February 2014. Reference lists of relevant publications were searched. All languages were included.	Qualitative studies reporting stroke survivors' experiences of inpatient stroke rehabilitation were selected independently by 2 reviewers. The search yielded 3039 records; 95 full-text publications were assessed for eligibility, and 32 documents (31 studies) were finally included. Comprehensiveness and explicit reporting were assessed independently by 2 reviewers using the consolidated criteria for reporting qualitative research framework. Discrepancies were resolved by consensus.	Data regarding characteristics of the included studies were extracted by 1 reviewer, tabled, and checked for accuracy by another reviewer. All text reported in studies' results sections were entered into qualitative data management software for analysis.	Extracted texts were inductively coded and analyzed in 3 phases using thematic synthesis. Nine interrelated analytical themes, with descriptive subthemes, were identified that related to issues of importance to stroke survivors: (1) physical activity is valued; (2) bored and alone; (3) patient-centered therapy; (4) recreation is also rehabilitation; (5) dependency and lack of control; (6) fostering autonomy; (7) power of communication and information; (8) motivation needs nurturing; and (9) fatigue can overwhelm.	The thematic synthesis provides new insights into stroke survivors' experiences of inpatient rehabilitation. Negative experiences were reported in all studies and include disempowerment, boredom, and frustration. Rehabilitation could be improved by increasing activity within formal therapy and in free time, fostering patients' autonomy through genuinely patient-centered care, and more effective communication and information. Future stroke rehabilitation research should take into account the experiences and preferences of stroke survivors.	
25846102	This study examined directly the impact of various factors associated with driving on 'A-class' roads in the United Kingdom (specifically length of platoon, proportion of heavy goods vehicles (HGVs), speed and opportunities for overtaking) on self-reported frustration and overtaking intentions. The impact of situational variables (being under time pressure, and time behind a slower moving platoon) were also examined, as was the association between frustration and self-reported overtaking intentions. 183 members of the public from the areas around Perth and Inverness, Scotland took part in the study. Participants viewed simulated 'driver's viewpoint' clips representing all the combinations of the experimental variables (except time pressure, which was a between-groups variable, and time behind platoon, which was examined separately in four specific clips). After each clip, participants responded on a paper questionnaire as to the level of frustration they would feel for a given clip, and the likelihood that at some point during the clip they would have attempted an overtake manoeuvre. The findings show that the links between traffic variables such as speed and platoon length, and behaviourally-relevant variables such as frustration and overtaking intentions, are not simple. Although there are broad and predictable effects of speed and platoon length (lower speeds and longer platoons leading to greater frustration) these are mediated by other variables, and it is not always the case that more frustration leads to more intention to overtake. Analysis of driver attitudes identified three clusters (low, medium and high risk drivers) and suggests that higher risk drivers' levels of frustration are more affected by situational changes than those of lower risk drivers. 
25843700	In line with the claim that regret plays a role in decision making, O'Connor, McCormack, and Feeney (Child Development, 85 (2014) 1995-2010) found that children who reported feeling sadder on discovering they had made a non-optimal choice were more likely to make a different choice the next time around. We examined two issues of interpretation regarding this finding: whether the emotion measured was indeed regret and whether it was the experience of this emotion, rather than the ability to anticipate it, that affected decision making. To address the first issue, we varied the degree to which children aged 6 or 7 years were responsible for an outcome, assuming that responsibility is a necessary condition for regret. The second issue was addressed by examining whether children could accurately anticipate that they would feel worse on discovering they had made a non-optimal choice. Children were more likely to feel sad if they were responsible for the outcome; however, even if they were not responsible, children were more likely than chance to report feeling sadder. Moreover, across all conditions, feeling sadder was associated with making a better subsequent choice. In a separate task, we demonstrated that children of this age cannot accurately anticipate feeling sadder on discovering that they had not made the best choice. These findings suggest that although children may feel regret following a non-optimal choice, even if they were not responsible for an outcome, they may experience another negative emotion such as frustration. Experiencing either of these emotions seems to be sufficient to support better decision making.
25838011	Given the psychological and financial costs involved with failing a clinical course, especially in developing countries, an alternative educational method was tested with students who had to repeat the year-long endodontic course at the University of Chile Faculty of Dentistry. The objectives of the intervention were to deepen theoretical knowledge and practical experiences, as well as to reinforce personal confidence in an endodontic clinical setting for students who failed the regular endodontic course. The aim of this study was to evaluate the success of this new model of educational intervention. In the study, 28 students who had failed the endodontic course repeated it with an alternative teaching method. The students attended patients immediately following practical competence exams, and they had access to simulated models that used rotary instruments and access cavities and had emergency care practice. Feedback sessions were held after each clinical session. Final grades were compared with those of other students who repeated the course without the intervention from 2007 to 2009. A survey was administered to understand the causes of initial failure and their opinions of the intervention. Students who participated in the alternative course did significantly better than their counterparts from previous years who did not receive the intervention (5.7±0.3 vs. 5.4±0.2; p<0.05). Their overall perception of the intervention was positive, and the main cause for previous course failure was personal insecurity and slow clinical care performance (54.2% of the students). The intervention course not only improved grades but also generated interest in endodontics, a contrasting perspective to the frustration students usually express after repeating the course. The results of this study support the introduction of similar interventions in endodontics and perhaps other courses. 
25837530	Many recent studies have indicated that depression and anxiety are more common in asthmatic patients than in the general population and psychological stress can lead to asthma exacerbations, but no study specifically targets cough variant asthma (CVA) patients. The purpose of this study was to evaluate depression and anxiety levels in CVA patients compared with classic asthma patients and to identify the psychological features of CVA patients.Fifty-nine outpatients with CVA and 128 outpatients with classic asthma were interviewed about psychosomatic and psychiatric symptoms, and they underwent three psychological tests: Self-rating Depression Scale (SDS), State-Trait Anxiety Inventory (STAI), and Comprehensive Asthma Inventory (CAI). They were ultimately screened for major and minor depression, dysthymia, panic disorder, generalized anxiety disorder, social anxiety disorder, and other anxiety disorders.	CVA patients showed higher SDS and STAI scores than classic asthma patients, and mood disorders and anxiety disorders were more common than in classic asthma outpatients. The psychological factors 'frustration', 'fright into illness', and 'distorted lifestyle' were more prominent in CVA patients than in classic asthma patients.	CVA patients are on average more depressed and anxious than classic asthma outpatients. Though CVA appears pathologically to be just an early stage of typical asthma, the psychological stress may often be more serious than in asthma controlled by medication, which may explain why CVA cannot be controlled by a bronchodilator alone and patients often require no less intense therapy than for severe asthma.	
25837520	Cognitive control (CC) of attention is a major prerequisite for effective information processing. Emotional distractors can bias and impair goal-directed deployment of attentional resources. Frustration-induced negative affect and cognition can act as internal distractors with negative impact on task performance. Consolidation of CC may thus support task-oriented behavior under challenging conditions. Recently, transcranial direct current stimulation (tDCS) has been put forward as an effective tool to modulate CC. Particularly, anodal, activity enhancing tDCS to the left dorsolateral prefrontal cortex (dlPFC) can increase insufficient CC in depression as indicated by a reduction of attentional biases induced by emotionally salient stimuli. With this study, we provide first evidence that, compared to sham stimulation, tDCS to the left dlPFC enhances processing speed measured by an adaptive version of the Paced Auditory Serial Addition Task (PASAT) that is typically thwarted by frustration. Notably, despite an even larger amount of error-related negative feedback, the task-induced upset was suppressed in the group receiving anodal tDCS. Moreover, inhibition of task-related negative affect was correlated with performance gains, suggesting a close link between enhanced processing speed and consolidation of CC by tDCS. Together, these data provide first evidence that activity enhancing anodal tDCS to the left dlPFC can support focused cognitive processing particularly when challenged by frustration-induced negative affect. 
25835325	Clinical education is foundational to health professional training. However, it is also a time of increased stress for students. A student's perception of stressors and their capacity to effectively manage them is a legitimate concern for educators, because anxiety and decreased coping strategies can interfere with effective learning, clinical performance and capacity to care for patients. Resilience is emerging as a valuable construct to underpin positive coping strategies for learning and professional practice. We report the development and evaluation of a psycho-education resilience program designed to build practical skills-based resilience capacities in health science (physiotherapy) students. Six final year undergraduate physiotherapy students attended four action research sessions led by a clinical health psychologist. Resilience strategies drawn from cognitive behavioural therapy, and positive and performance psychology were introduced. Students identified personal learning stressors and their beliefs and responses. They chose specific resilience-based strategies to address them, and then reported their impact on learning performance and experiences. Thematic analysis of the audio-recorded and transcribed action research sessions, and students' de identified notes was conducted. Students' initial descriptions of stressors as 'problems' outside their control resulting in poor thinking and communication, low confidence and frustration, changed to a focus on how they managed and recognized learning challenges as normal or at least expected elements of the clinical learning environment. The research suggests that replacing stressful challenges with positive coping strategies offers a potentially powerful tool to build self-efficacy and cognitive control as well as greater self-awareness as a learner and future health practitioner. 
25830794	Counterinsurgency (COIN) operations have served as the fundamental component of the nation's military strategy. Without the established boundaries of conventional operations, switching between diplomatic and combative roles can expose Soldiers to unique stressors when conducting COIN operations. An exploratory study of descriptive data obtained from a retrospective records review of 140 service members deployed to Operation Enduring Freedom identified and described problems in psychosocial functioning. Behavioral health records for the first 7 months of the deployment and throughout the first year of redeployment were reviewed. The most common problems reported by Soldiers were operational stress characterized by anxiety, fear, irritability, frustration, and isolation. Additionally, most of the Soldiers engaged services for psychosocial challenges within the first year of returning from deployment. Establishing reliable access to behavioral healthcare has emerged as an essential component of total force protection in COIN deployments. 
25830469	As the number of people with Alzheimer's disease (AD) increases, clinicians must learn to educate patients and their caregivers about the communication problems associated with different stages of illness. Patients with AD will experience varying degrees of language impairments, concentration problems, and difficulty expressing themselves. Caregivers can learn to avoid common communication mistakes, such as correcting, reasoning with, and arguing with the person with AD. By equipping caregivers with strategies to aid verbal and nonverbal communication, clinicians can improve the interactions between patients with AD and their caregivers and lessen frustration on both sides. 
25819635	Presentations of self-harm to paramedic and emergency staff are increasing, and despite being the first professionals encountered, patients who self-harm report the quality of care and attitudes from these staff are unsatisfactory. Understanding this care may provide opportunities to improve services. The aim of this study is to enhance knowledge building and theory generation in order to develop practice and policy through a metasynthesis of qualitative research relating to perceptions of paramedic and emergency care for people who self-harm.The metasynthesis draws on Evolved Grounded Theory Methodology (EGTM). A search was undertaken of CINAHL, MEDLINE, OVID and Psych INFO, and grey literature. Subject headings of 'self-harm' were used alongside key words 'suicide', 'paramedic' 'emergency', 'overdose', 'pre-hospital' mental health, ambulance, perceptions of care, emergency.	A total of 1103 papers were retrieved; 12 were finally included. No papers investigated paramedic care for self-harm. The following metaphors emerged: (a) frustration, futility and legitimacy of care; (b) first contact in the pre-hospital environment: talking, immediate and lasting implications of the moral agent; (c) decision making in self-harm: balancing legislation, risk and autonomy; (d) paramedics' perceptions: harnessing professionalism and opportunities to contribute to the care of self-harm.	Paramedics are often the first health professional contact following self-harm, yet limited qualitative literature has explored this encounter. Metaphors revealed in this paper highlight challenges in decision making and legislation, also opportunities to improve care through professionalization and tailored education.	
25812239	Infant crying is distressing for parents, evoking a range of difficult feelings. Infants who cry often maybe perceived as difficult by their parents, with negative effects on bonding and attachment. Infant crying as a stimulus for child-abuse is also highlighted, as parents' feelings of frustration may provoke harmful responses towards the child. A non-exhaustive literature review was conducted, exploring the impact of infant crying on parents, using CASP tools to support the analysis of twenty qualitative and quantitative studies, published between 2003 and 2013. This paper reports the findings of the review, with a specific focus on the effects of infant crying on the parent-infant relationship. The findings suggest parents may experience anxiety, depression, helplessness, anger and frustration in response to infant crying. Negative effects on bonding and parental perception of the baby are identified. Parents may also experience thoughts of harming their baby, and subsequent feelings of guilt and shame. Universal interventions to help parents prepare for parenthood, and to respond positively to crying are strongly recommended. Opportunities for parents to discuss their feelings towards their infant should be maximised, reducing the impact of infant crying on bonding and attachment. Parents should be empowered to develop strategies and sources of support to help them cope. Early identification of parents experiencing difficulties in coping with infant crying is essential, and risk in relation to potential abuse must be assessed. Health visitors have a key role in providing such support.
25800777	There is little research in Southeast Asia focusing on patients' experiences of seeking psychological treatment for chronic pain.This study aims to understand the experiences of patients seeking psychological treatment for chronic pain in this region.	Outpatient pain clinic at a tertiary hospital in Singapore.	People with experiences of attending psychological treatment for chronic pain, including some who were not receiving this type of treatment.	Fifteen inductive semi-structured interviews were conducted to explore patients' experiences regarding psychological treatment for their chronic pain. Thematic analysis was then applied.	Three main themes were identified: "Expectations and Realities of Health Professionals," "Patients' Attitudes and Beliefs," and "Practical and Social Factors." From the patients' perspectives, an empathetic health professional who was willing to listen contributed to a positive treatment seeking experience. Patients felt that health professionals' lack of knowledge about appropriate treatment contributed to their frustration. Patients could not understand how psychological treatment was related to pain treatment and queried why they were "paying just to talk." Conversely, their experiences were quite positive, and they found psychological treatments helpful when they participated in them.	Education for both patients and health professionals unfamiliar with psychological treatments for pain may improve access to these treatments.	
25796290	Although frustration has long been implicated in promoting aggression, the potential for poor frustration tolerance to function as a risk factor for physical child abuse risk has received minimal attention. Instead, much of the extant literature has examined the role of anger in physical abuse risk, relying on self-reports of the experience or expression of anger, despite the fact that this methodology is often acknowledged as vulnerable to bias. Therefore, the present investigation examined whether a more implicit, analog assessment of frustration tolerance specifically relevant to parenting would reveal an association with various markers of elevated physical child abuse risk in a series of samples that varied with regard to age, parenting status, and abuse risk. An analog task was designed to evoke parenting-relevant frustration: the task involved completing an unsolvable task while listening to a crying baby or a toddler's temper tantrum; time scores were generated to gauge participants' persistence in the task when encountering such frustration. Across these studies, low frustration tolerance was associated with increased physical child abuse potential, greater use of parent-child aggression in discipline encounters, dysfunctional disciplinary style, support for physical discipline use and physical discipline escalation, and increased heart rate. Future research directions that could better inform intervention and prevention programs are discussed, including working to clarify the processes underlying frustration intolerance and potential interactive influences that may exacerbate physical child abuse. 
25790919	The aim of the study was to examine the different perspectives of the children and their family caregivers' experiences in the treatment of relapsed cancer.We conducted 16 sessions of the Drawing-and-Story Procedure (D-S) with 5 to 12-year-old children who were in treatment due to recurrence of cancer, and 8 in-depth interviews among their family caregivers. The D-S and the interviews were audio-recorded with the participants' consent; the transcripts were analyzed using the thematic content analysis.	The children evidenced that they perceived the threatening and uncertainty, independently of their age or kind of communication established about the disease and prognosis. Caregivers expressed feelings of frustration, threat and loss of control in view of the relapsed cancer diagnosis and prognosis, which enhanced the fear of losing their children and hampered the process of attributing meaning to their existence. Dyads showed similar experiences related to the recurrent cancer issues, and the first treatment experience seemed to help them to give new meanings to the current situation.	Understanding the experiences of the children and their family caregivers can support the planning of psychological interventions that favor coping with the peculiarities of the disease situation resulting from the relapse diagnosis of childhood cancers.	
25777550	The aim of this research is to examine perceptions of those with comorbid chronic pain and obesity regarding their experience of comorbidity management in primary care settings.Chronic pain and obesity are common comorbidities frequently managed in primary care settings. Evidence suggests individuals with this comorbidity may be at risk for suboptimal clinical interactions; however, treatment experiences and preferences of those with comorbid chronic pain and obesity have received little attention.	Semi-structured interviews conducted with 30 primary care patients with mean body mass index=36.8 and comorbid persistent pain. The constant comparative method was used to analyze data.	Participants discussed frustration with a perceived lack of information tailored to their needs and a desire for a personalized treatment experience. Participants found available medical approaches unsatisfying and sought a more holistic approach to management. Discussions also focused around the need for providers to initiate efforts at education and motivation enhancement and to show concern for and understanding of the unique difficulties associated with comorbidity. Findings suggest providers should engage in integrated communication regarding weight and pain, targeting this multimorbidity using methods aligned with priorities discussed by patients.	
25769095	Patients with cognitive limitations may struggle understanding complex arguments and feel overwhelmed by the need to choose among medical options that they poorly understand. Such struggle may result in frustration and anger directed at the physician. The aim of the present study is to explain the characteristics underlying such situations. A decision tree is modeled to capture the choice that every patient has to make after receiving medical advice. Patient choices are phrased in terms of a threshold probability for accepting or rejecting advice by physicians. To a patient with poor understanding of medical exigencies all differences between present or absent disease state, prognosis, and risks of intervention may seem largely arbitrary and meaningless. With little or no guidance to make an informed decision, taking any medical action is deemed wasted and harmful, whereas inaction leaves the underlying medical problem unsolved. Both choices appear equally ineffective with respect to the patient's symptoms and therefore unappealing. As shown by applying threshold analysis to a patient in a state of ignorance, no threshold probability for following medical advice exists. Patients with cognitive limitations will become frustrated and angry by a seemingly dismal situation without good alternatives to choose from. 
25753356	Post-operative ileus (POI) is a common condition after surgery. Failure to restore adequate bowel function after surgery generates a series of complications and it is associated to patients frustration and discomfort, worsening their perioperative experience. Even mild POI can be source of anxiety and could be perceived as a drop out from the "straight-forward" pathway. Enhanced recovery programmes have emphasized the importance of early commencement of oral diet, avoiding the ancient dogmata of prolonged gastric decompression and fasting. These protocols with early oral feeding and mobilization have led to improved perioperative management and have decreased hospital length of stay, ameliorating patient's postoperative experience as well. Nonetheless, the incidence of POI is still high especially after major open abdominal surgery. In order to decrease the incidence of POI, minimally-invasive surgical approaches and minimization of surgical manipulation have been suggested. From a pharmacological perspective, a meta-analysis of pro-kinetics showed beneficial results with alvimopan, although its use has been limited by the augmented risk of myocardial infarction and the high costs. A more simple approach based on the postoperative use of chewing-gum has provided some benefits in restoring bowel function. From an anaesthesiological perspective, epidural anaesthesia/analgesia does not only reduce the postoperative consumption of systemic opioids but directly improve gastrointestinal function and should be considered where possible, at least for open surgical procedures. POI represents a common and debilitating complication that should be challenged with multi-disciplinary approach. Prospective research is warranted on this field and should focus also on patient s reported outcomes.
25751707	The purpose of this paper is to explore incarcerated women's awareness, beliefs, and experiences with human papillomavirus (HPV) infection and vaccination.Researchers conducted focus groups with 45 incarcerated women in an urban Midwestern US jail to assess how women talked about their Papanicolaou (Pap) test screening and abnormal Pap test follow-up experiences. Some focus group questions specifically assessed individual awareness, beliefs, and experiences with HPV infection and vaccination. Based on these data, the authors described participants' awareness of HPV, as well as used open coding to ultimately extract themes related to beliefs and experiences with HPV infection and vaccine.	While all 45 participants reported experiencing an abnormal Pap test event within the last five years, only two-thirds of participants (n=30) reported having heard of the HPV infection. Several themes emerged from the analysis of the data: the women's beliefs about cause and severity of HPV; frustration with age requirements of the vaccine; varied experiences with vaccinations for themselves and their children; the impact of media exposure on knowledge; and desire for more HPV infection and vaccine information.	Incarcerated women's awareness and limited experiences with HPV infection and vaccination may be a barrier to adequate screening and cervical cancer prevention. This study has implications for the development of cervical health education for this high-risk group of women, who are four to five times as likely to have cervical cancer as non-incarcerated women.	
25733980	Some studies on the occupational health of hospital physicians have found that working conditions have different effects on physician's well-being and health in different medical specialities. There has been no comparative study of the effects of various work stressors in different specialities. This study aims to close this gap.German hospital physicians were asked about their working conditions and aspects of health. The short version of the Instrument for Stress-Related Job Analysis for Hospital Physicians was used to measure working conditions. Irritation and emotional exhaustion were used to assess health. Physicians were also asked for socio-demographic aspects, including their medical speciality.	Data from 763 hospital physicians were included in the analyses. Significant differences between medical specialities were demonstrated for time pressure, uncertainty, frustration about how work needs to be done and social stressors with patients. Physicians in internal medicine showed consistently high levels of stressors. Time pressure, frustration about how work needs to be done, and emotional dissonance were found to be significantly related to both aspects of health.	The results showed that some medical specialities are more affected by specific stressors. It is therefore discussed how improvements can be implemented. Furthermore, it is illustrated which stressors are especially relevant for health. These relationships to health should be investigated in further research and in longitudinal designs to allow hints of causal relationships.	
25732152	Pain consists of sensory-discriminative and negative-affective components. Neuronal mechanisms for the sensory component of pain have been investigated extensively. On the other hand, neuronal mechanisms for the affective component of pain remain to be investigated. Recent behavioral studies have revealed the brain regions and neuronal mechanisms involved in the affective component of pain. Glutamatergic transmission within the anterior cingulate cortex and basolateral amygdaloid nucleus plays a critical role in pain-induced aversion. Noradrenaline and corticotropin-releasing factor (CRF) within the ventral and dorsolateral parts of the bed nucleus of the stria terminalis (BNST), respectively, play important roles in paininduced aversion. Electrophysiological studies have revealed that both noradrenaline and CRF activate type II BNST neurons, which may inhibit the BNST output neurons. A recent histochemical study showed that most VTA-projecting BNST output neurons are GABAergic neurons, which preferentially make synaptic contact with VTA GABAergic neurons. Therefore, activation of VTA-projecting BNST output neurons should increase the neuronal excitability of VTA dopaminergic (DAergic) neurons through increased inhibitory input to VTA GABAergic neurons, which negatively regulate VTA DAergic neurons. Pain-induced release of noradrenaline and CRF within the BNST may activate type II BNST neurons, which could suppress VTA-projecting BNST output neurons, thereby attenuating the excitatory influence to the VTA DAergic neurons. Recent optogenetic studies suggest that the suppression of VTA DAergic neurons is sufficient to induce place aversion. Pain-induced place aversion may be due to the suppression of VTA DAergic neurons via the processing of nociceptive information within the BNST. 
25725279	Although patients with critical limb ischemia (CLI) commonly undergo major limb amputation, the quality of life (QOL) of this group remains poorly described. Therefore, we sought to describe which domains vascular amputees consider important in determining their health-related QOL.We performed 4 focus groups in patients who had major lower extremity amputations resulting from CLI. They were conducted at 4 distinct centers across the United States to ensure broad geographic, socioeconomic, and ethnic representation.	Of 26 patients (mean age, 64 years), 19 (73%) were Caucasian, 6 (23%) were African American, and 1 (4%) was Native American. Nearly, three-quarter of patients were men (n = 19, 73%) and had a high-school education or more (n = 19, 73%). Overall, 8 (31%) were double amputees and 17 (65%) had diabetes. Time since amputation varied across patients and ranged from 3 months to more than 27 years (mean, 4.3 years). Patients stated that their current QOL was determined by impaired mobility (65%), pain (60%), progression of disease in the remaining limb (55%), and depression/frustration (54%). Across 26 patients, more than half (n = 16, 62%) described multiple prior revascularization procedures. Although most felt that their physician did his/her best to salvage the affected leg (85%), a sizable minority would have preferred an amputation earlier in their CLI treatment course (27%). Furthermore, when asked how their care might have been improved, patients reported that facilitating peer support (88%), more extensive rehabilitation and prosthetist involvement (71%), earlier mention of amputation as a possible outcome (54%), and the early discontinuation of narcotics (54%) were potential areas of improvement.	Although QOL in vascular amputees seems primarily determined by mobility impairment, pain, and emotional perturbation, our focus groups identified that physician-controlled factors such as the timing of amputation, informed decision making, and postamputation support may also play an important role. The assessment of patient preferences regarding maintenance of mobility at the cost of increased pain versus relief of pain with amputation at a cost of diminished mobility is central to shared decision making in CLI treatment.	
25721543	Despite intense brain-computer interface (BCI) research for >2 decades, BCIs have hardly been established at patients' homes. The current study aimed at demonstrating expert independent BCI home use by a patient in the locked-in state and the effect it has on quality of life.In this case study, the P300 BCI-controlled application Brain Painting was facilitated and installed at the patient's home. Family and caregivers were trained in setting up the BCI system. After every BCI session, the end user indicated subjective level of control, loss of control, level of exhaustion, satisfaction, frustration, and enjoyment. To monitor BCI home use, evaluation data of every session were automatically sent and stored on a remote server. Satisfaction with the BCI as an assistive device and subjective workload was indicated by the patient. In accordance with the user-centered design, usability of the BCI was evaluated in terms of its effectiveness, efficiency, and satisfaction. The influence of the BCI on quality of life of the end user was assessed.	At the patient's home.	A 73-year-old patient with amyotrophic lateral sclerosis in the locked-in state.	Not applicable.	The BCI has been used by the patient independent of experts for >14 months. The patient painted in about 200 BCI sessions (1-3 times per week) with a mean painting duration of 81.86 minutes (SD=52.15, maximum: 230.41). BCI improved quality of life of the patient.	In most of the BCI sessions the end user's satisfaction was high (mean=7.4, SD=3.24; range, 0-10). Dissatisfaction occurred mostly because of technical problems at the beginning of the study or varying BCI control. The subjective workload was moderate (mean=40.61; range, 0-100). The end user was highy satisfied with all components of the BCI (mean 4.42-5.0; range, 1-5). A perfect match between the user and the BCI technology was achieved (mean: 4.8; range, 1-5). Brain Painting had a positive impact on the patient's life on all three dimensions: competence (1.5), adaptability (2.17) and self-esteem (1.5); (range: -3 = maximum negative impact; 3 maximum positive impact). The patient had her first public art exhibition in July 2013; future exhibitions are in preparation.	Independent BCI home use is possible with high satisfaction for the end user. The BCI indeed positively influenced quality of life of the patient and supports social inclusion. Results demonstrate that visual P300 BCIs can be valuable for patients in the locked-in state even if other means of communication are still available (eye tracker).	
25720045	Adolescents affected by a severe disease who undergo high-risk treatment may experience stress, pain, extreme frustration, depression, and anger. In this large spectrum of emotions, several situations must be considered carefully. To improve coping and quality of services offered to adolescents in paediatric hospitals, we elaborated a semi-structured interview and a short questionnaire (Quality of life-adolescent-Istituto Giannina Gaslini, QoL-adol-IGG scale) to investigate the quality of life, the needs and expectations of adolescent in-patients.The study sample includes 117 in-patients aged between 10 and 20 years coming from several Italian regions who were admitted to the G. Gaslini Research Children's Hospital for a period of 10 days or more, regardless of the disease. The QoL-adol-IGG scale was administered - after obtaining informed consent from the children and their parents - in one single encounter by trained psychologist. The distribution of the answers was evaluated after stratification by patient's age, gender, area of residence, and clinical diagnosis. Continuous data were compared using the Kruskal-Wallis, while the χ2-test was used for categorical data.	Seventy-two percent had difficulty practicing normal daily activities during their stay in the hospital, not only because of the disease (40%), but also because of the poor organization within the hospital, the lack of proposals/activities and space for spare time, and the limited access to technologies. Adolescents ≥15 years were more frequently dissatisfied than youngsters concerning the access to Internet and other technologies, the possibility to make new friends and to take part in social activities.	The results of this study, which evaluated the hospital's organization, but also psychological functioning in a representative sample of patients, may contribute to optimize internal procedures of clinical departments where adolescent in-patients are present, on the basis of their requests and taking into account their age.	
25719562	Approximately 259,000 patients were discharged alive from U.S. hospices in 2010. There is a paucity of research describing the experiences of these individuals and their family members.The study objective was to explore the experiences of adults discharged from a hospice program due to decertification related to ineligibility or extended prognosis, from the perspective of the individual and his or her adult family members. Research questions were, How do participants perceive and describe (1) the experience of being discharged alive from hospice, and (2) their quality of life after a live hospice discharge?	A transcendental phenomenological design guided this study. Purposive, snowball sampling was used to recruit 12 volunteers, aged 35-92 years, who had experienced live hospice discharge due to decertification. Data collection included open-ended interviews and journals.	Findings included two primary themes: suffering "AS…" and the paradox of hospice discharge. These primary themes were supported by 12 subthemes: abandonment, unanswered questions, loss of security, loneliness, uncertainty, anger and frustration, physical decline, bearing exhaustive witness, having and needing support, mixed feelings, not dying fast enough, and hospice equals life.	Understanding this experience may enhance understanding and aid health care providers to anticipate the unique needs of the hospice population.	
25712238	Maternal mortality is very high in Tanzania. Competent hospital care is key to improving maternal outcomes, but there is a crisis of availability and performance of health workers in maternal care. This article uses interviews with managers, nurse-midwives, and women who had given birth in two hospitals providing virtually all the emergency maternal care in one Tanzania city. It contrasts women's experience in the two hospitals, and analyses interconnections with nurse-midwives' and managers' experiences of working conditions. The conceptual literature on nurse empowerment identifies some key explanatory variables for these contrasts. Staff experienced less frustration and constraint in one of the hospitals; had more access to structurally empowering resources; and experienced greater congruence between job commitment and working culture, resulting in better work engagement. Conversely, nurse-midwives in the other hospital were constrained by supply shortages and recurrent lack of support. Contrasting management styles and their impacts demonstrate that even in severely resource-constrained environments, there is room for management to empower staff to improve maternal care. Empowering management practices include participatory management, supportive supervision, better incentives, and clear leadership concerning ward culture. Structural constraints beyond the capacity of health facility managers must however also be addressed. © 2015 The Authors. International Journal of Health Planning and Management published by John Wiley & Sons, Ltd.
25711415	Despite evidence of elevated risk factors for suicidal thoughts and behavior in youth with Tourette syndrome and chronic tic disorders (CTD), few studies have actually examined that relationship. This study documented the frequency and clinical correlates of suicidal thoughts and behaviors in a sample of children and adolescents with CTD (N = 196, range 6-18 years old). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Centers for Disease Control.Youth and parents completed a battery of measures that assessed co-occurring psychiatric diagnoses, child emotional and behavioral symptoms, and impairment due to tics or co-occurring conditions.	A structured diagnostic interview identified that 19 youths with CTD (9.7%) experienced suicidal thoughts and/or behaviors, which was elevated compared to 3 youths (3%) who experienced these thoughts in a community control sample (N = 100, range 6-18 years old, P = .03). For youth with CTD, suicidal thoughts and behaviors were frequently endorsed in the context of anger and frustration. The Child Behavior Checklist (CBCL) anxious/depressed, withdrawn, social problems, thought problems, and aggressive behavior subscales, as well as the total internalizing problems scale, were associated with the presence of suicidal thoughts and/or behaviors. Suicidal thoughts and/or behaviors were significantly associated with tic symptom severity; tic-related impairment; and obsessive-compulsive, depressive, anxiety, and attention-deficit/hyperactivity disorders' symptom severity. CBCL anxiety/depression scores mediated the relationship between tic severity and suicidal thoughts and behaviors.	Findings suggest that about 1 in 10 youth with CTD experience suicidal thoughts and/or behaviors, which are associated with a more complex clinical presentation and often occur in the presence of anger and frustration.	
25710714	People living with complex regional pain syndrome (CRPS) experience frustration with the lack of knowledge and understanding of CRPS as a pain condition. We report on our attempt to address this issue.People living with CRPS taking part in a larger study were invited to co-construct a CRPS wiki page that addressed the areas in which they had experienced the most difficulty. A blank wiki page was set up for participants to populate with issues they felt needed to be raised and addressed.	Participants failed to engage with the wiki technology. We modified our procedure and completed an inductive analysis of a sister-forum which participants were using as part of the larger study. Six issues of importance were identified. We used the discussion forum threads to populate the themes. Due to a continued lack of engagement with the wiki technology, the team decided to create a suite of leaflets which were piloted with delegates at a CRPS patient conference.	Future work should be mindful of the extent to which patients are able and willing to share their experiences through such technology. Striking the balance between patient-endorsed and researcher-driven co-creation of such material is imperative.	
25708677	The objective was to assess the prevalence and risk factors for co-occurring pelvic floor disorders (PFDs): urinary incontinence (UI), symptomatic pelvic organ prolapse (sPOP), and fecal incontinence (FI), 20 years after one vaginal (VD) or one cesarean (CS) delivery.We carried out a registry-based national cohort study of primiparae who delivered during the period 1985-1988 and had no further deliveries. Medical Birth Registry data were linked to data from postal questionnaires distributed 20 years post-partum (response rate 65.2%, n = 5,236). Main outcome measures were prevalence and risk factors for combined and isolated PFDs.	The prevalence of any PFD was 46.5; 31.7% had one symptom and 14.8% had two or more. Co-occurring symptoms doubled after VD (17.1%) compared with CS (8.4%) (adjOR 2.26; 95% CI 1.84-2.79). The strongest association was observed between VD and having all three symptoms (adjOR 5.20; 95% CI 2.73-9.91), followed by the combination of sPOP and UI (adjOR 3.38; 95% CI 2.24-5.10). The degree of frustration perceived by the women because of pelvic floor dysfunction increased with each additional co-occurring PFD (p < 0.001). The strongest risk factors for clustering of PFDs were: VD (OR 2.19; 95% CI 1.75-2.73), family history (OR 2.03; 95% CI 1.73-2.34), and ≥2 degree tear (OR 1.78; 95% CI 1.24-2.55). Vacuum extraction and episiotomy were not risk factors.	The prevalence of co-occurring PFDs was high and was doubled in women after VD compared with CS. Women with UI most likely had it as an isolated symptom, whereas FI and sPOP more often occurred in combination.	
25707812	Erectile rehabilitation (ER) following radical prostatectomy (RP) is considered an essential component to help men regain erectile functioning; however, many men have difficulty adhering to this type of program. This qualitative study explored men's experience with ER, erectile dysfunction (ED), and ED treatments to inform a psychological intervention designed to help men adhere to ER post-RP.Thirty men, 1-to-3-years post-RP, who took part in an ER program, participated in one of four focus groups. Thematic analysis was used to identify the primary themes.	Average age was 59 years (standard deviation = 7); mean time since surgery was 26 months (standard deviation = 6). Six primary themes emerged: (1) frustration with the lack of information about postsurgery ED; (2) negative emotional impact of ED and avoidance of sexual situations; (3) negative emotional experience with penile injections and barriers leading to avoidance; (4) the benefit of focusing on the long-term advantage of ER versus short-term anxiety; (5) using humor to help cope; and (6) the benefit of support from partners and peers.	Men's frustration surrounding ED can lead to avoidance of sexual situations and ED treatments, which negatively impact men's adherence to an ER program. The theoretical construct of acceptance and commitment therapy was used to place the themes into a framework to conceptualize the mechanisms underlying both avoidance and adherence in this population. As such, acceptance and commitment therapy has the potential to serve as a conceptual underpinning of a psychological intervention to help men reduce avoidance to penile injections and adhere to an ER program.	
25705913	This qualitative study involved 54 individuals who were self-employed in a variety of solo businesses. All participants were administered a semistructured interview that inquired into various aspects of their work experience with the data subject to reliability and validity checks. The study identified stressful incidents, coping strategies, and emotional strains arising from those stressful incidents. Uncertainty about income was a common background stressor. Recent specific stressors included dramatic slowdowns in business, reputational threat, betrayal, unreasonable customers, and medical problems. Commonly occurring strains included apprehension/anxiety, frustration, anger, and sadness/depression. The self-employed used problem-focused coping much more often than emotion-focused coping. We also identified a third kind of coping that we labeled humanitarian coping. A number of questions/hypotheses for future research emerged, including identifying (a) a tipping point bearing on when the psychological benefits of self-employment (e.g., autonomy) are overtaken by business losses outside the individual's control and (b) the coping strategies that are most useful in managing work-related stressors.
25704840	Recent studies have posited that machine learning (ML) techniques accurately classify individuals with and without pain solely based on neuroimaging data. These studies claim that self-report is unreliable, making "objective" neuroimaging classification methods imperative. However, the relative performance of ML on neuroimaging and self-report data have not been compared. This study used commonly reported ML algorithms to measure differences between "objective" neuroimaging data and "subjective" self-report (ie, mood and pain intensity) in their ability to discriminate between individuals with and without chronic pain. Structural magnetic resonance imaging data from 26 individuals (14 individuals with fibromyalgia and 12 healthy controls) were processed to derive volumes from 56 brain regions per person. Self-report data included visual analog scale ratings for pain intensity and mood (ie, anger, anxiety, depression, frustration, and fear). Separate models representing brain volumes, mood ratings, and pain intensity ratings were estimated across several ML algorithms. Classification accuracy of brain volumes ranged from 53 to 76%, whereas mood and pain intensity ratings ranged from 79 to 96% and 83 to 96%, respectively. Overall, models derived from self-report data outperformed neuroimaging models by an average of 22%. Although neuroimaging clearly provides useful insights for understanding neural mechanisms underlying pain processing, self-report is reliable and accurate and continues to be clinically vital.The present study compares neuroimaging, self-reported mood, and self-reported pain intensity data in their ability to classify individuals with and without fibromyalgia using ML algorithms. Overall, models derived from self-reported mood and pain intensity data outperformed structural neuroimaging models.	
25702962	The present investigation focused on adolescents' defiance against parents by drawing upon psychological reactance theory (Brehm, 1966) and self-determination theory (Ryan & Deci, 2000). Psychological reactance would be elicited when freedom is taken away, thereby motivating individuals to engage in oppositional behavior. Throughout four studies (total N = 1,472, age ranging between 12 and 21 years), it was examined whether a controlling parenting style related to adolescents' experiences of autonomy need frustration (i.e., pressure) and reactance. Reactance, in turn, would relate to more externalizing and internalizing problems. Support was obtained for these associations in community and clinical samples, making use of different informants, and controlling for responsiveness and rule setting. A vignette-based study provided further support. The discussion highlights theoretical and clinical implications. 
25702167	The aim of this study was to identify how daughters or sons to parents suffering from mental illness perceive their situation. The objective was to provide new knowledge based on what they communicate on open Internet forums.The sample consisted of forum posts written by individuals who reported that they had mentally ill parents. Data collection comprised 301 comments from 35 forum threads on 5 different Swedish Internet forums, and predetermined inclusion criteria were used. Data were analyzed qualitatively using thematic analysis.	The analysis generated four themes: "Caregiver burden," "Knowledge seeking," "Support from the forum," and "Frustration and powerlessness over health care." The results showed that parents' mental illness affected the forum writers on several levels, and they often felt stigmatized. The writers often lacked knowledge of their parents' mental illness and sought out Internet forums for information and support from peers in similar situations. The psychiatric care given to the parents was a source of dissatisfaction among the forum writers, who often felt that their parents did not receive adequate care.	This study shows that fear of stigmatization and perceived lack of care and support caused forum writers to anonymously seek out Internet forums for information and support from others with similar experiences. The role of social support and the attractiveness of anonymity and availability typical for open Internet forums ought to be considered by health care professionals and researchers when developing new ways for providing support for children or adolescents with a mentally ill parent.	
25700534	Relative deprivation of income is hypothesised to generate frustration and stress through upward social comparison with one's peers. If psychosocial stress is the mechanism, relative deprivation should be more strongly associated with specific health outcomes, such as cardiovascular disease (compared with other health outcomes, eg, non-tobacco-related cancer).We evaluated the association between relative income deprivation and mortality by leading causes, using a cohort of 21 031 community-dwelling adults aged 65 years or older. A baseline mail-in survey was conducted in 2003. Information on cause-specific mortality was obtained from death certificates. Our relative deprivation measure was the Yitzhaki Index, derived from the aggregate income shortfall for each person, relative to individuals with higher incomes in that person's reference group. Reference groups were defined according to gender, age group and same municipality of residence.	We identified 1682 deaths during the 4.5 years of follow-up. A Cox regression demonstrated that, after controlling for demographic, health and socioeconomic factors including income, the HR for death from cardiovascular diseases per SD increase in relative deprivation was 1.50 (95% CI 1.09 to 2.08) in men, whereas HRs for mortality by cancer and other diseases were close to the null value. Additional adjustment for depressive symptoms and health behaviours (eg, smoking and preventive care utilisation) attenuated the excess risks for mortality from cardiovascular disease by 9%. Relative deprivation was not associated with mortality for women.	The results partially support our hypothesised mechanism: relative deprivation increases health risks via psychosocial stress among men.	
25690091	The Paced Auditory Serial Addition Test (PASAT) is regularly used in the evaluation of cognition in multiple sclerosis (MS). However, the test may impose frustration, distress, and anxiety in patients, which may result in refusal to participate by many patients.In this study, a subject- and experimenter-paced PASAT was compared and analyzed, with regard to independent measures of cognitive functions, as well as disability, fatigue, depression, and anxiety.	A population-based sample of patients with MS (n = 34; mean age 47.2 ± 8.6) was examined with the PASAT, including a subject-paced condition, in addition to the standard experimenter-paced conditions using three levels of interstimuli intervals (ISI: 3.0, 2.5, and 2.0 s). A comprehensive set of neuropsychological tests, measures of disease severity, fatigue, anxiety, and depression were studied as potentially associated factors.	Subject- and experimenter-paced PASAT performance correlated significantly and the subject-paced administration correlated even higher with measures of information processing speed, executive function, attention, and working memory than standard experimenter-paced administration of PASAT.	The associations between PASAT performance and measures of fatigue, anxiety, and depression were not significant.	The results indicate that the altered PASAT procedure measures the same cognitive functions in MS as the standard procedure. At the same time, the altered procedure may make the PASAT more user-friendly for patients with MS.	
25686804	Prenatal exposure to maternal psychological distress and glucocorticoids result in neurobiological adaptations within the fetus that increase risk for developing exaggerated emotional, behavioral, and stress responses to novelty and challenges in childhood. The current study investigated the influence of maternal depressed mood and cortisol during pregnancy on infant cardiac vagal control (CVC) to standardized laboratory challenge tasks.The sample comprised 194 women and their infants. Maternal reports of depressed mood and salivary cortisol were assessed at 14 and 32 weeks gestational age. Linear regression was used to examine associations between maternal measures during early and late pregnancy, and infant CVC indexed via respiratory sinus arrhythmia (RSA) at rest and in response to laboratory tasks designed to elicit frustration when infants were 6 months of age. It was hypothesized that maternal depressed mood and cortisol would be associated with lower basal RSA and smaller decreases in RSA from baseline to challenge.	A significant decrease in infant RSA from baseline to frustration tasks indicated that laboratory tasks elicited a reliable decrease in RSA from baseline to frustration among infants which is characterized by reduction in vagal efferent activity on the heart in response to challenge. Higher maternal cortisol, but not depressed mood, was associated with lower basal RSA and greater decrease in RSA from baseline to frustration. Associations between maternal cortisol and infant basal RSA were observed for both early and late pregnancy whereas the associations between prenatal cortisol and decrease in RSA from baseline to frustration were observed for early, but not late, pregnancy.	Maternal cortisol during pregnancy was associated with infant CVC at 6-months of age. Such influences may have enduring impacts on the child and important implications for the development of physical and mental health outcomes.	
25675043	Family physicians in Canada as reported in several studies do not recognize the importance of family history in relation to breast/ovarian cancer and thus Canadian women with strong family histories continue to develop early-onset breast cancer without the knowledge of or ability to make choices regarding increased surveillance or preventative strategies. This study explored the feelings of women who learned about their hereditary risk only after their diagnosis younger than 52 years and who eventually tested positive for a BRCA gene mutation.Thirty-four such women were mailed an invitation to participate in this research including a letter of information, consent form, and discussion prompts for their written narrative response. Rigorous mixed method analyses were performed using Charmaz-based qualitative analyses as well as quantitative analyses.	Thirteen women (38.2%) responded with narratives for qualitative analysis from which 4 themes were coconstructed as follows: I, types of emotions; II, emotional response; III, coping with emotions; and IV, advice to women at similar risk. Women felt they should have learned about their hereditary risk from their family physician and through public education before their diagnosis. Although not experienced at the time of diagnosis, anger, frustration, and regret were experienced after receiving their BRCA results. These emotions arose from our research participants' lack of opportunity for prior genetic counseling and testing opportunity for genetic counseling and testing.	With increased public and physician education, it is hoped that women with significant family histories of breast/ovarian cancer will be identified before diagnosis and given options regarding cancer surveillance and risk reduction strategies.	
25664829	The purpose of the current study was to examine the unique and interactive contributions of infant negative emotionality and family risk factors in the development of internalizing-only, externalizing-only, and co-occurring behavior problems in early childhood. The sample included 412 infants and their primary caregivers. Interviews and temperament assessments took place when infants were 5-7 months old, and primary caregivers completed child behavior ratings at ages 2 1/2 and 5 years. Mixed-effects multinomial logistic regression was used to examine associations between infant risk factors and "pure" and co-occurring child behavior problems, and test whether these associations changed over time. The results of this study showed that hostile parenting during infancy increased the likelihood that children would develop internalizing-only problems, whereas infants who were highly distressed in response to novelty were at increased risk of developing externalizing-only problems. Multiple risk factors, including maternal anxious and depressive symptoms, family conflict, and younger maternal age, independently predicted early childhood co-occurring problems. Additionally, there was a significant interaction between infant anger/frustration and hostile parenting: In the context of hostile parenting, infants high in anger were at increased risk of developing early co-occurring problems, though this association faded by age 5. These findings point to the importance of considering the infant's family context, and differentiating between "pure" and co-occurring behaviors when examining the etiology of early childhood behavior problems.
25659197	The majority of in-hospital deaths of children occur in paediatric and neonatal intensive care units. For nurses working in these settings, this can be a source of significant anxiety, discomfort and sense of failure.The objectives of this study were to explore how NICU/PICU nurses care for families before and after death; to explore the nurses' perspectives on their preparedness/ability to provide family care; and to determine the emotional content of language used by nurse participants.	Focus group and individual interviews were conducted with 22 registered nurses from neonatal and paediatric intensive care units of two major metropolitan hospitals in Australia. All data were audio recorded and transcribed verbatim. Transcripts were then analysed thematically and using Linguistic Inquiry to examine emotional content.	Four core themes were identified: preparing for death; communication challenges; the nurse-family relationship and resilience of nurses. Findings suggested that continuing to provide aggressive treatment to a dying child/infant whilst simultaneously caring for the family caused discomfort and frustration for nurses. Nurses sometimes delayed death to allow families to prepare, as evidenced in the Linguistic Inquiry analysis, which enabled differentiation between types of emotional talk such as anger talk, anxiety talk and sadness talk. PICU nurses had significantly more anxiety talk (p=0.018) than NICU nurses.	This study provided rich insights into the experiences of nurses who are caring for dying children including the nurses' need to balance the often aggressive treatments with preparation of the family for the possibility of their child's death. There is some room for improvement in nurses' provision of anticipatory guidance, which encompasses effective and open communication, focussed on preparing families for the child's death.	
25650169	This study examined the association between prenatal tobacco exposure (PTE) and infant cortisol reactivity at 9 months of infant age. Child sex and maternal parenting behavior were hypothesized moderators. The sample included 217 (148 tobacco-exposed, 69 non-exposed) mother-child dyads. Data used were obtained from pregnancy assessments, mother-infant feeding interactions at 2 months, and salivary cortisol at four time points in response to frustration at 9 months. Results indicated a significant association between PTE and infant cortisol that was moderated by infant sex and maternal intrusiveness. That is, PTE boys had lower cortisol than control boys, but there was no association between PTE and cortisol among girls. There was a significant association between PTE and cortisol among infants of intrusive mothers, but not among infants with non-intrusive mothers. Thus, PTE was associated with cortisol hypo-reactivity such that boys and non-exposed infants experiencing high maternal intrusiveness were at greater risk.
25645374	Aggression is widely observed in children with attention deficit/hyperactivity disorder (ADHD) and has been frequently linked to frustration or the unsatisfied anticipation of reward. Although animal studies and human functional neuroimaging implicate altered reward processing in aggressive behaviors, no previous studies have documented the relationship between fronto-accumbal circuitry-a critical cortical pathway to subcortical limbic regions-and aggression in medication-naive children with ADHD. To address this, we collected behavioral measures and parental reports of aggression and impulsivity, as well as structural and diffusion MRI, from 30 children with ADHD and 31 healthy controls (HC) (mean age, 10±2.1 SD). Using grey matter morphometry and probabilistic tractography combined with multivariate statistical modeling (partial least squares regression and support vector regression), we identified anomalies within the fronto-accumbal circuit in childhood ADHD, which were associated with increased aggression. More specifically, children with ADHD showed reduced right accumbal volumes and frontal-accumbal white matter connectivity compared with HC. The magnitude of the accumbal volume reductions within the ADHD group was significantly correlated with increased aggression, an effect mediated by the relationship between the accumbal volume and impulsivity. Furthermore, aggression, but not impulsivity, was significantly explained by multivariate measures of fronto-accumbal white matter connectivity and cortical thickness within the orbitofrontal cortex. Our multi-modal imaging, combined with multivariate statistical modeling, indicates that the fronto-accumbal circuit is an important substrate of aggression in children with ADHD. These findings suggest that strategies aimed at probing the fronto-accumbal circuit may be beneficial for the treatment of aggressive behaviors in childhood ADHD. 
25639789	It is necessary to raise a positive attitude towards cancer information to improve disease prevention and control.To identify social factors, health characteristics and cancer-related perceptions and knowledge associated with a positive attitude towards cancer information.	We ran multivariate logistic regression models to analyse population-based data from OncoBarómetro-2010, a Spanish representative survey on perceptions and knowledge, related to cancer, conducted among 7938 people aged 18 years or more.	Attitudes towards cancer information. A positive attitude includes feeling motivated to keep informed, to have screening tests or to change lifestyle. A negative attitude includes feeling indifference, concern, frustration or fear.	38.3% of the studied population reported having received information related to cancer (within the last 6 months). Among those, 31.5% expressed a negative attitude towards cancer information. People more likely to have a positive attitude towards cancer information (reference category: negative attitude) were people aged 35-74 (ref: aged 18-34) (P < 0.001) and cancer survivors (ref: those who had not had cancer) (OR: 3.05; 95% CI: 1.73-5.38). The likelihood of a positive attitude increased with the level of education (P < 0.001). The variables negatively associated with a positive attitude towards cancer information were poor self-rated health status (ref: fair) (OR: 0.63; 95% CI: 0.42-0.95) and high self-perceived risk of developing cancer (ref: low) (OR: 0.75; 95% CI: 0.60-0.92).	These findings have potential to inform programmes designed to promote cancer prevention behaviours. Policies should target population groups with low socio-economic groups, those with poor self-rated health and individuals with high self-perceived risk of cancer. Further, in order to increase knowledge of cancer symptoms, we need to focus on individuals with unhealthy lifestyles.	
25636012	Patients with incurable esophageal cancer (EC) or pancreaticobiliary cancer (PBC) often have multiple symptoms and their quality of life is poor. We investigated which problems these patients experience and how often care is expected for these problems to provide optimal professional care. Fifty-seven patients with incurable EC (N = 24) or PBC (N = 33) from our outpatient clinic completed the validated "Problems and Needs for Palliative Care" (PNPC) questionnaire and two disease-specific quality of life questionnaires, European Organization for Research and Treatment in Cancer (EORTC). Although patients in general had several problems, physical, emotional, and loss of autonomy (LOA) problems were most common. For these physical and emotional problems, patients also expected professional care, although to a lesser extent for LOA problems. Inadequate care was received for fatigue, fear, frustration, and uncertainty. We conclude that an individualized approach based on problems related to physical, emotional, and LOA issues and anticipated problems with healthcare providers has priority in the follow-up policy of patients with incurable upper gastrointestinal cancer. Caregivers should be alert to discuss needs for fatigue, feelings of fear, frustration, and uncertainty. 
25602121	This paper examines the phenomenon of trust spirals in small groups. Drawing on literature on the spiral reinforcement of trust, we theorize that diversity in propensity to trust has affective and cognitive consequences related to trust (i.e., feelings of frustration and perceptions of low similarity), reducing the level of experienced intragroup trust early in a group's development. Reduced experienced trust then fuels relationship conflict and lowers trust even further over time, ultimately having a negative effect on group performance. These ideas are tested using a sample of MBA student groups surveyed at 3 time periods over 4 months. Results confirm our hypothesis that diversity in propensity to trust is sufficient to trigger a downward trust spiral and poor performance in small groups.
25586798	This review aims to describe the factors that influence participation in physical activity (PA) in people with neuromusculoskeletal (NMS) conditions.A systematic search of six databases was conducted. Articles were included if the study qualitatively explored factors that influence participation in PA by individuals with a NMS condition. Fifteen peer-reviewed articles published between 2003 and 2013 were analysed for common themes and critically appraised.	Results were categorised using the International Classification of Functioning, Disability and Health framework. The most common demotivators reported for the three areas of functioning, body function and structures, activities and participation were lack of walking balance, muscle weakness, pain, stiffness, bladder and blower problems, depression, thermoregulation and fear of injury. Fluctuating symptoms and fatigue were mentioned as demotivators in all of the progressive conditions. Maintaining independence, function and weight, and the prevention of secondary conditions were the leading motivators reported in this domain. Most common environmental barriers include accessibility, costs, transport and insufficient information and knowledge from health professionals. Social support is a consistent determinate of PA and is reported as a facilitator in every study. The most common personal demotivators include lack of motivation, feelings of self-consciousness and embarrassment in public, anxiety, frustration and anger. Personal motivators include goal setting and achieving, enjoyment, feeling good, feeling "normal", motivation and optimism, redefining self and escapism from everyday boundaries.	Individuals with NMS conditions report complex common barriers, facilitators, demotivators and motivators to participation in PA. The way these factors influence participation in PA is unique to the individual; therefore, it is necessary to adopt an individually tailored approach when designing interventions.	Individuals with neuromusculoskeletal conditions report common factors that influence participation in physical activity. It is the characteristics, attitude and beliefs of an individual that determine the way in which these factors influence participation in physical activity. Health professionals should be guided by the International Classification of Functioning, Disability and Health framework when assessing individuals, as the model will ensure all major factors of interest with regard to disability and physical activity behaviour are considered. Interventions to promote participation in physical activity in people with neuromusculoskeletal conditions require an individual approach that facilitates the assessment and management of an individual's barriers to physical activity. A multi-disciplinary approach may be required to address factors that influence participation in physical activity. Health professionals must be informed about other areas of expertise and draw on this when necessary.	
25586796	To explore parents' views of the activities and participation of children with cerebral palsy (CP) with a range of communicative abilities and the factors (personal and environmental) that influenced these.Thirteen parents of children with CP aged 4-9 years participated in semi-structured individual interviews. Interviews were recorded, transcribed and analysed thematically. Identified codes and themes were mapped to the domains of the International Classification of Functioning, Disability and Health - Children and Youth Version (ICF-CY).	Parents' responses reflected all ICF-CY domains comprising activity, participation and environmental factors. Codes were primarily mapped to the domains learning and applying knowledge, communication, mobility and interpersonal interactions and relationships. Key barriers identified included aspects of parents' own interactions with their child (e.g. not offering choices), unfamiliar people and settings, negative attitudes of others and children's frustration. Facilitators included support received from the child's family and school, being amongst children, having a familiar routine and the child's positive disposition.	Despite the barriers experienced, children participated in a range of activities. Parents placed importance on communication and its influence on children's independence, behaviour and relationships. Barriers and facilitators identified highlight aspects of the environment that could be modified through intervention to enhance communication and participation.	Children's activities and participation were largely related to early learning tasks (e.g. literacy), communication, mobility and interactions. Intervention aimed at improving activities and participation may address the various child, impairment, social and environment factors identified here as impacting on activities and participation (e.g. the child's personal characteristics, communication and physical impairments, the support and attitudes of others and the familiarity of the environment). Therapists will need to consider (and manage) the potential negative impact communication deficits may have on children's behaviour, independence and social skills which may in turn detrimentally impact on activity and participation.	
25580675	This laboratory study examined the emotional reactivity of persons with heightened borderline personality (BP) features to a social rejection stressor. Participants with high levels of BP features (n = 43) and controls with low levels of BP features (n = 67) were randomly assigned to a condition involving negative evaluation and social rejection based on personal characteristics, or to a condition involving a frustrating arithmetic task and negative evaluation based on performance. Hypotheses were that the high-BP individuals would demonstrate greater increases in negative emotions, shame, and anger in response to the social rejection/negative evaluation stressor, compared with the frustrating arithmetic task. The high-BP group showed significant increases in negative emotions in both conditions, significant increases in shame only in the frustrating arithmetic task, and significant increases in hostility only in the social rejection condition. In contrast, low-BP controls showed significant increases in negative emotions generally in the frustrating arithmetic condition and shame specifically in the social rejection condition. These findings highlight the emotion and context-specific nature of emotional reactivity in relation to BP features.
25579081	The purpose of this study was to describe the patient experience of communication during mechanical ventilation.This descriptive study is a secondary analysis of data collected to study the relationship between sedation and the MV patients' recall of the ICU. Interviews, conducted after extubation, included the Intensive Care Experience Questionnaire. Data were analysed with Spearman correlation coefficients (rs) and content analysis.	Participants were recruited from a medical-surgical intensive care unit in the Midwest United States.	Participants (n = 31) with a mean age of 65 ± 11.9 were on the ventilator a median of 5 days. Inability to communicate needs was associated with helplessness (rs = .43). While perceived lack of information received was associated with not feeling in control (rs = 41) and helplessness (rs = 41). Ineffective communication impacted negatively on satisfaction with care. Participants expressed frustration with failed communication and a lack of information received. They believed receipt of information helped them cope and desired a better system of communication during mechanical ventilation.	Communication effectiveness impacts patients' sense of safety and well-being during mechanical ventilation. Greater emphasis needs to be placed on the development and integration of communication strategies into critical care nursing practice.	
25569693	Previous studies with children have demonstrated inhibition difficulties associated with prematurity, but the question of potentially catching up with a delay in inhibition processes before adolescence still remains. Moreover, preterm adolescents are more at risk than their term-born peers for presenting behavioral problems such as emotional difficulties and attention deficit/hyperactivity disorder. In addition to examining response inhibition, this study addressed, for the first time, the impact of an emotional context on response inhibition abilities and its relation to behavioral problems in late school-aged preterm children. Fifty-eight preterm children aged 9-12 years were compared with 61 controls on two versions of a stop-signal task, the Delay Frustration Task, and the Strengths and Difficulties Questionnaire. Results showed general difficulties in inhibiting a response, rather than a specific impact of emotional context in preterm children. Compared with controls, these children exhibited more and longer button presses in a delay situation, as well as faster go reaction times associated with lower probability of inhibition in the stop-signal tasks. These difficulties reflected impulsivity and were associated with higher hyperactivity/inattention and conduct problems. Additionally, intrauterine growth restriction was found to be an additional perinatal risk factor for hyperactivity/inattention symptoms. These findings suggest that remaining inhibition difficulties in the preterm population at preadolescence could reveal increasing behavioral issues.
25564890	Accurately assessing depression in African American cancer patients is difficult because of the similarities of physical symptoms observed in cancer and depression.To identify universal and distinctive depressive symptoms in African American cancer patients.	Seventy-four cancer patients (34 depressed and 23 non-depressed African Americans, and 17 depressed Whites) were interviewed. Qualitative and quantitative analyses were conducted.	Compared to non-depressed African Americans, depressed African Americans reported irritability, social isolation, insomnia, fatigue and crying (p ≤ 0.05) more frequently over time. Compared to depressed Whites, they reported sadness, frustration and intrusive thoughts less frequently (p ≤ 0.05), but insomnia and fatigue more frequently (p ≤ 0.05) during cancer treatment. There was little racial difference at the time of interview.	Depressed African American cancer patients may benefit from more culturally sensitive depression measures that consider symptoms of irritability, social isolation and altered expressions of depressive mood.	
25564748	In the present research, we examine the ways in which exposure to hostile sexism influences women's competitive collective action intentions. Prior to testing our main model, our first study experimentally induced high versus low levels of security-comfort with the aim of providing experimental evidence for the proposed causal link between these emotions and intentions to engage in social competition. Results showed that lower levels of security-comfort reduced women's readiness to compete socially with men. Experiment 2 investigated the effect of hostile sexism on women's emotional reactions and readiness to engage in social competition. Consistent with the proposed model, results showed that exposure to hostile beliefs about women (1) increased anger-frustration and (2) decreased security-comfort. More specifically, exposure to hostile sexism had a positive indirect effect on social competition intentions through anger-frustration, and a negative indirect effect through security-comfort. 
25548792	The aim of this study was to assess the impact of herpes zoster (HZ) and postherpetic neuralgia (PHN) on the daily activities of patients and family members who care for them. Some former patients and family members participated in face-to-face interviews or in a T-group meeting (qualitative phase) and some participated in telephone interviews (quantitative phase). They all expressed feelings of helplessness and frustration mixed with depression, sadness, or rage. Many of the former patients said their lives stopped, in contrast to family members who said that their lives were busy and stressful. Family members caring for patients with PHN were more psychologically stressed than those caring for patients with HZ. Although former patients appreciated the psychological and emotional support given by their family members, they underestimated the impact that their disease had on them. Former patients and their family never forgot this illness and its considerable impact on their lives, particularly when PHN occurred. We need to raise the awareness of the general public about the real life impact of HZ and PHN and their often severe, debilitating consequences and the potential benefits from vaccination. 
25543958	Parkinson's disease (PD) is a progressive neurodegenerative condition often resulting in significant disability and impacting on one's ability to participate in an occupation. The present study aimed to explore how people with advanced Parkinson's disease experience the phenomenon of occupation in their daily lives in order to inform the practice of occupational therapy in palliative care.Using a phenomenological approach, in-depth interviews were undertaken with a purposive sample of 10 people in the advanced stages of Parkinson's disease. These interviews were audiotaped, transcribed verbatim, and subsequently analyzed using a thematic content analysis approach. The study received approval from the relevant university ethics committee, as well as the research network of Parkinson's UK.	The experience of occupation emerged as being physical, psychological, social, and spiritual with related subthemes. Within each of these themes, participants described their experience of occupation that they valued and that were important to their daily lives. They also identified the strategies they employed to continue participating in certain occupations and described others they were no longer able to engage in and the impact of that loss.	Participants' experiences crossed the domains of palliative care and suggest that adopting a palliative care approach would enhance an enhanced quality of life, experienced in terms of meaningful and valuable occupation. Disruption to participation in occupation caused them distress and frustration, suggesting that access to occupation-focused therapy would significantly improve quality of life for people with PD. As there is a strong link between the ethos of occupational therapy and palliative care, it is proposed that there is a valuable role for occupational therapy intervention to play within palliative care.	
25540156	When confronted with inequality, human children and adults sacrifice personal gain to reduce the pay-offs of other individuals, exhibiting apparently spiteful motivations. By contrast, sacrifice of personal gain by non-human animals is often interpreted as frustration. Spite may thus be a uniquely human motivator. However, to date, no empirical study has demonstrated that psychological spite actually drives human behaviour, leaving the motivation for inequity aversion unclear. Here, we ask whether 4- to 9-year-old children and adults reject disadvantageous inequity (less for self, more for peer) out of spite or frustration. We show that children, but not adults, are more likely to reject disadvantageous allocations when doing so deprives their peer of a better reward (spite) than when their peer has already received the better reward (frustration). Spiteful motivations are thus present early in childhood and may be a species-specific component of humans' developing cooperative and competitive behaviour.
25539581	Intimate partner violence (IPV) is a prevalent public health problem that affects millions of families. Much of what is known about IPV comes from quantitative studies that often "count" acts of IPV without exploring in depth the circumstances surrounding the violence, thereby leaving critical questions unanswered; existing qualitative studies tend to focus solely on women's perspectives. There is a dearth of dyadic qualitative research exploring the context of IPV in families with children, thus hindering the development of effective interventions for families experiencing IPV.Seven heterosexual couples were recruited from a University-based family therapy clinic to participate in qualitative interviews. Couples were eligible if they had experienced severe verbal or any physical aggression during the past 4 months; had ≥ one child living in the household; were English-speaking; and were ≥ 18. Each individual was interviewed separately. Key topics explored included specific types of violence used by men and women; primary triggers and the context surrounding aggressive disagreements; degree to which the child(ren) were exposed; and perceived consequences for adults and children.	All couples listed household responsibilities and parenting as key IPV triggers. Couples with infants reported that parenting disagreements were particularly heated, with women using aggression due to frustration about their partners' lack of support. Couples also described substance use, wanting to be heard, and prior violence histories as triggers or as the background context for IPV episodes. Children were present during IPV and often intervened in conflicts involving severe violence. Parents' perceptions of the effects of IPV on their children ranged from minimal to major emotional distress, with men describing more significant impact than women.	When describing acute triggers, parents most commonly mentioned that arguments were instigated by concerns about the division of household labor and parenting, a finding that may have significant implications for intervention development; this was particularly notable for parents of infants. Our findings emphasize the need for innovative programs that help parents cope with the stresses of raising a family as well as programs that directly address the consequences of IPV for children.	
25539396	Patients' cultural health beliefs and behaviors may conflict with biomedical healthcare values and practices potentially leading to non-adherence with asthma treatment regimens. To optimize shared decision-making, healthcare providers should understand and be sensitive to these cultural beliefs and behaviors and negotiate an asthma management plan acceptable to parents. The purpose of this study was to obtain the perspective of Mexican mothers regarding (1) their experiences of living with a child with asthma, (2) their understanding of the nature of asthma, and (3) how their cultural beliefs influence asthma management.A qualitative, phenomenological study design was employed to assess mothers' lived experiences with and perceptions of their child's asthma. Individual in-depth interviews were conducted with a purposeful sample of 20 Mexican mothers of children ages 5-17 years with asthma. An inductive, theory-driven, phenomenological analysis approach was used to elicit thematic findings.	Mothers expressed a symptomatic perception of asthma and limited understanding of the disease. Most believe the disease is present only when their child is symptomatic. Many are surprised and puzzled by the unpredictability of their child's asthma attacks, which they report as sometimes "silent". The inconsistency of triggers also leads to frustration and worry, which may reflect their concerns around daily controller medication use and preference for alternative illness management strategies.	Our clinical encounters should be refocused to better understand the context of these families' lives and the cultural lens through which they view their child's asthma.	
25520027	Traumatic brain injury (TBI) can result in functional deficits that persist long after acute injury. The authors present a case study of an individual who experienced some of the most common debilitating problems that characterize the chronic phase of mild-to-moderate TBI-difficulties with neurobehavioral functions that manifest via complaints of distractibility, poor memory, disorganization, poor frustration tolerance, and feeling easily overwhelmed. They present a rational strategy for management that addresses important domain-general targets likely to have far-ranging benefits. This integrated, longitudinal, and multifaceted approach first addresses approachable targets and provides an important foundation to enhance the success of other, more specific interventions requiring specialty intervention. The overall approach places an emphasis on accomplishing two major categories of clinical objectives: optimizing current functioning and enhancing learning and adaptation to support improvement of functioning in the long-term for individuals living with brain injury. 
25514541	There are no published studies examining concurrent associations between temperament and behavior during toddlerhood in offspring of parents with bipolar disorder (OBD), a population at high familial risk for psychopathology. Better understanding of early determinants contributing to well-being or mental illness in this high-risk population has the potential to aid in the identification of problem domains to be targeted clinically, and facilitate the development of early intervention and prevention initiatives for an appropriate subgroup of children at the youngest possible age.A total of 30 offspring of mothers with BD (mean age=25.4±4.9 months) participated in this study at Emory University. The mothers completed the Early Childhood Behavior Questionnaire (ECBQ) and the Child Behavior Checklist (CBCL).	The results of the correlational analyses indicated that the broad temperament dimension Negative Affectivity and the individual ECBQ scales Sadness and Shyness were positively associated with the broad CBCL dimension Internalizing Problems, whereas Sociability was negatively associated with Internalizing Problems. In addition, the temperament scales Soothability and Frustration were negatively and positively associated with Internalizing Problems, respectively. All ECBQ scales included in the broad temperament dimension Effortful Control, except for Cuddliness, were significantly negatively associated with the broad CBCL dimension Externalizing Problems. A significant sex difference was found for the ECBQ scale Positive Anticipation and the CBCL scale Sleep Problems, with a higher mean rank score for girls than for boys.	This is the first systematic investigation of temperament and behavior and concurrent associations between these two domains in toddlers of mothers with BD. The present findings provide a platform for future investigations of the contribution of temperament and early behavior to potential well-being or mental illness in OBD.	
25512965	This paper, written by the RANZCP Committee for Research, provides an outline for how to survive in research, considering the ingredients likely to contribute to success, the role of supportive structures and the expected challenges. Learning how to survive in research is relevant for both trainees and for Fellows undertaking research at any stage of their career.Intellectual curiosity, perseverance, frustration tolerance, patience and humility are key for success as a researcher. Selection of the right supervisor is important, as is development and maintenance of a good working supervisor/supervisee relationship. The personal benefits of undertaking research include flexibility in work hours, and improved skills in writing, oral presentations, objectivity, critical thinking, problem solving and project management.	
25504242	Burnout was originally described as a mental condition characterized by reduced work performance, impotence, frustration and lack of capability to reach objectives or goals while performing a job. For some authors, burnout is a poorly defined mixture of symptoms and signs, while other professionals think of it as a disease and a potential threat to public health. Worldwide, it has been observed that the most afflicted professionals and technicians are those who work providing services or assistance to other people, especially those dedicated to health care. This paper focuses on the idea that burnout should be considered a disease more than a syndrome. On the other hand, definitions of health and disease have changed with time, as well as theoretical and methodological references about burnout. In addition, burnout remains a condition that is being discussed in various scientific areas, with radically opposing positions; these approaches are discussed in this article. After presenting different conceptions regarding burnout, the essay concludes with an exploration of its implications and the identification of possible treatments, especially for health workers, among whom it is more common depending on their predisposing conditions and environments. 
25499810	The past two decades has seen a growing understanding that health care leads to harm in a large number of patients. With this insight has come an understanding that clinicians who care for patients who are harmed experience an understandable and predictable emotional response. After an adverse event, medical care givers may experience a wide range of symptoms including anger, guilt, shame, fear, loneliness, frustration and decreased job satisfaction. These may be accompanied by physical signs of fatigue, sleep disturbances, concentration difficulties, tachycardia and hypertension. These clinicians have been referred to as the "second victims." While many clinicians recover relatively quickly from an adverse event, for some this syndrome can last for weeks, months or indefinitely. Some have even contemplated or completed suicide. Being involved in an adverse event or error may also negatively impact the quality of care the clinician subsequently provides, either because of acute emotional distraction or chronic burnout. This can lead to additional errors and a vicious cycle of error, burnout and error. Health care systems have a moral responsibility to care for second victims. Care might be as simple as asking, "Are you OK?" and acknowledging the normal human emotional response to adverse events. Some centers have developed formal peer support programs in which clinicians are trained to act as peer supporter for emotional recovery after adverse events. Finally, more formal emotional support systems might be needed by some clinicians, including employee assistance programs, hospital clergy or psychological and psychiatric services. 
25483875	As antiretroviral treatment has led to decreased morbidity, HIV testing policy has increasingly shifted towards routine, provider-initiated approaches. Yet, few studies have examined the acceptability of provider-initiated HIV testing in the intensive, or critical care setting, where knowledge of HIV status is likely to impact on clinical management but explicit consent for testing is difficult to obtain. We conducted qualitative research in an urban hospital and clinic in Johannesburg. In-depth interviews were conducted among HIV testing clients (n = 20), recently discharged critical care patients (n = 13) and family members of critical care patients (n = 14). One focus group discussion was held with health care providers (n = 10). HIV testing in critical care was viewed as acceptable but challenging to implement. An overarching theme of ambivalence emerged from patients and families, who saw HIV testing as a pre-requisite to appropriate clinical care, but were concerned about the quality of its delivery. While providers were aware of the current "no testing without consent" policy, they expressed frustration in cases when testing was in the patient's best interest but consent could not be obtained. Furthermore, providers found it stressful to weigh up patient confidentiality against medical necessity when assessing patients' "best interests". Without specific guidelines, they often developed pragmatic, ad hoc ways to resolve dilemmas around testing in critical care. Our findings suggest that HIV testing guidelines specific to the critical care setting may help providers do their jobs more ethically and transparently. Provider-initiated approaches are likely to be acceptable to patients and may improve clinical outcomes, but training and support in policy implementation and ethical decision-making are essential. 
25483800	Improving cognition is service users' top research priority for life after stroke, and future research should include outcomes that they deem important. Patient perspectives on outcomes are collected using patient-reported outcome measures (PROMs). There is currently no patient-centred PROM specific for cognitive rehabilitation trials.Inform PROM development by exploring stroke survivor perspectives on the important, measurable impacts of persisting post-stroke cognitive problems.	Qualitative semi-structured interviews in participants' homes.	Purposive sample of 16 cognitively impaired stroke survivors at least six months post-stroke.	Interviews used a schedule and communication aids developed through patient consultation. Interviews were transcribed verbatim with non-verbal communication recorded using field notes. Data were analysed using a framework approach to find commonalities to shape the focus and content of an outcome measure.	Participants identified important impacts of their 'invisible' cognitive problems, outside of other stroke-related impairments. Cognitive problems exacerbated emotional issues and vice versa. Changes in self-identity and social participation were prominent. Impact was not spoken about in terms of frequency but rather in terms of the negative affect associated with problems; terms like 'bothered' and 'frustration' were often used.	The results support the development of a PROM specifically designed to address the impact of cognitive problems. It should: include items addressing a comprehensive range of cognitive skills; ask questions about mood, self-identity and social participation; use accessible wording that respondents understand and endorse; measure impact rather than frequency; and explore perceived impact on carers.	

25471490	Family members in families with severe chronic disease play important roles in care-giving. In families affected by Huntington's disease (HD), caregivers encounter practical and emotional challenges and distress. Enduring caregiver burdens may lead to problems and caregivers are in need of social support and health services to deal with challenges. We wanted to explore coping strategies and behaviour patterns used by family caregivers to care for themselves, while caring for a family member with HD. Participants were recruited from hospitals and community-based healthcare. The sample represents experiences from care-giving in all stages of the disease. We conducted semi-structured interviews with 15 family caregivers in Norway. The transcribed material was analysed by use of systematic text condensation, a method for cross-case thematic analysis of qualitative data. We found that family members used various coping strategies, adjusted to the stage and progression of HD. They tried to regulate information about the disease, balancing considerations for protection and disclosure, within and outside the family. The participants made efforts to maintain a balance between their own needs in everyday life and the need for care for affected family member(s). As the disease progressed, the balance was skewed, and the family caregivers' participation in social activities gradually decreased, resulting in experiences of isolation and frustration. In later stages of the disease, the need for care gradually overshadowed the caregivers' own activities, and they put their own life on hold. Health professionals and social workers should acknowledge that family caregivers balance their needs and considerations in coping with HD. They should, therefore, tailor healthcare services and social support to family caregivers' needs during the different stages of HD to improve caregivers' abilities to maintain some of their own activities, in balance with care-giving. 
25470469	Despite an ageing population and an increased prevalence of chronic pain, the relationship between chronic pain and the concept of successful ageing is unclear. The aim of the present research was to explore older people's views on past and present experiences of pain, and its management, and how these experiences relate to their perceptions of successful ageing.Semi-structured interviews with six participants, aged 75 years or older, who considered themselves to have aged successfully, explored what this concept meant to them and their experiences of pain. Data analysis used methods drawn from grounded theory. The themes reported in this article are 'understanding of pain' and 'perceptions of ageing'.	None of the participants recalled painful experiences that were not attributable to physical trauma. They believed that pain is part of life and a natural consequence of the ageing process. While some accepted this with little resistance, others felt frustration at what they considered a dismissive attitude towards older people experiencing pain from healthcare practitioners. The concept of successful ageing was previously unfamiliar to participants, and their conceptualization of ageing derived from comparing themselves with their peers.	The findings of the present study suggest that predictable experiences of pain as one ages may contribute to an acceptance of pain as a biomedical certainty, a belief reinforced both by health professionals and society. However, one may have chronic pain and yet consider oneself to have aged successfully, and it should therefore be recognized that there is a distinction between having pain and having a problem with pain.	
25460266	Body-focused repetitive behaviors (BFRBs) are repetitive, injurious, and non-functional habits that cause significant distress or impairment, including hair-pulling, skin-picking, and nail-biting. The emotion regulation (ER) model suggests that BFRBs are triggered by negative emotions and reinforced by alleviation of unpleasant affect. The frustrated action (FA) model suggests that BFRBs are triggered by and alleviate impatience, boredom, frustration, and dissatisfaction. Individuals with BFRBs are hypothesized to be particularly susceptible to these emotions because they demonstrate maladaptive planning styles characterized by high standards and unwillingness to relax.The objective of this study was to test these two models.	This study compared urge to engage in BFRBs in a BFRB group (n = 24) and a control group (n = 23) in experimental conditions designed to elicit boredom/frustration, stress, and relaxation, respectively.	The BFRB group reported a significantly greater urge to engage in BFRBs than did the control group across conditions. Participants in the BFRB group reported a stronger urge to engage in BFRBs in the boredom/frustration condition than in the relaxation condition but not in the stress condition. Finally, the BFRB group presented significantly higher scores on maladaptive planning style, and maladaptive planning style was significantly correlated with difficulties with ER.	Future studies may wish to exclusively use validated mood induction techniques and more stringent inclusion criteria.	The results highlight the role of boredom, frustration, and impatience in triggering BFRBs, and support the FA model.	
25457931	Nonhuman and human studies have documented the adverse effects of early life stress (ELS) on emotion regulation and underlying neural circuitry. Less is known about how these experiences shape social processes and neural circuitry. In this study, we thus investigated how ELS affects children's perception of, and neural response to, negative social experiences in a social exclusion paradigm (Cyberball).Twenty-five foster or adopted children with ELS (age 10.6 ± 1.8 years, 13 male and 12 female) and 26 matched nonseparated controls (age 10.38 ± 1.7 years, 12 male and 14 female) took part in a Cyberball paradigm during functional magnetic resonance imaging (fMRI).	During peer rejection, children with ELS reported significantly more feelings of exclusion and frustration than nonseparated controls. On the neural level, children with ELS showed reduced activation in the dorsal anterior cingulate cortex (dACC) and dorsolateral prefrontal cortex (dlPFC), and reduced connectivity between dlPFC-dACC, areas previously implicated in affect regulation. Conversely, children with ELS showed increased neural activation in brain regions involved in memory, arousal, and threat-related processing (middle temporal gyrus, thalamus, ventral tegmental area) relative to controls during social exclusion. The number of separation experiences before entering the permanent family predicted reductions in fronto-cingulate recruitment. The relationship between early separations and self-reported exclusion was mediated by dlPFC activity.	The findings suggest that ELS leads to alterations in neural circuitry implicated in the regulation of socioemotional processes. This neural signature may underlie foster children's differential reactivity to rejection in everyday life and could increase risk for developing affective disorders.	
25446953	Pain is a common word used to refer to a wide range of physical and mental states sharing hedonic aversive value. Three types of pain are distinguished in this article: Physical pain, an aversive state related to actual or potential injury and disease; social pain, an aversive emotion associated to social exclusion; and psychological pain, a negative emotion induced by incentive loss. This review centers on psychological pain as studied in nonhuman animals. After covering issues of terminology, the article briefly discusses the daily-life significance of psychological pain and then centers on a discussion of the results originating from two procedures involving incentive loss: successive negative contrast-the unexpected devaluation of a reward-and appetitive extinction-the unexpected omission of a reward. The evidence reviewed points to substantial commonalities, but also some differences and interactions between physical and psychological pains. This evidence is discussed in relation to behavioral, pharmacological, neurobiological, and genetic factors that contribute to the multidimensional experience of psychological pain. 
25439157	To construct a risk score for adolescent mental health problems among children, using parental data only and without potentially stigmatizing mental health items.We prospectively derived a prediction model for mental health problems at age 16 using data from parent report on 1676 children aged 11 from the general population. Mental health problems were considered present in the top 15% scores on the combined Achenbach ratings. The model was validated in a separate cohort (n = 336) children. A risk score was constructed for practical application.	In the derivation cohort, 248 (14.8%) had mental health problems at follow-up. Predictors in the final model were gender, maternal educational level, family history of psychopathology, math achievement at school, frequently moving house, severe disease or death in the family, parental divorce, and child frustration level. The model was well calibrated, showed good discriminatory power (area under the curve 0.75; 95% confidence interval 0.72-0.78), and validated well. The risk score stratified children in classes of risk ranging from 6.6% to 52.2%.	A risk score based on parent-reported data only and without mental health items accurately estimated the 5-year risk of adolescent mental health problems among children from the general population. Children with high risk may benefit from further monitoring or intervention. The risk score may be particularly suitable when parents want to circumvent an explicit discussion on possible mental health problems of their child.	
25417896	This study evaluated continuity and change in maternal-child hypothalamic-pituitary-adrenal axis attunement in early childhood. Participants were drawn from a prospective study of 1,292 mother-child dyads, which were racially diverse, predominantly low-income, and non-urban. Child focused stress tasks designed to elicit anger, fear, and frustration were administered during early infancy, later infancy, and toddlerhood. Mothers' and children's saliva samples (later assayed for cortisol) were collected before and after the tasks. The strength of mother-child adrenocortical attunement was conserved across infancy and toddlerhood. The magnitude of maternal-child adrenocortical attunement decreased in response to the child-focused stress tasks. Maternal sensitivity and the child's task-related emotional reactivity moderated adrenocortical attunement across the task, with greater maternal sensitivity during a free-play, and lower levels of child emotional reactivity during the stress tasks, stabilizing attunement from pre- to post-task levels. The findings advance our understanding of individual differences in the social regulation of adrenocortical activity in early childhood.
25383652	Countertransference can be viewed as a source of valuable diagnostic and therapeutic information and plays a crucial role in psychotherapy process and outcome. Some empirical researches have showed that patients' specific personality characteristics tend to evoke distinct patterns of emotional response in clinicians. However, to date there have been no studies examining the impact of patients' symptomatology on the association between their personality and therapists' responses. This research aimed to (a) investigate the relationship between patients' symptom severity and clinicians' emotional responses; and (b) explore the possible mediated effect of symptom severity on the relationship between patients' personality pathology and countertransference responses. A sample of psychiatrists and clinical psychologists (N = 198) of different theoretical orientations completed the Shedler-Westen Assessment Procedure-200 and the Therapist Response Questionnaire on a patient currently in their care, who then completed the Symptom Checklist-90-Revised. The findings showed that patients' symptomatology partially mediates the relationship between their specific personality disorders (in particular, schizotypal, borderline, histrionic, and avoidant) and therapists' emotional responses, but in general, the impact of symptom severity is less sizable than one aroused by patients' personality style. Higher levels of patients' symptom severity are most associated with an intense feeling of being overwhelmed, disorganization, helplessness, and frustration in clinicians. These countertransference reactions are not accounted for by therapists' different therapeutic approaches and other variables (as gender, age, profession, and experience). The clinical implications of these results are addressed.
25382159	Therapeutic and informal interactions with nurses are integral to the quality of care that psychiatric patients receive. How well these interactions are performed, and their impact on the experience and outcomes of inpatient care, have not been subject to systematic evaluation. The aim of the present study was to examine patients' perceptions of the personal and professional qualities of nursing staff and how these contribute to the ward environment. Patients (n = 119) from 16 acute psychiatric wards were interviewed using a schedule developed by a service-user researcher. Transcriptions of interviews were coded and organized into six themes: staff duties, staff disposition, control, communication and engagement, therapeutic ward environment, and consistency. Patients recognized that nurses have a difficult and stressful job, but frequently expressed feelings of anger, frustration, and hopelessness about their experience of the wards. Patients frequently felt that nursing staff did not understand issues from their perspective or attempt to empathize with them. The findings indicate poorly-communicated and inconsistent care. Initiatives to improve patients' experiences of acute psychiatric wards are urgently needed. 
25380604	The aim of the present study is to evaluate mental workload and fatigue in fingers, hand, arm, shoulder in single-incision laparoscopic surgery (SILS) and multiport laparoscopy.Volunteers performed chosen tasks by standard laparoscopy and SILS. Time to complete tasks and finger and hand strength were evaluated. Lateral, tripod, and pulp pinch strengths were measured. Hand dexterity was determined by pegboard. Electromyography recordings were taken from biceps and deltoid muscles of both extremities. The main outcome measurement was median frequency (MF) slope. NASA-TLX was used for mental workload.	Time to complete laparoscopic tasks were longer in the SILS group (P < .05). Decrease of strength in fingers and hand were similar in SILS and standard laparoscopy. Pegboard time was increased in both hands after SILS (P < .05). MF slope of biceps muscle and deltoid muscle in SILS was far away from the reference slope. MF slope of biceps muscle and deltoid muscle in standard laparoscopy was close to reference slope, indicating there was more fatigue in biceps and deltoid muscles of both upper extremities in SILS group. NASA-TLX score was 73 ± 13.3 and 42 ± 19.5 in SILS and multiport laparoscopy, respectively (P < .01). Mental demand, physical demand, temporal demand, performance, effort, and frustration were, respectively, scored 10.7 ± 3.8, 11.7 ± 3.5, 12.2 ± 2.7, 11 ± 3, 13.6 ± 2.7, and 13.5 ± 2.8 in SILS and 6.3 ± 3.1, 6.6 ± 3.3, 7.3 ± 3.3, 7.1 ± 4.1, 7.9 ± 3.9, and 6.6 ± 3.8 in standard laparoscopy (P < .01).	SILS is mentally and physically demanding, particularly on arms and shoulders. Fatigue of big muscles, effort, and frustration were major challenges of SILS. Ergonomic intervention of instruments are needed to decrease mental and physical workload.	
25377762	Ninety-eight mothers of healthy firstborn infants 0 to 6 months old were randomly assigned to listen to 10-min of infant crying or infant cooing while continuously rating subjective feelings of frustration. Participants completed pre-test measures of depressed mood, empathy, and trait anger and post-test measures of infant-related harm thoughts, negative and positive emotions, and urge to comfort and to flee. Twenty-three (23.5 %) participants endorsed unwanted thoughts of active harm (e.g., throwing, yelling at, shaking the infant). Women in the cry condition were more likely than women in the coo condition to report thoughts of harm. Women in the cry condition who endorsed thoughts of harm reported higher frustration levels over the 10 min of crying, higher levels of post-test negative emotions, and stronger urges to flee the infant but not stronger urges to comfort the infant. Trait anger and personal distress empathy predicted the occurrence of unwanted thoughts of infant harm, whereas negative mood did not. Unwanted, intrusive, infant-related thoughts of harm may be triggered by prolonged infant crying, are predicted by personal distress empathy and a tendency to experience anger, and are associated with higher frustration, negative emotions, and the urge to escape the infant. 
25362676	End-stage liver disease (ESLD), the final stage of chronic liver disease, is treated with liver transplant. Many patients have serious ESLD-related complications and are admitted to the intensive care unit for treatment. Such patients are temporarily unsuitable to undergo transplant surgery and are placed into a temporarily inactive category, "status 7," on the transplant waiting list. Status 7 patients account for about 15% of all patients on the list. To describe the experience of a status 7 patient on the liver transplant waiting list from the perspectives of family members, 38 hours of bedside observation of participants, 9 semistructured interviews with 6 family members, and 9 semistructured interviews with 8 health care professionals from nursing, medicine, and other health care disciplines were done. Data were analyzed via conventional content analysis. Family members' perspectives fit into 3 phases that correspond to the progression of the patient's clinical condition: dealing with crisis, confusion and frustration, and back on the road to transplant. All 3 phases related to 1 goal: getting the patient's status reactivated on the liver transplant waiting list. This case exposes the struggles that patients with ESLD and their families may go through during the status 7 period and could serve as a starting point for further examination of this period. 
25356301	The International Society for Sexual Medicine (ISSM) Ad Hoc Committee for the Definition of Premature Ejaculation developed the first evidence-based definition for lifelong premature ejaculation (PE) in 2007 and concluded that there were insufficient published objective data at that time to develop a definition for acquired PE.The aim of this article is to review and critique the current literature and develop a contemporary, evidence-based definition for acquired PE and/or a unified definition for both lifelong and acquired PE.	In April 2013, the ISSM convened a second Ad Hoc Committee for the Definition of Premature Ejaculation in Bangalore, India. The same evidence-based systematic approach to literature search, retrieval, and evaluation used by the original committee was adopted.	The committee unanimously agreed that men with lifelong and acquired PE appear to share the dimensions of short ejaculatory latency, reduced or absent perceived ejaculatory control, and the presence of negative personal consequences. Men with acquired PE are older, have higher incidences of erectile dysfunction, comorbid disease, and cardiovascular risk factors, and have a longer intravaginal ejaculation latency time (IELT) as compared with men with lifelong PE. A self-estimated or stopwatch IELT of 3 minutes was identified as a valid IELT cut-off for diagnosing acquired PE. On this basis, the committee agreed on a unified definition of both acquired and lifelong PE as a male sexual dysfunction characterized by (i) ejaculation that always or nearly always occurs prior to or within about 1 minute of vaginal penetration from the first sexual experience (lifelong PE) or a clinically significant and bothersome reduction in latency time, often to about 3 minutes or less (acquired PE); (ii) the inability to delay ejaculation on all or nearly all vaginal penetrations; and (iii) negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy.	The ISSM unified definition of lifelong and acquired PE represents the first evidence-based definition for these conditions. This definition will enable researchers to design methodologically rigorous studies to improve our understanding of acquired PE. Serefoglu EC, McMahon CG, Waldinger MD, Althof SE, Shindel A, Adaikan G, Becher EF, Dean J, Giuliano F, Hellstrom WJG, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, and Torres LO. An evidence-based unified definition of lifelong and acquired premature ejaculation: Report of the second International Society for Sexual Medicine Ad Hoc Committee for the Definition of Premature Ejaculation. Sex Med 2014;2:41-59.	
25340366	Extensive research has shown high rates of burnout among physicians, including those who work in academic health centers. Little is known, however, about stress, burnout, and morale of academic biomedical scientists. The authors interviewed department chairs at one U.S. institution and were told that morale has plummeted in the past five years. Chairs identified three major sources of stress: fear of not maintaining sufficient funding to keep their positions and sustain a career; frustration over the amount of time spent doing paperwork and administrative duties; and distrust due to an increasingly adversarial relationship with the executive leadership.In this Commentary, the authors explore whether declining morale and concerns about funding, bureaucracy, and faculty-administration conflict are part of a larger national pattern. The authors also suggest ways that the federal government, research sponsors, and academic institutions can address these concerns and thereby reduce stress and burnout, increase productivity, and improve overall morale of academic biomedical scientists. 
25325598	A growing body of literature indicates that insomnia is related to suicidality. However, the mechanism through which insomnia correlates with suicide risk is unclear. The goal of the present research was to determine whether hopelessness, a robust predictor of suicidality, mediates the relation between insomnia and suicidal ideation (SI).The present study used archival data from community-dwelling adults. Participants (n = 766) completed a Health Survey, two weeks of daily sleep diaries, and five measures of daytime functioning, including the Beck Depression Inventory (BDI). BDI item 2 was used to assess hopelessness, and BDI item 9 was used to assess SI. Criteria from the DSM-5 as well as quantitative criteria were used to identify participants with insomnia (n = 135).	The analyses revealed that hopelessness is a significant mediator of the relation between insomnia and SI. After adding depression as an additional mediator, hopelessness remained a significant predictor of SI.	The present research suggests the need for clinicians to routinely screen clients who have insomnia for hopelessness and SI, and to treat hopelessness when it is present. Further research should address the limitations in this sample and should also consider other potential mediators of the insomnia-SI link.	
25322346	Athletic trainers have traditionally conceptualized rehabilitation programs in terms of 3 distinct physiologic phases; however, these phases appear to neglect athletes' psychosocial responses to their injuries.To document injured athletes' psychosocial responses during the different phases of injury rehabilitation.	Qualitative study.	National Collegiate Athletic Association Division II university in the mid-Atlantic region of the United States.	A total of 8 previously injured athletes (4 men and 4 women) participated in the study.	We collected participant data by using semistructured interviews, transcribed verbatim and analyzed by directed content analysis. Established themes were triangulated to determine trustworthiness.	Initially, athletes' cognitive appraisals were predominantly negative in nature, leading to negative emotions. These appraisals changed after diagnosis and when moving to the reaction-to-rehabilitation phase and the reaction-to-sport phase. During the reaction-to-rehabilitation phase, athletes reported mixed cognitive appraisals and identified frustration as the main emotional response. When returning to sport, athletes reflected on the lessons learned, yet they expressed some doubts related to their ability to return to play. These cognitive appraisals served as a precursor to the resulting emotional responses of nervousness and reinjury anxiety, as well as excitement. Throughout the various phases of rehabilitation, athletes reported seeking out social support: initially from significant others and then from their athletic trainers during the reaction-to-rehabilitation phase.	The results appear to support the use of the integrated model of psychological response to sport injury and the rehabilitation process and the 3 phases of rehabilitation as a framework for understanding how physical and psychosocial factors may interact during sport-injury rehabilitation. Understanding this interaction may help athletic trainers provide better care to their injured athletes.	
25316204	Relatively few studies have examined the relationship between conception of God and psychological outcomes in a self-determination theory (SDT) framework. The aim of this study was to examine the role of basic psychological needs as a mediator of the association between conception of God and psychological outcomes. In a sample of 210 religious young adults, we found that the concept of a controlling God was positively associated with feelings of need frustration and depression, whilst the concept of an autonomy-supporting God was positively associated with feelings of need satisfaction and vitality. In turn, need satisfaction promoted feelings of vitality, whereas need frustration led to feelings of depression. The satisfaction of needs was a full mediator of the relationship between autonomy-supporting God and vitality, whilst the frustration of needs was a full mediator of the relationship between controlling God and depression. These findings are discussed in terms of SDT. We also discuss how future research may further increase our understanding of the dynamics involved in concepts of God and psychological outcomes. 
25306386	Internet addiction disorder (IAD) is characterized by the problematic use of online video games, computer use, and mobile handheld devices. While not officially a clinical diagnosis according to the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), individuals with IAD manifest severe emotional, social, and mental dysfunction in multiple areas of daily activities due to their problematic use of technology and the internet.We report a 31year-old man who exhibited problematic use of Google Glass™. The patient has a history of a mood disorder most consistent with a substance induced hypomania overlaying a depressive disorder, anxiety disorder with characteristics of social phobia and obsessive compulsive disorder, and severe alcohol and tobacco use disorders.	During his residential treatment program at the Navy's Substance Abuse and Recovery Program (SARP) for alcohol use disorder, it was noted that the patient exhibited significant frustration and irritability related to not being able to use his Google Glass™. The patient exhibited a notable, nearly involuntary movement of the right hand up to his temple area and tapping it with his forefinger. He reported that if he had been prevented from wearing the device while at work, he would become extremely irritable and argumentative.	Over the course of his 35-day residential treatment, the patient noted a reduction in irritability, reduction in motor movements to his temple to turn on the device, and improvements in his short-term memory and clarity of thought processes. He continued to intermittently experience dreams as if looking through the device. To our knowledge, this is the first reported case of IAD involving problematic use of Google Glass™.	
25299853	People with generalized anxiety disorder (GAD) engage in maladaptive coping strategies to reduce or avoid distress. Evidence suggests that uncertainty and negative emotions are triggers for distress in people with GAD; however, there may also be other triggers. Recent conceptualizations have highlighted six types of experiences that people report having difficulty withstanding: uncertainty, negative emotions, ambiguity, frustration, physical discomfort, and the perceived consequences of anxious arousal. The present study examined the extent to which individuals high in symptoms of GAD are intolerant of these distress triggers, compared to individuals high in depressive symptoms, and individuals who are low in GAD and depressive symptoms. Undergraduate students (N = 217) completed self-report measures of GAD symptoms, depressive symptoms, and distress intolerance. Individuals high in GAD symptoms reported greater intolerance of all of the distress triggers compared to people low in symptoms of GAD and depression. Individuals high in GAD symptoms reported greater intolerance of physical discomfort compared to those high in depressive symptoms. Furthermore, intolerance of physical discomfort was the best unique correlate of GAD status, suggesting that it may be specific to GAD (versus depression). These findings support continued investigation of the transdiagnosticity and specificity of distress intolerance. 
25296699	To describe the life experiences of adolescents and young adults with congenital heart disease.Owing to medical advances, most children with congenital heart disease are expected to survive into adulthood. The transitional development from adolescence to adult is the critical period for fostering self-care.	Descriptive phenomenological study.	Thirty-five patients of 15-24 years old with congenital heart disease were recruited from paediatric cardiology clinics by purposive sampling. They were individually interviewed between October 2012-February 2013 using a semi-structured interview guideline and joined adult congenital heart disease clinics at two medical centres in northern Taiwan. The data were analysed using descriptive phenomenological method developed by Giorgi.	The essence of the life experience of adolescents and young adults with congenital heart disease involves a dynamic process of moving between invisible defects and coexistence with the disease. Six themes emerged: (1) invisible defects: the existence of imperfect understanding; (2) conflict: interpersonal frustrations; (3) imbalance: the loss of self-balance; (4) suffering: increasing anxiety; (5) encounters: meeting needs; and (6) coexistence: positive coping strategies.	As patients with congenital heart disease transition from adolescence into adulthood, they must learn about their disease, overcome frustration and anxiety and develop self-care strategies for coexisting with congenital heart disease. Results of this study may serve as clinical care guidelines for adolescents and young adults with congenital heart disease and give a reference for developing transitional intervention strategies.	
25282384	Pain is a symptom pediatric nurses commonly encounter in the hospital setting. Untreated pain can lead to adverse physiologic and psychological effects. This study examines in-hospital pain assessment methods nurses report using and assesses challenges, difficulties, and barriers nurses report to assessing pain in hospitalized children. Cross-sectional study of 82 pediatric nurses from all pediatric departments of a tertiary hospital in Israel. A self-report questionnaire was developed to examine how nurses assess children's in-hospital pain and barriers to in-hospital pain assessment. Nearly all nurses (90%) reported having enough knowledge to assess children's pain in the hospital, relying on child's self-report (86%) and being familiar with commonly used validated pain scales (90%). However, a majority (75%) reported not using pain scales recently and only half (58%) reported using an alternative method involving the child. Most nurses (86%) reported relying on their own overall impression of the child's pain and only a third (34%) reported involving the parents in their pain assessments. Nurses included comments stressing the importance of pain assessments and their frustration with the current validated measures available. This study adds to a growing body of literature demonstrating a gap between recommended pediatric pain assessment guidelines and reported practice, with nurses showing a resistance to relying on single-item or unidimensional measures to assess and evaluate the rich and complex pain experience. A multidimensional approach involving child self-report, parent report, and nurses' own overall impression based on clinical assessment skills of pain is discussed. 
25273675	Clinicians' emotions about practice are a potentially powerful yet largely overlooked factor in implementation of good-quality care. The present paper expands the current, limited evidence about clinicians' emotions by (i) describing clinician-reported examples of emotions about practice and (ii) identifying the clinical situations in which, according to clinicians, emotions emerge and influence practice.Semi-structured, face-to-face interviews with 25 clinicians (children's occupational therapists) were conducted across six health care organisations. Participants were asked to reflect on their practice in two recent patient cases, one that they perceived 'successful' and another 'unsuccessful'. Interviews were transcribed verbatim, and the transcripts were analysed for emerging themes. A proportion of transcripts were independently read and coded, and the themes were validated through critical discussion.	A key theme was clinicians' emotions, especially negative emotions including guilt, anger, worry, frustration and inadequacy. These were described in connection with situations where the clinicians perceived that (i) they failed to provide good quality care, (ii) they were unable to achieve positive health outcomes or engage the patient or (iii) there was conflict between what they were asked to do and the norms they held important.	Clinicians experience a range of negative emotions about practice. These are particularly likely to emerge in situations where clinicians perceive that their actions and practice fall short of the standards, norms or outcomes that they hold as important. The results inform the specification of emotions and emotion-triggering situations for future investigations of health care implementation.	
25273377	Military stressors such as survival training can affect endocrine functioning in the short term, and combat has been associated with endocrine changes linked to psychopathology. However, studies with military samples examining whether there are individual differences in these changes as part of normal development, or as an adaptive mechanism in adulthood are lacking. This study examined whether exposure to combat in a sample of veterans was associated with differential endocrine activity to a laboratory frustration task. Results indicated that Army veterans demonstrated significant testosterone reactivity to frustration and negative coupling between cortisol and testosterone. Alternatively, Navy and Marine veterans demonstrated little testosterone reactivity to frustration and positive coupling between cortisol and testosterone. Positive cortisol-testosterone coupling was stronger among individuals who had more dangerous combat experiences. This latter pattern may better prepare individuals for stressful life experiences and supports the contention that adulthood stressors may calibrate endocrine systems. Results are explained in the context of the Adaptive Calibration Model (Ellis et al., 2012, Developmental Psychology, 48(3), 598-623) which proposes that exposure to key environmental dimensions during endocrinologically malleable life stages (e.g., puberty) can change stress responsivity, resulting in a faster life history trajectory (e.g., increased risk-taking and aggression).
25257112	Suchtpatienten sind in der Hausarztpraxis meist problematische Patienten: Der Zeitaufwand für den Arzt ist oft groß, wenn mit der nötigen Behutsamkeit und Geduld vorgegangen werden soll. Tabuisierte Substanzen oder Verhalten, mangelnde Erfahrung und manchmal eigenes Suchtverhalten machen solche Gespräche für Ärzte schwierig. Dennoch bleibt die möglichst frühzeitige Erkennung und Intervention von Suchtgefährdeten und Suchterkrankten eine wichtige Aufgabe für Hausärzte, denn durch das Vertrauen, das sie bei ihren Patienten genießen, können sie vieles bewegen. Am Beispiel Alkohol werden vier Screeningtests für die Erkennung riskanten Trinkverhaltens vorgestellt (AUDIT, AUDIT-C, CAGE, SMAST-G) und ihre Stärken und Schwächen diskutiert. Die Hausarztpraxis ist auch eine effiziente Umgebung für Kurzinterventionen auf der Basis des Motivierenden Interviews (MI) und des Transtheoretischen Modells der Verhaltensänderung (TTM). Anhand der Beispiele Alkohol- und Nikotinsucht führen wir in diese Gesprächstechnik respektive Grundhaltung ein, und stellen moderne Methoden wie „Definiertes Trinken“ sowie neue Rauchstoppmethoden vor. Der Schlüssel zum Erfolg beim hausärztlichen Umgang mit Suchtpatienten liegt in einer respektvollen Grundhaltung und in kommunikativer Geschicklichkeit.Addiction patients are usually perceived as problematic patients in primary care practices: Encounters often are time-consuming and the approach to the patient is difficult. Moreover, patients sometimes are hiding their addictive behaviour and behave shameful. Other barriers are a lack of experience in communication skills among physicians or their own addictive behaviour. Nevertheless, to diagnose and treat addiction as early as possible is an important task for family doctors, as patients' confidence in them is an important factor to induce a behaviour change. We present four screening tests for the early diagnosis of addiction to alcohol (AUDIT, AUDIT-C, CAGE, SMAST-G) and discuss their strengths and shortcomings. The family doctor's practice is also a useful setting for brief interventions based on motivational interviewing (MI) techniques and the transtheoretical model of behaviour change (TTM). We shortly introduce to these techniques and attitudes using addiction to alcohol and nicotine as examples, and we present innovative methods as "defined drinking" and new quit smoking methods. A respectful attitude towards the patient and communication skills seem to be key factors for family physicians to successfully approach their addiction patients. 	
25253542	Pediatricians' workload is increasingly thought to affect pediatricians' quality of work life and patient safety. Workflow interruptions are a frequent stressor in clinical work, impeding clinicians' attention and contributing to clinical malpractice. We aimed to investigate prospective associations of workflow interruptions with multiple dimensions of mental workload in pediatricians during clinical day shifts.In an Academic Children's Hospital a prospective study of 28 full shift observations was conducted among pediatricians providing ward coverage. The prevalence of workflow interruptions was based on expert observation using a validated observation instrument. Concurrently, Pediatricians' workload ratings were assessed with three workload dimensions of the well-validated NASA-Task Load Index: mental demands, effort, and frustration.	Observed pediatricians were, on average, disrupted 4.7 times per hour. Most frequent were interruptions by colleagues (30.2%), nursing staff (29.7%), and by telephone/beeper calls (16.3%). Interruption measures were correlated with two workload outcomes of interest: frequent workflow interruptions were related to less cognitive demands, but frequent interruptions were associated with increased frustration. With regard to single sources, interruptions by colleagues showed the strongest associations to workload.	The findings provide insights into specific pathways between different types of interruptions and pediatricians' mental workload. These findings suggest further research and yield a number of work and organization re-design suggestions for pediatric care.	
25243737	Research from the sport medicine professional's (SMP's) perspective indicates that SMPs are often required to address psychosocial aspects of injuries during treatment. However, only a few authors have investigated injured athletes' experiences with these concerns.To explore injured professional athletes' views on the role of SMPs in the psychosocial aspects of sport-injury rehabilitation. Design : Qualitative study.	Professional association football and rugby union clubs.	Ten professional, male football (n = 4; 40%) and rugby union (n = 6; 60%) players (age = 22.4 ± 3.4 years). Data Collection and Analysis : We collected data using a semistructured interview guide, and the data were then transcribed and analyzed following the interpretative phenomenological analysis guidelines. We peer reviewed and triangulated the established emergent themes to establish trustworthiness.	Athletes in our study viewed injuries as "part and parcel" of their sports. Despite normalizing sport injuries, athletes reported frequent feelings of frustration and self-doubt throughout the rehabilitation process. However, athletes' perceived the role of SMPs in injury rehabilitation as addressing physical concerns; any intervention aimed at psychosocial outcomes (eg, motivation, confidence) needed to be subtle and indirect.	The SMPs working with injured athletes need to understand the psychosocial principles that underpin athletes' sport-injury processes and the effect psychosocial reactions can have on athletes. Moreover, SMPs must understand the self-regulatory processes that may take place throughout injury rehabilitation and be able to apply psychological principles in natural and subtle ways to aid athletes' self-regulatory abilities.	
25240708	Prolonged inconsolable crying bouts in the first months of life are frustrating to parents and may lead to abuse. There is no empirical description of frustration trajectories during prolonged crying, nor of their emotional predictors or emotional and behavioural sequelae. Frustration responses and their relationships were explored in an analogue cry listening paradigm. Without knowing how long it would last, 111 postpartum mothers were randomized to listen to a 10-min audiotape of infant crying or cooing while continuously recording frustration on a visual analogue 'slider' scale. The listening bout was preceded by questionnaires on negative mood, trait anger and empathy and followed by questionnaires on the reality of the cry sound, positive and negative emotions, soothing strategies, coping strategies and urges to comfort and flee. Individual frustration trajectories were modelled parametrically and characterized by frustration maximum, rate of rise, inflections and harmonicity parameters. As hypothesized, the modal response was of gradually increasing frustration throughout. However, there were marked individual differences in frustration trajectories. Negative mood, trait anger and empathy did not predict modal or modelled individual trajectories. However, frustration responses were significantly related to post-listening emotions and behavioural ratings. In particular, prolonged crying generated highly ambivalent positive and negative emotional responses. In summary, maternal frustration generally increased as the crying bout progressed; however, frustration trajectories were highly individual and emotional responses were highly ambivalent in terms of positive and negative emotions generated. Some emotional and behavioural responses were associated with specific trajectory parameters of frustration responses. 
25237747	We report the neuropsychological profile of a 4-year-old boy with the rare 18p deletion syndrome. We used a battery of standardized tests to assess his development in intellect, language, visuomotor integration, academic readiness, socialization, and emotional and behavioral health. The results showed borderline intellectual function except for low average nonverbal reasoning skills. He had stronger receptive than expressive language skills, although both were well below his age group. He had impaired visuomotor integration and pre-academic skills such as letter identification. Emotional and behavioral findings indicated mild aggressiveness, anxiety, low frustration tolerance, and executive function weaknesses, especially at home. Interestingly, he showed social strengths, responding to joint attention and sharing enjoyment with his examiner. With its assessment of development in many domains, this case report is among the first to characterize the neuropsychological and psychiatric function of a young child with 18p deletion syndrome. We discuss the implications of our findings for clinical practice. 
25229879	This study tests the hypothesis that hens that are reared in aviaries but produce in furnished cages experience poorer welfare in production than hens reared in caged systems. This hypothesis is based on the suggestion that the spatial restriction associated with the transfer from aviaries to cages results in frustration or stress for the aviary reared birds. To assess the difference in welfare between aviary and cage reared hens in production, non-beak trimmed white leghorn birds from both rearing backgrounds were filmed at a commercial farm that used furnished cage housing. The videos were taken at 19 and 21 weeks of age, following the birds' transition to the production environment at 16 weeks. Videos were analysed in terms of the performance of aversion-related behaviour in undisturbed birds, comfort behaviour in undisturbed birds, and alert behaviour directed to a novel object in the home cage. A decrease in the performance of the former behaviour and increase in the performance of the latter two behaviours indicates improved welfare. The results showed that aviary reared birds performed more alert behaviour near to the object than did cage reared birds at 19 but not at 21 weeks of age (P = 0.03). Blood glucose concentrations did not differ between the treatments (P>0.10). There was a significant difference in mortality between treatments (P = 0.000), with more death in aviary reared birds (5.52%) compared to cage birds (2.48%). The higher mortality of aviary-reared birds indicates a negative effect of aviary rearing on bird welfare, whereas the higher duration of alert behavior suggests a positive effect of aviary rearing. 
25225048	We used a qualitative focus group design to explore the experiences and challenges of nurses who work with hospitalized patients experiencing the sudden inability to verbalize their needs, also known as sudden speechlessness. In response to open-ended questions in facilitated focus groups, 18 nurses discussed issues around the care and communication needs of suddenly speechless (SS) patients. Nurses identified multiple, commonly occurring communication challenges when caring for SS patients. They believed these challenges led to poorer recognition of patient needs, with the potential for compromised patient care. Nurses described how the lack of reliable strategies to facilitate communication sometimes resulted in negative patient outcomes, including unmet psychosocial needs and the potential that informed consent and educational issues were being inadequately addressed for the SS patients. Even experienced nurses indicated ongoing problems in communicating with SS patients, despite using a multitude of strategies, leaving many to deal with issues of frustration and role conflict. 
25222539	Today in the digital age, with our advances in modern technology and communication, there are additional stressors for our military personnel and Veterans. Constant dangers exist both on and off the battlefield, unlike prior wars that had clearly-defined war zones. In addition, medical advances have assisted in saving the lives of many more gravely injured troops than ever previously possible. As the wars in Iraq and Afghanistan come to an end, large numbers of service men and women are returning home with multiple injuries. This group of Veterans has significantly higher rates of posttraumatic stress disorder (PTSD) and traumatic brain injury than ever before reported. Although existing PTSD therapies have been found to be highly effective for many Veterans, there is a substantial minority unsatisfactorily treated. Mantram repetition, an innovative, complementary, evidence-based treatment, is proving to be successful for these new Veterans. When used regularly it helps with "road rage, impatience, anger, frustration, and being out of control." A mantram is a brief, sacred word or phrase that embodies divine power or the greatest positive energy one can imagine (Easwaran, 2008a). Mantram repetition is a simple, quick, personal, portable, and private complementary practice that may be used as an adjunct to current treatments for PTSD. Growing research evidence supports mantram repetition's value for dissemination and adoption in the 21st century. This chapter summarizes Mantram Program research conducted from 2003 to 2014. It describes the health-related benefits of the Mantram Program in various populations. The current research focuses on benefits for managing psychological distress and promoting quality of life in Veterans. Future areas for research are suggested. 
25207710	Little research has been conducted exploring the issues surrounding parenting with an acquired brain injury (ABI). This study aimed to explore the experiences and needs of parents who suffered an ABI in the last 2 years from their own perspectives. For individuals with an ABI who have dependent children their ABI has the potential to impact upon their parenting abilities, skills and relationships.Interpretive phenomenological analysis (IPA) was used to analyse the data. Using IPA allowed the research questions and inquiry to be positioned epistemologically and directed towards 'meaning' rather than 'difference' or 'causality'.	Five participants (two female, three male) were interviewed using a semi-structured interview schedule.	Four main themes were identified: (i) Multiple losses, (ii) A mix of resigned acceptance and uncertain future, (iii) Giving and receiving support is part of the healing process and (iv) Hopes and aspirations.	The results indicated that the participants experienced an oscillation between experiencing the multiple losses of their parental role and attempting to adapt and adjust to these changes. These findings are discussed in relation to clinical and theoretical implications for parents who are inpatients with an ABI up to 2 years post-injury.	
25184788	The purpose of this study is to investigate how family-related opinions and stressful situations are related to psychological distress in women undergoing infertility treatment. The subjects in this cross-sectional study were recruited from female patients undergoing infertility treatment (n = 2540) at 70 infertility treatment institutions in Japan. Because of non-participation or missing data, the number of subjects included in the analysis was 635 (response rate, 25.0%). The family-related opinions and stressful situations were evaluated using the original questions. Psychological distress was assessed using a self-report measure, the Kessler Six-question Psychological Distress Scale (K6). The K6 scores of the following participants were significantly (p < 0.05) and independently high: those with more frequent miscarriage/stillbirth/abortions, those with repeated miscarriages as the cause of infertility, those with infertility of unknown causes, those living with no child, those having a low joint income with their partner, those with the opinion that "women should devote themselves to their household duties" those who had considered stopping treatment, those without the opinion that "married life without children is favorable" and those who had experienced stressful situations such as inadequate explanation by doctors, frustration of multiple failed attempts, differences of opinion with the partner, and lack of knowledge regarding when to stop treatment. Family-related opinions and stressful situations associated with psychological distress in women undergoing infertility treatment are outlined. The results of this study may contribute to the prevention of and care for psychological distress in female patients undergoing infertility treatment. 
25184154	This study aimed to compare the effect of satisfaction and perceived problems between Pelite, Dermo with shuttle lock, and Seal-In X5 liners on the transtibial amputees.A total of thirty transtibial amputees (17 male, 13 female) volunteered to take part in this research. Two prostheses were fabricated for each participant. Prosthetic Evaluation Questionnaire (PEQ) was filled in by the participants with the three liners.	The statistics highlight that Dermo liner showed significantly higher score (P = 0.05) in walking, walking on uneven surfaces, stairs walking, fitting, donning/doffing, sitting, suspension, and overall satisfaction with Dermo liner compared with Seal-In X5 and Pelite liners. Overall satisfaction was 34% higher with Dermo liner than Seal-In X5 liner and 28% higher than Pelite liner. Participants reported less problems with Dermo liner and significant differences (P < 0.05) were recorded between the three liners in sweating, skin irritation, frustration, and pain compared with Seal-In X5 and Pelite liners.	Participants experienced high level of satisfaction and practiced fewer problems with Dermo liner. These results showed that there is good indication to believe that Dermo liner might be a good choice for transtibial users and might help the clinicians and prosthetic practitioners in selection criteria of prosthetic liners.	
25182024	Implications for practice and research: Adoptive parents experience significant challenges in caring for children diagnosed with reactive attachment disorder. Informing prospective adoptive parents about attachment issues and providing concrete assistance to develop healthy attachment relationships may decrease some of the frustration experienced by parents and children affected with the disorder. Future research could address factors contributing to the diagnosis of reactive attachment disorder as well as best practices for ameliorating the disorder.
25181729	Many service members suffer from chronic pain that can be difficult to adequately treat. Frustration has led to more openness among service members to complementary and alternative medicine modalities. This report follows JK, a Marine with chronic pain related to an injury while on combat deployment through participation in a 6-week self-care-based Mind Body Medicine program and for 7 months after completion of the program. JK developed and sustained a regular meditation practice throughout the follow-up period. JK showed a noticeable reduction in perceived disability and improvements in psychological health, sleep latency/duration and quality of life. This report supports further study into the efficacy and feasibility of self-care-based mind body medicine in the treatment of chronic pain in the military medical setting. 
25178957	This paper examines male and female individual differences in situational triggers of aggressive responses (STAR) in three countries as well as cross-cultural sex differences in trait aggression (aggression questionnaire, AQ). Convenience sampling was employed (university students) for the descriptive correlational study (Poland N = 300, 63% female, mean age 21.86, SD = 2.12; UK N = 196, 60% female, mean age 20.48, SD = 3.79; Greece N = 299, 57% female, mean age 20.71, SD = 4.42). The results showed that the STAR scale is an equivalent construct across all three countries. Overall, females were more sensitive to both provocation (SP) and frustration (SF) than males. When controlling for trait aggression, Polish and Greek females scored similarly in SP and higher than UK females. No sex differences in SP or SF were found in the UK sample. Additionally, Polish participants scored the highest in SP. Furthermore, when trait aggression was removed, the Greek participants were most sensitive to frustration, whereas Polish and English participants' SF did not differ. We discuss the results with regard to intercultural differences between investigated countries. 
25150911	Increased food intake (FI) during television viewing has been reported in children, but it is unknown if this occurs following pre-meal video game playing (VGP). The objective was to determine the effect of pre-meal VGP for 30 min on subjective appetite and emotions, and FI in normal weight (NW) boys after a glucose or control preload. On four test mornings, NW boys (n = 19) received equally sweetened preloads of a non-caloric sucralose control or 50 g glucose in 250 mL of water, with or without VGP for 30 min. Food intake from an ad libitum pizza meal was measured immediately after. Subjective appetite was measured at 0, 15, 30, and 60 min. Subjective emotions were determined by visual analog scale at baseline and immediately before lunch. Both VGP (p = 0.023) and glucose (p <0.001) suppressed FI. Pre-meal VGP compared with no-VGP, and glucose compared with the non-caloric control, decreased FI by 59 and 170 kcal, respectively. Subjective average appetite increased to 30 min (p = 0.003), but was lower after glucose (p = 0.01) in both the VGP and no-VGP conditions compared with the control. Frustration and aggression scores increased after VGP (p <0.05), but did not correlate with FI. However, baseline and pre-meal happiness and excitement scores were inversely associated with FI. In conclusion, both pre-meal VGP and the glucose preload suppressed FI, supporting the roles of both physiologic and environmental factors in the regulation of short-term FI in 9- to 14-year-old NW boys. 
25134622	For mothers with breastfeeding difficulties, pumping can be recommended to help establish milk production. However, pumping may present some barriers to successful breastfeeding. Mothers with milk supply concern may be at higher risk of barriers to successful breastfeeding. No previous studies have described experiences of pumping among mothers with milk supply concern. We conducted 10 focus groups of 56 mothers who had milk supply concern in the first month after birth. A paid, trained facilitator led groups in a semi-structured approach. Sessions were audiorecorded and transcribed verbatim. The transcripts were coded independently by two investigators and analysed using grounded theory. We identified five themes related to the experience of pumping among mothers with milk supply concern: (1) additional control over breastfeeding from pumping: 'I would feed and then give him … whatever I could manage to pump to him'. (2) Painful experience: 'The first time I pumped my boobs hurt so bad'. (3) Pumped volume affected milk supply concern: 'Pump and there was hardly anything coming out that's when I started to worry'. (4) Pumping interfered with other nurturing activities: 'While you're pumping, you can't touch the baby'. (5) Frustration from inconsistent provider advice: 'They told me to pump … and then said, "That's going to cause your milk to increase too much" '. Mothers had positive and negative experiences with pumping. Clinicians should assess a mother's experience shortly after she initiates pumping, as further management and counselling may be necessary to avoid barriers to successful breastfeeding. 
25128685	Recent diagnostic and treatment advances in psychogenic nonepileptic seizures (PNES) have the potential to improve care for patients, but little is known about the current state of PNES care delivery in the Veterans Health Administration (VA). We conducted semistructured interviews with 74 health-care clinicians and workers in the VA, eliciting provider perceptions of PNES care. Data were analyzed according to principles of Grounded Theory. The results revealed variation in care and two emergent domain themes of frustration and hope. Frustration was manifest in subthemes including Complexity, Patient Acceptance, Uncertainty About Treatment, Need for Evidence-based Treatment, and Failure of Cross-Disciplinary Collaboration between neurologists and mental health providers. Hope encompassed subthemes of Positive Attitudes, Developing Cross-Disciplinary Treatment, and Specific PNES Care. Increased resources for diagnosing, treating, and researching PNES have improved awareness of the disorder. More research is needed to understand patients' and caregivers' perceptions of PNES care. 
25105752	Very preterm (VP) infants are at greater risk for cognitive difficulties that may persist during school-age, adolescence and adulthood. Behavioral assessments report either effortful control (part of executive functions) or emotional reactivity/regulation impairments.The aim of this study is to examine whether emotional recognition, reactivity, and regulation, as well as effortful control abilities are impaired in very preterm children at 42 months of age, compared with their full-term peers, and to what extent emotional and effortful control difficulties are linked.	Children born very preterm (VP; < 29 weeks gestational age, n=41) and full-term (FT) aged-matched children (n=47) participated in a series of specific neuropsychological tests assessing their level of emotional understanding, reactivity and regulation, as well as their attentional and effortful control abilities.	VP children exhibited higher scores of frustration and fear, and were less accurate in naming facial expressions of emotions than their aged-matched peers. However, VP children and FT children equally performed when asked to choose emotional facial expression in social context, and when we assessed their selective attention skills. VP performed significantly lower than full terms on two tasks of inhibition when correcting for verbal skills. Moreover, significant correlations between cognitive capacities (effortful control) and emotional abilities were evidenced.	Compared to their FT peers, 42 month-olds who were born very preterm are at higher risk of exhibiting specific emotional and effortful control difficulties. The results suggest that these difficulties are linked. Ongoing behavioral and emotional impairments starting at an early age in preterms highlight the need for early interventions based on a better understanding of the relationship between emotional and cognitive difficulties.	
25095650	To assess changes in quality of life (QL) and cognitive functions in patients with end-stage renal failure (ESRF) treated with hemodialysis using a succinate-containing dialyzing solution (SCDS).Sixty-seven patients with ESRF on hemodialysis using SCDS were examined. The investigators determined QL indicators using a Russianized variant of the Kidney Disease Quality of Life Short Form (KDQOL-SF) and the indicators of cognitive functions by the Benton visual retention test intended to evaluate visual short-term memory. The 6-minute walk test was used to evaluate exercise tolerance. The patients were examined before and 6 months after initiation of SCDS use.	Following 6 months of SCDS treatment, the patients showed positive changes in a number of QL indicators. Their exercise capacity (p = 0.03) and the quality of sleep (p = 0.03), and social interaction (p = 0.02) were improved. The magnitude of the complaints related to disease and treatment decreased (p = 0.001). The level of patient frustration was reduced (p < 0.001). Different limitations associated with chronic kidney disease and dialysis therapy came to disturb the patients to a lesser degree (p = 0.02). The Bentoin visual retention test exhibited fewer errors (p = 0.04).	Hemodialysis treatment with SCDS improved a number of QL indicators and cognitive functions in the patients.	
25091825	This article discusses men's transition to first time fatherhood, with a focus on the way they recognise various in-tension moral demands and negotiate an appropriate role for themselves. The findings are taken from a longitudinal study, drawing on elements of grounded theory, comprising a series of face-to-face and telephone interviews with 11 men over a 9-month period from the 12(th) week of pregnancy to 8 weeks after the birth. The analysis focuses on men's feelings and experience of exclusion and participation, and their response and reaction to that experience. The findings present two descriptive themes, 'on the inside looking in' and 'present but not participating', followed by third theme 'deference and support: a moral response' that exposes the dilemmatic nature of men's experience and explains the participants' apparent acceptance of being less involved. The discussion explores the concept of moral residue, arguing that while deference and support may be an appropriate role for fathers in the perinatal period it may also be a compromise that leads to feelings of uncertainty and frustration, which is a consequence of being in a genuinely dilemmatic situation.
25085806	Lymphedema resulting from breast cancer treatment is a chronic condition which can significantly compromise quality of life. We sought to review various aspects of breast-cancer related lymphedema including measurement techniques, definitions, risk factors, and specifically, impact on physical, psychological, and emotional well-being of women treated for breast cancer. For the purpose of this review, we performed a literature search using PubMed for articles on lymphedema secondary to breast cancer treatment published since 1997. While improvements in breast cancer therapy have contributed to a decrease in the incidence of lymphedema, the overall negative impact the condition has on patients and survivors has remained unchanged. The development of lymphedema results in physical impairments including compromised function, diminished strength, fatigue, and pain in the affected arm. Affected women may have decreased self-confidence resulting from a distorted body image. Negative emotions reported by women with lymphedema include anxiety, frustration, sadness, anger, fear, and increased self-consciousness. Lymphedema secondary to breast cancer treatment remains a significant quality of life issue, with known consequences related to a woman's physical, psychological, and emotional well-being. 
25085273	The aim of this study was to elucidate whether physicians' illness perceptions correlate with their frustration or resistance to accepting patients with fibromyalgia (FM). In this cross-sectional postal survey, questionnaires were sent to member physicians of the Japan College of Rheumatology and Japan Rheumatism Foundation. Measures collected included the Brief Illness Perception Questionnaire with Causal Attribution, the Illness Invalidation Inventory, and the Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10). Multiple logistic regression was performed to examine associations between the DDPRQ-10 and resistance to accepting patients with FM for treatment. We analyzed data from 233 physicians who had experience in consulting with patients with FM. Only 44.2 % answered that they wanted to accept additional patients with FM. Physicians' frustration was associated with difficulty controlling symptoms, patients' emotional responses, and causal attribution of FM to patient internal factors. Conversely, lower levels of frustration were associated with causal attributions to biological factors and uncontrollable external factors. However, the "difficult patient" perception did not correlate with resistance to accepting patients with FM. Difficulty controlling symptoms with treatment was the one factor common to both physicians' frustration and resistance to accepting patients with FM. Physicians may hesitate to accept patients with FM not because of the stigmatic image of the "difficult patient," but instead because of the difficulty in controlling the symptoms of FM. Thus, to improve the quality of consultation, physicians must continuously receive new information about the treatments and causes of FM. 
25079502	Acupuncture, a licensed health care profession in the United States, is poorly integrated into the American health care system, despite the evidence of its effectiveness. The purpose of this study was to offer a phenomenological description of the experience of acupuncturists who delivered acupuncture care in a tertiary teaching hospital in New York City. We analyzed data using methodology proposed by Colaizzi and identified four major clusters of themes: (a) acupuncturists' excitement about practicing in a hospital setting and frustration about organizational obstacles to effective acupuncture integration; (b) pride in being holistic practitioners; (c) attempts to preserve the holism and effectiveness of acupuncture while adjusting to the limitations of an inpatient setting, and (d) acupuncturists' realization that the medical staff knew very little about acupuncture and "it's all about trust." Practitioners of other healing traditions and therapies might find our study helpful in their own efforts toward similar integration. 

25069534	Improving the quality of care women receive during childbirth is as important as ensuring increased availability of care and numbers of healthcare providers. To be able to improve quality of care, it is important to understand what quality means for mothers as well as providers of care.33 postnatal mothers and 10 healthcare providers from all 4 major hospitals in one district in Malawi were interviewed via 27 in-depth interviews and 2 focus group discussions. Data was transcribed and analysed using the thematic framework approach.	Perceptions of quality of care differed substantially between care providers and postnatal mothers. For caregivers, characteristics of good quality care included availability of resources while for postnatal mothers positive relationships with their caregiver were important. Lack of autonomy and decision making power is a barrier to quality of care and it exists both at the level of the patient (mother) and at the level of her caregiver with healthcare providers unable to influence decisions made by more senior staff or management. Lack of autonomy was linked with the emerging themes of staff de-motivation, frustration, lack of empowerment to make change and resulting in a poor quality of care provided.	Creating a reciprocal understanding of what good quality care comprises and the barriers as well as promoters of this should be the starting point for improving the quality of maternity care. A renewed focus is needed on improving communication, strengthening patient rights and autonomy whilst simultaneously motivating and enabling healthcare workers to provide comprehensive and inclusive quality of care.	
25066432	Emotional lability (EL), characterized by negative emotional traits and emotional instability, is frequently reported in children and adults with attention deficit hyperactivity disorder (ADHD). However, EL is primarily assessed using retrospective self-report, which is subject to reporting bias and does not consider the potential influence of positive and negative everyday experiences.Ambulatory assessment was carried out in 41 men with ADHD without co-morbidity, current medication or substance abuse, and 47 healthy control participants. Reports of negative and positive emotions (irritability, frustration, anger, happiness, excitement) and the occurrence of bad and good events were completed eight times daily during a working week. Group differences in emotional intensity and instability were investigated using multilevel models, and explored in relation to bad and good events and the Affective Lability Scale - Short Form (ALS-SF), an EL questionnaire.	The ADHD group reported significantly more frequent bad events, heightened intensity and instability of irritability and frustration, and greater intensity of anger. The results for positive emotions were equivocal or negative. Bad events significantly contributed to the intensity and instability of negative emotions, and showed a stronger influence in the ADHD group. However, covariation for their effect did not eliminate group differences. Small-to-moderate correlations were seen between intensity and instability of negative emotions and the ALS-SF.	Adults with ADHD report heightened intensity and instability of negative emotions in daily life. The results suggest two components of EL in ADHD: a reactive component responsive to bad events and an endogenous component, independent of negative everyday events.	
25060349	Significant research has been done on the impact of moral distress among nurses, particularly in acute and intensive care settings. However, little research to date has investigated the experiences that nursing students have with moral distress. Additionally, there is a dearth of research on the role of nursing instructors' perceptions of their responsibilities to their students when encountering morally distressing situations. This manuscript describes a qualitative study conducted with eight mental health nursing instructors who acknowledged a responsibility for helping students deal with moral distress and ethical issues, but who also struggled with ways to do so. Additionally, instructors expressed frustration with their "guest" status on inpatient psychiatric units and their powerlessness to effect moral change in a medical model of psychiatric care.
25039552	The objectives were to examine how emergency medicine (EM) residents learn to care for patients in the emergency department (ED) who are homeless and how providing care for patients who are homeless influences residents' education and professional development as emergency physicians.We conducted in-depth, one-on-one interviews with EM residents from two programs. A random sample of residents stratified by training year was selected from each site. Interviews were digitally recorded and professionally transcribed. A team of researchers with diverse content-relevant expertise reviewed transcripts independently and applied codes to text segments using a grounded theory approach. The team met regularly to reconcile differences in code interpretations. Data collection and analysis occurred iteratively, and interviews continued until theoretical saturation was achieved.	Three recurring themes emerged from 23 resident interviews. First, residents learn unique aspects of EM by caring for patients who are homeless. This learning encompasses both specific knowledge and skills (e.g., disease processes infrequently seen in other populations) and professional development as an emergency physician (e.g., the core value of service in EM). Second, residents learn how to care for patients who are homeless through experience and informal teaching rather than through a formal curriculum. Residents noted little formal curricular time dedicated to homelessness and instead learned during clinical shifts through personal experience and by observing more senior physicians. One unique method of learning was through stories of "misses," in which patients who were homeless had bad outcomes. Third, caring for patients who are homeless affects residents emotionally in complex, multifaceted ways. Emotions were dominated by feelings of frustration. This frustration was often related to feelings of futility in truly helping homeless patients, particularly for patients who were frequent visitors to the ED and who had concomitant alcohol dependence.	Caring for ED patients who are homeless is an important part of EM residency training. Our findings suggest the need for increased formal curricular time dedicated to the unique medical and social challenges inherent in treating patients who are homeless, as well as enhanced support and resources to improve the ability of residents to care for this vulnerable population. Future research is needed to determine if such interventions improve EM resident education and, ultimately, result in improved care for ED patients who are homeless.	
25038524	Two hundred and thirty-three 5-month-old infants and their mothers participated in a study designed to examine the influence of maternal sensitivity and infant neurophysiology, as well as interactions between these, on infants' regulatory behavior and reactivity to emotional challenge. Maternal sensitivity was measured during two mother-child free-play episodes prior to the challenge task. Infant neurophysiology was derived from a measure of resting EEG asymmetry collected during a baseline episode. Infant regulatory behaviors (mother orienting and distraction) and reactivity to challenge (negative affect) were assessed during an arm restraint procedure. Maternal sensitivity predicted mother-orienting behavior for all infants, regardless of baseline EEG asymmetry. Maternal sensitivity also predicted more distraction behaviors for infants with left frontal EEG asymmetry at baseline. In contrast, maternal sensitivity predicted more negative affect for infants with right frontal EEG asymmetry at baseline. These findings lend support for the hypothesis that maternal sensitivity and infant neurophysiological functioning interact to predict regulatory behavior and reactivity and are discussed in terms of the significance for understanding infant regulatory development in the first year of life. 
25037843	Parent-focused preventive interventions for youth conduct problems are efficacious when offered in different models of delivery (e.g., individual in-home, group center-based). However, we know little about the characteristics of parents associated with a positive response to a particular model of delivery. We randomly assigned the parents of an ethnically diverse sample of kindergarten through second grade students (n = 246) displaying elevated levels of aggression to parent-focused program delivery models emphasizing receiving services in a community center largely with groups (Center; n = 121) or receiving services via an individualized in-home strategy (Outreach; n = 125). In both delivery models, parents received parent skills training and goal setting/case management/referrals over an average of 16 months. Structural equation modeling revealed a significant interaction between parental well-being at baseline and intervention delivery model in predicting parenting efficacy at year 2, while controlling for baseline levels of parenting efficacy. Within the Outreach model, parents with lower levels of well-being as reported at baseline appeared to show greater improvements in parenting efficacy than parents with higher levels of well-being. Within the Center model, parental well-being did not predict parenting efficacy outcomes. The strong response of low well-being parents within the Outreach model suggests that this may be the preferred model for these parents. These findings provide support for further investigation into tailoring delivery model of parent-focused preventive interventions using parental well-being in order to improve parenting outcomes.
25030490	The purpose of this project was to explore the parental experience of making a "do not resuscitate" (DNR) decision for their child who is or was cared for in a pediatric intensive care unit in Taiwan.A descriptive qualitative study was conducted following parental signing of a standard hospital DNR form on behalf of their critically ill child. Sixteen Taiwanese parents of 11 children aged 1 month to 18 years were interviewed. Interviews were recorded, transcribed, analyzed and sorted into themes by the sole interviewer plus other researchers.	Three major themes were identified: (a) "convincing points to sign", (b) "feelings immediately after signing", and (c) "post-signing relief or regret". Feelings following signing the DNR form were mixed and included "frustration", "guilt", and "conflicting hope". Parents adjusted their attitudes to thoughts such as "I have done my best," and "the child's life is beyond my control." Some parents whose child had died before the time of the interview expressed among other things "regret not having enough time to be with and talk to my child".	Open family visiting hours plus staff sensitivity and communication skills training are needed. To help parents with this difficult signing process, nurses and other professionals in the pediatric intensive care unit need education on initiating the conversation, guiding the parents in expressing their fears, and providing continuing support to parents and children throughout the child's end of life process.	
25028063	A critical incident is defined as an event stressful enough to overwhelm the usually effective coping skills of an individual. Firefighters are frequently exposed to critical incidents that might have consequences for individuals and their performance in organization.The aim of this study was to describe experiences of critical incidents among female and male Swedish firefighters.	In all 180 participants (16 women, 164 men) who had been involved in up to 25 critical incidents during the last year responded to a survey describing critical incidents experienced in the past year. A qualitative content analysis identified several areas for improvement in firefighters' working conditions.	Female firefighters were terse in describing their experiences, while the men described their experiences of critical events more vividly. The critical incidents described by the firefighters concerned such overwhelming situations as traffic accidents, huge fires, and other fatal incidents such as drownings and suicides. Risk of delay due to lack of equipment training and lack of medical education was mentioned. Lack of resources and organizational problems was mentioned as causing risks of failure. Several firefighters expressed frustration over being assaulted and threatened, or exposed to other kinds of violence. Not knowing how close, physically or mentally, one can get to people during ongoing rescue can lead to unsuccessful operations.	Gender patterns should always be taken into account, making it possible for all firefighters to express and reflect on existentially tough experiences. Education needs to focus more on medical and mental health issues. Firefighters were sometimes exposed to the difficult challenge of violence and assault during rescue operations. The complexity of this problem needs to be highlighted, not only in firefighter organizations, but also in society in general.	
25019964	Trait and contextual factors can shape individual and group differences in hypothalamic-pituitary-adrenal (HPA) response to stress; but the ways in which these factors may interact with each other to modulate stress activity have rarely been examined. Here, we investigated whether the association between a temperamental self-regulatory trait - Effortful Control (EC) - and HPA axis stress response is moderated by type of laboratory stress in sixty-five children (35 boys). EC was measured at ages 3 and 6 using age-appropriate laboratory batteries as well as mother reports. HPA axis responses were measured at age 7 by randomly assigning children to one of two laboratory stress tasks (frustration vs. fear). Results indicated that EC interacted with stress context in predicting cortisol response. Specifically, lower EC was associated with greater cortisol response (steeper reactivity slopes) in the context of a frustration stressor but this was reversed in a fear context where lower EC was associated with flatter, more gradual activation. It is likely that different components of EC, such as emotion regulation and attention, differentially interact with the stress context. These types of effects and interactions need to be more thoroughly understood in order to meaningfully interpret cortisol reactivity data and better characterize the role of the HPA axis in human psychopathology. 
25019540	Although abundant research has shown that self-critical perfectionism relates to binge eating symptoms, fewer studies have addressed the role of intervening processes that might explain why this is the case. Grounded in self-determination theory, we hypothesized that self-critical perfectionism would relate to an increased risk for binge eating symptoms because it engenders frustration of the psychological needs for autonomy, competence, and relatedness. This hypothesis was tested in a sample of 566 adolescents (72% female; mean age = 13.3 years) using a 3-wave longitudinal study with a 6-month interval. Structural equation modeling analyses showed that self-critical perfectionism related to increases in psychological need frustration which, in turn, predicted increases in binge eating symptoms. Structural relations were found to be equivalent for males and females. Theoretical and clinical implications of these findings are discussed.
25011413	The excessive workload of university students is an academic stressor. Consequently, it is necessary to evaluate and control the workload in education. This research applies the NASA-TLX scale, as a measure of the workload. The objectives of this study were: (a) to measure the workload levels of a sample of 367 psychology students, (b) to group students according to their positive or negative perception of academic context (AC) and c) to analyze the effects of AC on workload. To assess the perceived AC, we used an ad hoc questionnaire designed according to Demand-Control-Social Support and Effort-Reward Imbalance models. Using cluster analysis, participants were classified into two groups (positive versus negative context). The differences between groups show that a positive AC improves performance (p < .01) and reduces feelings of overload (p < .02), temporal demand (p < .02), and nervousness and frustration (p < .001). Social relationships with peers and teachers, student autonomy and result satisfaction were relevant dimensions of the AC (p < .001 in all cases). 

25005509	PURPOSE. To describe parents' concerns and hopes for their children who would be receiving occupational therapy using a sensory integration approach. METHOD. Content analysis of 275 parental responses to three open-ended questions on developmental-sensory history intake forms. FINDINGS. Parents' descriptions of why they sought for their children were categorized into four overarching concerns about their children's challenges: self-regulation, interacting with peers, participating in skilled motor activities, and self-confidence. Parents often linked these concerns together, revealing explanatory models of how they make sense of potential relationships among their children's challenges and how these challenges affect occupational performance. Parents hoped occupational therapy would help their children develop self-understanding and frustration tolerance to self-regulate their behavior in socially acceptable ways. IMPLICATIONS. Assessment and intervention should explicitly focus on links among self-regulation, social participation, skills, and perceived competence to address parents' expectations. 
24995668	The present study examines the influences of mothers' emotional availability toward their infants during bedtime, infant attachment security, and interactions between bedtime parenting and attachment with infant temperamental negative affectivity, on infants' emotion regulation strategy use at 12 and 18 months. Infants' emotion regulation strategies were assessed during a frustration task that required infants to regulate their emotions in the absence of parental support. Whereas emotional availability was not directly related to infants' emotion regulation strategies, infant attachment security had direct relations with infants' orienting toward the environment and tension reduction behaviors. Both maternal emotional availability and security of the mother-infant attachment relationship interacted with infant temperamental negative affectivity to predict two strategies that were less adaptive in regulating frustration. 
24966142	Patients with haemophilia experience bleeds because of absent or reduced clotting factor. The study objective was to understand the bleeding experience from the patients' perspective.Individuals with moderate/severe haemophilia participated in interviews and were asked to describe their most recent bleeding experience, including symptoms, signs of onset, impacts, when bleeding stopped and treatment effectiveness. Interview transcripts were analysed using a thematic analysis involving the coding of transcripts to identify key concepts and themes.	Twenty males [10 adults, mean age = 41 (19-52); 10 adolescents, mean age = 13 (12-17)] with moderate (n = 5) or severe (n = 15) haemophilia participated. Symptoms signalling bleed onset included pain, swelling, stiffness, tingling/numbness and/or warmth. Participants reported feeling anger and frustration due to the unpredictable nature, pain and inconvenience of the episode. Adults sometimes reported delaying treatment due to inconvenience or cost; adolescents generally treated right away. Reported bleed severity was influenced by pain level, speed of symptom progression, location, continued use of the affected area, recurrence in same location of recent bleed and treatment delay. Participants reported that it was 'easy' to know when the bleed had stopped. Participants reported that symptoms might linger for days before they returned back to 'normal'.	This qualitative study details the substantial impact of an acute bleed from the patient perspective. Given that treatment was reported to be delayed in part due to inconvenience, more convenient treatment options could help reduce delays in treating bleeds and thereby minimise bleed-related impacts. Clinical studies in haemophilia should include validated patient-reported measurements of acute symptoms and bleed severity to comprehensively assess the bleeding event.	
24951157	Symptoms of perinatal depression and anxiety are usually described and understood from a nosological perspective. This research sought to gain insight into women's lived experience of postnatal depression and anxiety, the factors that contribute to these symptoms and the context in which they develop.Face to face and telephone interviews were conducted with 28 women from metropolitan and rural areas across Australia, who had experienced postnatal depression and/or anxiety within the last five years. Analysis was conducted from a grounded theory perspective.	Particular symptoms of anxiety and depression develop in the context of the numerous changes inherent to the transition to motherhood and contribute to a common experience of frustration and loss. Symptoms were also associated with feelings of dissatisfaction with the pregnancy and motherhood experience.	The findings provide useful insights into women's experiences of mental health symptoms during the perinatal period, how these symptoms present and the factors involved in their development and maintenance. The need to consider women's perspectives to develop resources and health promotions strategies, as well as within the context of relationships with health professionals is highlighted. The study emphasizes the need for greater, more accurate information surrounding perinatal depression and the need to increase the profile and awareness of anxiety disorders.	
24927260	Students of health-professions suffer high levels of stress and burnout. The aim of the present study was to evaluate the relationship between perceived stress latent factors ('tenseness' and 'frustration') and the features ('overload', 'lack of development' and 'neglect') of the three burnout subtypes ('frenetic', 'under-challenged' and 'worn-out', respectively), in a sample of Spanish dental students.The study employed a cross-sectional design. A sample of Spanish dental students (n = 314) completed the 'Perceived Stress Questionnaire' and the 'Burnout Clinical Subtype Questionnaire Student Survey'. The associations among variables were observed by means of structural equation modelling using the unweighted least squares method from polychoric correlations.	Strong associations among perceived stress factors and the burnout characteristics were observed, although a distinct pattern of relations was observed for each burnout subtype. The 'overload' was moderately and positively associated with both 'tenseness' (0.45), and 'frustration' (0.38) dimensions of perceived stress; the 'lack of development' was positively associated with the 'frustration' dimension (0.72), but negatively associated with 'tenseness' (-0.69); the 'neglect' showed a weaker positive associated with 'frustration' (0.41), and a small negative association with 'tenseness' (-0.20). The model was a very good fit to the data (GFI  =  0.96; RSMR  =  0.07; AGFI = 0.96; NFI = 0.95; RFI = 0.95).	The stress factors of 'frustration' and 'tenseness' seems to be related in a distinct way to the burnout subtypes in Spanish dental students. This finding suggests that intervention programs specifically tailored to these subtypes may be a promising future direction.	
24920000	This article describes the development of a scale measuring the extent of men's belief in female sexual deceptiveness. This belief has been postulated as a component of hostile masculinity and a precursor to more serious sexual-assault-facilitating cognitions, though it has not yet been studied empirically. From a final pool of 22 items, the 14-item Belief in Female Sexual Deceptiveness (BFSD) scale was constructed. Data were collected via online survey from 131 predominantly Hispanic college males; scale items were selected by exploratory factor analysis. Three moderately strongly correlated factors emerged, though they overlapped strongly and are currently considered only for future study. An 8-item short form of the BFSD scale (the BFSD-S) was created, as well. The full BFSD scale showed strong internal consistency and significant correlations with gender role attitudes, unequal/coercive relationship attitudes, history of misperceiving women's platonic interest as sexual, history of sexual frustration in relationships, adult attachment, belief in immanent justice, attitudes toward intimate partner violence, and rape myth acceptance. Patterns of divergent correlations with other measures also supported the scale's validity. The BFSD-S performed nearly identically to the BFSD. Limitations, future directions, and implications are discussed. 
24916140	Younger women diagnosed with cancer often face compromised fertility as a result of their treatment. However, previous research has adopted a biomedical model of fertility and utilised hypothetico-deductive research methods which have not allowed for full exploration of women's subjectivity. This study explored younger women's construction of their fertility post-cancer, and their discussions of fertility with healthcare professionals, from a social constructionist epistemology. Semi-structured one-to-one interviews were conducted with eight women aged 18-26, across a variety of cancer types. Foucaultian Discourse Analysis identified three subject positions associated with fertility concerns: 'Inadequate woman: Accepting the motherhood mandate'; 'Adequate woman: Resisting the motherhood mandate'; and 'Survival of the fittest: Woman as genetically defective'. Implications of these subject positions included feelings of inadequacy, fear and devastation; feeling undesirable to romantic partners; and concern about passing on cancer-positive genes. In describing healthcare professional interactions, women adopted positions of 'Satisfied patient'; 'Passive recipient patient'; or 'Resisting the passive patient position'. Accounts of inadequate information provision were associated with anger and frustration, whereas feeling adequately informed was associated with satisfaction at making decisions about fertility preservation. These results suggest that fertility is of importance to young women cancer survivors, and that compromised fertility can negatively impact subjectivity. 
24912741	Nurses should be well-prepared to improve and address health-related needs of older adults, but students may have difficulty understanding and empathizing, as they may not yet have personally experienced aging-related challenges. Simulation games can be used to help students understand the experiences of others, but limited information is available on the impact of simulation experiences on student empathy.The objective of this study was to examine the impact of participation in an aging simulation game on nursing students' empathy and attitudes toward older adults as well as their understanding of patients' experiences in the healthcare system.	This study used a quasi-experimental, pretest-posttest design.	A school of nursing in the Midwestern United States.	The convenience sample included 58 sophomore-level baccalaureate nursing students.	Students played the role of an older adult during a 3-hour laboratory aging simulation game, the Geriatric Medication Game® (GMG). Students completed the (1) Kiersma-Chen Empathy Scale (KCES, 15 items, 7-point Likert-type), (2) Jefferson Scale of Empathy-Health Professions Students (JSE-HPS, 20 items, 7-point Likert-type), and (3) Aging Simulation Experience Survey (13 items, 7-point Likert-type) pre- and post-game to assess study objectives. Descriptive statistics and paired t-tests were performed in SPSS v.21.0, as the data were normally distributed.	Students' empathy (N=58) toward older adults significantly improved overall (KCES p=0.015, JSE-HPS p<0.001). Improvements also were seen on seven out of 13 questions related to attitudes and healthcare understanding (p<0.05). In the post-test, students agreed that they experienced frustration and impatience during the GMG.	Students may not be aware of older adults' feelings and experiences prior to experiencing aging-related changes themselves. Simulation activities, such as the GMG, can be a useful mechanism for addressing empathy and caring during student education.	
24909622	An increasing number of Child Protective Services (CPS) systems are implementing Differential Response (DR) approaches in which lower-risk families are served through a family assessment response that emphasizes a family centered approach and the provision of concrete and preventative services. Quantitative survey data collected from parents suggests that those who receive family assessments are more engaged, receive more concrete services, and have higher overall satisfaction than those who receive a traditional investigation; yet little is known about which services provided through a family assessment are most helpful to parents. This qualitative study sought input from 20 parents who received a DR family assessment response in order to provide an in-depth analysis of which aspects of their CPS experience they perceived as most helpful. Results suggest that a positive and emotionally supportive relationship with the caseworker was of utmost significance. Other caseworker-provided services were described as helpful, particularly those that helped parents establish or improve relationships with others, including advocacy with other service providers, mediation of family disagreements, and coaching on parenting or relationship skills. Material support, such as providing cash assistance for rent or furniture, was helpful when received but occurred less frequently and was sometimes a source of frustration when accompanied by lengthy waits for assistance. These findings have implications for CPS practice, including enhancing caseworkers' relationship-building and engagement skills through pre-service educational coursework and in-service trainings; allowing caseworkers adequate time to develop supportive relationships with parents; and reducing the institutional barriers that delay the provision of concrete support. 
24905371	"Problem patients" are rare, but they take up a disproportionate amount of clinician time and energy. They often are defined in terms of the effect they have on clinicians rather than any specific behavior - such effects can include frustration, self-doubt and unprofessional behavior. The key to avoiding those pitfalls is to take a deeper look and understand what is behind patients' problematic behaviors. Given the vagueness of the term there are many potential etiologies, most of which are addressable, at least in part. This article presents a brief guide to identifying and managing the various conditions that can cause a disruption of the usually rewarding doctor-patient relationship, and also encourages us to consider the role we might play in this disruption.
24898209	Feeding disorders occur commonly in the pediatric population and vary in severity from picky eating to extreme food selectivity. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases, 10th Revision provide more inclusive diagnostic criteria for feeding disorders, but little is known about the actual referral population to an outpatient feeding clinic. In this investigation, the nutrition status, reason for referral, and related exploratory questions of outpatient referrals are detailed.Children aged 1-18 years were eligible for enrollment. Survey data collected included demographics, prior diagnoses, parental/caretaker complaint, mealtime duration, referral source, and food repertoire. Exploratory questions examined the impact of the feeding disorder on immediate family.	Ten percent of participants had a weight-for-height z score or body mass index score of ≤-2. The most common parental/caretaker chief complaint were poor nutrition, food refusals, and poor weight gain. The food repertoire included 15 or fewer items (7%), between 15 and 25 items (18%), or greater than 25 items (75%). The most positive responses to exploratory questions were mealtime frustration, lack of understanding by other family members, lack of access to appropriate treatment in a timely fashion, and inability to meet the child's feeding needs.	Most referred infants and children were not undernourished. Despite this finding, most parents/caretakers were concerned about inadequate nutrition status and poor weight gain. Feeding disorders have an adverse effect on immediately family members. Revised diagnostic criteria should facilitate better identification of the broad spectrum of feeding disorders.	
24886052	Distress tolerance (DT), or the ability to withstand psychological distress, has been proposed as a mechanism underlying multiple forms of psychopathology. However, research on DT is limited in several areas. First, stability and change of DT over time has never been assessed in adults. Second, it is unclear whether alternative conceptualizations of DT yield differences in longitudinal stability and change. Third, gender differences in DT have yet to be examined in nonclinical adult samples. And fourth, longitudinal predictive utility of DT has not been adequately assessed. The purpose of this study was to investigate these 3 questions using data collected at 3 time points over a 6-month period, examining borderline personality disorder (BPD) features as an outcome. Using 3 different measures of DT, results indicated that there is no mean level change in DT. Similarly, there was moderate rank-order stability in DT and no significant individual level change across measures. These findings suggest that DT is similar to other stable, trait-like constructs, as has been previously theorized. Next, a series of cross-lagged panel models revealed that although DT had a cross-sectional relationship with BPD features across all time points, DT did not predict BPD traits longitudinally. These findings have implications for treatments for BPD.
24885591	Lymphangioleiomyomatosis (LAM) is a rare, progressive lung disease that affects almost exclusively women and is most often diagnosed before menopause. The main symptom of LAM is shortness of breath. LAM patients' perceptions of how the disease impacts their lives is largely unknown, but such information could be useful to generate patient reported outcome measures for use in drug trials (or other research studies) and to formulate interventions aimed at easing the burdens LAM imposes on patients.To capture patients' perceptions of how LAM affects their lives.	We used reflexive team analysis to analyze transcripts from semi-structured focus groups conducted with LAM patients at LAMposium 2013. We sought to determine what patients perceive as the primary symptoms of LAM and how the disease affects them in their daily lives.	The 37 participants described seven primary symptoms of LAM and five common psychological experiences from living with the disease. Shortness of breath and low energy (or fatigue) dominated the symptomatic picture; cough, sensations in the chest, difficulty sleeping, gastrointestinal issues, and mild cognitive difficulties were less common. The common psychological experiences participants reported included frustration, worry, loss of identity, embarrassment, and in some participants, a healthy defiance against the disease.	Patients perceive the physical symptoms from LAM to be intrusive and limiting. Women living with LAM are frustrated by their physical limitations, and they worry about what the future will be like if the disease progresses. Therapeutic interventions should take aim at improving these perceptions.	
28462288	In this article, we explore the experiences of racial microaggression among migrant nurses in the United Kingdom. Eleven migrant nurses kept a reflective diary for 6 weeks to record and reflect on their experiences of living and working in the United Kingdom. The diary entries were then thematically analyzed. The results suggest that migrant nurses experienced racial microaggression from patients and colleagues through racial preferences and bullying. Institutional racism also hindered their opportunities for further training and promotion. As a result, some experienced feelings of anger, frustration, and even paranoia. Despite the negative consequences of racial microaggression on their emotional well-being, incidents were downplayed as trivial because of their vague and subtle nature. To encourage better multicultural interactions in the workplace, supportive organizational infrastructures need to be in place to enhance diversity awareness and to improve mechanisms for reporting and dealing with cases of racial microaggression.
24880642	Why do chimpanzees react when their partner gets a better deal than them? Do they note the inequity or do their responses reflect frustration in response to unattainable rewards? To tease apart inequity and contrast, we tested chimpanzees in a series of conditions that created loss through individual contrast, through inequity, or by both. Chimpanzees were tested in four social and two individual conditions in which they received food rewards in return for exchanging tokens with an experimenter. In conditions designed to create individual contrast, after completing an exchange, the chimpanzees were given a relatively less-preferred reward than the one they were previously shown. The chimpanzees' willingness to accept the less-preferred rewards was independent of previously offered foods in both the social and individual conditions. In conditions that created frustration through inequity, subjects were given a less-preferred reward than the one received by their partner, but not in relation to the reward they were previously offered. In a social context, females were more likely to refuse to participate when they received a less-preferred reward than their partner (disadvantageous inequity), than when they received a more-preferred reward (advantageous inequity). Specifically, the females' refusals were typified by refusals to exchange tokens rather than refusals to accept food rewards. Males showed no difference in their responses to inequity or individual contrast. These results support previous evidence that some chimpanzees' responses to inequity are mediated more strongly by what others receive than by frustration effects. 
24871790	Utilizing grounded theory qualitative research methods, a model was developed for describing parental adaptation after voluntary placement of a child with severe or profound developmental disabilities in out-of-home care. Interviews of parents from 20 families were analyzed. Parents' cognitive appraisals of placement outcomes were classified as either inducing emotional stress (i.e., guilt, sadness, fear and worry, anger and frustration, and uncertainty) or relief. Parental appraisals of responses to placement by children, extended family, and friends were identified as factors affecting the parents' adaptation to placement. The primary coping methods used by parents to decrease emotional stress and increase relief consisted of reappraisals regarding the necessity of placement, involvement in the child's life, psychotherapy, and the passage of time.
24867131	This study explored the science communication potential of visual imagery by gauging an audience's interpretations of digitally enhanced, multimodal pictures depicting topics from recent Alzheimer's disease research. Guided by social semiotic theory, we created four pictures intended to communicate information about Alzheimer's disease unidirectionally, for an audience who had expressed interest in receiving such information (subscribers to an Alzheimer's disease research newsletter). We then disseminated the pictures to that audience via an online survey, to determine whether respondents received the messages we intended to convey. Our results demonstrated that, without accompanying explanatory text, pictures are most useful for evoking emotions or making loose connections between major concepts, rather than for communicating specific messages based on Alzheimer's research. In addition, participants more often expressed anger and frustration when the meaning of scientific imagery was unclear than when the meaning of emotional-social imagery was unclear. 
24865219	Cancer treatment-related out-of-pocket costs create substantial financial distress for many patients. However, little work has been done to describe available financial resources and barriers to connecting those resources to patients.This was a single-center, qualitative study that used semistructured interviews and focus groups with social workers and financial care counselors. Interview guides were used to elicit feedback from study participants pertaining to the types of financial problems that their patients were experiencing, the process for addressing these issues, patient assistance resources, and access barriers.	Four interviews and two focus group sessions (n = 15) were conducted in which four themes emerged among the social work and financial care counselor samples. Participants cited (1) frustration over the lack of financial resources and increasingly stringent eligibility criteria, (2) barriers to providing assistance such as process inefficiencies, (3) limited resources to identify at- risk patients and refer them for services, and (4) inadequate insurance coverage and availability. To bridge the gap between increasing patient need and limited resources, participants suggested development of interventions designed to aid in patient screening and resource identification.	Oncology social workers and financial care counselors reported inadequate financial resources and faced barriers to matching appropriate resources with patients in need. Limited social work resources hindered early screening for financial distress. Interventions that focus on screening for early identification of financial distress and identification of resources are needed.	
24863170	Workplace violence is one of the most complex and significant occupational hazards experienced by nurses in healthcare settings. Verbal abuse and physical violence are particularly prevalent in older person assessment wards, owing to the prevalence of illnesses involving cognitive dysfunction; the high frequency and nature of contact with staff; and the frustration caused by high levels of disability.To determine the frequency, kinds and cues of violence displayed by patients towards nurses in an acute older person assessment ward environment using a structured observational tool - the Violence Assessment Tool (VAT).	Observational study.	Non-participant structured observations of behavioural cues for violence towards nurses in an acute older person hospital ward were gathered and analysed.	One hundred and twelve hours of observations were undertaken, resulting in 95 behavioural cues for violence in 19 patients. Four of these patients subsequently escalated to physical violence. Pacing around the bed was the only commonality in the behavioural cues of patients who became violent. All patients who became violent had previously demonstrated showing.	To date, the assessment of potentially violent older patients has not been adequately addressed. The VAT may be one way of addressing this challenge through early identification of the more subtle behavioural cues that could indicate potential for violence. Further research on the VAT using a larger data set could determine its predictability for physically violent acts displayed by older people.	

24848805	The International Society for Sexual Medicine (ISSM) Ad Hoc Committee for the Definition of Premature Ejaculation developed the first evidence-based definition for lifelong premature ejaculation (PE) in 2007 and concluded that there were insufficient published objective data at that time to develop a definition for acquired PE.The aim of this article is to review and critique the current literature and develop a contemporary, evidence-based definition for acquired PE and/or a unified definition for both lifelong and acquired PE.	In April 2013, the ISSM convened a second Ad Hoc Committee for the Definition of Premature Ejaculation in Bangalore, India. The same evidence-based systematic approach to literature search, retrieval, and evaluation used by the original committee was adopted.	The committee unanimously agreed that men with lifelong and acquired PE appear to share the dimensions of short ejaculatory latency, reduced or absent perceived ejaculatory control, and the presence of negative personal consequences. Men with acquired PE are older, have higher incidences of erectile dysfunction, comorbid disease, and cardiovascular risk factors, and have a longer intravaginal ejaculation latency time (IELT) as compared with men with lifelong PE. A self-estimated or stopwatch IELT of 3 minutes was identified as a valid IELT cut-off for diagnosing acquired PE. On this basis, the committee agreed on a unified definition of both acquired and lifelong PE as a male sexual dysfunction characterized by (i) ejaculation that always or nearly always occurs prior to or within about 1 minute of vaginal penetration from the first sexual experience (lifelong PE) or a clinically significant and bothersome reduction in latency time, often to about 3 minutes or less (acquired PE); (ii) the inability to delay ejaculation on all or nearly all vaginal penetrations; and (iii) negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy.	The ISSM unified definition of lifelong and acquired PE represents the first evidence-based definition for these conditions. This definition will enable researchers to design methodologically rigorous studies to improve our understanding of acquired PE.	
24835132	In recent years, brain-computer interfaces (BCIs) have become mature enough to immensely benefit from the expertise and tools established in the field of human-computer interaction (HCI). One of the core objectives in HCI research is the design of systems that provide a pleasurable user experience (UX). While the majority of BCI studies exclusively evaluate common efficiency measures such as classification accuracy and speed, single research groups have begun to look at further usability aspects such as ease of use, workload and learnability. However, these evaluation metrics only cover pragmatic aspects of UX while still not considering the hedonic quality of UX. In order to gain a holistic perspective on UX, hedonic quality aspects such as motivation and frustration were also taken into account for our evaluation of three BCI-driven interfaces, which were proposed to be used as a two-stage neuroprosthetic control within the EU project MUNDUS.At the first stage, one of six possible actions was selected and either confirmed or cancelled at the second stage. For the experiment, a solely event-related-potential-based interface (ERP-ERP) and two hybrid solutions were tested that were controlled by ERP and motor imagery (MI)--resulting in the two possible combinations: ERP selection/MI confirmation (ERP-MI) or MI selection/ERP confirmation (MI-ERP). Behavioural, subjective and encephalographic (EEG) data of 12 healthy subjects were collected during an online experiment with the three graphical user interfaces (GUIs).	Results showed a significantly greater pragmatic quality (in terms of accuracy, efficiency, workload, use quality and learnability) for the ERP-ERP and ERP-MI GUIs in contrast to the MI-ERP GUI. Consequently, the MI-ERP GUI is least suited for use as a neuroprosthetic control. With respect to the comparison of the ERP-ERP and ERP-MI GUIs, no significant differences in pragmatic and hedonic quality of UX were found. Since throughout better results were obtained for the conventional approach and it was most preferred by the subjects, the ERP-ERP GUI seems more suitable for its deployment in actual end-users. Nevertheless, for individuals with stable MI patterns, the hybrid interface can be provided as an additional option of choice within the MUNDUS framework.	Although the paramount goal in BCI research still remains the improvement of classification accuracy and communication speed, it is of significance to note that it is equally important for end-users to keep up their motivation and prevent frustration. By including pragmatic as well as hedonic quality aspects, this study is the first effort to gain a holistic perspective of the UX while interacting with BCI-driven assistive technology aimed at actual end-users. The broad-scale methodology provided valuable insights into the underlying dynamics causing the users' experience to differ across the GUIs. The results will be used to refine a BCI-driven neuroprosthesis and test it with end-users.	
24827934	Studies from European-American cultures consistently reported that expressive suppression was associated with worse emotional consequence (e.g. depression) in comparison with acceptance. However, this conclusion may not apply to Chinese, as suppressing emotional displays to maintain relational harmony is culturally valued in East Asian countries. Thus, the present study examined the effects of suppression and acceptance on the depressive mood induced by a frustrating task in a Chinese sample.Sixty-four subjects were randomly assigned to one of three instructions: suppression, acceptance or no-regulation during a frustrating arithmetic task. The experience of depressive emotion and skin conductance response (SCR) were recorded during pre-frustration baseline, frustration induction and post-frustration recovery phases, respectively.	Compared with the control and acceptance instructions, suppression instruction was associated with decreased depressive experiences and smaller SCR activity during frustration. There were no significant differences between acceptance and control groups in both subjective depression and SCR activity during frustration. Moreover, the suppression group showed a better emotional recovery after the frustrating task, in comparison with the acceptance and control groups. Correlation analyses verified that SCR reactivity was a reliable index of experienced depression during the frustration.	Expressive suppression is effective in reducing depressive experiences and depression-related physiological activity (SCR) when Chinese people are involved. By contrast, the acceptance of depressive emotion in Chinese people does not produce a similar regulation effect. These findings suggest that cultural context should be considered in understanding the emotional consequences of suppression and acceptance strategies.	
24827866	The current study assessed antecedents and consequences of ad lib cigarette smoking in smokers diagnosed with attention-deficit/hyperactivity disorder (ADHD) using ecological momentary assessment (EMA). Adult smokers with ADHD (n = 17) completed 870 smoking and 622 nonsmoking electronic diary entries over a 7-day observation period of their naturalistic smoking behavior. Data collection occurred from 2011 to 2012. Generalized estimating equations indicated that ADHD smokers were more likely to smoke when urge to smoke, negative affect, boredom, stress, worry, and restlessness were elevated. In addition, participants were more likely to smoke in situations that elicited higher levels of nervousness and frustration. ADHD symptoms, in general, did not differ between smoking and nonsmoking contexts, though hyperactive-impulsive ADHD symptoms were elevated prior to smoking in frustrating situations. Additional situational antecedent variables were associated with smoking, including being in the presence of others smoking, being in a bar or restaurant, while outside, and while consuming caffeinated or alcoholic beverages. Participants also reported a significant improvement in urge to smoke, negative affect, stress, hunger, and ADHD symptoms after smoking a cigarette. Findings suggest certain contextual factors that may maintain ad lib cigarette smoking in smokers with ADHD and identify potential treatment targets in smoking cessation interventions for this at-risk group. Clinical implications and future research directions are discussed. Funding for this study was provided by the National Institute on Drug Abuse. 
24818520	Negative affect and low distress tolerance have been associated with increased likelihood of alcohol consumption and relapse. This study utilized the Paced Auditory Serial Attention Test - Computerized Version (PASAT-C) to examine affective reactivity, cognitive performance, and distress tolerance during early abstinence among heavy drinking adolescents.Participants, ages 16 to 18 (50% female), were 23 heavy episodic drinking youth (HED) and 23 demographically matched, nondrinking teens (CON). Both groups were drawn from the same schools and assessed at 3 time points: HED was first studied within 10 days (M = 4.26, SD = 4.4) of heavy episodic drinking and then at two 2-week intervals over 4 subsequent weeks of abstinence from alcohol and drugs. CON were studied at the same 2-week intervals.	From the findings, it was observed that HED responded with greater emotional response to the PASAT-C (i.e., greater increases in frustration and irritability and greater decreases in happiness) at the initial assessment, but their affective responses diminished with sustained abstinence. CON and HED task performance did not differ at the initial assessment or across time. HED showed faster task discontinuation times to the PASAT-C at the first assessment, and both groups reduced task persistence across testings. Among HED, greater lifetime and recent alcohol consumption, alcohol-induced blackouts, and withdrawal symptoms were associated with increases in negative affect with PASAT-C exposure. Earlier age of onset of alcohol use was linked to poorer performance.	Heavy episodic drinking adolescents demonstrated heightened emotional reactivity and poorer distress tolerance to a cognitively challenging task during early abstinence. The combination of elevated negative affect and low distress tolerance may place adolescents at a heightened risk of escalations in or return to alcohol involvement.	
24798053	There is very little research focused on older bereaved lesbians. This study is a response to the lack of knowledge about the issues for older lesbians who lose a partner. We examined bereavement issues for 55 older lesbians. The study asked participants to describe their concerns and experiences after losing a partner. Qualitative analysis identified several themes that ran throughout, including disenfranchised grief, the loneliness of isolation, and the frustration of relentless battles. These findings indicate the need for social workers to educate themselves and others about the particular needs facing this vulnerable group of older women. 
24779763	This article shares findings of work undertaken with a group of mental health ward managers to consider their roles through workshops using an action learning approach. The tensions between the need to balance the burden of administrative tasks and act as clinical role models, leaders and managers are considered in the context of providing recovery-focused services. The group reviewed their leadership styles, broke down the administrative elements of their roles using activity logs, reviewed their working environments and considered how recovery focused they believed their wards to be. Findings support the notion that the ward manager role in acute inpatient settings is at times unmanageable. Administration is one aspect of the role for which ward managers feel unprepared and the high number of administrative tasks take them away from front line clinical care, leading to frustration. Absence from clinical areas reduces opportunities for role modeling good clinical practice to other staff. Despite the frustrations of administrative tasks, overall the managers thought they were supportive to their staff and that their wards were recovery focused. 
24779529	The aim of the study was to report the lived experience of the wound care nurse (WCN) in caring for patients with pressure ulcers (PU). WCN play an important role in caring for patients with PU, but the effect on caring for individuals with such wounds is poorly understood. A descriptive and interpretative study on the life worlds of spatiality, temporality, relationality and corporeality was carried out. Utilising the hermeneutic Heideggerian phenomenology, data were collected over a 3-month period in 2012 using in-depth interviews with five WCN. The interviews revealed eight themes: 'challenge', 'making sense of it all', 'coping and self-care', 'advocate of mine/making a difference', 'knowledge and technology', 'we have seen what can happen', 'holistic caring' and 'frustration'. Twenty-five sub-themes were also identified. WCN experienced a demanding and rewarding role of caring, influenced by the environment and the challenges with individuals living with PU. This study demonstrated an enriching yet challenging role. Recommendations for WCN, health care authorities and education providers include raising awareness of the importance of self-care, greater recognition of the effect of this role on patients with PU and changing education to include reflective practice and resilience strategies. 
24773403	This article focuses on establishing a link between vocational fit and 1 domain of job performance: counterproductive work behaviors (CWB). The authors offer a model explaining from a self-regulation perspective how the lack of vocational fit generates CWB and test this model in 2 studies and 3 multisource samples. The 1st study offers support for the mediation model linking vocational lack of fit to CWB through frustration. The 2nd study shows across 2 samples, using both self- and supervisor ratings of CWB, that vocational fit has incremental validity for the prediction of CWB over established predictors, such as broad and narrow personality traits and affect.
24768529	Attitude of staff towards patients who present to the emergency department following deliberate self-poisoning may be integral to the outcome of these events. There is little in-depth understanding of emergency staff perceptions about this vulnerable group.Explore staff perceptions about caring for patients who present to the emergency department following deliberate self-poisoning.	Qualitative descriptive study.	Two open-ended questions enabled 186 clinicians to describe their perceptions about caring for people who present to the emergency department following deliberate self-poisoning. Data were analysed using qualitative data analysis procedures.	Three themes emerged from the data representing staff perceptions about caring for patients who deliberately self-poisoned and included depends on the patient, treat everyone the same, and skilled and confident to manage these patients.	Staff reported mixed reactions to patients presenting with deliberate self-poisoning. These included feelings of empathy or frustration, and many lacked the skills and confidence to effectively manage these patients.	Health networks are required to ensure that emergency staff have specialist support, knowledge, skills, and guidelines to provide effective care for this vulnerable population.	
24759861	Animals use aggressive behaviour to gain access to resources, and individuals adjust their behaviour relative to resource value and own resource holding potential (RHP). Normally, smaller individuals have inferior fighting abilities compared with larger conspecifics. Affective and cognitive processes can alter contest dynamics, but the interaction between such effects and that of differing RHPs has not been adjudged. We investigated effects of omission of expected reward (OER) on competing individuals with contrasting RHPs. Small and large rainbow trout (Oncorhynchus mykiss) were conditioned to associate a light with reward. Thereafter, the reward was omitted for half of the fish prior to a contest between individuals possessing a 36-40% difference in RHP. Small control individuals displayed submissive behaviour and virtually no aggression. By contrast, small OER individuals were more aggressive, and two out of 11 became socially dominant. Increased aggression in small OER individuals was accompanied by increased serotonin levels in the dorsomedial pallium (proposed amygdala homologue), but no changes in limbic dopamine neurochemistry were observed in OER-exposed individuals. The behavioural and physiological response to OER in fish indicates that frustration is an evolutionarily conserved affective state. Moreover, our results indicate that aggressive motivation to reward unpredictability affects low RHP individuals strongest. 
24752653	Perceived psychosocial abilities (i.e., competence in addressing the psychosocial aspects of patient care) and low frustration tolerance (LFT) (i.e., intolerance of physical or emotional discomfort) have been established as significant attributes of experienced medical professionals. We aimed to expand our understanding of the role motivation plays within communication skills training by investigating whether motivation precedes or, conversely, follows psychosocial attributes. According to goal orientations theory, motivation denotes the goals students pursue when engaging in learning tasks. We hypothesized that goal orientations would predict development of psychosocial attributes. More specifically, an adaptive goal orientation (i.e., mastery goal orientation) was expected to predict perceived psychosocial abilities, whereas the maladaptive goal orientations (i.e., performance-approach and avoidance goal orientations) were hypothesized to predict LFT (frustration intolerance). The study spanned two sequential years, in which two cohorts of first-year medical students (N = 151) completed questionnaires at the beginning and end of an annual physician-patient communication course. The questionnaires assessed goal orientations, perceived psychosocial abilities, and LFT. Cross-lagged analyses using Structural Equation Modeling indicated that goal orientations significantly predicted perceived psychosocial abilities, as hypothesized; however, LFT predicted maladaptive goal orientation, rather than the other way around. These findings provided further support for the contribution of goal orientations theory within medical education contexts. Medical schools are advised to consider motivational aspects when planning and implementing training programs. 
24751982	Medication adherence is essential for psoriasis management. Although studies have determined the prevalence and correlative factors of non-adherence, as far as we know, there has been no study specifically addressing them in China.Anonymous 23-item questionnaires were distributed to 324 psoriatic patients from June 2012 to June 2013. χ(2) test, normality test, Student's t test or Mann-Whitney U test, Bonferroni correction and the binary logistic regression model were applied.	Self-medication of psoriasis was high in China (82.4%). Joint involvement, absence of communication with families and short communication duration with doctors were the three top factors affecting adherence. Besides low efficacy (16.0%) and recurrence frustration (27.0%), we found that patients' deception by sham advertisings (24.1%) is an non-negligible issue.	Psoriasis self-medication in China was high. Improvement of patients' communication with families and/or doctors were suggested to be crucial to enhance adherence. Meanwhile, extermination of sham advertisings by administrative agencies is of great concern.	
24749740	This study aimed to examine pediatric residents' perspectives of primary care professional relationships. Using a longitudinal qualitative study design, we conducted 15 semi-structured interviews with five second-year pediatric residents who elected to participate in a one-year intervention, facilitating group well child care (GWCC). Pediatric residents described a spectrum of professional relationship types including: ignorant, transactional, workaround, educational and equitable. Residents described ignorant, transactional and workaround relationships with feelings of frustration, and they described educational and equitable relationships with feelings of satisfaction and humility. While residents described optimal relationships in both traditional WCC and GWCC, they described suboptimal relationships in only traditional WCC. Further study is needed to assess if our model of GWCC may create a scaffolding upon which optimal relationships in interprofessional teams are likely to flourish.
24716248	The aim of this study was to test the hypothesis that the conventional restorative treatment (CRT) and the atraumatic restorative treatment (ART) protocols, in comparison with the ultra-conservative treatment (UCT) protocol, would increase the quality of life of children over a period of 1 year. Cavitated primary molars of 302 children 6-7 years of age were treated according to the CRT, ART and UCT protocols at the school compound. Children's parents completed the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS) at baseline and one year later. Paired t-test, Chi-square test and ANOVA were applied in analysing the data. Questionnaires from 277 and 160 children were collected at baseline and after 1 year, respectively. A statistically significant difference in B-ECOHIS scores over the 1-year period was found for domains 'child symptoms' (P = 0.03) and 'child psychology' (P = 0.02). Treatment protocols did not statistically significantly influence the changes in B-ECOHIS scores over the 1-year period (P = 0.78). It can be concluded that the UCT protocol was as good as the two restorative protocols. All treatment protocols were effective in reducing children's experience of pain, their sleeping problems and their irritability and/or frustration levels over the 1-year period.
24710678	The present review critically appraises the various different definitions of and the ongoing discussions about the terms remission and recovery, which represent important aspects for describing the disease course, therapy planning and the setting of therapeutic targets for the patient, relatives and the professional care-giver. A symptomatic remission is well defined and is reached by about 30-60% of the first-time patients. However, this is not to be equated with functional, social and subjective remission. The term recovery has various definitions and has as yet only been studied in a relatively unempirical manner but represents an important supplement to the often strictly formulated therapeutic targets that need to be complemented by subjective and objective as well as personal and clinical perspectives. To inspire and maintain hope is thus an essential factor that extends beyond the therapeutic target of an often rather resigning symptomatic therapy. Even so, the provision of hope remains a balancing act. Too little hope can induce pessimism which in turn may have considerable negative therapeutic and personal consequences. On the other hand an uncritical attitude to hope may lead to unrealistic expectations--inevitably to be followed by frustration and resignation again.
24708762	While statistics is increasingly taught as part of the medical curriculum, it can be an unpopular subject and feedback from students indicates that some find it more difficult than other subjects. Understanding attitudes towards statistics on entry to graduate entry medical programmes is particularly important, given that many students may have been exposed to quantitative courses in their previous degree and hence bring preconceptions of their ability and interest to their medical education programme. The aim of this study therefore is to explore, for the first time, attitudes towards statistics of graduate entry medical students from a variety of backgrounds and focus on understanding the role of prior learning experiences.121 first year graduate entry medical students completed the Survey of Attitudes toward Statistics instrument together with information on demographics and prior learning experiences.	Students tended to appreciate the relevance of statistics in their professional life and be prepared to put effort into learning statistics. They had neutral to positive attitudes about their interest in statistics and their intellectual knowledge and skills when applied to it. Their feelings towards statistics were slightly less positive e.g. feelings of insecurity, stress, fear and frustration and they tended to view statistics as difficult. Even though 85% of students had taken a quantitative course in the past, only 24% of students described it as likely that they would take any course in statistics if the choice was theirs. How well students felt they had performed in mathematics in the past was a strong predictor of many of the components of attitudes.	The teaching of statistics to medical students should start with addressing the association between students' past experiences in mathematics and their attitudes towards statistics and encouraging students to recognise the difference between the two disciplines. Addressing these issues may reduce students' anxiety and perception of difficulty at the start of their learning experience and encourage students to engage with statistics in their future careers.	
24701621	'Heartsink' patients present a moral dilemma. We recognise their suffering, but at the same time struggle with the feelings they trigger in us. Patients also experience negative feelings. Without a diagnosis they lack a narrative or vocabulary to make sense of their own suffering.This article explores some of the challenges faced and strategies utilised when managing patients with medically unexplained symptoms.	Doctors and patients often experience frustration and helplessness in consultations around medically unexplained symptoms. Without a diagnosis, patients lack social legitimacy as 'sick' people with 'real' illnesses. They often describe feeling blamed for their own distress. Because of this, they can experience deep feelings of worthlessness and shame. Patients with a history of abuse can be particularly vulnerable. Management includes validating their suffering, helping them construct appropriate explanations for their distress and providing empathic interpersonal care, while minimising the risk of iatrogenic harm.	
24699035	Mammalian studies show that frustration is experienced when goal-directed activity is blocked. Despite frustration's strongly negative role in health, aggression and social relationships, the neural mechanisms are not well understood. To address this we developed a task in which participants were blocked from obtaining a reward, an established method of producing frustration. Levels of experienced frustration were parametrically varied by manipulating the participants' motivation to obtain the reward prior to blocking. This was achieved by varying the participants' proximity to a reward and the amount of effort expended in attempting to acquire it. In experiment 1, we confirmed that proximity and expended effort independently enhanced participants' self-reported desire to obtain the reward, and their self-reported frustration and response vigor (key-press force) following blocking. In experiment 2, we used functional magnetic resonance imaging (fMRI) to show that both proximity and expended effort modulated brain responses to blocked reward in regions implicated in animal models of reactive aggression, including the amygdala, midbrain periaqueductal grey (PAG), insula and prefrontal cortex. Our findings suggest that frustration may serve an energizing function, translating unfulfilled motivation into aggressive-like surges via a cortical, amygdala and PAG network. 
24688425	Medical school is recognized as a stressful environment that often has a negative effect on students' academic performance, physical health, and psychosocial well-being. Previous studies have not identified differences between depressed and nondepressed and anxious and nonanxious medical students' experiences of stress or their reactions to stressors. The present study aimed to identify the prevalence of depression and anxiety among a sample of 358 medical students attending a private university in Malaysia and to examine differences according to participants' gender, year of study, and stage of training (preclinical and clinical). Additionally, this study examined the extent to which stress predicts depression and anxiety, differences between depressed and nondepressed medical students' experiences of and reactions to stressors, and differences between anxious and nonanxious medical students' experiences of and reactions to stressors.The Student Life Stress Inventory was used to measure stress and reaction to stressors and the Depression, Anxiety, and Stress Scale was used to measure depression and anxiety.	The results showed that 44% (n = 158) of the students were anxious and 34.9% (n = 125) were depressed. More female students exhibited anxiety compared to male students. Stress is a predictor for depression and anxiety. A significant difference was found between depressed and nondepressed and anxious and nonanxious students' experience of stressors due to frustration, change, and their emotional reaction to stressors.	Overall, depressed and anxious students were found to experience more stress and react differently to stressors compared to nondepressed and nonanxious students.	
24682940	Patients treated for pituitary adenomas generally report a reduced quality of life (QoL). At present, the patient's perspective of QoL has not been fully addressed and this, and further insight in potential determinants of QoL in pituitary diseases is required to design strategies to improve QoL. We aimed to define patients' perceived QoL and to identify potential factors they perceive to contribute to QoL.We conducted four independent focus groups of six patients each, per specific pituitary disease (Cushing's disease, Non-functioning pituitary macroadenoma, acromegaly, prolactinoma). In two sessions these focus groups discussed aspects of QoL. Verbatim transcripts were analyzed using a grounded theory approach.	The issues raised by the patient groups were compatible with statements and items of available QoL questionnaires. In addition, other QoL aspects emerged, such as visual limitations (physical problems); issues with a desire to have children/family planning, fear of collapsing, fear of recurrence, panic, persisting thoughts, problems with an altered personality, anger, jealousy, sadness, frustration (psychological problems); and difficulties communicating about the disease, lack of sympathy and understanding by others, and a reduced social network (social problems). Next, this study uncovered factors which might contribute to a decreased QoL (e.g. less effective coping strategies, negative illness perceptions, negative beliefs about medicines, unmet needs regarding care).	This focus group study demonstrated that important disease-specific aspects of QoL are neglected in current pituitary disease-specific questionnaires and elucidated potential factors that contribute to a decreased QoL. Information provided in this study can (and will) be used for developing additional items for disease-specific QoL questionnaires and for the development of a self-management intervention aiming to improve QoL in patients treated for pituitary diseases.	
24679612	Despite evidence that viewing sexually explicit media (SEM) may contribute to greater numbers of sexual partners, sexual risk taking, greater interest in group sex, and lower self-esteem among men who have sex with men (MSM), research has not addressed compulsive use of Internet-based SEM due to the lack of a validated measure for this population. This report investigates the psychometric properties of the 14-item Compulsive Internet Use Scale (CIUS; Meerkerk, van den Eijnden, Vermulst, & Garretsen, 2009) adapted to assess the severity of compulsive Internet SEM use. A total of 265 Internet SEM-viewing MSM participated in an online survey about their SEM preferences, viewing habits, and recent sexual behaviors. A principal components analysis revealed a single-component, 13-item scale to adequately assess the cognitive, emotional, and behavioral aspects of this phenomenon, with a high internal consistency (α=.92). Greater compulsive use of Internet SEM was positively correlated with several relevant variables including boredom, sexual frustration, time spent viewing Internet SEM, and number of recent male sexual partners. The results offer preliminary evidence for the reliability and validity of using an adapted version of the CIUS to understand compulsive Internet SEM use, and allow for more research into the potential negative consequences of compulsive SEM use.
24679383	Hoarding Disorder (HD), a new diagnostic entity in DSM-5, is associated with substantial functional impairment and family frustration but data from well-characterized samples is lacking.Participants were 37 individuals meeting DSM-5 criteria for HD, 55 relatives of individuals meeting criteria for HD, and comparison groups of 51 self-identified collectors and 25 relatives of collectors. All participants completed a clinician-administered diagnostic interview for HD and an online battery of standardized measures of health, well-being, and impairment.	Substantial functional impairment was found for both HD individuals and their relatives. HD relatives reported significantly greater carer burden and accommodation of hoarding behaviors than relatives of collectors. Perceived level of squalor, co-habiting with, and increasing age of the HD individual were significant predictors of carer burden and functional impairment in the relatives.	The use of self-identified HD individuals may have produced a bias towards participants with relatively good insight. Subjective biases in self-reported symptoms cannot be ruled out, although the use of informant-report data provided some independent validation.	HD is associated with substantial functional impairment for both sufferers and their relatives. The level of carer burden experienced by HD relatives was comparable to or greater than that reported in the literature by relatives of individuals with dementia. The findings indicate that relatives of individuals with HD may benefit from increased support and suggest that it may be beneficial to involve family members in the treatment of HD.	
24669758	Absconding from hospital is a significant health and security issue within psychiatric facilities that can have considerable adverse effects on patients, their family members and care providers, as well as the wider community. Several studies have documented correlates associated with absconding events among general psychiatric samples; however, few studies have examined this phenomenon within samples of forensic patients where the perception of threat to public safety in the event of an unauthorized absence from hospital is often higher.We investigate the frequency, timing, and determinants of absconding events among a sample of forensic psychiatric patients over a 24-month period, and compare patients who abscond to a control group matched along several sociodemographic and clinical dimensions. We explore, in a qualitative manner, patients' motives for absconding.	Fifty-seven patients were responsible for 102 incidents of absconding during the two year study window. Forensic patients who absconded from hospital were more likely to have a history of absconding attempts, a diagnosed substance use disorder, as well as score higher on a structured professional violence risk assessment measure. Only one of the absconding events identified included an incident of minor violence, and very few included the commission of other illegal behaviors (with the exception of substance use). The most common reported motive for absconding was a sense of boredom or frustration.	Using an inclusive definition of absconding, we found that absconding events were generally of brief duration, and that no member of the public was harmed by patients who absconded. Findings surrounding the motivations of absconders suggest that improvements in therapeutic communication between patients and clinical teams could help to reduce the occurrence of absconding events.	
24654364	Getting to know your patients, well beyond recognition of their specific chief dental complaint, is most important in operating a successful and satisfying practice. In addition to the clinical findings and pertinent history alerts, a good understanding of the person being treated can go a long way toward cementing lasting and rewarding doctor-patient relationships. Almost all new patients to the practice are welcome. However, an occasional "difficult" patient can be identified. This is the patient who you will not be able to satisfy, who cultivates misunderstandings, is unfairly over demanding, wastes office time in innumerable ways and eventually causes great frustration for the dentist. These patients may leave the practice in an unpleasant termination. Concerns of litigation arise, and one must also consider the waste of economic and emotional currency, as well as any other negative repercussions that may result. The dentist should become skilled at early identification of potentially risky, disruptive and problematic persons seeking treatment.
24629677	Health personnel are at risk of threats and violence, especially when young and inexperienced. Also, working in emergency departments, psychiatric wards, and eldercare bears a risk. The phenomenon is reported from all over the world and may originate in intoxication, confusion or frustration during long waiting hours and uncertainty of treatment and prognosis. Experiences of threats and violence result in decreased well-being, anger, helplessness and thoughts about change of workplace or quitting the job. Training in communication and teamwork may prevent threats and violence.
24629505	Despite decision-making featuring throughout the trajectory of cancer care, children's participation in decision-making remains an area much under-researched and complicated by conflicting opinions. This study explored children's participation in shared decision-making (SDM) from multiple perspectives from one haematology/oncology unit in Ireland.Qualitative research design was used to explore participants' experiences of children's decision-making. Interviews were conducted with children(1) aged 7-16 years (n = 20), their parents (n = 22) and healthcare professionals (n = 40). Data were managed with the aid of NVivo (version 8).	Parents and children's roles in decision-making were significantly influenced by the seriousness of the illness. Cancer is a life-threatening illness and so the treatment 'had to be done'. Children were not involved in major decisions (treatment decisions) as refusal was not an option. They were generally involved in minor decisions (choices about care delivery) with the purpose of gaining their cooperation, making treatment more palatable, giving back a sense of control and building trusting relationships. These choices were termed 'small' decisions that would not compromise the child's welfare. Some adolescents were aware that choices were not 'real' decisions since they were not allowed to refuse and expressed feelings of frustration.	Healthcare professionals and parents controlled the process of SDM and the children's accounts revealed that they held a minimal role. Children appeared content that adults held responsibility for the major treatment decisions. However, they desired and valued receiving information, voicing their preferences and choosing how treatments were administered to them.	
24620450	This study evaluates patient inertia (PtInert) factors including hopelessness in African Americans participating in church cardiovascular screening programs in low income areas in Forsyth County, North Carolina. Patient inertia is defined as an inability to assume adequate hypertension self-management behaviors, leading to poorly controlled hypertension. Previous findings revealed hopelessness related to blood pressure (BP) control as a key PtInert factor in acute medical environment participants.Questionnaires were administered by facilitated interview. Clinical components of the cardiometabolic syndrome were obtained.	The study was conducted within six Forsyth County churches that were participating in cardiovascular screening programs sponsored by the Consortium for Southeastern Hypertension Control.	67 African Americans (72% female; 49% personal history of hypertension) with an average age of 55 years served as study participants.	Participants without a history of hypertension were overweight, pre-hypertensive, and normocholesterolemic while those with a history of high BP receiving antihypertensive treatment were normocholesterolemic, obese, and on average had a BP of 143/75 mm Hg. Hopelessness related to BP control was found in 18% of those with a personal history of high BP. A significant relationship was found between hopelessness and family history of high BP, perceived ability to control high BP, and frustration with BP treatment.	Our findings suggest that hopelessness, while exhibited less often in church participants as compared to previous findings in the acute medical environment, is associated with participant thoughts, feelings, and histories but is not associated with clinical components of the metabolic syndrome.	
24612415	As most young teenagers grow up in families, parents might be well situated to facilitate and support their weight management and thereby prevent or manage obesity prior to adulthood.This paper explores parents' perceptions of, and views about, their teenage children's weight and the factors that influence parents' weight management strategies.	We conducted two qualitative studies in Scotland, UK, involving in-depth interviews with the parents of overweight/obese and 'normal' weight 13-15 year olds (n = 69).	Parents' concerns about their own weight provided useful context for understanding their attitudes or actions with regards to their teenage child. Some parents described their teenager's weight as being of concern to them, although puberty often introduced confusion about a child's weight status. Genetic explanations were very often put forward as a way of making sense of teenage weight or body size. Frustration about advising teenagers about weight management was expressed, and some parents worried about giving their growing child a 'problem' if they directly raised concerns about weight with them.	Parents' views about their own weight as well as social and moral norms about labelling a teenager as overweight or as needing help with their weight could usefully inform patient-centred service development. Parent/teenage partnerships and supporting parents to create a healthy home in which teenagers can make healthier choices are suggestions for intervention development.	The study highlights the importance of taking parents' perceptions into account when developing family-based interventions to address teenage overweight and obesity.	
24598560	Patients' perspectives of posttransplant self-management tasks have not been explored.OBJECTIVE-To explore the concept and the presence of self-management tasks mastered by patients in the early phase after kidney transplant.Mixed-method study using semistructured interviews and a structured questionnaire.Setting-Outpatient Division of Nephrology at University Hospital Zurich, Switzerland.	Twelve patients (median age, 52 years, interquartile range, 42.25-65.25 years; median time after kidney transplant, 6.5 months; interquartile range, 2.25-15.75 months) were included.Analysis-Qualitative data were analyzed according to Corbin and Strauss' 3 self-management tasks with content analysis procedures. In the quantitative analysis, the presence of each self-management task is expressed as a frequency.	-The qualitative findings showed that patients were greatly challenged by the effort to manage the upcoming instability, which has a persistent broad impact on their lives. Managing emotions comprised dealing with uncertainty, disappointment, and frustration. Additionally, patients had to manage changes in self-perception. Managing life roles mainly involved an adaptation of relationships, occupational changes, and interactions with health care providers. Taking medications, managing symptoms, integrating new behaviors, and understanding one's course of disease were further tasks. Quantitatively, self-management tasks that were perceived as a challenge by at least half of the patients were primarily tasks from the questionnaire section "managing stressful emotions and self-perception." The synthesis of qualitative and quantitative findings indicates that self-management programs for kidney transplant recipients should focus on strengthening patients' self-management of emotional tasks and on regaining stability in daily life.	
24598107	Facial expressions have long been proposed to be important agents in forming and maintaining cooperative interactions in social groups. Human beings are inordinately cooperative when compared with their closest-living relatives, the great apes, and hence one might expect species differences in facial expressivity in contexts in which cooperation could be advantageous. Here, human children and chimpanzees were given an identical task designed to induce an element of frustration (it was impossible to solve). In children, but not chimpanzees, facial expressions associated with effort and determination positively correlated with persistence at the task. By contrast, bodily indicators of stress (self-directed behaviour) negatively correlated with task persistence in chimpanzees. Thus, children exhibited more behaviour as they persisted, and chimpanzees exhibited less. The facial expressions produced by children, could, therefore, function to solicit prosocial assistance from others. 
24588656	Seriously ill hospitalized patients and their loved ones are frequently faced with complex treatment decisions laden with expressions of emotional distress during palliative care (PC) consultations. Little is known about these emotional expressions or the compassionate responses providers make and how common these are in PC decision-making conversations.To describe the types and frequency of emotional distress that patients and loved ones express and how providers respond to these emotions during PC decision-making consultations with seriously ill hospitalized patients.	We used a quantitative descriptive approach to analyze 71 audio-recorded inpatient PC decision-making consultations for emotional distress and clinicians' responses to those emotions using reliable and established methods.	A total of 69% of conversations contained at least one expression of emotional distress. The per-conversation frequency of expressions of emotional distress ranged from 1 to 10. Anxiety/fear were the most frequently encountered emotions (48.4%) followed by sadness (35.5%) and anger/frustration (16.1%). More than half of the emotions related to the patient's feelings (53.6%) and 41.9% were related to the loved ones' own emotions. The majority of emotions were moderate in intensity (65.8%) followed by strong (20.7%) and mild (13.5%). Clinicians responded to a majority of emotions with a compassionate response (75.7%) followed by those with medical content (21.9%) and very few were ignored (1.3%).	Expressions of emotional distress are common during PC consultations and are usually met with compassionate responses by the clinician.	
24579714	(1) Using Riner's framework, the development of an international service learning program in the Dominican Republic (DR) for Baccalaureate nursing students will be described, and (2) an initial impact of the students' experiences will be examined.A qualitative descriptive research design was used to examine its impact. The international service learning program included (1) didactic (five, 2 hr and one full day educational sessions) prior to (2) immersion (2 weeks in country), and (3) posttrip debriefing session. Ten females, senior nursing students participated in the program. Students' daily journals were examined using thematic analysis.	Five major themes that emerged were as follows adapting physically, encountering frustration in their inability to fully meet patients' needs, increasing confidence in speaking Spanish and assessing health problems, and increasing cultural awareness. Students were descriptive regarding their daily activities, and did some, but limited, critical reflection.	Models of reflection need to be explored to select the most appropriate technique to facilitate students' critical reflection in meeting the goals and objectives of the experience. Curriculum integration of global learning, social consciousness, and global cultural competence development is needed.	
24571924	The Lifetime Impairment Survey, conducted in Europe, assessed impairment and symptoms of attention-deficit/hyperactivity disorder (ADHD) in childhood, and experiences of ADHD diagnosis and treatment, as recalled by adults.Adults with ADHD and without ADHD (control group) were invited to participate in an internet-based survey and report on their childhood experiences. History of ADHD diagnosis was self-reported. Groups were compared using impairment and symptom scales.	Overall, 588 adults with ADHD and 736 without ADHD participated. Mean (standard deviation [SD]) age at diagnosis of ADHD was 20.0 (12.6) years (median 18.0) following consultation with 3.8 (5.1) doctors (median 2) over 44.6 (69.3) months (median 17.0). A total of 64.1% (377/588) of adults with ADHD reported frustration or difficulties during the diagnostic process. The ADHD group had a higher mean (SD) score versus control for general (3.3 [1.2] vs 2.1 [1.2]; p < 0.001) and school impairment (2.8 [0.7] vs 2.3 [0.6]; p < 0.001) but not home impairment (2.1 [0.5] for both groups). Discussion The survey demonstrated that ADHD had a negative impact on all aspects of childhood investigated, as recalled by adults.	These data provide insights into childhood impairments and identify areas for improvement in the management and treatment of ADHD.	
24558057	After pediatric cochlear implantation, parents have to make decisions concerning which communication modality the child and the child's family will use. The choice has to be made against a background of opposing views on communication modality in follow-up after pediatric cochlear implantation. The opposing views form a discourse that has been a core issue in the international body of literature for a long time. For hearing parents caught up in this ongoing controversy, the choice can be a difficult one. The study reported in this article explores the discourse on communication modality and is based on 27 written parental accounts on experiences with follow-up. From the perspective of Foucault's thinking, discourses exert knowledge and power. Drawing on Foucault, the study explores how the discourse on communication modality is constructed, how it operates, and how it governs thinking and acting. The Foucauldian analysis brings to the fore the complex nature of the discourse and states that follow-up, which is intended to be helpful for parents, may induce insecurity and frustration. The study brings into conversation a broader understanding of the discourse on communication modality and addresses a need for increased awareness on how the discourse governs thinking and acting in follow-up. 
24558056	Over the last decade, caring for patients who are conscious while receiving mechanical ventilator treatment has become common in Scandinavian intensive care units. Therefore, this study aimed to describe anesthetists', nurses', and nursing assistants' experiences of caring for such patients. Nine persons were interviewed. A hermeneutic method inspired by Gadamer's philosophy was used to interpret and analyze the interview text. Staff members found it distressing to witness and be unable to alleviate suffering, leading to ethical conflicts, feelings of powerlessness, and betrayal of the promises made to the patient. They were frustrated about their inability to understand what the patients were trying to say and often turned to colleagues for help. When caring for conscious patients, it takes time to get to know them and establish communication and a trusting relationship. 
24557080	Joint hypermobility syndrome (JHS) is common in patients presenting to rheumatologists and can cause a range of symptoms leading to physical and psychological distress. Chronic musculoskeletal pain in patients with JHS often responds poorly to analgesics, and a pain management approach may be helpful. Since patients with JHS often have beliefs and experiences different to those of other chronic pain patients, they could fare better in JHS-specific programmes. Here, we report on the outcomes of patients in a JHS cognitive behavioural pain management programme. Patients fulfilling the Brighton criteria for JHS, who had suffered pain for at least 3 months, were assessed by a psychologist and physiotherapist for suitability for this programme. Those accepted took part in a programme of 8 days spread over 6 weeks, delivered by a multidisciplinary team and incorporating a cognitive behavioural approach. Outcomes were assessed at baseline, 1- and 5-month post-programme using validated outcome measures. Outcome measures at baseline and 1-month were available for 87 patients (96 % female, mean age 35 years). There were significant improvements in self-efficacy, pain catastrophising, depression, anxiety, frustration, impact of pain and average pain intensity (all P < 0.001). Although by 5 months all these outcomes had regressed towards pre-programme levels there remained significant improvements compared to baseline in all except average pain intensity. This open study shows that patients with JHS experienced significant benefits after attending a JHS-specific pain management programme, which were still evident 5 months later. Longer-term controlled studies are required. 
24547663	Managing grief and difficult emotions related to end-of-life (EOL) care is an often under-recognized part of the work of resident care aides (RCAs). In this interpretive analysis we explore the shared and socially constructed ideas that 11 RCAs in 1 Canadian city employ to make sense of death and the provision of EOL care. RCAs spoke of personal challenges involved in witnessing death and experiencing loss, as well as helplessness and frustration when they could not provide quality EOL care. RCAs invoked "consoling refrains" to manage grief, including "such is life," "they are better off," and "they had a full life." To manage guilt and moral distress, RCAs reminded themselves "I did my best" and "I experience rewards." Though these ideas help RCAs, some may need to be reframed through coaching and mentorship, to prevent unintended negative effects on care or the reproduction of ageist beliefs more broadly.
24532340	Long-term sick leave due to common mental disorders (CMD) is an increasing problem in many countries. Recent reviews indicate that return to work (RTW) interventions have limited effect on reducing sickness absence among this group of sick-listed. The aims of this study were to investigate how sick-listed persons with CMD experienced participating in an RTW intervention and how workability assessments and RTW activities influenced their RTW-process, and to examine the working mechanisms of the intervention. The gained knowledge can help improve future RTW intervention design and implementation.In-depth interviews were conducted with 17 participants on sick leave due to CMD who participated in an RTW intervention. Interviews were conducted at three time points with each participant. Principles of interpretative phenomenological analyses guided the analysis.	The workability assessment consultations and RTW activities such as psychoeducative group sessions and individual sessions with psychologist could result in both motivation and frustration depending on the extent to which the RTW professionals practiced what we have termed an individual approach to the sick-listed person.	The individual approach seems necessary for the realization of the positive potential in the RTW intervention. However, the fact that RTW professionals are both the facilitators and the controllers of the sick-listed persons' RTW process is an inherent paradox in the intervention, which can impede the necessary establishment of a high-quality relationship between the sick-listed persons and RTW professionals.	
24517900	The current shortage of professional nurses in Taiwan both undermines hospital quality of care and raises hospitals' human resource management costs. Few studies have concurrently investigated the interaction effect between professional commitment and, respectively, the positive and negative work attitudes of nurses. Results of this investigation may help improve strategies designed to raise nurse retention rates.This study used the interaction effects of work excitement and work frustration to assess their influence on the professional commitment of nurses.	This study was conducted at one hospital in southern Taiwan and used a cross-sectional design with self-administrated questionnaires. Seven hundred thirty-five nurses completed and submitted valid questionnaires (valid response rate: 68.5%). Exploratory and confirmatory factor analysis confirmed the reliability and validity of the three measurement models of work excitement, work frustration, and professional commitment. Correlation and hierarchical regression analysis verified the direct and interaction effects with the correlations among the three measured variables.	Work frustration was higher than work excitement among participants (M = 2.72, SD = 0.71 vs. M = 2.26, SD = 0.62). The mean participant score for professional commitment was 2.72 (SD = 0.45) on a 4-point Likert scale. There was a significant and positive correlation between work excitement and professional commitment and a significant and negative correlation between work frustration and professional commitment. High work frustration had a negative effect on professional commitment, whereas high work excitement had a higher positive effect on professional commitment. The two-way interaction between work excitement and frustration was statistically significant in explaining the effects of professional commitment (p < .01).	Nurses often work in conditions that are highly frustrating. Although work excitement has been shown as having a greater influence on professional commitment when nurses experienced the dual work affects simultaneously, work frustration significantly reduces the professional commitment effect of nurses. This study suggests that managers should not only construct a positive and exciting work environment but also work to mitigate the causes of work frustration to promote professional commitment and retention among nurses.	
24512173	Our goal in the present study was to examine the effects of maternal smoking during pregnancy on infant self-regulation, exploring birth weight as a mediator and sex as a moderator of risk. A prospective sample of 218 infants was assessed at 6 months of age. Infants completed a battery of tasks assessing working memory/inhibition, attention, and emotional reactivity and regulation. Propensity scores were used to statistically control for confounding risk factors associated with maternal smoking during pregnancy. After prenatal and postnatal confounds were controlled, prenatal tobacco exposure was related to reactivity to frustration and control of attention during stimulus encoding. Birth weight did not mediate the effect of prenatal exposure but was independently related to reactivity and working memory/inhibition. The effect of tobacco exposure was not moderated by sex.
24507081	The role of temperament traits in shaping the outcome of gastric bypass for severe obesity has not been established yet. This study evaluated whether temperament traits influence weight loss 1 year after gastric bypass, controlling for the potential confounding effect of Axis I and II disorders.Forty-nine patients with severe obesity (body mass index = 46.4 ± 6.7) undergoing gastric bypass completed a thorough psychiatric evaluation before surgery, including structured interviews, rating scales, and questionnaire assessing the presence and severity of co-morbid Axis I and II disorders. Temperament was evaluated with the Temperament and Character Inventory (TCI). Weight loss 1 year after surgery was calculated as percent total weight loss (%TWL). Predictors of weight loss were investigated with multivariate linear hierarchical regression.	After accounting for psychiatric covariates, higher TCI persistence scores independently predicted 1-year outcome of gastric bypass and explained 40% of the variance in %TWL. Patients with low persistence scores showed a significantly lesser weight loss than patients with high scores.	Temperament traits denoting the ability to persevere in one's goals in spite of immediate frustration (persistence) are associated with greater weight loss 1 year after gastric bypass. These data suggest the utility of preoperatively assessing and reinforcing such capacity to optimize surgical outcome. Future research will clarify the behavioral mechanisms mediating this relationship as well as the influence of temperament on weight maintenance.	
24501250	We explore whether spousal caregiving is associated with enhanced well-being for older husbands and wives.We use time diary data from the 2009 Panel Study of Income Dynamics and Disability and Use of Time supplement. We measure experienced well-being as ratings of happiness and frustration during activities recalled for the previous day. We estimate separately for husbands and wives 3 distinct effects on experienced well-being: having a spouse with a disability; doing household or personal care tasks ("chores") for someone other than a spouse with a disability; and doing such tasks for a spouse with a disability ("care").	For husbands, neither care status nor spouse's disability status are associated with experienced well-being. In contrast, for wives, carrying out chores is associated with lower reports of happiness compared with other activities and providing care to one's husband is associated with greater reports of happiness than carrying out chores.	For women, chores such as meal preparation, laundry, and cleaning--but not caregiving per se--are associated with worse experienced well-being than other activities. Findings underscore that there are positive aspects of spousal caregiving for older wives that offset the innately unpleasant nature of household tasks.	
24498440	Tuberculosis is a serious global health problem. Its paradigms are shifting through time, especially in rapidly developing countries such as China. Health providers in China are at the forefront of the battle against tuberculosis; however, there are few empirical studies on health providers' perspectives on the challenges they face in tuberculosis control at the county level in China. This study was conducted among health providers to explore their experiences with tuberculosis control in order to identify bottlenecks and emerging challenges in controlling tuberculosis in rural China.A qualitative approach was used. Semi-structured, in-depth interviews were conducted with 17 health providers working in various positions within the health system of one rural county (ZJG) of China. Data were analyzed based on thematic content analysis using MAXQDA 10 qualitative data analysis software.	Health providers reported several problems in tuberculosis control in ZJG county. Migrant workers and the elderly were repeatedly documented as the main obstacles in effective tuberculosis control in the county. At a personal level, doctors showed their frustration with the lack of new drugs for treating tuberculosis patients, and their opinions varied regarding incentives for referring patients.	The results suggest that several problems still remain for controlling tuberculosis in rural China. Tuberculosis control efforts need to make reaching the most vulnerable populations a priority and encourage local health providers to adopt innovative practices in the local context based on national guidelines to achieve the best results. Considerable changes in China's National Tuberculosis Control Program are needed to tackle these emerging challenges faced by health workers at the county level.	
24491516	Fatigue is one of the top complaints of people with inflammatory bowel disease (IBD); however this is often not addressed in clinical consultations. This study aimed to gain an understanding of healthcare practitioners' (HCPs) perception of IBD fatigue as experienced by people with IBD.Descriptive phenomenology was conducted with 20 HCPs who work with people with IBD. In-depth semi-structured interviews were audio recorded and transcribed verbatim. Colazzi's framework was used to analyse data.	Three themes and several sub-themes were identified. The main themes were: the phenomenon of fatigue as perceived by HCPs; the impact of fatigue on patients' lives; and the methods used by HCPs to deal with fatigue. Fatigue was identified as an important, but difficult and frustrating, symptom to understand. HCPs reported that fatigue impacts on the emotional, private and public aspects of patients' functioning, however there were few methods suggested on how to assess and manage the fatigue. Many expressed frustration at not being able to help more.	The study identified a gap in HCPs' knowledge and their understanding of the complexity of IBD fatigue and the full impact that IBD fatigue has on people's lives. There is a need for more research-generated evidence to enhance our understanding of the concept and the factors associated with IBD fatigue. Advances in the assessment and management of this complicated and poorly understood clinical symptom are needed in order to help enable HCPs to provide better quality care to people affected by IBD and IBD fatigue.	
24485210	To enhance the dietary education presented to women with gestational diabetes (GDM) by exploring the reasons and experiences that women with GDM reported in making their food-choice decisions after receipt of dietary education from a healthcare professional.Food Choice Map (FCM) semi-structured in-depth interviews were conducted with 30 women with GDM living in the Winnipeg area during their pregnancies. Verbatim transcripts were generated from the interviews. A constant comparative method was used to generate common themes to answer research inquiries.	Personal food preferences, hunger and cravings were the main factors affecting food choice decision-making in women with GDM. Although the information from healthcare professionals was 1 factor that affected food choice decision-making for most of the participants, more than half of the women, including all the women who were on insulin, reported difficulties in quick adaptation to dietary management in a limited time period. Information from other sources such as family members, friends, and internet were used to cope with the adaptation. These difficulties led to a sense of decreased control of GDM and were accompanied by frustration, especially for women taking insulin.	Food choice decision-making varied for this group of women with GDM. Knowledge and information aided in making healthy food choices and in portion control. However, balancing individual needs and blood glucose control in a short time period was felt to be difficult and created frustration. The findings suggested that dietary consultation needs to be personalized and to be time sensitive to promote confidence in self-control.	
24471358	The purpose of this investigation was to determine the relationship between distress tolerance and risky and aggressive driving. Distress tolerance, defined as an individual's capability to experience and endure negative emotional states, was hypothesized to be related negatively to aggressive driving and risky driving.An anonymous, web-based survey of 769 college students was conducted at a large East Coast university.	After controlling for age, gender, race, ethnicity, year in school, grade point average, and driving frequency, distress tolerance was significantly inversely related to reported risky driving and aggressive driving.	College drivers who have a diminished capacity to endure frustration without experiencing negative emotional states (i.e., low distress tolerance) tend to drive aggressively and in a risky manner. Traditional deterrence-based approaches to highway safety may benefit from inclusion of a wider array of prevention strategies that focus on emotion regulation while driving.	
24466330	The training to become a dentist can create psychological distress. The present study evaluates the structure of the 'Perceived Stress Questionnaire' (PSQ), its internal consistency model and interrelatedness with burnout, anxiety, depression and resilience among dental students.The study employed a cross-sectional design. A sample of Spanish dental students (n = 314) completed the PSQ, the 'Goldberg Anxiety and Depression Scale' (GADS), 'Connor-Davidson Resilience Scale' (10-item CD-RISC) and 'Maslach Burnout Inventory-Student Survey' (MBI-SS). The structure was estimated using Parallel Analysis from polychoric correlations. Unweighted Least Squares was the method for factor extraction, using the Item Response Theory to evaluate the discriminative power of items. Internal consistency was assessed by squaring the correlation between the latent true variable and the observed variable. The relationships between the PSQ and the other constructs were analysed using Spearman's coefficient.	The results showed a PSQ structure through two sub-factors ('frustration' and 'tenseness') with regard to one general factor ('perceived stress'). Items that did not satisfy discriminative capacity were rejected. The model fit were acceptable (GFI = 0.98; RSMR = 0.06; AGFI = 0.98; NFI = 0.98; RFI = 0.98). All the factors showed adequate internal consistency as measured by the congeneric model (≥0.91). High and significant associations were observed between perceived stress and burnout, anxiety, depression and resilience.	The PSQ showed a hierarchical bi-factor structure among Spanish dental students. Using the questionnaire as a uni-dimensional scale may be useful in perceived stress level discrimination, while the sub-factors could help us to refine perceived stress analysis and improve therapeutic processes.	
24454958	The use of peripheral vascular catheters (PVCs) is an extremely common and necessary clinical intervention, but inappropriate PVC care poses a major patient safety risk in terms of infection. Quality improvement initiatives have been proposed to reduce the likelihood of adverse events, but a lack of understanding about factors that influence behaviours of healthcare professionals limits the efficacy of such interventions. We undertook qualitative interviews with clinical staff from a large group of hospitals in order to understand influences on PVC care behaviors and subsequent patient safety.Ten doctors, ten clinical pharmacists, 18 nurses and one midwife at a National Health Service hospital group in London (United Kingdom) were interviewed between December 2010 and July 2011 using qualitative methods. Responses were analysed using a thematic framework.	FOUR KEY THEMES EMERGED: 1) Fragmentation of management and care, demonstrated with a lack of general overview and insufficient knowledge about expected standards of care or responsibility of different professionals; 2) feelings of resentment and frustration as a result of tensions in the workplace, due to the ambiguity about professional responsibilities; 3) disregard for existing hospital policy due to perceptions of flaws in the evidence used to support it; and 4) low-risk perception for the impact of PVC use on patient safety.	Fragmentation of practice resulted in ill-defined responsibilities and interdisciplinary resentment, which coupled with a generally low perception of risk of catheter use, appeared to result in lack of maintaining policy PVC standards which could reduced patient safety. Resolution of these issues through clearly defining handover practice, teaching interdisciplinary duties and increasing awareness of PVC risks could result in preventing thousands of BSIs and other PVC-related infections annually.	
24454951	Different people make different responses when they face a frustrating situation: some punish others (extrapunitive), while others punish themselves (intropunitive). Few studies have investigated the neural structures that differentiate extrapunitive and intropunitive individuals. The present fMRI study explored these neural structures using two different frustrating situations: an ego-blocking situation which blocks a desire or goal, and a superego-blocking situation which blocks self-esteem. In the ego-blocking condition, the extrapunitive group (n = 9) showed greater activation in the bilateral ventrolateral prefrontal cortex, indicating that these individuals prefer emotional processing. On the other hand, the intropunitive group (n = 9) showed greater activation in the left dorsolateral prefrontal cortex, possibly reflecting an effortful control for anger reduction. Such patterns were not observed in the superego-blocking condition. These results indicate that the prefrontal cortex is the source of individual differences in aggression direction in the ego-blocking situation.
24452443	A growing group of inpatients on acute clinical teaching units have non-acute needs, yet require attention by the team. While anecdotally, these patients have inspired frustration and resource pressures in clinical settings, little is known about the ways in which they influence physician perceptions of the learning environment. This qualitative study explored residents' and attending physicians' perceptions of caring for these patients, including their educational value. Using constructivist grounded theory, we conducted seven homogeneous focus groups and three interviews with residents and attending physicians from neurology and general internal medicine. A constant comparative analytical approach was employed alongside data collection, using theoretical sampling to explore emergent themes. Residents consistently described non-acute patients as non-educational, uninteresting, but still in need of care. Some attending physicians echoed this view, while others described multiple learning opportunities presented by non-acute patients. Both groups described residents as engaging with non-acute patients in a professional capacity, but not as learners. This engagement in a professional capacity could be considered diligent disinterest, or resigned professionalism. A constructivist understanding of the dynamics which influence learning in the workplace was used to explore the reasons why the residents in our study did not recognize the learning opportunities presented by non-acute patients. Our results resonate with Billett's theory of workplace affordances, which offers an explanation as to why learners may not identify or take advantage of potential learning opportunities. Overall, our study assists our understanding of the sociocultural factors that influence learners' choices to engage with particular clinical learning opportunities. 
24448048	As calls for training and accreditation standards around improved patient care transitions have recently increased, more publications describing medical student education programs on care transitions have appeared. However, descriptions of students' experience with care transitions and the sender/receiver communication that supports or inhibits them are limited. To fill this gap, the authors developed this project to understand students' experiences with and perceptions of care transitions.At the start of a patient safety intersession at the Medical College of Wisconsin (2010), 193 third-year medical students anonymously wrote descriptions of critical incidents related to care transitions they had witnessed that evoked a strong emotional reaction. Descriptions included the emotion evoked, clinical context, and types of information exchanged. The authors analyzed the incident descriptions using a constant comparative qualitative methodology.	Analysis revealed that 111 of the 121 medical students (92%) who disclosed emotional responses had strong negative reactions to unsuccessful transitions, experiencing frustration, irritation, fear, and anger. All of these negative emotions were associated with lack of or poor communication between the sender and receiver: ambiguous roles and responsibilities, insufficient detailing of the patient's medical course, inadequate identification of the people involved in the transition, incomplete delineation of what the patient needed, and unclear reasons for the transition.	Third-year medical students' descriptions of care-transition incidents reveal high rates of strong negative emotions and of communication gaps that may adversely affect patient care. Results support curricular innovations that align students' needs and experiences with safe patient care transitions.	
24446244	Forming part of a process evaluation of a large randomised controlled trial (the Maudsley Outpatient Study of Treatments for Anorexia Nervosa and Related conditions, MOSAIC) comparing two outpatient therapies for Anorexia Nervosa (AN), the Maudsley Model for Treatment of Adults with Anorexia Nervosa (MANTRA) and Specialist Supportive Clinical Management (SSCM), this study adopted a qualitative approach to examine therapist experiences of treatment delivery.Twenty MOSAIC therapists completed semi-structured interviews. Interviews were recorded, transcribed and analysed thematically.	Themes of positive aspects, challenges and therapeutic fit emerged. MANTRA was seen as structured and flexible but could feel demanding on therapist time and skill. The slow pace and narrower focus of SSCM gave patients space to talk, but the lack of psychological tools and nutritional emphasis could create frustration. Views on the therapeutic relationship and patient-therapy fit differed across treatments.	Findings provide testable hypotheses about what works for whom, ideas for therapist training, treatment development and delivery.	
24429732	The holistic aspect of stroke rehabilitation to include psychological well-being is currently neglected, with more emphasis placed on physical recovery despite anxiety and depression being common poststroke. From the limited amount of current literature, it seems that creative strategies such as art therapy (AT) can be beneficial in reducing isolation and anxiety among stroke patients.Stroke patients (able to consent) in a hospital rehabilitation unit were invited to participate in two weekly AT sessions for 6 weeks, facilitated by an art psychotherapist using paints, crayons, clay, a camera and an iPad. Hospital anxiety and depression scales (HAD) and therapy outcome measures (TOM) were measured at the beginning and end of the study.	Six male patients were recruited, average age 69 years (38-85). Group discussions allowed patients to express openly feelings of frustration as well as hope for physical and emotional recovery: 'fight like a ferret', an expression used by a group member. The group produced several art objects and photographic images that were collated using stop-frame animation to produce a 10 min film. Median HAD score for the group was eight points upon entering the study and six points on finishing the study.	There is little attention to the emotional needs of stroke patients in rehabilitation. Properly designed research studies exploring the role of AT in addressing anxiety and depression poststroke are needed. Our study showed that AT was a feasible intervention that helped patients explore the sequel of stroke in an open supportive environment.	
24416437	Many individuals restrict their food intake to prevent weight gain. This restriction has both homeostatic and hedonic effects but their relative contribution is currently unclear. To isolate hedonic effects of food restriction, we exposed regular chocolate eaters to one week of chocolate deprivation but otherwise regular eating. Before and after this hedonic deprivation, participants viewed images of chocolate and images of high-calorie but non-chocolate containing foods, while experiential, behavioral and eyeblink startle responses were measured. Compared to satiety, hedonic deprivation triggered increased chocolate wanting, liking, and chocolate consumption but also feelings of frustration and startle potentiation during the intertrial intervals. Deprivation was further characterized by startle inhibition during both chocolate and food images relative to the intertrial intervals. Individuals who responded with frustration to the manipulation and those who scored high on a questionnaire of impulsivity showed more relative startle inhibition. The results reveal the profound effects of hedonic deprivation on experiential, behavioral and attentional/appetitive response systems and underscore the role of individual differences and state variables for startle modulation. Implications for dieting research and practice as well as for eating and weight disorders are discussed. 
24413583	Minors have difficulty adhering to the strict management regimen required whilst on renal dialysis for chronic renal failure. This leads to ethical tensions as healthcare professionals (HCPs) and parents try, in the minor's best interests, to ensure s/he adheres. All 11 dialysis nurses working in a large, regional paediatric dialysis unit were interviewed about their perceptions and management of non-adherence and the ethical issues this raised for them. Participants reported negative attitudes to non-adherence alongside sympathy and feelings of frustration. They discussed the competing responsibilities between nurses, parents and minors, and how responsibility ought to be transferred to the minor as s/he matures; the need for minors to take responsibility ahead of transferring to adult services; and, the process of transferring this responsibility. Our discussion concentrates on the ethical issues raised by the participants' reports of how they respond to non-adherence using persuasion and coercion. We consider how understandings of capacity, traditional individual autonomy, and willpower can be used to comprehend the issue of non-adherence. We consider the relational context in which the minor receives, and participates in, healthcare. This exposes the interdependent triad of relationships between HCP, parent and minor and aids understanding of how to provide care in an ethical way. Relational ethics is a useful alternative understanding for professionals reflecting upon how they define their obligations in this context. 
24412811	Although barriers related to lesbian, gay, bisexual, transgender and queer (LGBTQ) youth's experiences accessing sexual health services have been examined in detail, research into the experiences and perceptions of clinicians providing these services has been conspicuously absent. The aim of this article is to explore the perceptions and experiences of clinicians providing sexual health services for LGBTQ youth. Drawing on in-depth, semi-structured interviews, this study examines 24 clinicians' experiences providing sexual health services to LGBTQ youth in five communities in British Columbia, Canada. Our findings reveal how many clinicians provide services to LGBTQ youth with a lack of cultural competency-either implicitly (e.g., by describing heteronormative practices) or explicitly (e.g., by expressing frustration that they had not been sufficiently provided with appropriate training related to LGBTQ youth sexual health). Institutional norms and values were identified as the dominant barriers in the effective provision of LGBTQ-tailored services. Many clinicians find themselves unprepared to provide culturally competent sexual health services that have both the capacity to address individual-level issues (e.g. promoting condom use) while considering (and adapting services to) the broader socio-cultural and structural conditions that can render LGBTQ youth socially vulnerable.
24407087	Moral distress can consist in anxiety or concern about one's capacity to meet challenges to one's integrity; it can also consist in the sense that one has failed to meet these challenges, betraying fundamental moral values or commitments. When the sense of moral failure is compounded by feelings of frustration or impotence, of being constrained or impeded in one's ability to act as one believes one ought, one experiences moral disempowerment. Drawing on narratives of moral distress emerging from work in the clinical context, this essay explores a distinction between cases in which moral distress does, and does not, center around the experience of moral disempowerment. When moral distress is tied to moral disempowerment, the acute personal toll is joined with broader moral costs, for effective moral agency is stymied. If we are to support individuals' resilience and effectiveness in working constructively with moral distress, we need to understand and redress the social, systemic, and institutional factors contributing to moral disempowerment. 
24401134	To assess principal investigators' and study coordinators' views and experiences regarding community consultation in a multicenter trial of prehospital treatment for status epilepticus conducted under an exception from informed consent for research in emergency settings.Principal investigators and study coordinators at all 17 hubs for the Rapid Anticonvulsant Medication Prior to Arrival Trial (RAMPART) were invited to complete a web-based survey regarding community consultation at their site for RAMPART. Major domains included 1) perceived goals of community consultation, 2) experiences with and views of community consultation methods used, 3) interactions with IRB regarding community consultation, and 4) general satisfaction and lessons learned. Descriptive statistics were tabulated for Likert scale data; relevant themes were reported for text-based data.	Twenty-eight individuals (16 coordinators and 12 investigators) representing all 17 RAMPART hubs completed the survey. Respondents considered multiple community consultation goals to be important, with least support for the role of community consultation in altering study design. All sites used multiple methods (median = 5). The most widely used, and generally favored, method was attending previously scheduled meetings of existing groups. Respondents expressed frustration with low attendance and responsiveness at open public meetings.	Coordinators and investigators in this trial viewed community consultation efforts as successful but reported real challenges generating public interest. Individuals with the condition under study were found to be more engaged and supportive of the trial. Respondents endorsed numerous potential goals of the community consultation process and often combined methods to achieve these goals.	
24377357	[Correction Notice: An Erratum for this article was reported in Vol 106(3) of Journal of Personality and Social Psychology (see record 2014-07574-006). In the article, the name of author Edward Deci was missing his middle name initial and should have read as Edward L. Deci. In addition, an incorrect version of figure 1 was published.] Recent studies have examined whether electronic games foster aggression. At present, the extent to which games contribute to aggression and the mechanisms through which such links may exist are hotly debated points. In current research we tested a motivational hypothesis derived from self-determination theory-that gaming would be associated with indicators of human aggression to the degree that the interactive elements of games serve to impede players' fundamental psychological need for competence. Seven studies, using multiple methods to manipulate player competence and a range of approaches for evaluating aggression, indicated that competence-impeding play led to higher levels of aggressive feelings, easier access to aggressive thoughts, and a greater likelihood of enacting aggressive behavior. Results indicated that player perceived competence was positively related to gaming motivation, a factor that was, in turn, negatively associated with player aggression. Overall, this pattern of effects was found to be independent of the presence or absence of violent game contents. We discuss the results in respect to research focused on psychological need frustration and satisfaction and as they regard gaming-related aggression literature.
24372741	To obtain qualitative information on fears and anxieties of coronary artery bypass grafting patients with short waiting periods (up to a maximum of four weeks) before surgery.Coronary artery bypass grafting is a standard procedure in cardiac surgery. However, many patients suffer significant anxiety and fear before the operation. Preoperative anxiety and fear correlate with adverse outcomes, but there is a lack of data on the emotional stressors for patients with short waiting periods as applicable in Germany. This knowledge would be a prerequisite for the development of in-hospital interventions to reduce patients' anxieties and fears.	An exploratory study was chosen to learn about patients' anxieties and fears.	The day before coronary artery bypass grafting, 24 patients were examined with respect to their emotional experience using semi-structured interviews. The results were categorised by inductive content analysis.	The overall waiting time for coronary artery bypass grafting was 6 ± 6 days. According to the analysis, the patients' statements were grouped in 'fears', 'negation of fears' and 'other emotional and physical conditions'. The interviews could cover all categories simultaneously. Eighteen patients mentioned fears, and most of them referred to specific issues. However, 16 of the 18 patients also named nonspecific fears and uncertainties. Fifteen patients negated fear. Twenty-three patients described their emotions and/or somatic conditions.	Patients with short waiting periods before coronary artery bypass grafting experience specific as well as nonspecific fears on the day before surgery. In contrast to patients with long waiting (longer than four weeks), uncertainty and frustration about waiting time and feelings of disability are no concerns.	The detailed insight into the emotional experiences of patients with a short waiting time before coronary artery bypass grafting surgery is a basis for targeted anxiety-reducing interventions.	
27087701	The Strengths and Difficulties Questionnaire (SDQ) is a robust, powerful and internationally recognised diagnostic screening tool for emotional and behaviour problems among children, with the particular advantage that it can be used by non-health professionals. This makes it useful in a South African context characterized by shortages of professional mental health carers. However the cultural and contextual acceptability and potential uses of the SDQ have not yet been examined in the South African context.The aim of the current study was to evaluate the acceptability of the SDQ in a Sesotho speaking area of South Africa. As part of a larger study to standardise the SDQ for use among Sotho speakers, teachers were asked to use the tool to assess learners in their class. Ten teachers were then asked to write a report on their experience of the SDQ and how useful and applicable they found it for their school setting. These findings were discussed at two later meetings with larger groupings of teachers. Reports were analysed using a modified contextualised interpretative content analysis method.	Teachers found the SDQ very useful in the classroom and easy to administer and understand. They found it contextually relevant and particularly useful in gaining an understanding of the learners and the challenges that learners were facing. It further allowed them to differentiate between scholastic and emotional problems, assisting them in developing relationships with the pupils and facilitating accurate referrals. There were very few concerns raised, with the major problem being that it was difficult to assess items concerning contexts outside of the school setting. The teachers expressed interest in obtaining further training in the interpretation of the SDQ and a greater understanding of diagnostic labels so as to assist their learners.	The SDQ was found to be acceptable and useful in the context of this very disadvantaged community. The teachers felt it assisted them in their role as teachers by providing a greater understanding of emotional and behaviour problems among learners. However, lack of places for referral and their own lack of appropriate skills and time did generate frustration.	
25827004	52 elderly women and 36 matched by age and education men with initiatory stages of chronic brain ischemia (CBI) have been studied using comparative analysis of personality characteristics. Women with CBI had higher level of psychosocial stress than men. The results demonstrate the predomination of extrapunitive frustration reactions among women. Intropunitive ones prevailed in men. Women-patients had higher levels of excitement, stress and anxiety than men that surpassed women by the indicators of emotional security. The received data may be important for individualization of therapeutic intervention.
24367315	IN LIFE, EVERYONE GOES THROUGH HURTFUL EVENTS CAUSED BY SIGNIFICANT OTHERS: a deceiving friend, a betraying partner, or an unjustly blaming parent. In response to painful emotions, individuals may react with anger, hostility, and the desire for revenge. As an alternative, they may decide to forgive the wrongdoer and relinquish resentment. In the present study, we examined the brain correlates of forgiveness using functional Magnetic Resonance Imaging (fMRI). Healthy participants were induced to imagine social scenarios that described emotionally hurtful events followed by the indication to either forgive the imagined offenders, or harbor a grudge toward them. Subjects rated their imaginative skills, levels of anger, frustration, and/or relief when imagining negative events as well as following forgiveness. Forgiveness was associated with positive emotional states as compared to unforgiveness. Granting forgiveness was associated with activations in a brain network involved in theory of mind, empathy, and the regulation of affect through cognition, which comprised the precuneus, right inferior parietal regions, and the dorsolateral prefrontal cortex. Our results uncovered the neuronal basis of reappraisal-driven forgiveness, and extend extant data on emotional regulation to the resolution of anger and resentment following negative interpersonal events. 
24364851	Previous research has suggested that a goal-incongruent outcome leads to more intense negative emotions when it is unexpected and close to a goal-congruent outcome. Until now, however, no studies have disentangled the influence of the appraisals of expectancy and proximity on emotions. We experimentally manipulated each of these variables in 3 slot machine experiments and measured emotions via differences in motivation (i.e., the tendency to repair the goal incongruence) and feelings (i.e., disappointment, frustration, and anger). The experiments consisted of a series of trials that each started with the sequential presentation of 3 symbols. In case of a win trial, all symbols were equal (e.g., AAA) and the participant gained 10 cents; in case of a loss trial, one or more of the symbols differed and the participant gained 0 cents. Three different loss trials were compared: unexpected proximal ones (e.g., AAB), expected proximal ones (e.g., ABA), and expected distal ones (e.g., ABC). The tendency to repair was measured online via behavior as well as retrospectively via self-reports; feelings were measured retrospectively (Experiments 1 and 2) or online (Experiment 3). Unexpected losses seemed to increase the tendency to repair as well as feelings of disappointment (in all experiments) and feelings of frustration and anger (in Experiments 1 and 3). Proximal losses increased only the tendency to repair (in all experiments). This suggests that the appraisals of expectancy and proximity have a distinct influence on emotions.
24364850	We examined the relations of negative emotions in toddlerhood to the development of ego-resiliency and social competence across early childhood. Specifically, we addressed whether fear and anger/frustration in 30-month-old children (N = 213) was associated with the development of ego-resiliency across 4 time points (42 to 84 months), and, in turn, whether ego-resiliency predicted social competence at 84 months. Child anger/frustration negatively predicted the intercept of ego-resiliency at 42 months (controlling for prior ego-resiliency at 18 months) as well as the slope. Fear did not significantly predict either the intercept or slope of ego-resiliency in the structural model, although it was positively correlated with anger/frustration and was negatively related to ego-resiliency in zero-order correlations. The slope of ego-resiliency was positively related to children's social competence at 84 months; however, the intercept of ego-resiliency (set at 42 months) was not a significant predictor of later social competence. Furthermore, the slope of ego-resiliency mediated the relations between anger/frustration and children's later social competence. The results suggest that individual differences in anger/frustration might contribute to the development of ego-resiliency, which, in turn, is associated with children's social competence.
24359619	This research belongs to a more comprehensive study on the care of street children in Cameroon. The idea is to develop an analysis of the street pathology where symptoms such as addictive behavior and drug addiction can be found. Beside HIV AIDS, addictive behaviors are the main risk factors that many professionals have to face with while dealing with the street problems today.Through an intercultural approach, we examined the practices of addictive typology, their initiatory role and their function in the integration of the street system. We also analysed their importance in the survival strategies. After an overview of theoretical controversies that feed the debate on addictions, we questioned the impact of these practices on the street career through the prism of general theory of addictions, particularly the hedonic management model. Addiction helps to resist adversity, it helps to desist and then to begin a harmonious neo development despite the horrors of the street experience.	We undertook a quantitative and qualitative study on a sample of 148 street children. We proposed to 128 of them a questionnaire focused on addictive behaviors and survival strategies in the street context. We notably evaluated the street career of 24 of them, using interviews and standardized tests to assess self-esteem (Coopersmith's SEI) frustration tolerance (Rosenweig's P-F) and self-efficacy (Sherer's SE Scale) in order to measure the impact of addictive behaviors on the resilience process.	We found that the street career is essentially traumatic, and that addictive behaviors involving various integration strategies are strongly linked to the interculturation process through the identity strategies and the intercultural competences. Addiction itself is not significantly related to self-esteem issues but strongly impacts on self-efficacy and the ability to tolerate frustration. They allow the street children to withstand the street adversity but are a real obstacle to their resilience process.	
24355601	The Lifetime Impairment Survey assessed impairment and symptoms of attention-deficit/hyperactivity disorder (ADHD) in children/adolescents from six European countries. Parents/caregivers of children/adolescents aged<20 years with ADHD (ADHD group; n = 535) and without ADHD (control group; n=424) participated in an online survey. History of ADHD diagnosis was self-reported. ADHD and control groups were compared using impairment and symptom scales; higher scores indicate greater impairment. Mean (SD) age at ADHD diagnosis was 7.0 (2.8) years, following consultation of 2.7 (2.6) doctors over 20.4 (23.9) months. Parents/caregivers (64%; 344/535) reported frustration with some aspect of the diagnostic procedure; 74% (222/298) were satisfied with their child's current medication. ADHD had a negative impact on children/adolescents in all aspects of life investigated. The ADHD group had a higher mean (SD) school impairment score (2.7 [0.7]) compared with the control group (2.1 [0.7]; P<0.001) and were more likely to be in the bottom of their class (P<0.001). These data provide insights into impairments associated with ADHD in childhood/adolescence, and identify areas for improvement in its management and treatment.
24351995	The purpose of this study was to explore the health-illness transition of patients with Young-Onset Parkinson's Disease (YOPD).From June to November 2011, 17 patients with YOPD who visited a neurologic clinic in a tertiary hospital participated in the study. Data were collected through in-depth interviews and analyzed using the grounded theory of Strauss and Corbin.	The core category of the participants' health-illness transition emerged as 'reshaping identity following uncontrollable changes'. The participants' health-illness transition process consisted of six phases in sequence: ego withdrawal, loss of role, frustration, change of thought, modification of life tract, and second life. Although most participants proceeded through the six phases chronologically, some returned to the frustration phase and then took up the remaining phases.	The study results provide an in-depth understanding of health-illness transition experiences in the participants. These findings suggest a need to develop appropriate nursing intervention strategies according to the different phases in the health-illness transition of patients with YOPD.	
24321432	Ireland is heavily reliant on non-EU migrant health workers to staff its health system. Shortages of locally trained health workers and policies which facilitate health worker migration have contributed to this trend. This paper provides insight into the experiences of non-EU migrant doctors in the Irish health workforce.In-depth interviews were conducted with 37 non-EU migrant doctors in Ireland in 2011/2012.	Respondents believed they had been recruited to fill junior hospital doctor 'service' posts. These posts are unpopular with locally trained doctors due to the limited career progression they provide. Respondents felt that their hopes for career progression and postgraduate training in Ireland had gone unrealised and that they were becoming de-skilled. As a result, most respondents were actively considering onward migration from Ireland.	Failure to align the expectations of non-EU migrant doctors with the requirements of the health system has resulted in considerable frustration and a cycle of brain gain, waste and drain. The underlying reasons for high mobility into and out of the Irish medical workforce must be addressed if this cycle is to be broken. The heavy reliance on non-EU migrant doctors to staff the medical workforce has distracted from the underlying workforce challenges facing the Irish medical workforce.	
24320713	Depressive symptomatology is associated with impaired recognition of emotion. Previous investigations have predominantly focused on emotion recognition of static facial expressions neglecting the influence of social interaction and critical contextual factors. In the current study, we investigated how youth and maternal symptoms of depression may be associated with emotion recognition biases during familial interactions across distinct contextual settings. Further, we explored if an individual's current emotional state may account for youth and maternal emotion recognition biases. Mother-adolescent dyads (N = 128) completed measures of depressive symptomatology and participated in three family interactions, each designed to elicit distinct emotions. Mothers and youth completed state affect ratings pertaining to self and other at the conclusion of each interaction task. Using multiple regression, depressive symptoms in both mothers and adolescents were associated with biased recognition of both positive affect (i.e., happy, excited) and negative affect (i.e., sadness, anger, frustration); however, this bias emerged primarily in contexts with a less strong emotional signal. Using actor-partner interdependence models, results suggested that youth's own state affect accounted for depression-related biases in their recognition of maternal affect. State affect did not function similarly in explaining depression-related biases for maternal recognition of adolescent emotion. Together these findings suggest a similar negative bias in emotion recognition associated with depressive symptoms in both adolescents and mothers in real-life situations, albeit potentially driven by different mechanisms.
24288189	The aim of this study was to explore the experience of service providers in Spain regarding their daily professional encounters with battered immigrant women and their perception of this group's help-seeking process and the eventual abandonment of the same. Twenty-nine in-depth interviews and four focus group discussions were conducted with a total of 43 professionals involved in providing support to battered immigrant women. We interviewed social workers, psychologists, intercultural mediators, judges, lawyers, and public health professionals from Spain. Through qualitative content analysis, four categories emerged: (a) frustration with the victim's decision to abandon the help-seeking process, (b) ambivalent positions regarding differences between immigrant and Spanish women, (c) difficulties in the migratory process that may hinder the help-seeking process, and (d) criticisms regarding the inefficiency of existing resources. The four categories were cross-cut by an overarching theme: helping immigrant women not to abandon the help-seeking process as a chronicle of anticipated failure. The main reasons that emerged for abandoning the help-seeking process involved structural factors such as economic dependence, loss of social support after leaving their country of origin, and limited knowledge about available resources. The professionals perceived their encounters with battered immigrant women to be frustrating and unproductive because they felt that they had few resources to back them up. They felt that despite the existence of public policies targeting intimate partner violence (IPV) and immigration in Spain, the resources dedicated to tackling gender-based violence were insufficient to meet battered immigrant women's needs. Professionals should be trained both in the problem of IPV and in providing support to the immigrant population. 
24284690	This study examined civilian employment among Army National Guard soldiers who had recently returned from Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF). Of specific interest were relationships of re-employment and financial difficulties to several conditions, such as amount of social support during and after deployment, combat exposure, negative feelings during and after deployment, and postdeployment adjustment symptoms. Survey data from the Army's Reintegration Unit Risk Inventory were used (4,546 soldiers in 50 units who were deployed during 2010). Few soldiers reported financial difficulties during deployment (7.1% of the sample) and after having returned (11.8%). Of those who reported postdeployment financial difficulties, nearly one-half had reported such difficulties during deployment, and not having resumed the predeployment job was associated with more postdeployment financial difficulties. Logistic regression analyses showed the relative contribution of the study variables to changed financial status, from deployment to postdeployment. Reported deployment support (e.g., trust in the unit chain-of-command and available support) was associated with decreased financial difficulties. In contrast, increased financial difficulties were associated with having seen others wounded or killed in combat. Other postdeployment experiences, such as feelings of anger and frustration and available support, were associated with increased financial difficulties, in addition to alcohol use, trouble sleeping and suicidal thoughts. Implications of results for policy and practice to lessen financial hardships and job loss associated with deployment are discussed. 
24283766	To describe male first-line managers' experiences of their work situation in elderly care.First-line managers' work is challenging. However, less attention has been paid to male managers' work situation in health care. Knowledge is needed to empower male managers.	Fourteen male first-line managers were interviewed. The interview text was subjected to qualitative content analysis.	Work situations were described as complex and challenging; challenges were the driving force. They talked about 'Being on one's own but not feeling left alone', 'Having freedom within set boundaries', 'Feeling a sense of satisfaction and stimulation', 'Feeling a sense of frustration' and 'Having a feeling of dejection and resignation'.	Although the male managers report deficiencies in the support structure, they largely experience their work as a positive challenge.	To meet increasing challenges, male first-line managers need better access to supportive structural conditions. Better access to resources is needed in particular, allowing managers to be more visible for staff and to work with development and quality issues instead of administrative tasks. Regarding organisational changes and the scrutiny of management and the media, they lack and thus need support and information from superiors.	
24274688	People with HIV are living longer with potent antiretroviral therapy (ART), and HIV is increasingly complicated by other chronic medical comorbidities. The objective of this study was to explore HIV-positive patients' perspectives on living with HIV and diabetes mellitus (DM) or hypertension (HTN) and factors affecting medication adherence.We conducted six focus groups. Two investigators independently coded transcripts for thematic content using editing style analysis. Codes were grouped into conceptual themes using consensus process.	Thirty-five HIV-positive patients with diabetes or hypertension participated. Four major themes emerged: (1) Comorbidities are a source of concern and frustration, sometimes eclipsing concern regarding HIV (2) Understanding of health conditions and medications promotes adherence, (3) Simpler regimens with fewer side effects promote adherence, and (4) Untreated substance abuse and mental health issues hinder adherence.	HIV-positive patients in this study voiced concern regarding medical comorbidities and highlighted patient understanding, regimen factors, and substance abuse/mental health issues as barriers to adherence. Addressing these issues may improve outcomes in the aging HIV-positive population. Adherence to medications among HIV-positive patients with DM or HTN may be influenced by providing targeted disease-specific education, simplifying regimens, and treatment of substance abuse/mental health issues.	
24273294	Fatigue is reported as a prevalent symptom post stroke. The purpose of this study is to explore the patent perspective of this symptom, how it is experienced, and its subjective impact on the patient.The qualitative procedure of interpretative phenomenological analysis (IPA) was used to analyze the narratives of 10 subjects with previous stroke, who each undertook a single, semi-structured interview.	Fatigue was a salient symptom for all the patients. Six main themes were identified. Tiredness/sleep was recognized in all the narratives, and themes of restriction, frustration, and determination/coping reflected varying degrees of physical, cognitive, and psychological dimensions to fatigue. Depression/motivation was also identified, reflecting low mood and helplessness. The remaining theme support indicated a social dimension, with patients recognizing the need for professional and familial support. Further subthemes were identified, and the thematic descriptions of the physical and psychosocial aspects indicated the complexity of fatigue and unique patient profiles. A holistic overview of each narrative furthered an understanding of the dynamic interrelationships between these aspects and their impact on the patient. There were prevalent patterns, but these were different for each patient.	A better understanding of the varied dimensions or themes elaborated for poststroke fatigue, and their interrelationships, should help in mitigating its impact. The analysis cautions against giving any simplistic and unitary advice to patients about dealing with fatigue.	
24273140	Estimating affective and cognitive states in conditions of rich human-computer interaction, such as in games, is a field of growing academic and commercial interest. Entertainment and serious games can benefit from recent advances in the field as, having access to predictors of the current state of the player (or learner) can provide useful information for feeding adaptation mechanisms that aim to maximize engagement or learning effects. In this paper, we introduce a large data corpus derived from 58 participants that play the popular Super Mario Bros platform game and attempt to create accurate models of player experience for this game genre. Within the view of the current research, features extracted both from player gameplay behavior and game levels, and player visual characteristics have been used as potential indicators of reported affect expressed as pairwise preferences between different game sessions. Using neuroevolutionary preference learning and automatic feature selection, highly accurate models of reported engagement, frustration, and challenge are constructed (model accuracies reach 91%, 92%, and 88% for engagement, frustration, and challenge, respectively). As a step further, the derived player experience models can be used to personalize the game level to desired levels of engagement, frustration, and challenge as game content is mapped to player experience through the behavioral and expressivity patterns of each player. 
24269148	to explore what women who have had a pregnancy terminated due to a detected fetal malformation perceived as having been important in their encounters with caregivers for promoting their healthy adjustment and well-being.an exploratory descriptive design was used. Semi-structured interviews were audiotaped, and the information pathway described. The text was processed through qualitative content analysis in six steps.	four fetal care referral centres in Stockholm, Sweden.	11 women opting for pregnancy termination due to fetal malformation.	in-depth understanding and compassion are important factors in providing the feeling of support people need so they are able to adapt to crisis. The women emphasised that the caregivers have to communicate a sense of responsibility, hope and respect and provide on-going care for them to feel assured of receiving good medical care and treatment. Aside from existing psychological conditions, the women identified as having emotional distress directly after termination and for at least the following three months. Most women experienced a range of negative emotions after pregnancy termination, including sadness, meaninglessness, loneliness, tiredness, grief, anger and frustration. Still some of this group had positive reactions because they experienced empathy and well-organised care.	The most important factors associated with satisfaction regarding pregnancy termination due to a fetal malformation are the human aspects of care, namely state-dependent communication and in-depth understanding and compassion. The changes in care most often asked for were improvements in the level of standards and provision of adequate support through state-dependent communication, in-depth understanding and compassion, and complete follow-up routines and increased resources. Targeted education for the caregivers may be suited to ensuring that they properly meet needs of their patients.	
24260503	Hendra virus is a highly pathogenic novel paramyxovirus causing sporadic fatal infection in horses and humans in Australia. Species of fruit-bats (genus Pteropus), commonly known as flying-foxes, are the natural host of the virus. We undertook a survey of horse owners in the states of Queensland and New South Wales, Australia to assess the level of adoption of recommended risk management strategies and to identify impediments to adoption. Survey questionnaires were completed by 1431 respondents from the target states, and from a spectrum of industry sectors. Hendra virus knowledge varied with sector, but was generally limited, with only 13% of respondents rating their level of knowledge as high or very high. The majority of respondents (63%) had seen their state's Hendra virus information for horse owners, and a similar proportion found the information useful. Fifty-six percent of respondents thought it moderately, very or extremely likely that a Hendra virus case could occur in their area, yet only 37% said they would consider Hendra virus if their horse was sick. Only 13% of respondents stabled their horses overnight, although another 24% said it would be easy or very easy to do so, but hadn't done so. Only 13% and 15% of respondents respectively had horse feed bins and water points under solid cover. Responses varied significantly with state, likely reflecting different Hendra virus history. The survey identified inconsistent awareness and/or adoption of available knowledge, confusion in relation to Hendra virus risk perception, with both over-and under-estimation of true risk, and lag in the uptake of recommended risk minimisation strategies, even when these were readily implementable. However, we also identified frustration and potential alienation by horse owners who found the recommended strategies impractical, onerous and prohibitively expensive. The insights gained from this survey have broader application to other complex risk-management scenarios. 
24257589	The emergency department (ED) is a key clinical care setting for identifying and managing patients with alcohol-related presentations. We explored the experiences of emergency physicians in providing alcohol-related care to adolescents.Purposeful sampling was used to identify pediatric emergency physicians with at least 1 year of experience (n = 12) from pediatric EDs across Canada. Data were collected via telephone using a semistructured interview guide. Hermeneutic phenomenology was used to identify common and unique experiences among respondents, using Moustakas' immersion/crystallization procedures.	Physicians expressed frustration with patient behaviors accompanying intoxication and described providing care as a struggle; developing an effective therapeutic alliance was challenging. Physicians believed intoxicated adolescent patients required more clinical time and resources than they could offer. Although physicians described the ED as unsuitable for ensuring continuity of care and addressing the broader social issues that accompany alcohol use, they did view the ED as a place to medically stabilize the patient and initiate a discussion on alcohol use and its harmful effects.	Pediatric ED physicians struggled during the caring experience and were skeptical that broader, more chronic social issues that are often associated with adolescent alcohol misuse can be effectively managed in a clinical setting where they feel primarily responsible for providing medical stabilization. Physicians did believe the ED was an appropriate place to ensure medical stability of a patient and then initiate a conversation regarding alcohol use and its harmful effects.	
24250327	Human errors in healthcare delivery pose serious threats to patients undergoing treatment. While clinical concern is growing in response, there is need to report social and behavioural context of the problem in Nigeria.To examine patients' knowledge and perceived reactions to medical errors.	A cross-sectional survey was conducted using a semi-structured questionnaire was used to collect data from 269 in-patients and 10 In-Depth Interviews were conducted among health caregivers in the University of Calabar Teaching Hospital, Nigeria.	Majority (64.5%) of respondents reported annoyance and disappointment with medical errors. Severity of error (88.5%) and the perception of negligence mediated intention to litigate. Voluntary disclosure significantly reduced patients' intention to litigate caregivers (chi(2)=3.584; df=1; P=0.053). Frustration/anger was not more likely to influence patient to litigate than feelings of resignation/forgiveness (chi(2)=2.156; df=1; P>.05). Financial difficulties arising from error had an important influence on litigation. Health caregivers admitted possibility of errors; and insisted that although notifying patients/relatives about errors is appropriate, disclosure was dependent on the seriousness, health implications and the causes.	Voluntary disclosure and teamwork is very important in dealing with medical error. The role of medical social workers could be important in the discourse and disclosure of medical error.	
24245835	There is a paucity of research investigating the role of interpersonal variables in vulvodynia--a prevalent, chronic, vulvo-vaginal pain condition that negatively affects many aspects of women's sexual health, emotional well-being and intimate relationships. Cross-sectional studies have shown that male partner responses to painful intercourse are associated with pain and sexual satisfaction in women with vulvodynia. Partner responses can be solicitous (attention and sympathy), negative (hostility and frustration), and facilitative (encouragement of adaptive coping). No research has assessed the influence of daily partner responses in this population. Further, there is limited knowledge regarding the impact of partner responses on sexual function, which is a key measure of impairment in vulvodynia.Using daily diaries, 66 women (M age = 27.91, SD = 5.94) diagnosed with vulvodynia and their cohabiting male partners (M age = 30.00, SD = 8.33) reported on male partner responses and sexual function on days when sexual intercourse occurred (M = 6.54, SD = 4.99). Drawing on the Actor-Partner Interdependence model (APIM), a multivariate multilevel modeling approach was adopted.	A woman's sexual functioning improved on days when she perceived greater facilitative and lower solicitous and negative male partner responses, and when her male partner reported lower solicitous responses. A man's sexual functioning was poorer on days when he reported greater solicitous and negative responses.	Findings suggest that facilitative male partner responses may improve sexual functioning whereas solicitous and negative responses may be detrimental. Partner responses should be targeted in psychological interventions aimed to improve the sexual functioning of affected couples.	
24239062	Understanding is limited of the meaning attributed to behaviors of children with autism spectrum disorder and strategies used to prevent challenging behaviors in the context of hospitalization.This qualitative study consisted of two focus groups (n = 10; five mothers and five health care providers [HCPs]). Transcripts were analyzed using the qualitative method of narrative inquiry.	The meaning attributed to behaviors by the mothers and the HCPs differed. The mothers attributed behaviors to the child's communication of frustration, hyperactivity, and self-calming. The HCPs attributed challenging behaviors to self-stimulation and child aggression. Strategies to prevent behaviors also differed. Mothers focused on preparation prior to hospitalization and attempts to partner with HCPs. HCPs identified fewer strategies and consulted mothers for strategies to manage challenging behaviors.	HCP and parent collaboration could lead to strategies to increase supports for children with autism spectrum disorder in the hospital to decrease their frustration and challenging behaviors.	
24238387	To compare intrusive memories in groups of people who do (PWS), and who do not (PWNS), stutter.Twenty-one participants who stuttered and 21 matched controls were given a semi-structured interview which explored imagery in speaking situations. The data were analyzed using a Content Analysis approach. Other outcome measures were the Beck Anxiety Inventory, the Beck Depression Inventory, the Post Traumatic Stress Disorder, PTSD, Symptom Scale: Self-Report Version.	Significantly more stuttering participants than control participants indicated both recurrent imagery and associated memories. Content Analysis revealed themes of disfluency, anxiety, negative social evaluation, self-focus and pressure to speak that were common to both groups' reports. Additional themes of helplessness, shame, sadness and frustration were found only in the images and memories of the stuttering group. No group differences were evident for the number of sensory modalities involved in images and memories, or for ratings of their vividness or strength of associated emotions, or on self-reports of depression, anxiety and trauma.	Recurrent imagery about events in childhood is a potent factor in the memories of PWS. It is worth modifying interventions that have been successfully applied for treating social anxiety for use with people who stutter.	After reading this article, participants will be able to: (a) identify the role of intrusive memories in psychiatric disorders and stuttering; (b) investigate how DSM criteria can be employed with people who stutter; (c) employ anxiety instruments used for assessing psychiatric disorders for stuttering; (d) distinguish between the intrusive memories experienced by people who stutter, and people who do not stutter; (e) apply treatments for intrusive memories in psychiatric disorders to work with people who stutter.	
24231890	Hospitals and healthcare providers are looking for methods to reduce hospitalization rates and improve patient outcomes for patients with heart failure (HF). Using behavioral approaches to increase patients' confidence in their abilities to perform self-care is 1 such approach. Motivational interviewing is an empirically validated modality that has shown promise in improving motivation to change and confidence in the ability to do so.This case represents a number of themes common in the management of care for a HF patient and explores a 4-session brief motivational interviewing approach to address these themes. The manner in which patient frustration is linked to hospitalization is discussed along with possible ways to address problems in self-care behaviors.	With the use of this brief motivational interviewing approach, the patient reported an increase in her motivation and ability to change and developed a postdischarge plan for incorporating self-care behaviors in her daily routine.	Motivational interviewing may be an effective method of increasing the self-care behaviors of patients with HF.	
24218376	The purpose of this study was to explore the formation and impact of attitudes and beliefs among people experiencing acute and chronic low back pain.Semistructured qualitative interviews were conducted with 12 participants with acute low back pain (less than 6 weeks' duration) and 11 participants with chronic low back pain (more than 3 months' duration) from 1 geographical region within New Zealand. Data were analyzed using an Interpretive Description framework.	Participants' underlying beliefs about low back pain were influenced by a range of sources. Participants experiencing acute low back pain faced considerable uncertainty and consequently sought more information and understanding. Although participants searched the Internet and looked to family and friends, health care professionals had the strongest influence upon their attitudes and beliefs. Clinicians influenced their patients' understanding of the source and meaning of symptoms, as well as their prognostic expectations. Such information and advice could continue to influence the beliefs of patients for many years. Many messages from clinicians were interpreted as meaning the back needed to be protected. These messages could result in increased vigilance, worry, guilt when adherence was inadequate, or frustration when protection strategies failed. Clinicians could also provide reassurance, which increased confidence, and advice, which positively influenced the approach to movement and activity.	Health care professionals have a considerable and enduring influence upon the attitudes and beliefs of people with low back pain. It is important that this opportunity is used to positively influence attitudes and beliefs.	
24216506	Beyond the biological risk factors of early childhood caries (ECC) is child temperament. This study aimed to investigate the relationship of ECC to different traits of child temperament, directly and indirectly through the nutritional and oral hygiene habits. Through a multi-stage sampling, 373 kindergarten children aged 18-36 months participated in this study. The primary caregivers filled in the Early Childhood Behaviour Questionnaire (ECBQ) and a checklist containing demographic data and the dietary and oral hygiene habits of the children. Children were examined for dental caries. The frequency of ECC was 41.14%. With 18 aspects of a child's temperament under consideration, attentional shifting, fear, frustration, low-intensity pleasure, sadness and shyness were significantly higher in the ECC group. Cuddliness, perceptual sensitivity, positive anticipation and soothability were significantly higher in caries-free children. Attentional shifting (p = 0.02), frustration (p = 0.02) and shyness (p = 0.03) were risk factors and cuddliness (p < 0.001) was a protecting factor for ECC. In the multiple regression model regarding nutritional and oral hygiene habits, easily soothable children were 0.69 times less likely to use sweetened liquids frequently [odds ratio (OR) 0.69, 95% confidence interval (CI) 0.49-0.97, p = 0.03], while sad children were 0.58 times less likely to brush (OR 0.58, 95% CI 0.36-0.94, p = 0.02). Considering temperament traits along with socioeconomic status, positive anticipation was the most significant determinant of ECC (OR 1.57, 95% CI 1.13-2.19, p = 0.007). However, considering temperament, socioeconomic measures and child habits among ECC risk factors, the most significant was the initiation of brushing habits (OR 5.41, 95% CI 2.81-12.98, p = 0.002).
24213523	Throughout the past 50 years mental health services have aimed to provide and improve high quality inpatient care. It is not clear whether there has been improvement as service users and nursing staff have both expressed frustration at the lack of therapeutic activities. In particular, it may be that the changing levels of symptoms over the past 50 years may affect engagement with ward activities.Eight wards in a health care trust in London serving an inner city and urban populations participated. Data were collected on participation in activities and 116 service users' perceptions of acute care as well as clinical factors.	Less time was spent participating in activities today than 50 years ago, while one quarter of service users reported taking part in no activities at all. Uptake of activities was related to more positive service user perceptions of the wards. Symptom severity did not impact the frequency of participation in activities, although those who took part in no activities at all had higher negative symptoms scores.	Service users' uptake of activities was not related to the severity of their illness. This belies the belief that the acutely ill cannot take part in meaningful activities. This study supports the view that more therapeutic activities could be taken up by the acutely ill and are in fact appreciated.	
24206153	Health care organisations are increasingly conceptualised as complex, indivisible entities made up of web-like networks of staff that connect to each other in changeable ways. This study draws on the theoretical framework of activity theory and the concept of knotworking to illustrate how health professionals improvise collaboratively to negotiate everyday challenges and contribute positively to patients' health priorities.The aim of this paper is to contribute to evolving ideas about collective learning, change and improvement in secondary care by exploring how health professionals work and learn together and how this compares with earlier findings from primary care.	This study applied a constructionist methodology within the research paradigm of interpretivism. Qualitative data were gathered through 26 hours of observations and 17 field interviews within the natural environment of a working hospital over a 3-month period. The research site encompassed a medical receiving ward, a chronic ward, an out-patient clinic and the connecting corridors. Staff participants included a range of clinical, nursing, ancillary and clerical staff.	The study found a recurring pattern of spontaneous team forming and interprofessional shared learning to respond to care needs within the hospital as they arise. These are presented in four analytical themes: motion, flux and the unpredictability of 'team spirit'; adaptive, responsive learning through seeing, doing and asking questions; the collective learning gap between doctors and other staff; and frustration, compassion and the desire for improvement.	Health care professionals in the hospital setting both create and experience complex inclusion and exclusion behaviours that define who is empowered to act with professional authority in any given moment of care. This paper discusses issues of power, the particular exclusion of doctors from interprofessional knotworking, and the greater emphasis on questions as the pivotal aspect of shared collective learning when compared with primary care.	
24199887	Given the prevalence and costs of somatoform disorders, it is important to identify and adequately treat these patients as early as possible. Instruments assessing experiences, perceptions, and behaviors of somatoform disorders are rare. In this study we evaluated the structure and validity of the German version of the Health Attitude Survey (HAS), a multidimensional self-report questionnaire for somatoform disorders.This cross-sectional study involved 1452 participants. The sample was randomly split for independent exploratory (EFA) and confirmatory factor analyses (CFA). Each of the two samples (n1=726; n2=726) included patients with organic vertigo and current mental disorders (somatoform and other mental disorders). Somatic symptom burden was assessed using the Patient Health Questionnaire (PHQ-15).	The CFA did not confirm the original HAS factor structure. The EFA revealed six factors. To enhance the fit of the model, we deleted two factors with the poorest reliability and items with low factor loadings. A modified and shortened version achieved good fit indices (CFI=0.92; RMSEA=0.068). It consists of 14 instead of 27 items and four scales ("dissatisfaction with care," "frustration with ill health," "high utilization of care," "excessive health worry"). HAS subscales discriminated among somatoform patients and physically ill and/or patients with a mental but not somatoform disorder, controlled for age, sex and number of (comorbid) mental diagnoses, confirming its construct validity.	A modified shortened version of the HAS appears to be a reliable, valid, and economical instrument for assessing facets of somatoform disorders or of the recently published DSM-5 Somatic Symptom Disorder.	
24199597	Treatment resistance is an omnipresent frustration in eating disorders. Attempts to identify the features of this resistance and subsequently develop novel treatments have had modest effects. This selective review examines treatment resistant features expressed in core eating disorder psychopathology, comorbidities and biological features. Novel treatments addressing resistance are discussed.The core eating disorder psychopathology of anorexia nervosa becomes a coping mechanism likely via vulnerable neurobiological features and conditioned learning to deal with life events. Thus it is reinforcing and ego syntonic resulting in resistance to treatment. The severity of core features such as preoccupations with body image, weight, eating and exercising predicts greater resistance to treatment. Bulimia nervosa patients are less resistant to treatment with treatment failure related to greater body image concerns, impulsivity, depression, severe diet restriction and poor social adjustment. For those with binge eating disorder overweight in childhood and high emotional eating predicts treatment resistance. There is suggestive data that a diagnosis of an anxiety disorder and severe perfectionism may confer treatment resistance in anorexia nervosa and substance use disorders or personality disorders with impulse control problems may produce resistance to treatment in bulimia nervosa. Traits such as perfectionism, cognitive inflexibility and negative affect with likely genetic influences may also affect treatment resistance. Pharmacotherapy and novel therapies have been developed to address treatment resistance. Atypical antipsychotic drugs have shown some effect in treatment resistant anorexia nervosa and topiramate and high doses of SSRIs are helpful for treatment of resistant binge eating disorder patients. There are insufficient randomized controlled trials to evaluate the novel psychotherapies which are primarily based on the core psychopathological features of the eating disorders.	Treatment resistance in eating disorders is usually predicted by the severity of the core eating disorder psychopathology which develops from an interaction between environmental risk factors with genetic traits and a vulnerable neurobiology. Future investigations of the biological features and neurocircuitry of the core eating disorders psychopathology and behaviors may provide information for more successful treatment interventions.	
24192504	In Canada, the prevalence of oral diseases is very high among people on social assistance. Despite great need for dental treatment, many are reluctant to consult dental professionals, arguing that dentists do not welcome or value poor patients. The objective of this research was thus to better understand how dentists perceived and experienced treating people on social assistance.This descriptive qualitative research was based on in-depth semi-structured interviews with 33 dentists practicing in Montreal, Canada. Generally organized in dentists' offices, the interviews lasted 60 to 120 minutes; they were digitally recorded and later transcribed verbatim. The interview transcripts were coded with NVivo software, and data was displayed in analytic matrices. Three members of the research team interpreted the data displayed and wrote the results of this study.	Dentists express high levels of frustration with people on social assistance as a consequence of negative experiences that fall into 3 categories: 1) Organizational issues (people on social assistance ostensibly make the organization of appointments and scheduling difficult); 2) Biomedical issues (dentists feel unable to provide them with adequate treatment and fail to improve their oral health); 3) Financial issues (they are not lucrative patients). To explain their stance, dentists blame people on social assistance for neglecting themselves, and the health care system for not providing adequate coverage and fees. Despite dentists' willingness to treat all members of society, an accumulation of frustration leads to feelings of powerlessness and discouragement.	The current situation is unacceptable; we urge public health planners and governmental health agencies to ally themselves with the dental profession in order to implement concrete solutions.	
24184058	Numerous studies have demonstrated that the Paced Auditory Serial Addition Test (PASAT) has utility for the detection of cognitive processing deficits. While the PASAT has demonstrated high levels of internal consistency and test-retest reliability, administration of the PASAT has been known to create undue anxiety and frustration in participants. As a result, degradation of performance may be found on the PASAT. The difficult nature of the PASAT may subsequently decrease the probability of their return for follow up testing.This study is a preliminary attempt at assessing the potential of a PASAT embedded in a virtual reality environment. The Virtual Reality PASAT (VR-PASAT) was compared with a paper-and-pencil version of the PASAT as well as other standardized neuropsychological measures. The two modalities of the PASAT were conducted with a sample of 50 healthy university students, between the ages of 19 and 34 years. Equivalent distributions were found for age, gender, education, and computer familiarity.	Moderate relationships were found between VR-PASAT and other putative attentional processing measures. The VR-PASAT was unrelated to indices of learning, memory, or visuospatial processing.	Comparison of the VR-PASAT with the traditional paper-and-pencil PASAT indicated that both versions require the examinee to sustain attention at an increasingly demanding, externally determined rate.	Results offer preliminary support for the construct validity (in a college sample) of the VR-PASAT as an attentional processing measure and suggest that this task may provide some unique information not tapped by traditional attentional processing tasks.	
24170517	To assess temperament in patients with central serous chorioretinopathy (CSCR) compared to healthy controls.A total of 32 patients diagnosed with acute CSCR and 30 healthy controls matched by age and sex were assessed with the self-report Cloninger's Temperament and Character Inventory. Central serous chorioretinopathy was diagnosed based on fluorescein angiography and spectral optical coherence tomography.	Significantly higher mean scores of harm avoidance in patients with CSCR were found. Differences also were noted in subscales of novelty-seeking and reward dependence.	The patients with CSCR demonstrated less exploratory behaviors, higher risk avoidance, restraint, and low extravagance. They were more quick-tempered, disorganized, and easily frustrated, with a tendency to avoid negative and potentially harmful stimuli, less tolerance to frustration, higher level of insecurity, and higher level of anticipatory anxiety.	
24169091	This study explores the mechanisms linking the psychosocial characteristics of the workplace with employees' work-related musculoskeletal complaints. Poor safety climate perceptions represent a stressor that may elicit frustration, and subsequently, increase employees' reports of musculoskeletal discomforts. Results from an employee sample supported that when employees' perceived safety was considered a priority, they experienced less frustration and reported fewer work-related upper body musculoskeletal symptoms. Psychological hardiness, a personality trait that is indicative of individuals' resilience and success in managing stressful circumstances, moderated these relationships. Interestingly, employees with high hardiness were more affected by poor safety climate. 
24168713	In light of the current controversy about whether severe temper outbursts are diagnostic of mania in young children, we conducted a study to characterize such children, focusing on mania and other mood disorders, emotion regulation, and parental psychiatric history.Study participants included 51 5-9-year-old children with frequent, impairing outbursts (probands) and 24 non-referred controls without outbursts. Parents completed a lifetime clinical interview about their child, and rated their child's current mood and behavior. Teachers completed a behavior rating scale. To assess emotion regulation, children were administered the Balloons Game, which assesses emotion expressivity in response to frustration, under demands of high and low regulation. Parental lifetime diagnoses were ascertained in blind clinical interviews.	No child had bipolar disorder, bipolar disorder not otherwise specified (NOS), or major depression (MDD). The most prevalent disorder was oppositional defiant disorder (88.2%), followed by attention-deficit/hyperactivity disorder (74.5%), anxiety disorders (49.0%), and non-MDD depressive disorders (33.3%). Eleven probands (21.6%) met criteria for severe mood dysregulation. During the Balloons Game, when there were no demands for self-regulation, children with severe outbursts showed reduced positive expressivity, and also showed significant deficits in controlling negative facial expressions when asked to do so. Anxiety disorders were the only diagnoses significantly elevated in probands' mothers.	Overall, young children with severe temper outbursts do not present with bipolar disorder. Rather, disruptive behavior disorders with anxiety and depressive mood are common. In children with severe outbursts, deficits in regulating emotional facial expressions may reflect deficits controlling negative affect. This work represents a first step towards elucidating mechanisms underlying severe outbursts in young children.	
24165310	in the UK, two-thirds of patients in general hospitals are older than 70, of whom half have dementia or delirium or both. Our objective was to explore doctors, nurses and allied health professionals' perceptions of their preparation to care for confused older patients on general hospital wards.: using a quota sampling strategy across 11 medical, geriatric and orthopaedic wards in a British teaching hospital, we conducted 60 semi-structured interviews with doctors, nurses and allied healthcare professionals and analysed the data using the Consensual Qualitative Research approach.	: there was consensus among participants that education, induction and in-service training left them inadequately prepared and under-confident to care for confused older patients. Many doctors reported initial assessments of confused older patients as difficult. They admitted inadequate knowledge of mental health disorders, including the diagnostic features of delirium and dementia. Handling agitation and aggression were considered top priorities for training, particularly for nurses. Multidisciplinary team meetings were highly valued but were reported as too infrequent. Participants valued specialist input but reported difficulties gaining such support. Communication with confused patients was regarded as particularly challenging, both in terms of patients making their needs known, and staff conveying information to patients. Participants reported emotional and behavioural responses including frustration, stress, empathy, avoidance and low job satisfaction.	: our findings indicate that a revision of training across healthcare professions in the UK is required, and that increased specialist support should be provided, so that the workforce is properly prepared to care for older patients with cognitive problems.	
24152431	The prevalence of dementia as a disease has increased worldwide with advancing age and growing population numbers, affecting whole families. However, most previous research does not separate the spouses or cohabitants from the adult children, but instead regards all next of kin involved in the everyday care of the person suffering from dementia as caregivers. This has made it difficult to find previous research regarding what it means to be an adult child of a person with dementia, and as such, the aim of this study is to explore that topic. The method used was narrative interviews analysed using phenomenological hermeneutics. Our comprehensive understanding showed that to be an adult child of a person with dementia means being burdened with the responsibility to act on behalf of the diseased parent despite a deep sense of grief and loss, which leads to frustration and despondence. The adult children's existence and reality are threatened not only by the loss of the parent but also by the possibility that one day they too may inherit the disease. This could be compared to a psychic crisis, which is defined as a situation that leads to radical changes in the afflicted person's relationship to life and reality, or, simply, "an upset in a steady state." The findings suggest that adult children of people with dementia are in need of support for a substantial period of time in order to adapt to the fact that they have lost a parent who is still alive. They also need information about the disease and the process of diagnosis and treatment to feel more a part of the process, as well as understand the behavior and needs of their parent. 
24143904	Athletic training students (ATSs) are involved in various situations during the clinical experience that may cause them to express levels of frustration. Understanding levels of frustration in ATSs is important because frustration can affect student learning, and the clinical experience is critical to their development as professionals.To explore perceived levels of frustration in ATSs during clinical situations and to determine if those perceptions differ based on sex.	Cross-sectional study with a survey instrument.	A total of 14 of 19 professional, undergraduate athletic training programs accredited by the Commission on Accreditation of Athletic Training Education in Pennsylvania.	Of a possible 438 athletic training students, 318 (72.6%) completed the survey.	The Athletic Training Student Frustration Inventory was developed and administered. The survey gathered demographic information and included 24 Likert-scale items centering on situations associated with the clinical experience. Descriptive statistics were computed on all items. The Mann-Whitney U was used to evaluate differences between male and female students.	A higher level of frustration was perceived during the following clinical situations: lack of respect by student-athletes and coaching staffs, the demands of the clinical experience, inability of ATSs to perform or remember skills, and ATSs not having the opportunity to apply their skills daily. Higher levels of frustration were perceived in female than male ATSs in several areas.	Understanding student frustration during clinical situations is important to better appreciate the clinical education experience. Low levels of this emotion are expected; however, when higher levels exist, learning can be affected. Whereas we cannot eliminate student frustrations, athletic training programs and preceptors need to be aware of this emotion in order to create an environment that is more conducive to learning.	
24142832	This study examined parasympathetic physiology as a moderator of the effects of early adversity (i.e., child abuse and neglect) on children's inhibitory control. Children's respiratory sinus arrhythmia (RSA) was assessed during a resting baseline, two joint challenge tasks with mother, and an individual frustration task. RSA assessed during each of the joint parent-child challenge tasks moderated the effects of child maltreatment (CM) status on children's independently-assessed inhibitory control. No moderation effect was found for RSA assessed at baseline or in the child-alone challenge task. Among CM-exposed children, lower RSA levels during the joint task predicted the lowest inhibitory control, whereas higher joint task RSA was linked to higher inhibitory control scores that were indistinguishable from those of non-CM children. Results are discussed with regard to the importance of considering context specificity (i.e., individual and caregiver contexts) in how biomarkers inform our understanding of individual differences in vulnerability among at-risk children.
24141641	Violence is a major cause of morbidity and mortality among adolescents. We conducted serial focus groups with 30 youth from a violence prevention program to discuss violence in their community. We identified four recurrent themes characterizing participant experiences regarding peer decision-making related to violence: (1) youth pursue respect, among other typical tasks of adolescence; (2) youth pursue respect as a means to achieve personal safety; (3) youth recognize pervasive risks to their safety, frequently focusing on the prevalence of firearms; and (4) as youth balance achieving respect in an unsafe setting with limited opportunities, they express conflict and frustration. Participants recognize that peers achieve peer-group respect through involvement in unsafe or unhealthy behavior including violence; however they perceive limited alternative opportunities to gain respect. These findings suggest that even very high risk youth may elect safe and healthy alternatives to violence if these opportunities are associated with respect and other adolescent tasks of development. 
24124078	This study examined weight bias among students training in health disciplines and its associations with their perceptions about treating patients with obesity, causes of obesity, and observations of weight bias by instructors and peers.Students (N = 107) enrolled in a post-graduate health discipline (Physician Associate, Clinical Psychology, Psychiatric Residency) completed anonymous questionnaires to assess the above variables.	Students reported that patients with obesity are a common target of negative attitudes and derogatory humor by peers (63%), health-care providers (65%), and instructors (40%). Although 80% of students felt confident to treat obesity, many reported that patients with obesity lack motivation to make changes (33%), lead to feelings of frustration (36%), and are non-compliant with treatment (36%). Students with higher weight bias expressed greater frustration in these areas. The effect of students' weight bias on expectations for treatment compliance of patients with obesity was partially mediated by beliefs that obesity is caused by behavioral factors.	Weight bias is commonly observed by students in health disciplines, who themselves report frustrations and stereotypes about treating patients with obesity. These findings contribute new knowledge about weight bias among students and provide several targets for medical training and education.	
24113162	The purpose of this study was to gain an understanding of how caregivers of people with pulmonary hypertension are using an online discussion board. The chronicity and complex medical needs of people with pulmonary hypertension warrant a holistic nursing approach combining the patient and caregiver concerns to adequately address their needs. A qualitative descriptive approach was utilized. A convenience sample over an 18-month period of those caregivers who posted Internet messages to the Pulmonary Hypertension Discussion Board was included. Sociodemographics collected were age and gender of the person with pulmonary hypertension and the relationship of the caregiver to the person with pulmonary hypertension. Clinical variables collected were medications and oxygen use and years since diagnosis. Thematic analysis was used to identify themes. A total of 98 caregivers posted to the discussion board during the 18-month period; 46% of those posting were mothers of children with pulmonary hypertension. Four themes emerged: fear and frustration, questions and concerns, someone to listen to, and moving on with life. These themes characterize how caregivers of people with pulmonary hypertension were using the discussion board. Caregivers of people with pulmonary hypertension may need more information and support from their healthcare providers to adequately care for those with pulmonary hypertension. 
24108725	Brain–computer interfaces (BCI) provide a valuable new input modality within human–computer interaction systems. However, like other body-based inputs such as gesture or gaze based systems, the system recognition of input commands is still far from perfect. This raises important questions, such as what level of control should such an interface be able to provide. What is the relationship between actual and perceived control? And in the case of applications for entertainment in which fun is an important part of user experience, should we even aim for the highest level of control, or is the optimum elsewhere? In this paper, we evaluate whether we can modulate the amount of control and if a game can be fun with less than perfect control. In the experiment users (n = 158) played a simple game in which a hamster has to be guided to the exit of a maze. The amount of control the user has over the hamster is varied. The variation of control through confusion matrices makes it possible to simulate the experience of using a BCI, while using the traditional keyboard for input. After each session the user completed a short questionnaire on user experience and perceived control. Analysis of the data showed that the perceived control of the user could largely be explained by the amount of control in the respective session. As expected, user frustration decreases with increasing control. Moreover, the results indicate that the relation between fun and control is not linear. Although at lower levels of control fun does increase with improved control, the level of fun drops just before perfect control is reached (with an optimum around 96%). This poses new insights for developers of games who want to incorporate some form of BCI or other modality with unreliable input in their game: for creating a fun game, unreliable input can be used to create a challenge for the user.
24098926	Individuals with lower social status have been reported to express more anger, but this evidence comes mostly from Western cultures. Here, we used representative samples of American and Japanese adults and tested the hypothesis that the association between social status and anger expression depends on whether anger serves primarily to vent frustration, as in the United States, or to display authority, as in Japan. Consistent with the assumption that lower social standing is associated with greater frustration stemming from life adversities and blocked goals, Americans with lower social status expressed more anger, with the relationship mediated by the extent of frustration. In contrast, consistent with the assumption that higher social standing affords a privilege to display anger, Japanese with higher social status expressed more anger, with the relationship mediated by decision-making authority. As expected, anger expression was predicted by subjective social status among Americans and by objective social status among Japanese. Implications for the dynamic construction of anger and anger expression are discussed.
24098384	Multiple sclerosis is now more common among minority ethnic groups in the UK but little is known about their experiences, especially in advanced stages. We examine disease progression, symptoms and psychosocial concerns among Black Caribbean (BC) and White British (WB) people severely affected by MS.Mixed methods study of 43 BC and 43 WB people with MS (PwMS) with an Expanded Disability Status Scale (EDSS) ≥6 involving data from in clinical records, face-to-face structured interviews and a nested-qualitative component. Progression Index (PI) and Multiple Sclerosis Severity Score (MSSS) were calculated. To control for selection bias, propensity scores were derived for each patient and adjusted for in the comparative statistical analysis; qualitative data were analysed using the framework approach.	Median EDSS for both groups was (6.5; range: 6.0-9.0). Progression Index (PI) and Multiple Sclerosis Severity Score (MSSS) based on neurological assessment of current EDSS scores identified BC PwMS were more likely to have aggressive disease (PI F = 4.04, p = 0.048, MSSS F = 10.30, p<0.001). Patients' reports of the time required to reach levels of functional decline equivalent to different EDSS levels varied by group; EDSS 4: BC 2.7 years v/s WB 10.2 years (U = 258.50, p = 0.013), EDSS 6∶6.1 years BC v/s WB 12.7 years (U = 535.500, p = 0.011), EDSS 8: BC 8.7 years v/s WB 10.2 years. Both groups reported high symptom burden. BC PwMS were more cognitively impaired than WB PwMS (F = 9.65, p = 0.003). Thematic analysis of qualitative interviews provides correspondence with quantitative findings; more BC than WB PwMS referred to feelings of extreme frustration and unresolved loss/confusion associated with their rapidly advancing disease. The interviews also reveal the centrality, meanings and impact of common MS-related symptoms.	Delays in diagnosis should be avoided and more frequent reviews may be justified by healthcare services. Culturally acceptable interventions to better support people who perceive MS as an assault on identity should be developed to help them achieve normalisation and enhance self-identity.	
24096703	Animals may experience positive affective states in response to their own achievements. We investigated emotional responses to problem-solving in dogs, separating these from reactions to rewards per se using a yoked control design. We also questioned whether the intensity of reaction would vary with reward type. We examined the response (behavior and heart rate) of dogs as they learned to gain access to different rewards: (1) food (2) human contact, and (3) dog contact. Twelve beagles were assigned to matched pairs, and each dog served as both an experimental and a control animal during different stages of the experiment. We trained all dogs to perform distinct operant tasks and exposed them to additional devices to which they were not trained. Later, dogs were tested in a new context. When acting as an experimental dog, access to the reward was granted immediately upon completion of trained operant tasks. When acting as a control, access to the reward was independent of the dog's actions and was instead granted after a delay equal to their matched partner's latency to complete their task. Thus, differences between the two situations could be attributed to experimental dogs having the opportunity to learn to control access to the reward. Experimental dogs showed signs of excitement (e.g., increased tail wagging and activity) in response to their achievements, whereas controls showed signs of frustration (e.g., chewing of the operant device) in response to the unpredictability of the situation. The intensity of emotional response in experimental dogs was influenced by the reward type, i.e., greatest response to food and least to another dog. Our results suggest that dogs react emotionally to problem-solving opportunities and that tail wagging may be a useful indicator of positive affective states in dogs.
24080080	Connect-Four, a new sensorimotor rhythm (SMR) based brain-computer interface (BCI) gaming application, was evaluated by four severely motor restricted end-users; two were in the locked-in state and had unreliable eye-movement.Following the user-centred approach, usability of the BCI prototype was evaluated in terms of effectiveness (accuracy), efficiency (information transfer rate (ITR) and subjective workload) and users' satisfaction.	Online performance varied strongly across users and sessions (median accuracy (%) of end-users: A=.65; B=.60; C=.47; D=.77). Our results thus yielded low to medium effectiveness in three end-users and high effectiveness in one end-user. Consequently, ITR was low (0.05-1.44bits/min). Only two end-users were able to play the game in free-mode. Total workload was moderate but varied strongly across sessions. Main sources of workload were mental and temporal demand. Furthermore, frustration contributed to the subjective workload of two end-users. Nevertheless, most end-users accepted the BCI application well and rated satisfaction medium to high. Sources for dissatisfaction were (1) electrode gel and cap, (2) low effectiveness, (3) time-consuming adjustment and (4) not easy-to-use BCI equipment. All four end-users indicated ease of use as being one of the most important aspect of BCI.	Effectiveness and efficiency are lower as compared to applications using the event-related potential as input channel. Nevertheless, the SMR-BCI application was satisfactorily accepted by the end-users and two of four could imagine using the BCI application in their daily life. Thus, despite moderate effectiveness and efficiency BCIs might be an option when controlling an application for entertainment.	
24055493	Two recent microarray and qRT-PCR studies showed that inbred Roman high- (RHA-I, low anxiety and frustration vulnerability) and low-avoidance (RLA-I, high anxiety and frustration vulnerability) rats, psychogenetically selected on the basis of their divergence in two-way avoidance performance, differed in basal whole-brain and hippocampal expression of genes related to neurotransmission, emotion, stress, aversive learning, and drug seeking behavior. We have extended these studies by analyzing strain differences in hippocampal gene expression following a frustrative experience involving reward downshift, i.e. instrumental successive negative contrast (iSNC), a phenomenon in which the sudden reduction of an expected reward induces frustration/anxiety. Food-deprived male Roman rats were exposed to a reduction in the amount of solid food presented in the goal of a straight alley (from 12 pellets in "training" trials - i.e. preshift trials- to 2 pellets in "frustration testing" trials - i.e. postshift trials-). The iSNC effect, as measured by response latencies in the "postshift" trials, appeared only in RLA-I rats (i.e. higher response latencies in the 12-2 RLA-I group as compared to the 2-2 RLA-I control group in postshift trials). Two and a half hours after the "postshift" behavioral test, hippocampi were removed and stored (-80°C) until analysis. Microarray analysis of these hippocampi showed that four differentially-expressed, and qRT-PCR-validated genes (TAAR2, THAP1, PKD2L1, NANOS), have relevance for brain function and behavior, including schizophrenia, depression, anxiety, and drug addiction, thus showing the usefulness of Roman strains as a genetic model for research on the neurogenetic basis of frustration.
24051061	Law enforcement is often the first to respond to medical emergencies in the community, including overdose. Due to the nature of their job, officers have also witnessed first-hand the changing demographic of drug users and devastating effects on their community associated with the epidemic of nonmedical prescription opioid use in the United States. Despite this seminal role, little data exist on law enforcement attitudes toward overdose prevention and response.We conducted key informant interviews as part of a 12-week Rapid Assessment and Response (RAR) process that aimed to better understand and prevent nonmedical prescription opioid use and overdose deaths in locations in Connecticut and Rhode Island experiencing overdose "outbreaks." Interviews with 13 law enforcement officials across three study sites were analyzed to uncover themes on overdose prevention and naloxone.	Findings indicated support for law enforcement involvement in overdose prevention. Hesitancy around naloxone administration by laypersons was evident. Interview themes highlighted officers' feelings of futility and frustration with their current overdose response options, the lack of accessible local drug treatment, the cycle of addiction, and the pervasiveness of easily accessible prescription opioid medications in their communities. Overdose prevention and response, which for some officers included law enforcement-administered naloxone, were viewed as components of community policing and good police-community relations.	Emerging trends, such as existing law enforcement medical interventions and Good Samaritan Laws, suggest the need for broader law enforcement engagement around this pressing public health crisis, even in suburban and small town locations, to promote public safety.	
24050041	Encopresis is a medical condition that can be seen in the school setting with children of all ages, though primarily at the early childhood and elementary level. This condition can cause a great amount of frustration with the student, family, and teachers due to the child's inability to control elimination patterns. The school nurse must be aware of the warning signs that a student may be experiencing encopresis in order to promote treatment. This article will assist the school nurse in understanding typical causes for functional encopresis, knowing how to help a student who soils, and developing an individualized healthcare plan that assists a student to become continent of stool again. Encopresis is not just an accident.
24044373	Caring for a person with dementia can be an unrelenting and burdensome task, one that is often detrimental to the caregiver's health, well-being, and functionality. The enduring stress and frustration of the caregiver role can also contribute to poorer outcomes for dementia sufferers. Building on growing clinical interest in the capacity for Transcendental Meditation(®) (TM; a relaxation technique) to reduce stress and anxiety in healthy workers, this study examines whether similar improvements could be experienced by dementia caregivers.The study objective was to ascertain whether a TM program can improve psychological stress, quality of life, affect, and cognitive performance of dementia caregivers.	The study was a pilot prospective, single-center, randomized wait-list controlled trial with two parallel arms.	Community-dwelling carers of persons with diagnosed dementia, residing in metropolitan Adelaide, South Australia, were included in this study.	Participants will be randomly assigned to a 13-hour TM training program or wait-list control over 12 weeks.	Primary outcomes include quality of life and stress. Secondary outcomes include affect, cognitive performance, cost-effectiveness, and study feasibility. Outcomes will be assessed at baseline, week 12 (postintervention), and week 24 (follow-up).	Results are expected to be available early in 2014.	This project responds to a need for robust evidence of the clinical and economic effectiveness of TM for the management of caregiver stress. If Transcendental Meditation is shown to be effective, it could indicate a simple, cost-effective, and easily implemented strategy to assist many of the growing numbers of caregivers to cope with the demanding and often difficult caregiver role.	
24041101	There is increased awareness of the consequences of poor performance amongst healthcare professionals on patient care. Understanding the experiences and needs of GP trainers involved in the management of trainees in difficulty (TiDs) is important in ensuring a successful outcome for trainer, learner, and patient care. However, there is a paucity of empirical data in this area.The aim of this study was to explore the perceived responses of GP trainers involved in the management of TiDs. We also sought to explore the strategies that GP trainers used in managing these responses, and the support they accessed.	Semi-structured interviews were conducted with a purposive sample of 11 GP trainers involved in educational supervision of a TiD in London.	Semi-structured face-to-face interviews were undertaken. These were recorded, and transcribed verbatim. Data were handled using NVivo. Thematic analysis was undertaken by a team of clinical educators.	GP trainers managing TiDs expressed significant anxiety as a result of concerns about patient safety, frustration at the lack of progress made by TiDs, and being seen as a failing trainer. GP trainers described the impact that TiDs had on themselves, their patients, practices, and on the trainer-trainee relationship as well as the strategies they used to manage these impacts. GP trainers used well-honed skills for identifying their own emotions, reflection and support (from peers and trainers' workshops) to manage these emotions, and steer the trainer-trainee relationship in a constructive direction.	This study is one of the first to explore the impact on GP trainers of managing a TiD. It highlights the challenges faced and strategies used by GP trainers in helping TiDs. The use of experiential and peer-learning strategies is an important part of the approach for GP trainers in supporting TiDs as well as managing their own emotions. Providers of medical education need to ensure that trainers are adequately supported in managing such trainees.	
24021853	Intentional inhibition refers to stopping oneself from performing an action at the last moment, a vital component of self-control. It has been suggested that intentional inhibition is associated with negative hedonic value, perhaps due to the frustration of cancelling an intended action. Here we investigate hedonic implications of the free choice to act or inhibit. Participants gave aesthetic ratings of arbitrary visual stimuli that immediately followed voluntary decisions to act or to inhibit action. We found that participants for whom decisions to act produced a strong positive hedonic value for the immediately following visual stimulus made more choices to act than those with weaker hedonic value for action. This finding is consistent with reinforcement learning of action decisions. However, participants who experienced inhibition as generating more positive hedonic value did not choose to inhibit more than other participants. Thus, voluntary inhibition of action did not act as reinforcement for future inhibitory behaviour. Our finding that inhibition of action lacks motivational capacity may explain why self-control is both difficult and limited. 
24021763	Altruistic punishment is an evolutionary-based mechanism aimed at maximizing the probability of reciprocity in cooperative exchanges, through the deterrence of non-cooperators. In economic games, humans will often punish others for non-cooperation, even if this punishment is costly to the self. For instance, in the Ultimatum Game paradigm, people refuse offers considered as unfair even though they are disadvantaged financially by doing so. Here, we hypothesize that, due to an impulsive decision making style, individuals with alcoholism will display an heightened unfairness sensitivity that leads them to reject advantageous offers more frequently on the Ultimatum Game.Thirty recently detoxified alcohol-dependent individuals and 30 matched healthy control participants performed the Ultimatum Game task, in which participants had to respond to take-it-or-leave-it offers ranging from fair to unfair and made by a fictive proposer.	Alcohol-dependent participants decided to reject unfair offers more frequently during the Ultimatum Game, as compared to controls.	In situations of social frustration or irritation, such as unfair Ultimatum Game offers, alcohol-dependent individuals may have more difficulty than controls regulating their emotional impulses, and respond aggressively or retributively (i.e., by rejecting the unfair offer).	
24015985	The present study examined the role of media use in adolescents' cyberbullying behavior. Following previous research, we propose a Cyclic Process Model of face-to-face victimization and cyberbullying through two mediating processes of anger/frustration and antisocial media content. This model was tested utilizing a cross-sectional design with adolescent participants (N=892). Exposure to antisocial media content was measured with a newly developed content-based scale (i.e., the C-ME), showing good psychometric qualities. Results of structural equation modeling showed that adolescents' exposure to antisocial media content was significantly associated with cyberbullying behavior, especially in adolescents who experienced anger and frustration due to face-to-face victimization. Goodness of fit indices demonstrated a good fit of the theoretical model to the data and indicated that exposure to antisocial media content acts as an amplifier in a cyclic process of victimization-related anger and cyberbullying behavior.
24013484	The purpose of this study was to evaluate if the impact of urinary incontinence (UI) on quality of life (QOL) differs between women based on age.A retrospective review of patients presenting for the management of UI was performed. Patients with UI and their corresponding degree of bother were identified by their responses to validated questionnaires. Distributions of comorbidities and types of UI were presented as frequencies and compared between age cohorts with a chi-square test. Mean scale scores were assessed for normality and a one-way analysis of variance with a post hoc Scheffé's test was used to compare the scores.	Of 765 patients meeting inclusion criteria, 22.4 % were <45, 28.9 % were 45-55, and 48.8 % were >55 years of age. Women older than 55 were significantly more likely to have urge UI and mixed UI than their counterparts (p < 0.001). Women <45 and 45-55 were more negatively impacted in their ability to perform physical activities compared to women >55 (p = 0.004), whereas women >55 were significantly less likely to feel frustrated by their incontinence than women <45 (p = 0.022). However, there was no significant difference in overall impact of incontinence among groups (p = 0.585).	UI equally impacts the functional and psychological QOL in women regardless of age. UI in women <55 results in a greater negative impact on level of physical activity, whereas women <45 are significantly more frustrated.	
24009085	In this study, we examined whether parenting and HPA-axis reactivity during middle childhood predicted increases in internalizing symptoms during the transition to adolescence, and whether HPA-axis reactivity mediated the impact of parenting on internalizing symptoms. The study included 65 children (35 boys) who were assessed at age 5, 7, and 11. Parenting behaviors were assessed via parent report at age 5 and 11. The child's HPA-axis reactivity was measured at age 7 via a stress task. Internalizing symptoms were measured via teacher reports at age 5 and 11. High maternal warmth at age 5 predicted lower internalizing symptoms at age 11. Also, high reported maternal warmth and induction predicted lower HPA-axis reactivity. Additionally, greater HPA-axis reactivity at age 7 was associated with greater increases in internalizing symptoms from age 5 to 11. Finally, the association between age 5 maternal warmth and age 11 internalizing symptoms was partially mediated by lower cortisol in response to the stress task. Thus, parenting behaviors in early development may influence the physiological stress response system and therefore buffer the development of internalizing symptoms during preadolescence when risk for disorder onset is high.
24005961	Men who spend a greater proportion of time apart from their female partner since the couple's last copulation are at greater "objective" sperm competition risk. We propose a novel cue to sperm competition risk: the time she spends with her male friends. Four hundred and twenty men in a committed, heterosexual, sexual relationship completed a questionnaire. The results indicate that men at greater objective sperm competition risk report less time desired until the couple's next copulation, greater interest in copulating with their partner, and greater anger, frustration, and upset in response to their partner's sexual rejection, but only among men whose partner spends more time with her male friends. These results remain after controlling statistically for the participant's age and their partner's age. We discuss limitations of the current research, and discuss how research in human sperm competition can inform social issues, including men's partner-directed sexual coercion. 
24004363	Major depressive disorder (MDD) is one the most common mental disorders; it affects about 5-10% of the world population. This study explores the experiences of people with major depressive disorder in Zanjan, Iran. In order to identify recurring themes and patterns in individuals' experiences of major depressive disorder, semi-structured interviews with 18 patients were recorded and transcribed verbatim. The transcripts were then analyzed based on conventional qualitative content analysis. Five main categories emerged. The first category was called emotional paralysis and included the subcategories feeling severely depressed; feeling anxious; feeling impatient and irritable; and having dyshedonia. The second category was disturbance of thinking and was comprised of the subcategories of preoccupation, instable spiritual beliefs, and guilt. Cognitive decline was the third identified category and was further divided into subcategories of frustration, unawareness of the disorder, negative evaluation, indecisiveness, and loss of focus and loss of memory. Another major category was physical illnesses with the subcategories of physical discomfort, sleep problems, appetite disturbance, facial changes, sexual dysfunction, and medical conditions. The final category was failure in life, which had failure in personal affairs, jeopardized interpersonal relations, and unstable work life as subcategories. These findings provide a base for further research in this area. They also have clinical relevance for health care providers working with patients with MDD. Related cultural issues also are discussed. 
24000855	In conceptualizing CBT as an approach to treatment that is closely linked to basic empirical principles of human behavior, it is possible to incorporate evidence-based contributions from different theoretical orientations. This is illustrated by how CBT can be open to a variety of interventions that are not typically associated with CBT, but which nonetheless have empirical support. This article describes the following clinical interventions, together with their theoretical rationale and empirical support: (a) Having a therapeutic focus on what is occurring within the session itself, (b) Becoming aware of one's negative reactions toward the patient and transforming them into a more compassionate stance, and (c) Using procedures for enhancing emotional arousal in changing a patient's cognitive-affective distortions.
24000025	Bariatric surgery helps significantly in weight loss. Little is known whether the change in body shape and size is enough to meet the expectations created preoperatively.To evaluate the different perceptions of body size and shape before and after bariatric surgery.	A total of 423 patients were evaluated by Nine-figure Outline Scale. Of these, 32% were pre-surgery (PreS), 20% were evaluated between 10 and 12 months after surgery (PO-1), 13% between 18 and 24 months (PO-2), 15% between 30 and 36 months (PO-3) and 20% after 42 months of operation (PO-4). Groups were compared using one-way analysis of variance.	When choosing figures that represented a man and a woman of normal size, no differences were observed between groups. Regarding the choice of figures representing the own size, differences were observed between groups PreS and all other groups (p<0.001), and PreS chosen larger figures. In choosing figures that represented a size that believed they could achieve, PreS differed from the PO-1, PO-2 and PO-3 (p <0.001), showing a tendency to choose larger silhouettes after surgery. When choosing figures that represented a size that would like to have PO-4 differed from PO-1 and PO-2 (p <0.05), showing that in the PO-4 there was a tendency to choose larger figures.	The body perception seems to comply with own body size, even after weight loss. As longer postoperative period, the participants were more aware of the real possibilities of weight loss. There were signs of dissatisfaction with the body size and shape, mainly in the PO-1 and PO-2, which can lead to frustration and little use of the benefits of the surgery for health and quality of life.	
23989841	The use of electronic health records (EHRs) in dental care and their effect on dental care provider-patient interaction have not been studied sufficiently. The authors conducted a study to explore dental care providers' interactions with EHRs during patient visits, how these interactions influence dental care provider-patient communication, and the providers' and patients' perception of EHR use in the dental clinic setting during patient visits.The authors collected survey and interview data from patients and providers at three dental clinics in a health care system. The authors used qualitative and quantitative methods to analyze data obtained from patients and dental care providers.	The provider survey results showed significant differences in perceptions of EHR use in patient visits across dental care provider groups (dentists, dental hygienists and dental assistants). Patient survey results indicated that some patients experienced a certain level of frustration and distraction because of providers' use of EHRs during the visit.	The provider survey results indicated that there are different perceptions across provider groups about EHRs and the effect of computer use on communication with patients. Dental assistants generally reported more negative effects on communication with patients owing to computer use. Interview results also indicated that dental care providers may not feel comfortable interacting with the EHR without having any verbal or eye contact with patients during the patient's dental visit.	A new design for dental operatories and locations of computer screens within the operatories should be undertaken to prevent negative nonverbal communication such as loss of eye contact or forcing the provider and patient to sit back to back, as well as to enhance patient education and information sharing.	
23981397	This study aimed to investigate how users perceive the different elements of an internet based smoking cessation intervention and to see if the program meet needs and expectations of people in a smoking cessation process. Nine semi-structured interviews were conducted in February 2010. Participants were recruited via the homepage of the smoking cessation program Dit Digitale Stopprogram (Your Digital Quit Program) operated by the Danish Cancer Society. The main result was that participants established a relationship to the program which influenced their smoking cessation process. Participants perceived the program as caring and found it supportive. However, the program also created feelings of frustration, disappointment and anger. Some participants in the last phase of cessation experienced text messages from the program as smoking cues. The study concluded that individual interpretations of the different elements in an Internet-based smoking cessation intervention can have both positive and negative impact on the smoking cessation process of participants. 
23978405	although maintaining activity is key to successful pain management, and important to health and wellbeing, it is known that older people in pain frequently alter or reduce activity levels. A 'fear-avoidance' model is often used to explain avoidance of activity in the face of pain. However, this model is not intended to take account of the wider context in which activity changes take place, nor older people's own explanations for their behaviour.to investigate the reasons why older people in the community adjust their activity levels when living with chronic pain.	thirty-one people aged between 67 and 92 were purposively sampled from respondents to a community-based cross-sectional survey. All participants had reported long-term pain and were interviewed about this. Data were collected and analysed using a qualitative constructivist grounded theory approach.	explanations for deliberative reduction or ceasing of activities reflected a desire to prevent pain exacerbation, thereby avoiding medical intervention. It also reflected a desire to safeguard autonomy in the face of pain in older age. Restrictions were often rationalised as normal in older age, although co-existing accounts of perseverance and frustration with limitation were also evident.	a rational desire to avoid pain exacerbation and medical intervention motivated restrictions to activity. However, deliberative limitation of activity has the potential to compromise autonomy by increasing social isolation and de-conditioning. Supporting older people with pain to be active requires sensitivity to the function of activity restriction, especially as a means of preventing deterioration.	
23974400	Nine focus groups (N = 57), which included a demographic survey, were conducted to evaluate urban, low-income, African American light smokers' experiences of cessation counseling. Chi-squared and independent t-tests were run to analyze survey data. Participants with a self-reported co-morbidity were more likely than participants without a co-morbidity to have been asked about quitting, and advised to quit. Fewer than half of all participants reported recommendations to use cessation pharmacotherapy, try a quit smoking program, or have a follow-up. Qualitative analysis revealed three focus group themes: (1) health provider as information source; (2) unsatisfactory counseling; and (3) mistrust of physician-prescribed pharmacotherapy. Participants expressed frustration regarding receiving inadequate counseling for smoking cessation since they viewed health providers as the most trusted source for health information. Findings demonstrate the need for further study of cessation counseling among urban, low-income, African American light smokers, particularly those with co-morbidities. 
23954408	We developed a novel delay discounting task to investigate outcome impulsivity in pigs. As impulsivity can affect aggression, and might also relate to proactive and reactive coping styles, eight proactive (HR) and eight reactive (LR) pigs identified in a manual restraint test ("Backtest", after Bolhuis et al., 2003) were weaned and mixed in four pens of four unfamiliar pigs, so that each pen had two HR and two LR pigs, and aggression was scored in the 9h after mixing. In the delay discounting task, each pig chose between two levers, one always delivering a small immediate reward, the other a large delayed reward with daily increasing delays, impulsive individuals being the ones discounting the value of the large reward quicker. Two novel strategies emerged: some pigs gradually switched their preference towards the small reward ('Switchers') as predicted, but others persistently preferred the large reward until they stopped making choices ('Omitters'). Outcome impulsivity itself was unrelated to these strategies, to urinary serotonin metabolite (5-HIAA) or dopamine metabolite (HVA) levels, aggression at weaning, or coping style. However, HVA was relatively higher in Omitters than Switchers, and positively correlated with behavioural measures of indecisiveness and frustration during choosing. The delay discounting task thus revealed two response strategies that seemed to be related to the activity of the dopamine system and might indicate a difference in execution, rather than outcome, impulsivity. 
23944248	In the study that we describe in this article, we aimed to preserve the voices of people suffering from chronic pain by encouraging them to tell the story of their suffering. Participants' stories reflect how chronic pain has altered their lives. This is partly due to their discomfort, but also to the frustration they experience from delays in diagnosis and treatment. Patients often pursue a lengthy quest for medical care that culminates in the diagnosis of an 'incurable' disease and a prognosis of disability. This in turn affects patient interactions with doctors and their social network. We illustrate how chronic pain leads to a sense of alienation or 'not-belonging,' whereby patients perceive pain as an entity parallel to yet dominating their own lives. 
23937732	Numerous quantitative studies have illustrated the potential usefulness of exercise programs for women with fibromyalgia. However, a deeper understanding of the physical and especially psychosocial benefits of exercise therapy from the subjective perspective of this population is still needed. This study was conducted with 25 women who had fibromyalgia and were participating in a nine-month, group-based exercise program. The aim was to provide an in-depth description and analysis of the perceived physical and psychosocial benefits of participation. Qualitative data were collected through observation, interviews, and focus groups. The exercise program not only alleviated the physical symptoms of fibromyalgia, but social interactions within the group helped to counteract the isolation, frustration, and depression often associated with this chronic condition. The data from this study may contribute to a deeper understanding of the benefits of exercise for women with fibromyalgia and might be useful for the improvement of future exercise programs for this population. 
23926046	Although intergenerational patterns of punitive physical punishment garner considerable research attention, the mechanisms by which historical, cognitive, and contextual factors interplay to influence disciplinary responding remains poorly understood. Disciplinary attitudes have been shown to mediate the association between disciplinary history and disciplinary responding. The present study investigated whether frustration influences these mediation effects. Half of a sample of 330 undergraduates was randomly assigned to frustration induction. Structural equation modeling confirmed that, for participants in the frustration condition, the relation between disciplinary history and physical discipline decision-making was fully mediated by attitudes approving physical discipline. In contrast, for respondents in the no-frustration condition, the pathway from disciplinary history to discipline decision-making was only partially mediated by attitudes. Under conditions of frustration, attitudes may become a more central means by which personal disciplinary history is associated with disciplinary decision-making.
23923808	The treatment of persons who frequently present to the healthcare system following repetitive foreign body ingestion has been addressed in the psychiatric literature. However, there has been little exploration of the ethical considerations regarding the treatment of these patients. The complexity of their medical and psychiatric presentation raises fundamental ethical questions regarding the duty to treat, patient autonomy, justice, and futility. Careful ethical analysis is particularly important in this context, since the frustration that medical professionals may feel in response may lead to false assumptions that can negatively impact patient care. A careful exploration of these questions can increase awareness and understanding, which in turn can lead to improved treatment of patients who repetitively ingest foreign bodies. Care for patients who inflict self-harm, particularly by repetitive foreign body ingestion, is not futile. The patients have a right to treatment and are entitled to resources. Efforts should be made to provide a more comprehensive treatment approach to these patients.
23918193	Emotionally arousing stimuli have been largely unsuccessful in eliciting cortisol responses in young children. Whether or not emotion challenge will elicit a cortisol response, however, may in part be determined by the extent to which the tasks elicit behavioral reactivity and regulation. We examined relations of behavioral reactivity and regulation to emotional arousal in the context of fear and frustration to the cortisol response at 7, 15, and 24 months of age in a low income, rural population based sample of 1,292 families followed longitudinally from birth. At each age, children participated in fear and frustration inducing tasks, and cortisol samples were taken at three time points (before the tasks began, 20 min following peak emotional arousal or after the series of tasks ended, and 40 min after peak arousal or the tasks ended) in order to capture both increases (reactivity) and subsequent decreases (regulation) in the cortisol response. Using multilevel models, we predicted the cortisol response from measures of behavioral reactivity and regulation. At 7 months of age, cortisol reactivity and recovery were related to behavioral reactivity during a frustration-eliciting task and marginally related to behavioral reactivity during a fear-eliciting task. At 15 and 24 months of age, however, cortisol reactivity and recovery were related only to behavioral reactivity during a fear-eliciting task. Results indicate that while behavioral reactivity is predictive of whether or not infants and young children will exhibit a cortisol response to emotionally arousing tasks, behavioral and cortisol reactivity are not necessarily coupled.

23906508	Low trait self-control constitutes a core criterion in various psychiatric disorders. Personality traits such as low self-control are mostly indexed by self-report measures. However, several theorists emphasized the importance of differentiating between explicit and implicit indices of personality traits, Therefore, the present study examined the unique predictive validity of an implicit measure of trait self-control for spontaneous dysfunctional behavior.As a measure of implicit trait self-control, we used an irrelevant feature task: a speeded reaction time task comprising a task-relevant stimulus feature (i.e., capital vs. lower case letter type) and a task-irrelevant feature (high vs. low self-control word type). The irrelevant feature had to be ignored, while participants (n = 34) responded to the relevant stimulus feature. However, their response was either congruent or incongruent with the irrelevant stimulus feature, resulting in facilitated or deteriorated task performance. As indicators of trait-related spontaneous dysfunctional behavior, we included indices of frustration tolerance and the preference for short-term reward over meeting long-term goals. We also included two explicit measures of trait self-control: a self-report questionnaire and an explicit self-relevance rating of the implicit task stimuli.	Specifically the implicit measure of trait self-control showed predictive validity for the target self-control behaviors.	The predictive validity of implicit measures of personality traits requires further study in larger, non-student samples.	As predicted, the implicit measure of trait self-control showed superior predictive power for spontaneous trait-related behavior. This finding points to the relevance of complementing the routinely used self-report measures with implicit measures of trait self-control.	
23899462	Patients suffering from stroke have a diminished ability to recognize emotions. This paper presents a review of neuropsychological studies that investigated the basic emotion processing deficits involved in individuals with interhemispheric brain (right, left) damage and normal controls, including processing mode (perception) and communication channels (facial, prosodic-intonational, lexical-verbal).An electronic search was conducted using specific keywords for studies investigating emotion recognition in brain damage patients. The PubMed database was searched until March 2012 as well as citations and reference lists. 92 potential articles were identified.	The findings showed that deficits in emotion perception were more frequently observed in individuals with right brain damage than those with left brain damage when processing facial, prosodic and lexical emotional stimuli.	These findings suggest that the right hemisphere has a unique contribution in emotional processing and provide support for the right hemisphere emotion hypothesis.	This robust deficit in emotion recognition has clinical significance. The extent of emotion recognition deficit in brain damage patients appears to be correlated with a variety of interpersonal difficulties such as complaints of frustration in social relations, feelings of social discomfort, desire to connect with others, feelings of social disconnection and use of controlling behaviors.	
23895168	A transactional model examining the longitudinal association between vagal regulation (as indexed by vagal withdrawal) and maternal sensitivity from age 2.5 to age 5.5 was assessed. The sample included 356 children (171 male, 185 female) and their mothers who participated in a laboratory visit at age 2.5, 4.5, and 5.5. Cardiac vagal tone was obtained during a baseline task and during emotional frustration tasks. Maternal sensitivity was assessed via direct observation during a pretend play and cleanup task. To test for transactional associations, a path model estimating stability paths for vagal withdrawal and maternal sensitivity was compared with a full reciprocal model that included all cross-lagged pathways. A chi-square difference test was used to evaluate whether the cross-lagged model explained the data above and beyond the stability model. The vagal withdrawal cross-lagged model was found to fit significantly better than the stability model and revealed that maternal sensitivity at 2.5 years was associated positively with vagal withdrawal at 4.5 years, and vagal withdrawal at 4.5 years was associated positively with maternal sensitivity at 5.5 years. These results suggest that early sensitive responding by mothers was associated with increases in vagal withdrawal, which in turn was associated with higher levels of sensitive parenting.
23893229	The purpose of the study was to understand and describe the overcoming experiences of family members caring for elderly patients with dementia at home.Data came from autobiographies on the overcoming experiences of caregiving from 31 participants, who had submitted the autobiographies to a public contest held by the Seoul Metropolitan Center for Dementia in 2012. Data were analyzed using qualitative content analysis.	Four overcoming stages emerged from the analysis: confronting stage; challenging stage; integrating stage; and transcendental stage, representing transformation of experiences from frustration and suffering to happiness and new hope in life. The confronting stage illustrates severe negative feelings and exhaustion occurring after the diagnosis of dementia. The challenging stage signifies major driving forces in taking good care of their patients. It includes tender loving memories about the patients as well as family and social supports. The integrating stage shows genuine empathy for the patients' situation and the happiness of 'here and now', while the transcendental stage represents new hope in the future.	Health professionals need to support caregivers to find true meaning of caring and happiness in everyday life, while providing specific information on dementia care and relieving various negative feelings.	
23880383	The additive and interactive relations of parenting styles (authoritative and authoritarian parenting) and child temperament (anger/frustration, sadness, and effortful control) to children's internalizing problems were examined in a 3.8-year longitudinal study of 425 Chinese children (aged 6-9 years) from Beijing. At Wave 1, parents self-reported on their parenting styles, and parents and teachers rated child temperament. At Wave 2, parents, teachers, and children rated children's internalizing problems. Structural equation modeling indicated that the main effect of authoritative parenting and the interactions of Authoritarian Parenting × Effortful Control and Authoritative Parenting × Anger/Frustration (parents' reports only) prospectively and uniquely predicted internalizing problems. The above results did not vary by child sex and remained significant after controlling for co-occurring externalizing problems. These findings suggest that (a) children with low effortful control may be particularly susceptible to the adverse effect of authoritarian parenting and (b) the benefit of authoritative parenting may be especially important for children with high anger/frustration. 

23876789	Internet addiction disorder (IAD) has raised widespread public health concerns. In this study, we used a gambling task to simulate extreme win/lose situations to find the reward/punishment sensitivities after continuous wins and losses. FMRI data were collected from 16 IAD subjects (21.4±3.1years) and 15 healthy controls (HC, 22.1±3.6years). Group comparisons showed higher superior frontal gyrus activations after continuous wins for IAD subjects than for HC. The brain activities in IAD subjects were not disturbed by their losses. In addition, IAD participants showed decreased posterior cingulate activation compared to HC after continuous losses. These results indicated that IAD participants showed preference to win while neglecting their losses. Therefore they engaged less executive endeavor to control their frustration after continuous losses. Taken together, we concluded that IAD subjects showed enhanced sensitivity to win and decreased sensitivity to lose. This can help us understand why IAD subjects continue playing online even after noticing the severe negative consequences of their behaviors. 
23875652	To describe people's experiences of suffering a lower limb fracture and undergoing surgery, from the time of injury through to the care given at the hospital and recovery following discharge.There is a lack of research on people's experiences of suffering a lower limb fracture and undergoing surgery - from injury to recovery.	A qualitative approach was used.	Interviews with nine participants were subjected to thematic content analysis.	One theme was expressed: from realising the seriousness of the injury to regaining autonomy. Participants described feelings of frustration and helplessness when realising the seriousness of their injury. The wait prior to surgery was a strain and painful experience, and participants needed orientation for the future. They expressed feelings of vulnerability about being in the hands of staff during surgery. After surgery, in the postanaesthesia unit, participants expressed a need to have control and to feel safe in their new situation. To mobilise and regain their autonomy was a struggle, and participants stated that their recovery was extended.	Participants found themselves in a new and unexpected situation and experienced pain, vulnerability and a striving for control during the process, that is, 'from realising the seriousness of the injury to regaining autonomy'. How this is managed depends on how the patient's needs are met by nurses. The nursing care received while suffering a lower limb fracture and undergoing surgery should be situation specific as well as individual specific. The safe performance of technical interventions and the nurse's comprehensive explanations of medical terms may help the patient to feel secure during the process.	
23866487	In today's high technological world, scientific discoveries contribute remarkable development to human life, but it could also have an adverse impact on mankind. Among all these advancements, media is one of the inventions which aims at capturing a countless group of viewers and transmit information via various mediums. Media violence is considered one of the hampering determinants which harms an individual psychologically. The primary goal of a health professional is to work for the maintenance of mental health. Therefore, it is imperative to create an understanding about the impact of media violence on mental health, particularly in the Pakistani context. Violence has become a major public health problem in Pakistan. The main cause of violence seems to be anger and frustration due to poverty, political conflicts, lack of education, and the overall governance approach in the country. Therefore, there is a prime need to think and work on this neglected area like conducting research and increasing public awareness, and to curb media violence.
23866232	This study's objective is to analyze temperament and parenting variables as they relate to proactive and reactive aggression in children. To be specific, profiles based on these variables were analyzed in children with high levels of proactive versus reactive aggression. The sample was made up of two groups: 482 children (52.3% boys) between 1 and 3 years-old, and 422 children (42.42% boys) 3 to 6 years-old. Statistical analyses of the two age groups included: Pearson's correlations to explore the relationships among variables, Cluster Analysis to create groups with different levels of aggression, and finally discriminant analysis to determine which variables discriminate between groups. The results show that high levels of frustration/negative affect in the 1-3 year-old group and low effortful control in children 3 to 6 years old are the most relevant variables in differentiating between aggressive and non-aggressive subjects. Nevertheless, differential profiles of subjects with high levels of proactive versus reactive aggression were not observed. The implications of these different types of aggression in terms of development and prevention are discussed.
23863516	Anogenital warts are one of the most prevalent sexually transmitted virus infections in the Netherlands and cause frustration, shame, and even depression. This study was performed to determine the effect of having anogenital warts on the quality of life in Dutch soldiers with the use of a dermatology-specific quality of life (QoL) questionnaire.We used the Skindex-29 QoL questionnaire in 100 predominantly heterosexual soldiers with clinically confirmed first episode of condylomata acuminate in this study.	Results confirmed that first episodes of anogenital warts cause high mean scores on subscale Emotions with lower scores on the subscales Symptoms and Functioning. Sex, age, educational level, anatomical site, or number of anatomical sites did not influence the outcome in this study.	Having anogenital warts influences QoL, especially with regard to intimacy, shame, and concern. Our data show that the Skindex-29 QoL questionnaire can be easily used in these patients with good internal consistency. Clinicians should be aware of the great emotional impact of anogenital warts on their patients.	
23849996	To explore the everyday dilemmas of parents living with a child with nocturnal enuresis and to describe their support needs in relation to healthcare professionals.The study was conducted in 2011 in Uppsala County, Sweden. Parents of 13 children with enuresis, 10 mothers and three fathers, participated in qualitative semi-structured in-depth interviews, which were analysed using systematic text condensation.	The analysis of the material resulted in six themes: enuresis is socially stigmatising and handicapping; all practices and home remedies are tested; it creates frustration in the family; protecting the child from gossip or teasing; support from healthcare providers would have helped; it's something we just have to live with. Two patterns of coping were identified: the Unworried wet-bed-fixers and the Anxious night-launderers.	Having a child with enuresis can be stressful for parents, although they tried hard not to blame their child. Because parents can feel reluctant to bring up enuresis themselves, they want child health nurses to routinely raise the issue of bedwetting at the yearly check-up. Parents' information needs included causes of and available treatment options for enuresis as well as access to aids and other support for affected families.	
23834347	In Australia, people experiencing personality disorder have featured little in policing studies and policy or mental health policy and legislation, and in the absence of specific guidance their behaviours represent an ongoing challenge for police. This paper presents police officers' accounts from a qualitative research project that explored police encounters with people experiencing mental illness. The officers singled out people with personality disorder and expressed frustration, anger, powerlessness and resignation with their referrals of this group to health services. Officers reported that emergency departments were reluctant to assess people with personality disorder and when they did assess them stated that the person did not meet criteria for admission to mental health services, or if admitted, they were quickly discharged. People with personality disorder were reported to take up considerable police resources. When police were told by mental health professionals that there was nothing they could do about people experiencing personality disorder, then the question from police was what was to be done with them. While pockets of collaborative practice exist between police and mental health services, much change is required to demonstrate that the needs of the person with personality disorder are being met.
23829584	Up to a quarter of the adults who own hearing aids never use them. To provide these 'non-users' with the best help, hearing care professionals need to have an in-depth understanding of the non-users' beliefs and feelings with regard to the non-use. This qualitative study explored these beliefs and feelings in order to increase our understanding of hearing aid non-users.Individual face-to-face semi-structured interviews were completed.	Eleven hearing aid owners (aged 54-80 years) who reported that they never or hardly ever used their hearing aids.	The participants expressed a variety of feelings towards their non-use, including indifference, self-annoyance, frustration, powerlessness, shame, and guilt. Their feelings were related to beliefs about: (1) the severity of their hearing handicap with and without hearing aids, (2) whom or what was responsible for the non-use, and (3) the attitudes of significant others towards the non-use.	Hearing-aid non-users differ in their beliefs and feelings towards the non-use. A patient-centred approach is needed.	
23816658	Nail disorders have considerable psychological impact and may limit activity by impairing functionality of both fingers and toes.To evaluate the impact of nails disorders on quality of life (QoL).	1063 patients with nail disorders completed an anonymous nail-specific QoL questionnaire consisting of 24 and 16 questions, respectively, for fingernails and toenails with five possible responses to each question. A score of 1-5 was given to each response and the final score was adjusted on a percentile scale. The subjects were classified in groups according to nail disorders. Statistical analysis was carried out using T-test to compare the means between two groups and ANOVA analysis of variance to compare the impact of quality of life on the different types of nail disorders.	Comparison between groups showed a statistically significant higher impact for trauma, onychomycosis, other infections, structure abnormalities, psoriasis, other inflammatory diseases and paronychia and a lower impact for chromonychias and tumours. QoL was statistically significantly more affected in patients having multiple nails involved, women, and in people aged 60-79 years. There was no statistically significant difference on the QoL impact between patients having only fingernails or only toenails involved.	Even though published literature tends to focus on the impact of nail psoriasis and onychomycosis on QoL, other nail disorders cause similar frustration to patients. A possible explanation for this is that appearance of the nail has a more significant impact on QoL than the severity of the disorder.	
23816057	This article examines the relationship between children's oppositional behaviour and the exercise of parental authority. It seeks to explore the value of a heuristic approach to psychic temporality in exercising parental authority. The study aims to better understand the role of psychic temporality in operations producing symbolic law. It goes on to describe a disorder of temporality, known as temporal anomie, which may be involved in a child's oppositional disorders.Psychiatric or psychological consultations motivated by oppositional disorders in children have increased steadily in the past fifteen years in France. The primary reason for consultation is in the form of difficulties for children in accepting the social rules or constraints, but also the difficulties of parenting while coping with the opposition of their children. This increase is made in connection with the works analysing the social and psychological effects imposed by modernity and its acceleration. Correspondingly, we find that some parents do not prioritize their educational requirements, do not know when or how to frustrate their child, or even if it is legitimate to expect from him/her a certain type of behaviour. They seem more preoccupied with the fear of not being loved by their child more than their duty to educate. A general trend suggests an alteration of psychological time, characterized by: a) a disinvestment of links between present and past for the enjoyment of the moment and its extension in the immediate future ; b) a difficulty in supporting educational responses causing frustration for the child ; c) a lack of continuity and constancy in educational requirements. The author proposes to define temporal anomie as the psychical time that weakens the consistency of educational responses. A link between psychological temporality and the symbolic law is discussed. Specifically, the study notes that: in intersubjective relations, mastery of psychological time by parents is an integrating factor of the law for the child. In this sense, temporal anomie can affect the child's development of superego. Anomie time is the result of a weakening of the transitional temporality. Transitional temporality provides legitimacy for educational interventions. This allows parents to support conflicts and opposition of the child. To this end, transitional temporality promotes links between past, present and future, between tradition and innovation.	Psychic temporality offers a new perspective, particularly heuristic because it is undoubtedly an essential dimension involved in the process of subjectivation and socialization. The concept of anomie time enables one to better understand the fragility of parenthood frequently encountered in child psychiatric consultations and allows one to link this to the evolution of society.	
23815315	To describe people's experiences of living with dementia in Iran.A knowledge gap exists regarding the experiences of living with dementia in nonWestern contexts. This gap may be especially apparent within the Iranian context, where dementia research is relatively new. Deeper understanding about context-related experiences of dementia is a prerequisite for nurses' ability to provide adequate and meaningful care.	Qualitative, cross-sectional design.	Qualitative content analysis of semi-structured interviews with people living with dementia in urban Iran (six women and nine men; 60-87 years old).	The participants experienced their condition as a state of forgetfulness that was accompanied by losses and dependency on others. They wanted to feel good about themselves and feel important, but they continually struggled with matters such as a loss of accountability, feelings of futility and the frustration of others. Economic dependency and a lack of economic resources were sources of feelings of futility.	Experiences of living with dementia in Iran included a substantial struggle to stay connected to the social world and to deal with dramatic life changes, aspects of living with dementia that seem to be universal. However, the feelings of financial burden and the experience of being nagged for their shortfalls by family members have seldom been described in other studies and seem to represent a cultural aspect of their experience.	The results of the study call for further nursing efforts in supporting people living with dementia in their struggle with their altered lives and in retaining their connections to everyday life. Furthermore, their family members might benefit from specific nursing interventions including information about dementia and advice on how to help the family members with dementia to interact with others while exercising their individual strengths.	
23808644	Evidence shows that most people prefer to die at home; however, the majority of expected deaths occur away from home. Although home deaths require family caregiver (FCG) commitment and care, we understand very little about their experiences in this context.The study's aim was to gain a better understanding of the experiences of FCGs when circumstances prevented a desired home death for a family member with advanced cancer.	An interpretive description approach was used. Data collection involved semistructured interviews. Field notes and reflective journaling aided interpretive and analytical processes.	The study was conducted in western Canada and included 18 bereaved FCGs.	FCGs were committed to the promises made to care for their family member at home until death. These promises were challenged by a lack of preparedness for caregiving, difficulty accessing professional support and information, and frustration with the inadequate help they received. The events that precipitated dying family members leaving their home for hospital or hospice were unexpected and often influenced by FCGs' lack of situation-specific knowledge and ability to cope with complex caregiving responsibilities. FCGs found it extremely challenging to reconcile with breaking their promise to care at home until death and many were unable to do so.	FCGs' despair about not being able to keep their promise for a home death was related to complicated bereavement. Prospective studies of the experiences of FCGs who are aiming for home deaths are needed to identify both short- and long-term interventions to effectively support death at home.	
23805998	The estimated prevalence of irritable bowel syndrome (IBS) is 10%. Up to one third of patients develop chronic symptoms, which impact on everyday functioning and psychological wellbeing. Guidelines suggest an increased role for primary care in the management of patients with IBS, and referral for psychological interventions. Literature reports dissatisfaction and frustration experienced by both patients with IBS and healthcare professionals. The aim of this study was to explore the perspectives of general practitioners (GPs) in relation to the diagnosis and management of IBS and their views on the potential use of a risk assessment tool to aid management decisions for patients with IBS in primary care.This was a qualitative study using face-to-face semi-structured interviews with GPs in North West England. Interviews were fully transcribed and data analyzed using constant comparison across interviews. Tensions between GP accounts and the NICE guideline for the management of IBS were highlighted.	GPs described IBS as a diagnosis of exclusion and the process as tentative and iterative, with delay in adding a Read code to the patient record until they were confident of the diagnosis. Whilst GPs accepted there was a link between IBS and psychological symptoms they suggested that the majority of patients could be managed within primary care without referral for psychological interventions, in conflict with the NICE guideline. They did not feel that a risk assessment tool for patients with IBS would be helpful.	This study highlights the tensions between evidence recognizing the need to identify patients whose symptoms may become chronic and offer pro-active care, including referral for psychological therapies, and the perspectives of GPs managing patients in every-day clinical practice. The reluctance of GPs to refer patients for evidence-based psychological treatments may have implications for commissioning services and patient care.	
23802867	Female orgasmic disorder (FOD) is the second most prevalent sexual disorder in women. According to the most recent revision of the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-IV-TR), the term "marked distress" is central to the diagnosis of FOD. In practice, the term "distress" for use as a criterion for a clinical diagnosis is a medical construct and may not correlate with the language used by women with FOD to describe what they are experiencing.The objective of this study was to explore the terminology used by women to describe their feeling associated with difficulties in achieving orgasm.	Women experiencing difficulties in achieving orgasm were invited to participate in a focus group. The focus groups included a characterization, picture sort and language exploration exercise and completing the Female Sexual Distress Scale-Desire, Arousal, Orgasm (FSDS-DAO) to determine the impact and emotional associations of decreased/lack of orgasms.	Patient reported terminology for characterization of their FOD, and validity of question 15 of FSDS-DAO.	Sixty-seven percent (44/66) of the women used the word "frustrated" when asked, "What one word would you use to describe your orgasm difficulties?" In the language exploration exercise, the most common term used to describe emotions associated with decreased orgasm was "frustration." Responses (0 = never to 4 = always) to question 15 (frustrated by problems with orgasm) of the FSDS-DAO, ranged from 1 to 4 (mean 3.0) indicating that women were very frustrated.	The term "frustrated" was the most relevant and common emotion women feel when they have difficulties in achieving orgasm. Additionally, the women consistently supported the content validity of question 15 of the FSDS-DAO. Despite the use of the term "distress" in the DSM-IV-TR criteria for FOD, the term reflects the medical construct required to become a sexual dysfunction and does not appear to be an accurate representation of most women's feelings of orgasm difficulties.	
23801553	This study directly tests a central prediction of rational emotive behaviour therapy (REBT) that has received little empirical attention regarding the core and intermediate beliefs in the development of posttraumatic stress symptoms.A theoretically consistent REBT model of posttraumatic stress disorder (PTSD) was examined using structural equation modelling techniques among a sample of 313 trauma-exposed military and law enforcement personnel.	The REBT model of PTSD provided a good fit of the data, χ(2) = 599.173, df = 356, p < .001; standardized root mean square residual = .05 (confidence interval = .04-.05); standardized root mean square residual = .04; comparative fit index = .95; Tucker Lewis index = .95. Results demonstrated that demandingness beliefs indirectly affected the various symptom groups of PTSD through a set of secondary irrational beliefs that include catastrophizing, low frustration tolerance, and depreciation beliefs.	Results were consistent with the predictions of REBT theory and provides strong empirical support that the cognitive variables described by REBT theory are critical cognitive constructs in the prediction of PTSD symptomology.	
23797551	To verify if mothers of newborns hospitalized recognize the defining characteristics of "parental role conflict" as representative of that experience.A cross-sectional and descriptive study, developed in a neonatal unit of a public teaching hospital in the state of São Paulo. The sample consisted of 100 women who assigned scores of 1 to 5 to the defining characteristics of the diagnosis, where 1 meant "not at all characteristic" and 5 meant "completely characteristic of what I am experiencing."	Of the total sample, 96 women self-identified with the diagnosis. The most prevalent defining characteristics were: "anxiety," "mother expresses concern(s) in relation to changes in maternal role"; "verbalizes feelings of frustration," "reports concern about family" and "fear". Women who were with their children less often during hospitalization had a higher number of defining characteristics.	There was a high prevalence of the defining characteristics of the studied diagnosis, suggesting the relevance of the topic and the need for further studies to be developed in the neonatal unit.	
23782579	Female orgasmic disorder (FOD) is the second most frequently reported sexual dysfunction in women. According to the Diagnostic and Statistical Manual of Mental Disorders, the term "marked distress" is central to the diagnosis of FOD.Objectives of this study were to explore terminology used by women diagnosed with FOD to describe their associated feelings and establish a correlation between patient ratings of question 15, "How often do you feel frustrated by problems with orgasm" on the Female Sexual Distress Score/Desire Arousal Orgasm (FSDS-DAO) with clinician evaluations of FOD.	Research was performed at one sexual medicine facility. Recruited participants were patients diagnosed with FOD. Fifteen women meeting inclusion/exclusion criteria were enrolled, completed the FSDS-DAO and a structured interview to assess terminology associated with orgasm difficulties.	Patient reported terminology for characterization of FOD, validity of question 15 of FSDS-DAO.	When asked to describe their orgasm difficulties, 60% of participants said "frustrated." Other terms included disappointed, pariah, subhuman, desperate, and concerned. Fifty-three percent (53%) claimed their inability to orgasm affected day-to-day life. In participants where FOD did not affect day-to-day life, 57% actively suppressed thoughts about inability to orgasm. Responses to question 15 of the FSDS-DAO ranged from 2-4 (mean 3.6) indicating participants were very frustrated.	To diagnose FOD, clinicians assess the level of associated distress through individualized patient interviews with no standardized tool. The term "distressed" is a medical construct and did not resonate with participants when describing their experience. participants used "frustrated" as an emotional descriptor to their sexual experience and scored high on question 15 of the FSDS-DAO. This study demonstrates the FSDS-DAO, specifically question 15, correlates well with the clinician diagnosis of marked distress and may be an appropriate tool for evaluating treatment benefit in the FOD population.	
23758226	When first conceptualized, it was thought that individuals with severe mental illness who needed assertive community treatment (ACT) would need ACT for life. Today, ACT-for-life is contrary to recovery-based principles, and teams routinely transition consumers to less intensive services. However, there is little qualitative information about the experiences of consumers who transition from ACT. To address this gap in our knowledge, we conducted semi-structured interviews with 11 consumers who had transitioned from ACT to case management services. Consumers expressed feelings of loss and frustration about transitioning from ACT to case management services. Findings underscore the importance of facilitating open dialogue about transitions with consumers, managing consumers' expectations of post-transition services, and facilitating consumer independence prior to transition. ACT teams should be deliberate about preparing consumers for transitions from ACT. More research is needed about facilitating successful transitions from ACT.
23754970	Recent increases in attention deficit hyperactivity disorder (ADHD) diagnoses, and the escalation of stimulant prescriptions, has raised concern about diversion and abuse of stimulants, as well as the ethics of using these drugs as "cognitive enhancers."Such concern appears misplaced in the face of substantial evidence that stimulant drugs do not improve the academic performance of ADHD-diagnosed students. Moreover, numerous studies have found little or no benefit of stimulants on neuropsychological tests of ADHD-diagnosed as well as normal, individuals. This paper examines the apparent paradox: why don't drugs that improve "attention," produce better academic outcomes in ADHD-diagnosed students? We found that stimulant drugs significantly improved impairment of episodic memory in ADHD-diagnosed undergraduate students. Nevertheless, we also found consistent academic deficits between ADHD students and their non-ADHD counterparts, regardless of whether or not they used stimulant medications. We reviewed the current literature on the behavioral effects of stimulants, to try to find an explanation for these conflicting phenomena. Across a variety of behavioral tasks, stimulants have been shown to reduce emotional reactions to frustration, improve the ability to detect errors, and increase effortful behavior. However, all of these effects would presumably enhance academic performance. On the other hand, the drugs were also found to promote "risky behavior" and to increase susceptibility to environmental distraction. Such negative effects, including the use of drugs to promote wakefulness for last minute study, might explain the lack of academic benefit in the "real world," despite their cognitive potential. Like many drugs, stimulants influence behavior in multiple ways, depending on the environmental contingencies. Depending on the circumstances, stimulants may, or may not, enhance cognition.
23754040	Provocations and frustrating events can trigger an urge to act aggressively. Such behaviors can be controlled, but perhaps more so for people who can better distinguish effective from ineffective courses of action. The present three studies (total N = 285) introduce a scenario-based measure of this form of social competence (SC). In Study 1, higher levels of SC predicted lower levels of trait anger. Study 2 presented provocation scenarios and asked people whether they would engage in direct, indirect, and symbolic forms of aggression when provoked. SC was inversely predictive of all forms of aggressive responding. Study 3 focused on reactions to frustrating events in daily life. Such events were predictive of hostile behavior and cognitive failures particularly at low levels of SC. The research establishes that SC can be assessed in an objective manner and that variations in it are systematically predictive of reactive aggression. 
23748499	Psychopathic traits affect social functioning and the ability to make adaptive decisions in social interactions. This study investigated how psychopathy affects the neural mechanisms that are recruited to make decisions in the ultimatum game. Thirty-five adult participants recruited from the community underwent functional magnetic resonance imaging scanning while they performed the ultimatum game under high and low cognitive load. Across load conditions, high psychopathy scorers rejected unfair offers in the same proportion as low scorers, but perceived them as less unfair. Among low scorers, the perceived fairness of offers predicted acceptance rates, whereas in high scorers no association was found. Imaging results revealed that responses in each group were associated with distinct patterns of brain activation, indicating divergent decision mechanisms. Acceptance of unfair offers was associated with dorsolateral prefrontal cortex activity in low scorers and ventromedial prefrontal cortex activity in high scorers. Overall, our findings point to distinct motivations for rejecting unfair offers in individuals who vary in psychopathic traits, with rejections in high psychopathy scorers being probably induced by frustration. Implications of these results for models of ventromedial prefrontal cortex dysfunction in psychopathy are discussed. 
23748168	There has been increasing interest in the direct and indirect effects of parental self-regulation on children's outcomes. In the present investigation, the effects of maternal self-regulation, home chaos, and inter-parental relationship adjustment on broad and specific indicators of infant negative emotionality (NE) were examined. A sample of maternal caregivers and their 4-month-old infants (N = 85) from a rural community participated. Results demonstrated that better maternal self-regulation was associated with lower infant NE broadly, as well as with lower infant sadness and distress to limitations/frustration and better falling reactivity (i.e., emotion regulation), specifically. Maternal self-regulation also predicted less chaotic home environments and better maternal inter-parental relationship adjustment. Findings also supported the indirect effects of maternal self-regulation on broad and specific indicators of infant NE through home chaos and maternal relationship adjustment. Some differential effects were also identified. Elevated home chaos appeared to specifically affect infant frustration/distress to limitations whereas maternal relationship adjustment affected broad infant NE, as well as several specific indicators of infant NE: frustration/distress to limitations, sadness, and falling reactivity. In conjunction with other recent investigations that have reported the effects of maternal self-regulation on parenting, the findings in the present investigation suggest that parental self-regulation may influence children's outcomes through several proximal environmental pathways.
23747126	The return of restraint in psychiatry raises many ethical issues for caregivers. However their experience is little explored in literature.Our objective was to study the feelings of caregivers facing restraint with regard to an ethical perspective and to identify areas for improvement.	Between November 2011 and February 2012 a descriptive cross-sectional epidemiological study was performed in two psychiatric emergency services and two closed units in which doctors and nurses were individually interviewed using semi-structured questionnaires. Five topics were explored: indications and contexts, impact on the patient, caregiver-patient relationship, perspective on the practice and feelings of caregivers on which we insist particularly. Results were presented in tables with percentages and possibly diagrams. The notable responses of caregivers were also cited.	Twenty nurses and nine psychiatrists, mostly female, were recruited. They all had participated in experiments of restraint. The self-aggressiveness, the aggressiveness against other persons and agitation were the most frequent indications. In the patients, caregivers identified misunderstanding (79.3%) and anger (75.9%). The majority of nurses (75%) felt that there was an improvement in the caregiver-patient relationship after the episode of restraint compared to what it had been in the moments preceding this measure. The emotional experience of caregivers was rich, intense and predominantly negative type of frustration (35% of nurses; 66.7% of doctors), anger (30 and 33.3%) and lack of feeling (35 and 44.4%). The feelings of doctors and nurses were not completely similar. For caregivers it was "a difficult but necessary experience" (82.75%), "an act of care and safety" (68.9%). All psychiatrists and almost half of the nurses (45%) said they did not feel the same when they used seclusion. In their opinion, seclusion entailed a less painful experience because of its therapeutic properties. More than half of the caregivers thought that there were alternatives to restraint: the strengthening of containing function in the hours before the use of restraint; the use of seclusion at the time of the decision to restrain. They identified contexts (80%) encouraging the use of restraints, not only related to the patient, the lack of resources but also institutional contexts, in particular conflicts or divisions in the health care team.	The misunderstanding of the patient led us to wonder about the quality of the information he/she received: it was sometimes too formal and did not take into account the uniqueness of the patient. The frustration of caregivers could concern the lack of resources but also be directed towards a patient or caregiver. In addition, there were often cleavages between doctors and nurses that stemmed from a misunderstanding, also with rivalries and power struggles. From the literature and caregivers' reflections we identified three prospects to reduce the use of restraint and modify feelings of caregivers: 1) develop better crisis management upstream through increasing resources and improving training; 2) promote patients support in using ethical principles of autonomy and beneficence by showing them solicitude, inviting them to tell themselves and helping them to regain their own experience; 3) develop an afterthought in setting up institutional reflection time by restoring a central role in clinical team meetings in psychiatry, possibly supplemented by supervision, but also through regional ethical spaces.	In our investigation, we found that caregivers had a predominantly negative experience with frustration, anger and a lack of feeling. Among caregivers we also identified awareness of ethical issues that may be for the first time for a change.	
23732841	Irritability is common in children and adolescents and is the cardinal symptom of disruptive mood dysregulation disorder, a new DSM-5 disorder, yet its neural correlates remain largely unexplored. The authors conducted a functional MRI study to examine neural responses to frustration in children with severe mood dysregulation.The authors compared emotional responses, behavior, and neural activity between 19 severely irritable children (operationalized using criteria for severe mood dysregulation) and 23 healthy comparison children during a cued-attention task completed under nonfrustrating and frustrating conditions.	Children in both the severe mood dysregulation and the healthy comparison groups reported increased frustration and exhibited decreased ability to shift spatial attention during the frustration condition relative to the nonfrustration condition. However, these effects of frustration were more marked in the severe mood dysregulation group than in the comparison group. During the frustration condition, participants in the severe mood dysregulation group exhibited deactivation of the left amygdala, the left and right striatum, the parietal cortex, and the posterior cingulate on negative feedback trials, relative to the comparison group (i.e., between-group effect) and to the severe mood dysregulation group's responses on positive feedback trials (i.e., within-group effect). In contrast, neural response to positive feedback during the frustration condition did not differ between groups.	In response to negative feedback received in the context of frustration, children with severe, chronic irritability showed abnormally reduced activation in regions implicated in emotion, attention, and reward processing. Frustration appears to reduce attention flexibility, particularly in severely irritable children, which may contribute to emotion regulation deficits in this population. Further research is needed to relate these findings to irritability specifically, rather than to other clinical features of severe mood dysregulation.	
23713691	Constraint-induced movement therapy (CIMT) is an effective intervention to improve hand function in children with cerebral palsy (CP). However, some of its features, including the restraining of the unaffected arm and the intensive training, may result in stressful experiences for children and interfere with family routine. This study aimed to document the perceptions of children with CP and their caregivers regarding the experience of undergoing the CIMT protocol.Qualitative data were collected from semi-structured interviews conducted with five children with CP and their caregivers (n = 6). Content analysis structured and summarized data into two emergent categories: (i) Perception of children and caregivers about CIMT implementation procedures; (ii) Occupational performance before and after the CIMT protocol. The interviews' content revealed that children and caregivers recognized the benefits of CIMT, including increased use of the affected arm and decreased need for assistance; they believed that these gains outweighed the difficulties they experienced in daily routine.	
23713509	Delay aversion (DAv) is thought to be a crucial factor in the manifestation of impulsive behaviors in patients with attention-deficit/hyperactivity disorder (ADHD). The imposition of delay is predicted to elicit negative emotional reactions in ADHD. The present study offers a multimodal approach to the investigation of DAv. Twelve adult patients with ADHD and 12 matched healthy controls were tested on a new task with several levels of anticipated delays during functional magnet resonance imaging (fMRI). Behavioral measures of delay discounting, DAv, and delay frustration were collected. Skin conductance and finger pulse rate were assessed. Results indicated a group difference in response to changes in delay in the right amygdala: For control participants activity decreased with longer delays, whereas activity tended to increase for ADHD patients. The degree of amygdala increase was correlated with the degree of behavioral DAv within the ADHD group. Patients also exhibited increased emotional arousal on physiological measures. These results support the notion of an exacerbated negative emotional state during the anticipation and processing of delay in ADHD.
23713130	Central to the hospice philosophy is the belief that the patient/family owns the plan of care. However, barriers prevent the majority of hospice patients/families from participating in the meetings where plans are created and revised. This study evaluates the participant experience of the ACTIVE (assessing caregivers for team intervention via video encounters) intervention, designed to use web conferencing technology to overcome the barriers of participation in development and review of individual care plans. Interviews were done with hospice caregivers following the death of their loved one. Caregivers involved in the intervention reported positive relationships with the hospice staff, felt involved in decision making, and got answers to their questions. Furthermore they reported staff was responsive to their needs and that participation increased their confidence, trust in the team, and provided a feeling of not being alone if they needed help. Challenges included issues with the technology, a feeling of being rushed and a frustration when they did not feel included or involved. Suggestions for improving the intervention included a more frequent meeting time, a need for to train hospice staff how to conduct web-based interactions, and suggestions for additional information for caregivers. 
23710758	Previous research has shown that brain injury patients with Organic Personality Disorder (OPD) may display "borderline" traits due to prefrontal damage, and their personality structure may be unstable and close to a borderline personality organisation. They may have few general neuropsychological dysfunctions but specific executive deficits. Similar deficits have been found in patients with Borderline Personality Disorder (BPD). The objective of this study was to identify differences and similarities between the neuropsychological and personality profiles of BPD and OPD patients.Twenty BPD patients and 24 OPD patients were assessed with the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II), the Karolinska Psychodynamic Profile (KAPP), and a comprehensive neuropsychological test battery.	Very few neuropsychological differences were found between the two patient groups. However, the verbal fluency, verbal intelligence, verbal memory, and immediate auditory memory/attention of the BPD patients were significantly poorer than the OPD patients'. The KAPP profiles of the BPD patients showed significantly poorer functioning in three areas: frustration tolerance, the body as a factor of self-esteem, and overall personality organisation.	These results support our clinical experience and expectations concerning the severity of symptoms of both patient groups. We suggest considering in depth assessments of both neuropsychological and personality-related problems for each of these patients in order to inform treatment.	
23703718	The purpose of this existential-phenomenological study was to investigate the experience of being in a wheelchair. It was a prelude to a pilot study examining the effect of "seated" Tai Chi.An interpretive research group was used as were direct quotations to support the analysis. The interview question was as follows: "please describe specific experiences you have had in your wheelchair that stand out for you."	The interrelated themes were (a) humiliation, (b) frustration, (c) loss, and (d) humility, arising from a ground of self as disabled and time.	The accommodations from the ADA Act have greatly facilitated the independence for those who are disabled, yet many obstacles remain.	People using wheelchairs experience the same health problems as the able-bodied and are thus found in all areas of nursing practice.	
23702666	Pelvic floor muscle training (PFMT) is the recommended first-line treatment for women with urinary incontinence (UI). Success rates are variable and dependent on a number of factors. The development of an incontinence treatment motivation questionnaire (ITMQ) provides us with a tool to assess patient self-motivation with respect to PFMT and UI. The aim of this study was to determine the effect of women's self-motivation to perform PFMT on outcome.Women with stress predominant UI completed an ITMQ and a 24-h pad test and then underwent a 12-week course of supervised PFMT. At the end of their treatment they completed a patient global impression of improvement questionnaire (PGI-I) and a second 24-h pad test. The PGI-I scores and the difference in pad test weight correlated with the ITMQ according to Spearman's correlation coefficient.	Sixty-five women were recruited. Thirty-two (49%) patients perceived themselves as having improved, 28 women (43%) did not experience any change in symptoms and 5 women (8%) felt that their symptoms deteriorated following treatment. When correlating the PGI-I with the ITMQ, 3 of the 5 domains: MQS1 (positive attitude for treatment; p = 0.003), MQS3 (frustration of living with incontinence; p = 0.002) and MQS4 (desire for treatment; p = 0.002) correlated significantly with outcome. Desire for treatment was the only domain to correlate with change in pad weight (p = 0.001).	Self-motivation is essential in order to determine improved success rates with PFMT.	

23689792	Personality traits like depression on the one hand and aggression and impulsivity on the other are assumed to be predisposing factors for different types of alcohol dependence. Both types are associated with sensitivity to frustration, but this may be different for the two types of personality according to whether they are confronted with frustrations caused by withdrawal from positive or infliction of negative events. It has not been shown so far if both types of personality factors and the two different sources of frustration are differently relevant for the propensity of relapse. This was investigated here in a study on 60 abstinent male alcohol-dependent patients.Correlations between the number of previous detoxifications reflecting liability to relapse and questionnaire scores on personality factors and on reactions to frustration were computed.	Bonferroni-corrected correlations yielded significant relationships between the number of detoxifications and the personality factor of aggression as well as pronounced depressive reactions to frustrating conditions of non-reward caused by humans. Controlling for impulsivity, aggression and depression revealed that depressive reactions to frustration are genuine predictors for probability of relapse independent of underlying personality factors. Persons particularly sensitive to frustrations from human denial of positive reinforcers are liable to relapse which fits the theory of sensitivity to reward in drug-addicted individuals.	Results demonstrate that relapse is clearly more related to aggression than to impulsivity, depression and anxiety and may be facilitated if persons are sensitive to frustrating conditions of non-reward caused by social partners.	
23682208	Grandparents provide a significant amount of child care to their grandchildren. However, there is limited research investigating whether grandparents would view a parenting program developed specifically for them as useful. Our study adopted a consumer focused perspective to program design and examined the challenges encountered by grandparents in their role as an informal child care provider. Focus groups were conducted with fourteen grandparents (11 females, 3 males) aged 45-76 years (M = 60.14) the majority of whom provided 11-20 h of care per week to their grandchild. A thematic analysis indicated that grandparents have difficulty managing the relationship with the parents and remembering effective parenting strategies. In addition, grandparents also indicated wanting further strategies to cope with the stressors associated with the role, particularly surrounding feelings of frustration and guilt. These results suggest that grandparents could benefit from a parenting program and this paper argues that an existing evidence-based parenting program should be modified. In terms of implications for program design the inclusion of a module centered on improving grandparent-parent communication and partner support may buffer potential conflict and tension that can arise in co-parenting situations.
23674469	Expressed emotion (EE) refers to the emotional climate within a family. High EE significantly increases the risk of relapse in people with psychosis. The focus of research to date has largely been on understanding mechanisms underlying high EE. A greater understanding of low EE would help guide family interventions to build strengths within the family. The aim of this study was to understand how low EE relatives respond to having a close family member with psychosis.A subsample of eight low EE relatives, from a larger study investigating relatives' adaptation to recent onset psychosis, was interviewed. Transcripts were analysed following the principles of interpretive phenomenological analysis (IPA).	Semi-structured interviews were carried out with each relative covering broad areas of their experience, including their awareness of the development of mental health problems and relationship with their relative.	Four core themes emerged: witnessing the distress; empathy through acceptance and understanding; a broad range of coping strategies to reduce distress; and realistic optimism for the future.	The study highlights that, although relatives described distressing experiences and feelings of frustration and anger, they showed empathy and commitment to support the person. They demonstrated psychological mindedness about the psychosis and related behaviours, had developed coping strategies, and had adjusted their expectations for the future. Further research is warranted to investigate the findings in larger samples, with a view to informing the development of more effective ways of supporting families.	
23665076	A handoff is the process of conveying necessary information in order to transfer primary responsibility for providing safe and effective drug therapy to a patient from one community pharmacist to another, typically during a shift change. The handoff information conveyed in pharmacies has been shown to be unstructured and variable, leading to pharmacist stress and frustration, prescription delays, and medication errors.The purpose of this study was to describe and categorize the information hazards present in handoffs in community pharmacies.	A qualitative research approach was used to elicit the subjective experiences of community pharmacists. Community pharmacists who float or work in busy community pharmacies were recruited and participated in a face to face semi-structured interview. Using a systematic content data analysis, the study identified five categories of information hazards that can lead to information chaos, a framework grounded in human factors and ergonomics.	Information hazards including erroneous information and information overload, underload, scatter, and conflict, are experienced routinely by community pharmacists during handoff communication and can result in information chaos. The consequences of information chaos include increased mental workload, which can precipitate problematic prescriptions "falling between the cracks." This can ultimately impact patient care and pharmacist quality of working life.	The results suggest that handoffs in community pharmacies result in information hazards. These information hazards can distract pharmacists from their primary work of assessing prescriptions and educating their patients. Further research on how handoffs are conducted can produce information on how hazards in the system can be eliminated.	
23654406	Individuals with sensorineural hearing loss often report frustration with speech being loud but not clear, especially in background noise. Despite advanced digital technology, hearing aid users may resort to removing their hearing aids in noisy environments due to the perception of excessive loudness. In an animal model, sensorineural hearing loss results in greater auditory nerve coding of the stimulus envelope, leading to a relative deficit of stimulus fine structure. Based on the hypothesis that brainstem encoding of the temporal envelope is greater in humans with sensorineural hearing loss, speech-evoked brainstem responses were recorded in normal hearing and hearing impaired age-matched groups of older adults. In the hearing impaired group, there was a disruption in the balance of envelope-to-fine structure representation compared to that of the normal hearing group. This imbalance may underlie the difficulty experienced by individuals with sensorineural hearing loss when trying to understand speech in background noise. This finding advances the understanding of the effects of sensorineural hearing loss on central auditory processing of speech in humans. Moreover, this finding has clinical potential for developing new amplification or implantation technologies, and in developing new training regimens to address this relative deficit of fine structure representation.
23651123	Psychological factors can increase severity and intensity of headaches. While great attention has been placed on the presence of anxiety and/or depression as a correlate to a high frequency of migraine attacks, very few studies have analyzed the management of frustration in children with headache. Aim of this study was to analyze the possible correlation between pediatric migraine severity (frequency and intensity of attacks) and the psychological profile, with particular attention to the anger management style.We studied 62 migraineurs (mean age 11.2 ± 2.1 years; 29 M and 33 F). Patients were divided into four groups according to the attack frequency (low, intermediate, high frequency, and chronic migraine). Pain intensity was rated on a 3-levels graduate scale (mild, moderate and severe pain). Psychological profile was assessed by Picture Frustration Study test for anger management and SAFA-A scale for anxiety.	We found a relationship between IA/OD index (tendency to inhibit anger expression) and both attack frequency (r = 0.328, p = 0.041) and intensity (r = 0.413, p = 0.010). When we analyzed the relationship between anxiety and the headache features, a negative and significant correlation emerged between separation anxiety (SAFA-A Se) and the frequency of attacks (r = -0.409, p = 0.006). In our patients, the tendency to express and emphasize the presence of the frustrating obstacle (EA/OD index) showed a positive correlation with anxiety level (“Total anxiety” scale: r = 0.345; p = 0.033).	Our results suggest that children suffering from severe migraine tend to inhibit their angry feelings. On the contrary, children with low migraine attack frequency express their anger and suffer from separation anxiety.	
23640303	The purpose of the study was to assess the value of reinforcing diabetes self-management for improving glycemia and self-care among adults with type 2 diabetes who had at least 3 hours of prior diabetes education.In this randomized controlled trial, 134 participants (75% white, 51% female, 59 ± 9 years old, 13 ± 8 years with diabetes, A1C = 8.4% ± 1.2%) were randomized to either a group map-based program (intervention) or group education on cholesterol and blood pressure (control). Participants were assessed for A1C levels, diabetes self-care behaviors (3-day pedometer readings, 6-minute walk test, blood glucose checks, frequency of self-care), and psychosocial factors (distress, frustration, quality of life) at baseline, 3, 6, and 12 months post intervention and health literacy at baseline.	Groups did not differ on baseline characteristics including A1C levels, health literacy, or self-care; however, the intervention group had more years of education than controls. Intervention arm participants modestly improved A1C levels at 3 months post intervention but did not maintain that improvement at 6 and 12 months while control patients did not improve A1C levels at any time during follow-up. Importantly, frequency of self-reported self-care, diabetes quality of life, diabetes-related distress, and frustration with diabetes self-care improved in both groups over time.	Reinforcing self-care with diabetes education for patients who have not met glycemic targets helps improve A1C and could be considered a necessary component of ongoing diabetes care. The best method to accomplish reinforcement needs to be established.	
23631778	Many global health practitioners are currently reaffirming the importance of recruiting and retaining effective community health workers (CHWs) in order to achieve major public health goals. This raises policy-relevant questions about why people become and remain CHWs. This paper addresses these questions, drawing on ethnographic work in Addis Ababa, the capital of Ethiopia, between 2006 and 2009, and in Chimoio, a provincial town in central Mozambique, between 2003 and 2010. Participant observation and in-depth interviews were used to understand the life histories that lead people to become CHWs, their relationships with intended beneficiaries after becoming CHWs, and their social and economic aspirations. People in Ethiopia and Mozambique have faced similar political and economic challenges in the last few decades, involving war, structural adjustment, and food price inflation. Results suggest that these challenges, as well as the socio-moral values that people come to uphold through the example of parents and religious communities, influence why and how men and women become CHWs. Relationships with intended beneficiaries strongly influence why people remain CHWs, and why some may come to experience frustration and distress. There are complex reasons why CHWs come to seek greater compensation, including desires to escape poverty and to materially support families and other community members, a sense of deservingness given the emotional and social work involved in maintaining relationships with beneficiaries, and inequity vis-à-vis higher-salaried elites. Ethnographic work is needed to engage CHWs in the policy process, help shape new standards for CHW programs based on rooting out social and economic inequities, and develop appropriate solutions to complex CHW policy problems.
23631239	Nicotine dependence involves both psychological and physiological dependence on nicotine. Evidences suggest that nicotine depends on dopamine for its reinforcing effects. A recent summary description of the clinical aspects of nicotine dependence disorders is provided in the DSM-IV-TR of the American Psychiatric Association. Nicotine withdrawal is defined by the DSM-IV-TR as a condition in which a person, after using nicotine daily for at least several weeks, exhibits at least four of the following symptoms within 24 hours after reduction or cessation of nicotine use: (1) dysphoric or depressed mood, (2) insomnia, (3) irritability, frustration or anger, (4) anxiety, (5) difficulty concentrating, (6) restlessness, (7) decreased heart rate, (8) increased appetite or weight gain. Among those symptoms, depression needs special consideration.
23627532	Research on the psychosocial reactions to stroke has been used to inform rehabilitation programmes. Yet much less research has been conducted into experiences of, and reactions to, transient ischaemic attack (TIA), despite its link with secondary stroke. This study aimed to investigate the subjective psychological experiences of TIA.Repertory grid technique was used because of its capacity to make individual implicit experiences explicit. Using the standard repertory grid protocol, 12 post-TIA patients were asked to consider how five everyday activities had been affected by TIA. Each participant generated six constructs or personal perspectives, which were analysed using proprietary (RepGrid IV) software.	Despite the individualised nature of the responses, six themes emerged from the constructs. These included deep-seated anxiety about future uncertainties/disruption to normality, loss of confidence, frustration, TIA as a wake-up call, a sense of loss and sadness, and embarrassment.	Research has shown that the patient's subjective experience and perspective are important to the rehabilitation process post-stroke. Relatively little research has been conducted into the subjective experiences of TIA patients. This study has revealed a range of subjective reactions to TIA, which could be used to inform individualised post-TIA management, adaptation and rehabilitation.	
23625531	Although a series of well-designed studies have reported that supplementation with vitamins/minerals and omega-3 fatty acids reduces the incidence of aggressive behavior, to date, the relative contribution and interaction between these nutrients has not been examined. The aim was therefore to consider the relative contribution of supplementation with multivitamins/minerals and/or docosahexaenoic acid (DHA) on laboratory-based measures of aggression, impulsivity, and stress.In a double-blind randomized trial, four groups of young adult men without a history of aggressive or impulsive behavior received a placebo (n = 42), multivitamins/minerals (n = 43), DHA (n = 47) or both (n = 41) for 3 months.	With the Picture-Frustration Task, DHA decreased the display of aggressive behavior. DHA also decreased impulsivity as measured using the GoStop Impulsivity Paradigm that examines the ability to inhibit already initiated behavior. Although a multivitamin and mineral supplement did not influence these measures, it did decrease perceived stress.	The influence of supplementation on aggression and impulsivity can be conveniently studied in a sample without a history of antisocial behavior, using laboratory-based measures. No evidence was found of a synergistic interaction between vitamins/minerals and DHA.	
23622154	Diagnosis appears as a triumph, crucial for further therapeutic endeavors. Yet, what is said may be misunderstood. New, even helpful, diagnosis may be disturbing. All we have is information. It is necessary to know the person and to understand the context in which diagnosis is given, by a senior, in privacy. What may seem "good news" to the neurologist may be tempered by the scale of the ordeal that has to be faced by the child and family. To understand the frustration of the parents obliges us to look at some of the motives for having children. The stages of grief are shock, denial, depression, guilt, and coming to terms. "Psychological defences" consists of repression, denial, projection, displacement, rationalization, and sublimation. Diagnosis represents a potential major and irreversible life change. As for any other medical act, announcing to parents that their child has severe neurological sequelae consists of an irreversible decision in which the physician is often faced with situations for which written regulations are clearly insufficient. Indeed, moral duty dictates injunctions that pull the decision in opposite directions: loyalty in announcing a terrible truth but protection from dreadful moral sufferance.
23621986	Laboratory-induced dyspnea (breathing discomfort) in healthy subjects is widely used to study perceptual mechanisms, yet the relationship between laboratory-induced dyspnea in healthy volunteers and spontaneous dyspnea in patients with chronic lung disease is not well established. We compared affective responses to dyspnea 1) in COPD patients vs. healthy volunteers (HV) undergoing the same laboratory stimulus; 2) in COPD during laboratory dyspnea vs. during activities of daily living (ADL).We induced moderate and high dyspnea levels in 13 COPD patients and 12 HV by increasing end-tidal CO2 (PETCO2) during restricted ventilation, evoking air hunger. We used the multidimensional dyspnea profile (MDP) to measure intensity of sensory qualities (e.g., air hunger (AH) and work/effort (W/E)) as well as immediate discomfort (A1) and secondary emotions (A2). Ten of the COPD subjects also completed the MDP outside the laboratory following dyspnea evoked by ADL.	COPD patients and HV reported similar levels of immediate discomfort relative to sensory intensity. COPD patients and HV reported anxiety and frustration during laboratory-induced dyspnea; variation among individuals far outweighed the small differences between subject groups. COPD patients reported similar intensities of sensory qualities, discomfort, and emotions during ADL vs. during moderate laboratory dyspnea. Patients with COPD described limiting ADL to avoid greater dyspnea.	In this pilot study, we found no evidence that a history of COPD alters the affective response to laboratory-induced dyspnea, and no difference in affective response between dyspnea evoked by this laboratory model and dyspnea evoked by ADL.	
23593947	Chaplains working in the Veterans Health Administration have numerous roles and challenges. They work closely with other behavioral health professionals, especially social workers, to address the multiplicity of needs of the Veteran population. They are essentially an understudied subset of the military Chaplaincy service (most studies focus on those engaged in combat areas). In this exploratory qualitative study, VHA Chaplains responded to a survey to determine how they defined their role and professional challenges, what they felt were the rewards and frustrations of their work and their unique function within the VHA system. Findings showed that role differences between Chaplains and social workers and other behavioral health providers are clearly defined; rewards and challenges were diverse and frustrations were common to those working in a bureaucratic structure.
23592602	The present studies examined the self-validating role of anger within provoking driving situations, using a scenario method. Specifically, we predicted that one reason for why individuals higher (rather than lower) in trait driving anger are more likely to aggress when provoked is because these individuals are more confident in their thoughts resulting from the provocation. Higher thought confidence, in turn, may influence the amount of anger experienced and the extent to which the anger translates into aggressive behavior. Study 1 found that participants higher in driving anger were more confident in their thoughts in a provoking situation and their thought confidence mediated the effect of trait driving anger on anger in response to the provocation. Using a manipulation of consistency, Study 2 found that thought confidence mediated the influence of anger on aggressive driving intentions, but only for individuals higher in driving anger. The current research adds to the growing work examining a new mechanism by which emotion (e.g., anger) can affect behavior.
23583055	Paroxysmal nonepileptic events of psychogenic etiology in children and adolescents are common. Patients and their parents are often confused by the terminology used to describe these events. This can lead to frustration and may result in the failure to obtain the necessary nonpharmacologic treatment. Various terms are used to describe such events, some of which might be considered offensive to some individuals. Surveys from 146 parents or guardians of patients identified from a general pediatric clinic, a general neurology clinic, and a pediatric epilepsy monitoring unit were completed with the aim of determining which words and phrases were least offensive. It was determined that nonepileptic events, functional seizures, and nonepileptic attack disorder were the least offensive labels; whereas "it is all in his or her head," hysterical seizures, and psychogenic seizures were the most offensive terms. This is the only study of its type in the pediatric population. Although each child and family requires individualized communication, we hope that this article will provide useful information to guide the practicing pediatric neurologist in informing families that their children are having events of nonepileptic etiology.
23571181	In February 2012, The Wall Street Journal summarized cases and research documenting growth in the numbers of physicians who ask families to leave their practices due to parental refusal of vaccines for pediatric patients. (1) Some physicians ask families to leave because they feel that they have a professional obligation to maintain a standard of care that is unattainable when parents refuse vaccines for their children. Others struggle with how to maintain a therapeutic relationship with a child whose parents' health beliefs conflict with vaccine schedule recommendations. Additionally, one social and cultural trend that seems to influence physician-family relationships in these cases is "anti-intellectualism." I consider some important challenges these issues pose for professionalism in the physician-family relationship, and consider a few values helpful in configuring responses to those challenges. 
23570255	Infertility affects about 15% of couples in Western-societies with most progressing to fertility clinics for treatment. Despite being common, infertility is often experienced as a lonely road for affected couples. In this paper we expand on our previously published findings of women's experiences with infertility or difficulty of viable pregnancy who had sought Traditional Chinese Medicine (TCM) therapy in Australia, and focus on women's quality of life, coping strategies, and support needs.We applied mixed methods using the Tuebingen Quality of Life and the COPE questionnaires and in-depth interviews with 25 women with primary or secondary infertility, recurrent miscarriages or unexplained stillbirth, and who had consulted a TCM practitioner. We used a thematic approach to analyse the interviews, and descriptive statistics to evaluate questionnaire responses.	Women reported through both questionnaires and interviews compromised quality of life due to the high level of distress, guilt, grief, and frustration caused by infertility. However, our women represented a highly motivated sample, actively seeking alternative support. While the TCM approach to infertility management increased women's sense of personal agency and control through education and continuity of care, the need for greater understanding and support on a societal level remains.	In infertility, ongoing emotional and instrumental support is pivotal to the wellbeing and quality of life of the affected. Traditional Chinese Medicine addresses some support needs in infertility not routinely available in the Western model of care. More peer-led and professional-led support groups are greatly needed for women experiencing infertility to help break isolation and raise awareness of integrative approaches to fertility management.	
23567422	While typically examined as a unitary construct, there is evidence that caregiver burden may be composed of several dimensions. The purpose of this study was to examine the factor structure of the Zarit Burden Interview (ZBI) in a sample of dementia caregivers and to explore the relationship between these factors and demographic, mood, and care recipient variables.Cross-sectional.	Academic medical center.	206 spousal or adult child caregivers for patients with mild to moderate dementia residing in the community.	Caregiver measures included the ZBI, Center for Epidemiologic Studies Depression Scale, and the Burns Relationship Satisfaction Scale. Patient measures included scores on the Dementia Rating Scale, Lawton-Brody Activities of Daily Living scale, and Revised Memory and Behavior Problems Checklist.	Factor analysis revealed three dimensions of caregiver burden: direct impact of caregiving upon caregivers' lives, guilt, and frustration/embarrassment. Caregiver depression and age emerged as unique predictors of the first two factors. Caregivers' satisfaction with their relationship with the patient and patients' functional independence also uniquely predicted the direct impact of caregiving upon caregivers' lives. Patients' behavioral problems and caregivers' level of relationship satisfaction with the care recipient served as unique predictors of frustration/embarrassment.	Findings demonstrate the multidimensionality of caregiver burden among dementia caregivers. Given the unique predictors of each dimension of burden, caregivers may benefit from different types of tailored interventions specific to the subtype of burden they are experiencing.	
23557712	Intraindividual differences in executive functions (EFs) have been rarely investigated. In this study, we addressed the question of whether the emotional fluctuations that schoolchildren experience in their classroom settings could generate substantial intraindividual differences in their EFs and, more specifically, in the fundamental unifying component of EFs, their inhibition function. We designed an experimental research with ecological validity within the school setting where schoolchildren of three age groups (8-, 10-, and 12-year-olds) were involved. We executed three experiments. In Experiment 1, using a between-participants design, we isolated a classroom episode that, compared with the other episodes, generated significant differences in inhibitory function in a consequent Go/NoGo task. This was an episode that induced frustration after the experience of anxiety due to the uncertainty. Experiment 2, using a within-participants design, confirmed both the induced emotions from the episode and the intraindividual variability in schoolchildren's inhibition accuracy in the consequent Go/NoGo task. Experiment 3, again using a within-participants design, examined whether the same episode could generate intraindividual differences in a more demanding inhibition task, namely the anti-saccade task. The experiment confirmed the previous evidence; the episode generated high variability that in some age groups accounted for more than 1.5 standard deviations from the interindividual variability between the schoolchildren of the same age. Results showed that, regardless of their sex and the developmental progression in their inhibition with age, the variability induced within participants from the experienced frustration was very high compared with the interindividual variability of the same age group.
23557651	Dermatitis is a frequent cause for referral to the pediatric dermatologist. In this article, a brief overview is given of common childhood dermatoses as well as some rarer dermatoses that may give the clinician cause for concern. Widespread scaling and erythema, described as erythroderma, are a cause of frustration for patients, families, and their physician(s). Both unusual and common skin disorders can present in this fashion. Just as recognizing common dermatoses is important, it is also important to recognize when a dermatitis fails to fit the common pattern and may prompt further investigation.

23551790	To examine overall job satisfaction and its association with extrinsic and intrinsic characteristics of job satisfaction among nurse practitioners at the chosen practice site. The objectives were to identify relevant retention and recruitment strategies, from the nurse practitioners perspective, by examining (1) what role aspects are most satisfying, and (2) approaches for successful, professional development and integration in the role.Supportive professional practice environments are particularly important to nurses' satisfaction with their work and the quality of patient care provided. Hence, research that examines nurse practitioners practice implications and barriers in today's healthcare system is essential.	A descriptive-correlational design using survey methodology. A nonprobability sample of convenience was used. The outcome measures were: The Misener Nurse Practitioner Job Satisfaction Scale and two investigator-developed surveys.	Participants expressed dissatisfaction with professional and monetary recognition, assertive influence, administrative support and collegial relationships.	Interaction of subscale factors on overall job satisfaction and demographic survey findings has important implications for health administrators and nurse practitioners in similar organisations.	Stakeholders in healthcare milieus need to be fully engaged in the redesign of the American healthcare system heeding the recommendations of the Institute of Medicine to provide safer health systems to the public. By doing this, issues related to frustration by nurse practitioners related to job satisfaction will be addressed. The need for cooperation, participation, collaboration and instrumental communication are essential in the delivery of safe, quality patient care. A better understanding of intrinsic professional rewards needs to be learned by nurse practitioners who want to seek professional satisfaction and engage in the survival and growth of the profession. Nurse practitioners armed with this translational information have viable agenda items that can be negotiated into extrinsic rewards.	
23550631	Male impotence and infertility are health and social problems that have resulted in significant suffering to men the world over. From an African perspective, and in Zimbabwe in particular, the taboo nature of male impotence and infertility carries a lot of mystique. Based on evidence from focus-group discussions, in-depth and key-informant interviews, this study reveals rural Shona people to have indigenous knowledge systems that trigger the investigation of signs of impotence (perceived as associated with male infertility) at infancy, puberty and after marriage. Male infertility carries overtones of failure, frustration, pain, social ostracism, stigma, marital instability, discomfiture and suicide. Intervention strategies to remedy perceived problems were exclusively sociocultural, involving the administration of traditional herbs and traditional healers' divination. Given the existence of indigenous knowledge systems for the investigation and mediation of male impotence and infertility, it is worth incorporating traditional healers in future strategies targeting these emasculating conditions.
23542812	This study investigated the relationships between children's secure base and emotion regulation, namely their behavioral strategies and emotional expressiveness, during different situational and social contexts in naturalistic settings. Fifty-five children ranging in age from 18 to 26 months of age and their mothers participated in this study. Children were exposed to three situational (fear, positive affect and frustration/anger) and two social (maternal constraint and involvement) contexts. Toddlers' behavioral strategies differed as function of emotion-eliciting context, maternal involvement and attachment quality. Emotional expressiveness varied as function of an interaction involving situational contexts, maternal involvement and children's attachment security.
23537843	Psychological models of depression in schizophrenia have proposed that cognitive structures (e.g., self-esteem, dysfunctional beliefs) may have a role in the development and maintenance of depression. However, it has not been clear what the characteristics of these cognitive structures were in people with schizophrenia and whether they have an independent association with depression, especially in those from a Chinese cultural background. The present investigation examined 133 people with schizophrenia and 50 healthy controls and indicated that compared to the controls people with schizophrenia showed lower self-esteem, higher levels of dysfunctional beliefs and negative coping styles. Multiple linear regression analysis revealed that only low frustration tolerance, problem solving and self-blame were found to be the independent correlates of depression in schizophrenia. Results are discussed with the view of clinical implications of cognitive formulation and therapy for schizophrenia in China. 
23525175	Substance abuse counselors who work with offenders are facing increasing caseloads, which puts them at higher risk of job frustration. The purpose of this study was to explore differences between substance abuse counselors employed in prison versus community settings in terms of level of organizational support and job frustration. This study also investigated whether organizational support was associated with job frustration after controlling for counselor characteristics and workplace setting. This was accomplished utilizing data that were collected from 267 counselors as part of the Criminal Justice Drug Abuse Treatment Studies research cooperative. Results indicated that counselors employed in community settings, as compared with those employed in prisons, are more likely to report higher levels of perceived organizational support. In addition, ordinal logistic regression results reveal that counselors who are non-White and have greater levels of organizational support have less job frustration, after controlling for counselor characteristics and workplace setting. The researches to practice implications are discussed. 
23496853	An emergency department (ED) should offer timely care for acutely ill or injured persons that require the attention of specialized nurses and physicians. This study was aimed at exploring what is actually going on at an ED.Qualitative data was collected 2009 to 2011 at one Swedish ED (ED1) with 53.000 yearly visits serving a population of 251.000. Constant comparative analysis according to classic grounded theory was applied to both focus group interviews with ED1 staff, participant observation data, and literature data. Quantitative data from ED1 and two other Swedish EDs were later analyzed and compared with the qualitative data.	The main driver of the ED staff in this study was to reduce non-acceptable waiting. Signs of non-acceptable waiting are physical densification, contact seeking, and the emergence of critical situations. The staff reacts with frustration, shame, and eventually resignation when they cannot reduce non-acceptable waiting. Waiting management resolves the problems and is done either by reducing actual waiting time by increasing throughput of patient flow through structure pushing and shuffling around patients, or by changing the experience of waiting by calming patients and feinting maneuvers to cover up.	To manage non-acceptable waiting is a driving force behind much of the staff behavior at an ED. Waiting management is done either by increasing throughput of patient flow or by changing the waiting experience.	
23495098	To investigate how toilet training (TT) is dealt with and what the associated feelings are in Flemish families using day-care at least once a week.A questionnaire was provided to 256 parents of healthy children between 15 and 35 months old, using day-care every week. Data were analyzed using SPSS18.0.	Two hundred twenty-two questionnaires were completed (response rate: 87%), of which 221 were valid. The overall results show that the start of TT and method used are mainly in line with current recommendations, and that the cooperation between parents and day-care is seen as positive, providing support for the parents in guiding their child in the TT-process. Most parents (74%) stated that day-care and parents should play an equal role in the TT-process. However, 17% of the parents experienced uncertainty, stress, and/or frustration related to TT. This percentage increased to 30% when asked about the right moment to start TT. Moreover, 18% of the parents reported a lack of time to guide their child in the TT-process. Eighteen percent of the parents agreed that responsibility for TT is increasingly passed on to day-care, while 46% remained undecided. In addition, 40% of the parents had no idea whether they used the same TT method as the day-care center.	The results, in general, reflect a positive image of how TT is dealt with. However, several concerns were raised about the shared TT between parents and day-care, implying that further research on this topic is needed.	
23489117	To explore processes of conceptualizing nodding syndrome (NS), an unknown illness which has been reported to affect thousands of children in post-conflict northern Uganda, in South Sudan and in Tanzania.This qualitative study comprised 40 in-depth interviews with affected families, health workers and politicians during five months of fieldwork in northern Uganda and a review of available reports, newspapers and academic literature on NS. In addition, observations have been made at treatment centers and during outreaches and meetings. Focus is put on how meanings of key terms related to NS are produced and negotiated. Attention is being paid to the circulation of different discourses and explanatory models.	Discourses and explanatory models play an active role in the conceptualization of illness, as much by medical personnel as by affected families and the media. The prominent use of biomedical terms in the academic discourse on NS is striking; links are suggested with onchocerciasis and epilepsy. In contrast, the local discourse associates NS with social issues. The illness experiences are connected to the trauma of past conflict, to poverty and to (region-bound) frustration over neglect. The cultural significance of physical symptoms raises the question of the impact of culture on health.	By only looking at the biomedical significance of this new syndrome, we will miss important aspects of how this illness is being experienced and understood. In our future dealings with NS, we will have to consider and re-conceive the relation between culture and neurobiology.	
23482684	The present study examined bidirectional relations between child temperament and parenting styles in a sample (n = 425) of Chinese children during elementary school period (age range = 6 to 9 years at Wave 1). Using two waves (3.8 years apart) of longitudinal data, we tested two hypotheses: (1) whether child temperament (effortful control and anger/frustration) at Wave 1 predicts parenting styles (authoritative and authoritarian parenting) at Wave 2, controlling for Wave 1 parenting; and (2) whether parenting styles at Wave 1 predict Wave 2 temperament, controlling for Wave 1 temperament. We found support for bidirectional relations between temperament and authoritarian parenting, such that higher effortful control and lower anger/frustration were associated with higher authoritarian parenting across time and in both directions. There were no significant cross-time associations between children's temperament and authoritative parenting. These findings extend the previous tests of transactional relations between child temperament and parenting in Chinese children and are consistent with the cultural values toward effortful control and control of anger/frustration in Chinese society.
23475827	Low threshold of dissatisfaction and frustration in child and adolescent patients with ADHD lead to changes in dietary pattern with contribution to the development of obesity and other nutritional disorders.A total of 362 patients with the diagnosis of ADHD and 390 children without any chronic disease were included to the study. We evaluated the anthropometric measurements for all cases.	The overweight/obese cases according to weight for height (WFH) and body mass index scores were more likely in ADHD cases than control group. Malnourished cases according to WFH were more common in ADHD cases. Patients with weight standard deviation scores between <-2 and >2 were significantly higher in ADHD cases than the control group patients.	Frequency of malnutrition and overweight/obese patients was found higher in ADHD cases compared with control group, and this situation suggested that ADHD is a risk factor for the development of eating disorders.	
23470553	Juvenile neuronal ceroid lipofuscinosis (JNCL) is characterized by severe visual impairment with onset around age 4-8 years, and a developmental course that includes blindness, epilepsy, speech problems, dementia, motor coordination problems, and emotional reactions. There is presently no cure and the disease leads to premature death. There have been few studies of non-medical intervention for individuals with JNCL, probably because of the negative prognosis. The present chapter discusses the education of children and adolescents with JNCL on the basis of current knowledge about the variation in perceptual, cognitive and language abilities through the course of the disease, and the possibilities that exist for supporting coping and learning within and outside the classroom. Adapted and special needs education may contribute significantly to improved learning conditions, better maintenance of skills and less frustration for individuals with JNCL. This article is part of a Special Issue entitled: The Neuronal Ceroid Lipofuscinoses or Batten Disease.
23467965	Researchers in environmental psychology, health studies and urban design are interested in the relationship between the environment, behaviour settings and emotions. In particular, happiness, or the presence of positive emotional mindsets, broadens an individual's thought-action repertoire with positive benefits to physical and intellectual activities, and to social and psychological resources. This occurs through play, exploration or similar activities. In addition, a body of restorative literature focuses on the potential benefits to emotional recovery from stress offered by green space and 'soft fascination'. However, access to the cortical correlates of emotional states of a person actively engaged within an environment has not been possible until recently. This study investigates the use of mobile electroencephalography (EEG) as a method to record and analyse the emotional experience of a group of walkers in three types of urban environment including a green space setting.Using Emotiv EPOC, a low-cost mobile EEG recorder, participants took part in a 25 min walk through three different areas of Edinburgh. The areas (of approximately equal length) were labelled zone 1 (urban shopping street), zone 2 (path through green space) and zone 3 (street in a busy commercial district). The equipment provided continuous recordings from five channels, labelled excitement (short-term), frustration, engagement, long-term excitement (or arousal) and meditation.	A new form of high-dimensional correlated component logistic regression analysis showed evidence of lower frustration, engagement and arousal, and higher meditation when moving into the green space zone; and higher engagement when moving out of it.	Systematic differences in EEG recordings were found between three urban areas in line with restoration theory. This has implications for promoting urban green space as a mood-enhancing environment for walking or for other forms of physical or reflective activity.	
23462103	To learn how students experience clinical placements in a setting of diversity and how they cope with the emotional challenges involved.This study is based on inductive, qualitative research undertaken with Israeli nursing students.	In-depth interviews were conducted with 20 students: 10 Arabs (5 men and 5 women), 9 Jews (2 men and 7 women), and 1 Circassian. The interviews were analyzed through coding and categorization.	The students' experiences are characterized by emotional strains of various sorts-stress, ambivalence, disgust, frustration, and conflict-that arise in three types of relationships: relationships with patients, with the clinical instructors, and with other students who are on their teams. The data show that diversity has an impact on all these relationships. The data further show that the students cope with the emotional strains by using several strategies of emotional work: distancing, self-strengthening, self-motivation work, and minimizing significance.	(a) Nursing students' experiences during their clinical placements should be understood in terms of emotional challenges, and their emotional work and coping strategies call for appropriate forms of support. (b) The diversity of the clinical placement environment should be considered as an important factor, both in understanding students' experiences and learning processes and in designing the support that they need.	Culturally diverse settings entail distinct challenges that impact students' emotional reaction to clinical work. Understanding the types of emotional work students do in the process of their clinical experience is critical for educators seeking to promote genuinely caring and effective nursing in culturally diverse settings. 	
23454424	This study examined linkages between 6-month-old infants' (n = 101) orienting response, measured physiologically by brief bradycardia or heart deceleration at the onset of a frustration task (maternal arm-restraint) and mother-infant co-regulation measured during a 15-min unstructured free play episode. Given the socially disruptive nature of the frustration task, we suspected that infants who experienced more positive co-regulated interactions including symmetrical (both partners actively engaged and attending to each other) or asymmetrical (one partner actively engaged while partner attends to the other) with mothers would be more likely to display an orienting response (bradycardia) during the onset of the arm-restraint procedure than infants who experience unilateral (one partner focused on other but the other focused on self), unengaged (neither partner attending to the other) or disruptive interactions. Findings indicate that dyads that experienced more asymmetrical co-regulation had infants who were more likely to experience bradycardia while unengaged interactions predicted the absence of bradycardia. These findings suggest that mother-infant co-regulation may help establish expectations about social interactions and that when these relational expectancies are violated infants are more likely to exhibit bradycardia at the onset of a socially disruptive task. Alternative explanations are also considered.
23452009	To develop a theoretical understanding of the processes hindering person-centred care of older people with cognitive impairment in acute care settings.Although person-centred care with its holistic focus on the biopsychosocial needs of patients is commonly considered the gold standard care for older people with cognitive impairment, the extent to which care is person-centred can increase in acute care settings generally.	Grounded theory inspired by Strauss and Corbin.	The study used a grounded theory approach to generate and analyse data from a Swedish sample of acute care staff, patients and family members.	The substantive theory postulates that staff risks 'falling behind' in meeting the needs of older patients with cognitive impairment if working without consensus about the care of these patients, if the organisation is disease-oriented and efficiency-driven, and if the environment is busy and inflexible. This facilitated 'falling behind' in relation to meeting the multifaceted needs of older patients with cognitive impairment and contributed to patient suffering, family exclusion and staff frustration.	The theory highlights aspects of importance in the provision of person-centred care of older people with cognitive impairment in acute settings and suggests areas to consider in the development of caring environments in which the place, pace and space can meet the needs of the older person.	The proposed substantive theory can be used to critically examine current ward practices and routines, and the extent to which these support or inhibit high-quality person-centred care for older patients with known or unknown cognitive impairments.	
23451447	To assess the leg length discrepancy (LLD) in the patients who underwent primary total hip replacement both the actual inequality (anatomical LLD) and the perceived feeling of inequality (perceived LLD). Moreover the impact of the perceived LLD on quality of life was evaluated.From January 2011-January 2012, 151 hips from 151 consecutive patients were studied about the post-operative LLD by measuring the post-operative radiographs at follow-up time. Questionnaires concerning the perception of LLD and the Harris hip score (HSS) were completed. Assessing the postoperative quality of life with the EQ-5D patient self-rating tool also was done.	Seventy nine patients had anatomical LLD and 41 patients could perceive LLD. Age, gender, post-operative time at follow-up and the HSS were not significantly different between both perceived LLD and non-perceived LLD patients. After 12 months post-operatively all non-anatomical LLD patients perceived no LLD. Only the EQ-5D of non-perceived LLD group was significantly better.	Perception of LLD after total hip replacement is a significant factor that influences the patients quality of life. However, this frustration could resolve or improve with time.	
23449844	Although people typically avoid engaging in antisocial or taboo behaviors, such as cheating and stealing, they may succumb in order to maximize their personal benefit. Moreover, they may be frustrated when the chance to commit a taboo behavior is withdrawn. The present study tested whether the desire to commit a taboo behavior, and the frustration from being denied such an opportunity, increases attraction to violent video games. Playing violent games allegedly offers an outlet for aggression prompted by frustration. In two experiments, some participants had no chance to commit a taboo behavior (cheating in Experiment 1, stealing in Experiment 2), others had a chance to commit a taboo behavior, and others had a withdrawn chance to commit a taboo behavior. Those in the latter group were most attracted to violent video games. Withdrawing the chance for participants to commit a taboo behavior increased their frustration, which in turn increased their attraction to violent video games.
23445145	Women with postmenopausal bleeding (PMB) are referred for specialist assessment within 2 weeks of presentation to their GP. No research has previously examined women's experiences of expedited referral. This was investigated in the present study using questionnaires (6-item State Anxiety Inventory (6-STAI)) and focus groups. A total of 55 women completed questionnaires. Results showed high levels of anxiety at first hospital visit (mean 47.0 (SD 14.27); 95% CI 43.14-50.93). Scores declined by 90 days, but were higher in those not undergoing hysteroscopy. Fifteen women who underwent hysteroscopy attended focus groups. Women recalled fear of cancer from symptom onset until receipt of results. Anxiety was exacerbated by poor knowledge of PMB and lack of awareness of expedited referral. Post-discharge, those with unexplained or recurrent symptoms expressed frustration and upset. Effective strategies to raise awareness of PMB and its causes are needed, including reasons for expedited referral. Women without cancer may also need more support.
23437816	Implantable cardioverter defibrillator recipients sometimes report "phantom shocks" (PSs), defined as a reported shock lacking objective evidence. The aim of this study was to describe the subjective experience of PSs and their psychosocial correlates using a mixed methods approach.PS participants were matched on sex and age with individuals who received objective shocks only (OSO). Participants were interviewed and completed measures of posttraumatic stress disorder (PTSD Checklist-Civilian Version), depression and anxiety (Hospital Anxiety and Depression Scale), disease-specific distress (Cardiac Anxiety Questionnaire-CAQ), and social desirability (Socially Desirable Response Set-SDRS). Interviews were analyzed using interpretative phenomenological analysis (IPA).	Seventeen male patients participated (PS: n = 9; OSO: n = 8). Three themes emerged from IPA: (1) PS as a somatic experience, (2) the emotional impact of PSs, and (3) searching for meaning. Quantitative analyses showed that both groups exhibited elevated trauma and anxiety levels. Effect size differences (ESD) suggested a medium ESD on depression (P = 0.176, ηp (2) = 0.118) and PTSD (avoidance: P = 0.383, ηp (2) = 0.055, numbing: P = 0.311, ηp (2) = 0.068), and a large ESD on SDRS (P = 0.081, ηp (2) = 0.189), where PS participants, comparatively, exhibited elevated levels. A medium ESD was detected on CAQ-fear (P = 0.237, ηp (2) = 0.092) where OSO participants exhibited greater heart-focused worry.	The qualitative and quantitative findings of this mixed method study show convergence in terms of the emotional factors associated with the experience of PSs. PSs are often reported to be indistinguishable from objective shocks, evoking alarm, frustration, and confusion, forcing the individual to face the uncertainties of what to them is a novel and confusing experience.	
23436472	Using an adapted form of the Taylor Competitive reaction Time (TCRT) task [Taylor (1967). Journal of Personality, 35, 297-310], this study is the first to examine the influence of individual differences in sensitivity to provocations (SP) [Lawrence (2006). Aggressive Behavior, 32, 3, 241-252] as opposed to sensitivity to frustrations (SF) on provoked aggression (noise blasts delivered to a bogus partner). Participants (N = 144) played a competitive reaction time task against a bogus partner, who delivered increasingly loud noise blasts to participants on trials when the participant lost. The study also manipulated the partner's behavior such that, in initial trials, the partner either delivered moderate blasts to the participant or no blasts at all. While accounting for broad trait aggression, those high in SP delivered louder noise blasts to a bogus partner when provoked but not when unprovoked. These individuals also delivered more maximum blasts to the partner and delivered maximum blasts earlier in the TCRT. The effects of SP became non-significant when the partner was initially non-aggressive. Similarly, an initially non-aggressive partner reduced participant aggression under later conditions of moderate provocation from the partner, but this effect became non-significant under subsequent high provocation from the partner. While being related to SP, SF did not influence provoked aggression.
23427930	Pelvic girdle pain (PGP) is a universally disabling condition affecting three of 10 pregnant women. Qualitative studies on the subject are lacking.To describe pregnant women's experiences of PGP as related to daily life.	In all, 27 women with PGP participating in a randomised controlled study were interviewed during 2010-2011. Qualitative content analysis was used.	Five main categories emerged: PGP affects the ability to cope with everyday life; Coping with motherhood; Relationships between partners often reached the breaking point; Questioning one's identity as defined by profession and work, and Lessons learned from living with PGP. The categories illustrate how women's everyday lives were interrupted. Their inability to meet their own and others' expectations put a strain on their lives causing disappointment, sadness and frustration. It made them question and doubt their roles and identities as mothers, partners and professionals, and kept them from looking forward to future pregnancies, in the absence of effective treatment for PGP. Knowledge gained was that women with PGP should seek help immediately, listen to their bodies, and acknowledge their limitations.	PGP severely affects pregnant women's everyday lives. There appears to be a lack of knowledge and awareness in general, as well as among caregivers and employers of PGP that needs to be highlighted and rectified. There is also a great need to learn how to support those suffering from it. Appropriate support during this important and rare phase in a woman's life is highly warranted.	
23421004	Recent work has begun to look at the impact of abusive supervision, a dysfunctional workplace behavior, on employee outcomes. This study extends this line of research by examining vicarious abusive supervision (abuse not directly experienced, but rumors about it or hearing about it, that is "experienced vicariously"). In particular, this research effort investigates whether vicarious abuse has effects above and beyond those accounted for by personally experienced abusive supervision on the outcomes of job frustration, coworker abuse, and perceived organizational support. Our sample is composed of 233 workers from a large variety of organizations. Results reveal that both personally experienced and vicarious abuse have negative impacts and these effects are heightened when both forms of abusive supervision are present. Practical and theoretical implications, as well as directions for future research, are offered.
23418718	Examining case studies of research projects can prove useful to determine what design aspects can be changed to improve the robustness and feasibility of future projects.Pharmacists who took part as research partners in a feasibility study of an eczema support service that failed to achieve its recruitment objectives were asked to attend a focus group to determine their views about factors that may have affected pharmacist recruitment rate.	Pharmacists expressed positive opinions about being involved in research in principle and remaining engaged for further projects. However, they identified problems in their relationship with the medical practices, their unfamiliarity with this particular study design and the challenges this brought. They also experienced frustration from delays to the research timetable holding back their contribution to the research.	In this case study, pharmacists described how and why they wanted a study process to be made as simple and easy as possible for the participants and themselves to engage in, so as to maintain their own and participants' engagement in studies.	
23413201	While symptoms of deficient emotional self-regulation (DESR) such as low frustration tolerance, temper outbursts, emotional impulsivity, and mood lability are commonly associated with attention deficit hyperactivity disorder (ADHD), little is known about their nature. The main aim of this post hoc study was to examine the correlates of DESR in a large sample of adults with and without ADHD. Subjects were 206 adults with ADHD and 123 adults without ADHD from a family study of ADHD. Emotional impulsivity was operationalized using items from the Barkley Current Behavior Scale. Subjects were comprehensively assessed for psychiatric comorbidity using structured diagnostic interview methodology. We used the Quality of Life, Enjoyment, and Satisfaction Questionnaire-Short Form (QLES-Q-SF) and Social Adjustment Scale-Self-report (SAS-SR) to assess quality of life and psychosocial functioning. DESR was more common among ADHD compared with non-ADHD adults, and 55% of adults with ADHD reported extreme DESR of greater severity than 95% of control subjects. The association of ADHD and DESR was not entirely accounted for by either current or lifetime comorbid disorders. DESR was also associated with significant functional impairment as evaluated by the QLES-Q-SF and SAS-SR, and with reduced marital status, as well as higher risk for traffic accidents and arrests. DESR adversely impacts quality of life in adults with ADHD. More work is needed to further evaluate DESR in clinical and investigational studies of subjects with ADHD.
23394623	This study assessed self-reported quality of life of children with a cochlear implant (CI), comparing results with two published reports from the past decade.Participants included 33 pediatric CI recipients with a mean age of 10.12 years (SD = 3.59), mean implantation age of 1.36 years (SD = 0.46), and mean CI experience of 6.23 years (SD = 1.75). Children in all three studies completed a self-report quality-of-life questionnaire that included seven benefit and six problem items, rated on a 5-point Likert scale.	Outcomes revealed agreement across studies in overall benefit and problem ratings. Environmental awareness and frustration reduction were the most and least positively rated outcomes, respectively. Items contributing to overall ratings differed across studies. Current CI recipients rated speech production, making new friends, and understanding speech more positively and taking extra care of the device more negatively than previous generations of pediatric CI users.	Overall, benefits outweigh problems of the device, according to children using CI. Differences in issues motivating self-report ratings reflect changes in CI candidacy, technology, and social participation over the past decade. These findings emphasize the need for clinicians to address not only communication needs, but also quality-of-life issues to optimize outcomes in children using CI.	
23379391	This is a report on a 2008 investigation of the influence of abusive supervision on nursing performance among registered nurses in an urban South Florida county. The findings suggest implications for patient satisfaction.Research suggests that a myriad of negative personal and workplace consequences result when a supervisor is abusive. Researchers have reported frustration, anxiety, stress, psychological distress, problem drinking, family problems, less organizational commitment, fewer organizational citizenship behaviors, and greater intention to resign. Abusive supervision affects an estimated 13.5% of U.S. workers and costs U.S. corporations an estimated $23.8 billion annually. However, there was little understanding of abusive supervision's impact on performance, including within health care.	This study utilized an anonymous mail questionnaire of a random sample of 6,500 registered nurses in an urban South Florida county. Descriptive statistics were used to examine the responses. The survey instrument was self-reporting.	The study found that targeted subordinates reacted with noncompliance with significant organizational performance norms. The incidence of abusive supervision was 46.6%, with 36.6% of the nurses reporting negative influence on performance and compliance.	Supervisory abuse is a problem to the healthcare organizations because of the counterproductive behaviors that resulted. Concern is specifically suggested regarding possible negative influences to patient satisfaction. This article offers a change model and recommendations to curtail abusive supervision.	
23364041	The purpose of this research was to develop a scale to measure the life transition process of parents of children with autism, against the backdrop of a lack of research on this topic.Seventy preliminary items were drawn from previous qualitative research, and content validity was tested by three professors as well as three parents of children with autism. A questionnaire survey was also done between August 2011 and February 2012. Data were collected from 207 parents of children with autism and analyzed using descriptive statistics, item analysis, Cronbach's alpha, Pearson correlation coefficients, and factor analysis with the SPSS Win 15.0 program.	Twenty-nine items were selected to constitute the appropriate measuring scale and categorized into 5 factors explaining 63.2% of the total variance. The 5 factors were named; stages of denial (5 items), wandering (6 items), devotion (7 items), frustration (3 items), and finally acceptance (8 items). Cronbach's alpha for the 29 items was .80.	The results of this study not only suggest assessment criteria for the life transition process of parents who have children with autism but also provide basic directions for program development to provide differentiated support and care at each stage.	
23350880	The current study explored domains of assistive technology (AT) device outcomes that are most valued by AT users. A secondary objective was to identify elements in the device acquisition process that affect outcomes.Focus groups were conducted at geographically dispersed locations within the USA. The groups were moderated by experienced AT practitioners who followed a detailed procedure emphasizing a nominal group facilitation technique.	Twenty-four adult AT users, representing a range of ages and disability populations, participated in four focus groups. Many had over 15 years of experience with multiple device types. Qualitative analysis yielded 13 threads that embodied salient outcome domains (e.g. independence, subjective well-being, participation in work and school, cost-effectiveness) and key factors associated with the device acquisition process (e.g. lengthy periods of frustration, variable quality of service providers). Ironically, these data were evoked only after the term "outcomes" was omitted from focus group questions.	AT outcomes studies are needed that report data regarding (a) the impact of AT on participation, (b) costs of AT provision and (c) key elements in the AT service delivery process. Future studies will be further strengthened to the extent that their methodologies actively assimilate consumer perspectives. Implications for Rehabilitation Consumers highly value the impact of AT devices on their independence, subjective well-being and participation in work and school. The process of acquiring assistive technology devices is often lengthy and frustrating for consumers. Future AT outcomes research should report descriptive data regarding service delivery processes, as well as long-term impacts for consumers. Practitioners and researchers should avoid the use of potentially confusing professional jargon when administering surveys to consumers.	
23343358	The aim was to describe and understand how connecting rehabilitation experiences and everyday life was characterised in the lived experiences during the rehabilitation in women with stress-related ill health.Five women were interviewed on three occasions during a rehabilitation programme and once 3 months later. Data were analysed using the Empirical, Phenomenological and Psychological method.	The participants experienced connections between their rehabilitation and their previous, present and future everyday life influencing both rehabilitation and everyday life in a back-and-forth process. These connections were experienced in mind or in doing, mostly targeting the private arena in everyday life. Connecting rehabilitation experiences to their working situations was more challenging and feelings of frustration and being left alone were experienced.	Although the participants described constructive connections between rehabilitation experiences and the private arena in everyday life, they mostly failed to experience connections that facilitated a positive return to work. Recommended support in the return to work process in rehabilitation comprises the provision of practical work-related activities during rehabilitation; being supportive in a constructive dialogue between the participant and the workplace, and continuing this support in follow-ups after the actual rehabilitation period.	Rehabilitation for persons with stress-related ill health needs to focus on the private arena as well as the work situation in everyday life. Creative activities may enable experiences that inspire connections in mind and connections targeting the private arena in everyday life. The work situation needs to be thoroughly discussed during rehabilitation for enabling the participants to experience a support in the return to work process. Rehabilitation including practical work-related activities, support in a constructive dialogue between the participant and the manager at the workplace, and continued support in follow-ups targeting the workplace might be beneficial for successfully return to work.	
23342957	Reactive aggression (RA) refers to angry responses to provocation or frustration, while proactive aggression (PA) denotes nonemotional, instrumental, and unprovoked aggression. The current study examined personality-related and cognitive correlates of both aggressive types. Respectively, the predictive values of antisocial personality disorder (ASPD), and of hostile interpretation bias, which is the tendency to interpret ambiguous stimuli in a hostile manner, were studied. The sample consisted of n = 37 male adult patients with mixed diagnoses and n = 29 male nonpatients that responded to vignettes and pictures of ambiguous situations, using both open and closed answer formats. ASPD was assessed by means of the Structured Clinical Interview for DSM-IV Axis II disorders (SCID-II), and the Reactive Proactive Questionnaire (RPQ) measured RA and PA. Results showed that although both RA and PA types were predicted by ASPD traits, RA was additionally predicted by a hostile interpretation bias. These findings suggest that reducing hostile bias is a promising avenue for clinical treatment of ASPD-patients high in RA.
23329354	Although distress tolerance is an emerging construct of empirical interest, we know little about its temporal change, developmental trajectory, and prospective relationships with maladaptive behaviors. The current study examined the developmental trajectory (mean- and individual-level change, and rank-order stability) of distress tolerance in an adolescent sample of boys and girls (N = 277) followed over a four-year period. Next we examined if distress tolerance influenced change in Externalizing (EXT) and Internalizing (INT) symptoms, and if EXT and INT symptoms in turn influenced change in distress tolerance. Finally, we examined if any of these trends differed by gender. Results indicated that distress tolerance is temporally stable, with little mean- or individual-level change. Latent growth models reported that level of distress tolerance is cross-sectionally associated with both EXT and INT symptoms, yet longitudinally, only associated with EXT symptoms. These results suggest that distress tolerance should be a focus of research on etiology and intervention.
23324712	The aim of this study was to increase the understanding of stroke survivors' thoughts and experiences from returning to work after stroke.Semi-structured interviews were carried out with twelve persons, based on a thematic interview guide. A qualitative content analysis was performed.	The main theme; Striving for optimal function at work creates mixed feelings of appreciation and frustration, contained three categories: 1) Multiple arrangements and strategies are necessary for returning to work, 2) Work as an activity holds multiple subjective meanings that are important for the motivation to return to work, and 3) The return-to-work process generates many and mixed feelings.	The complexity of the process involving many different actors constitutes great challenges for the affected person in addition to general and medical problems. The stroke survivor should be encouraged to be an active participant during the return-to-work process. Our findings can be used for the development of a programme, including a personal mentor, to support the person striving for returning to work. For detailed planning of such a programme further research is needed.	
23315603	In this secondary analysis, we examined whether older adults with diabetes (aged 60-75 years) could benefit from self-management interventions compared with younger adults. Seventy-one community-dwelling older adults and 151 younger adults were randomized to attend a structured behavioral group, an attention control group, or one-to-one education.We measured A1C, self-care (3-day pedometer readings, blood glucose checks, and frequency of self-care), and psychosocial factors (quality of life, diabetes distress, frustration with self-care, depression, self-efficacy, and coping styles) at baseline and 3, 6, and 12 months postintervention.	Both older (age 67 ± 5 years, A1C 8.7 ± 0.8%, duration 20 ± 12 years, 30% type 1 diabetes, 83% white, 41% female) and younger (age 47 ± 9 years, A1C 9.2 ± 1.2%, 18 ± 12 years with diabetes, 59% type 1 diabetes, 82% white, 55% female) adults had improved A1C equally over time. Importantly, older and younger adults in the group conditions improved more and maintained improvements at 12 months (older structured behavioral group change in A1C -0.72 ± 1.4%, older control group -0.65 ± 0.9%, younger behavioral group -0.55 ± 1.2%, younger control group -0.43 ± 1.7%). Furthermore, frequency of self-care, glucose checks, depressive symptoms, quality of life, distress, frustration with self-care, self-efficacy, and emotional coping improved in older and younger participants at follow-up.	The findings suggest that, compared with younger adults, older adults receive equal glycemic benefit from participating in self-management interventions. Moreover, older adults showed the greatest glycemic improvement in the two group conditions. Clinicians can safely recommend group diabetes interventions to community-dwelling older adults with poor glycemic control.	
23292480	The aim of this study was to describe how persons with rheumatoid arthritis (RA) of working age experience and handle their fatigue in everyday life. Six focus group discussions were conducted focusing on experiences of fatigue in 25 persons with RA (19 women, 6 men), aged 20-60 years. The discussions were recorded, transcribed verbatim, and analyzed according to qualitative content analysis. The analyses resulted in four categories. (1) Perception of fatigue: Fatigue was experienced different from normal tiredness, unpredictable, and overwhelming. It was associated with negative emotions, changed self-image, and fears. Feelings of frustration and shame were central when the persons were forced to omit valued life activities. (2) Consequences due to fatigue: The fatigue caused changes in cognitive ability, ability to act, and overall activity pattern where the increased need for rest and sleep caused an imbalance in daily life. The participants struggled not to let the fatigue interfere with work. The fatigue also brought negative consequences for their significant others. (3) Communicating fatigue: Fatigue was difficult to gain understanding for, and the participants adjusted their communication accordingly; it was important to keep up appearances. During medical consultation, fatigue was perceived as a factor not given much consideration, and the participants expressed taking responsibility for managing their fatigue symptoms themselves. (4) Strategies to handle fatigue: Strategies comprised conscious self-care, mental strategies, planning, and prioritizing. Fatigue caused considerable health problems for persons with RA of working age: negative emotions, imbalance in daily life due to increased need for rest, and difficulties gaining understanding. This draws attention to the importance of developing new modes of care to address fatigue in RA. Person-centered care to improve balance in life may be one approach needing further investigations.
23292306	The clinical management of 'difficult' patients is a major challenge which exposes mental health teams to an increased risk of frustration and stress and may lead to professional burnout. The aim of the present study was to investigate whether a cognitive-analytic therapy (CAT) based training undertaken by a mental health team working with 'difficult' patients reduced professional burnout symptoms, improved patients' service engagement and increased the levels of team-cohesion. Twelve mental health staff members from different professional and educational backgrounds took part in five 2-hour sessions providing a basic CAT training intervention, an integrative and relational model of psychotherapy for the treatment of borderline personality disorders. Participants were administered the Maslach Burnout Inventory (MBI), the Service Engagement Scale (SES) and the Group Environment Questionnaire (GEQ) before (T0) and after (T1) CAT training, and at 1-month follow-up (T2). A significant decrease were found, at T2, on the MBI Emotional Exhaustion scores, the SES Availability subscale, the GEQ Attraction to Group-Social and Group Integration-Social, while the MBI-Personal Accomplishment scores increased from baseline.The results of this study suggest that a CAT-based training can facilitate team cohesion and patient engagement with a service and reduce burnout levels among mental health team members dealing with 'difficult' patients. 
23289406	Stereotypic behaviours, i.e. repetitive behaviours induced by frustration, repeated attempts to cope and/or brain dysfunction, are intriguing as they occur in a variety of domestic and captive species without any clear adaptive function. Among the different hypotheses, the coping hypothesis predicts that stereotypic behaviours provide a way for animals in unfavourable environmental conditions to adjust. As such, they are expected to have a lower physiological stress level (glucocorticoids) than non-stereotypic animals. Attempts to link stereotypic behaviours with glucocorticoids however have yielded contradictory results. Here we investigated correlates of oral and motor stereotypic behaviours and glucocorticoid levels in two large samples of domestic horses (NStudy1 = 55, NStudy2 = 58), kept in sub-optimal conditions (e.g. confinement, social isolation), and already known to experience poor welfare states. Each horse was observed in its box using focal sampling (study 1) and instantaneous scan sampling (study 2). Plasma samples (collected in study 1) but also non-invasive faecal samples (collected in both studies) were retrieved in order to assess cortisol levels.Results showed that 1) plasma cortisol and faecal cortisol metabolites concentrations did not differ between horses displaying stereotypic behaviours and non-stereotypic horses and 2) both oral and motor stereotypic behaviour levels did not predict plasma cortisol or faecal cortisol metabolites concentrations.	Cortisol measures, collected in two large samples of horses using both plasma sampling as well as faecal sampling (the latter method minimizing bias due to a non-invasive sampling procedure), therefore do not indicate that stereotypic horses cope better, at least in terms of adrenocortical activity.	
23289220	The article presents data on features of uneasiness and depression in elderly and senile patients with arterial hypertension. Age and gender differences of these problems are discussed. The patients of the senior age groups have normal level of uneasiness on a scale of situational uneasiness, and women of advanced age and patients of control group have the raised level of uneasiness on a scale of personal uneasiness. The gender differences on a scale of personal uneasiness are revealed. Frustrations of a depressive range are noted at assessment of the depressive status in all age and gender groups.
23288207	The goal of this first-of-its-kind qualitative study was to examine the awareness, attitudes, and experiences among parents of autistic children regarding autism genetic testing.We conducted in-depth, individual, and semistructured interviews with 42 parents of autistic children with diverse racial/ethnic backgrounds. All interviews were audio-taped, transcribed, and coded into major themes and subthemes.	Approximately one-quarter of participants had two or more autistic children, and about half of them were ethnic/racial minorities. The majority of participants postulated favorable attitudes toward autism genetic testing for three main reasons: early intervention and treatment, identifying the etiology of autism, and informed family planning. Nevertheless, among parents who had taken their children for genetic testing, some expressed frustration and questioned the competency of their providers in interpreting test results. Asian parents and those with a low socioeconomic status expressed lower awareness and tended to have more limited access to autism genetic testing.	As health-care providers play a vital role in providing genetic services and education, these professionals should be educated and be sensitive to the needs of parents with autistic children. Further quantitative research is required to examine the effects of socio-demographic factors on parents' awareness, attitudes, and experiences regarding autism genetic testing.	
23287637	This longitudinal study builds on existing research exploring the developmental course of infants' negative reactivity to frustration in a sample of 84 irritable infants. We investigated whether infants' negative reactivity to frustration differed during the first year as a function of infant attachment classification. Various elements of the designs of previous studies investigating negative reactivity and attachment preclude the strong conclusion that negative reactivity develops differently as a function of attachment. Thus, we utilized the same observational assessment of infant negative reactivity, conducted without parental involvement, at 5 and 12 months. One proposition, based in attachment theory (Bowlby, 1969/1982; Cassidy, 1994), is that relative to secure infants, insecure-avoidant infants come to minimize their negative emotional reactions, whereas insecure-ambivalent infants come to maximize their negative emotional reactions. As expected, we found that at 5 months, attachment groups did not differ in reactivity, but at 12 months, insecure-avoidant infants were the least reactive, followed by secure infants, and insecure-ambivalent infants were the most reactive. Results are discussed in terms of conceptualizing the development of emotion regulation and their implications for future research.
23285834	This article documents the experiences of providing housing and supportive services, or ecologically based treatment, to shelter-recruited, substance-abusing homeless women with young children in their care. Among clients, observed experiences related to housing, substance abuse, and health and mental health care are discussed. Among therapists, experiences related to managing the chaotic nature of the client's lives, wanting to manage the client's lives, and frustration with client's life trajectories are reviewed. Observations related to the therapeutic process include the client's relationship to the therapist, balancing the client's independence and need for assistance, and unrealistic expectations among the clients. Recommendations for successfully approaching these clinical situations and experiences are offered. The purpose of this article is to document these therapy experiences to facilitate the work of future teams seeking to intervene in the lives of homeless families through homeless shelters or other settings.
23285231	To ascertain impairment in quality of life and work productivity among patients with psoriasis and psoriatic arthritis.From 2003 through 2011, the National Psoriasis Foundation collected survey data from patients with psoriasis and psoriatic arthritis via email and telephone correspondences.	Survey data were collected from psoriasis and psoriatic arthritis patients in the general community in the U.S.	Quality of life focusing on emotional impact (anger, frustration, helplessness, etc.) and physical impact (pain, pruritus, physical irritation, etc.); employment status.	The surveys were performed through random sampling of participants from a database of over 75,000 patients.	From 2003 to 2011, 5,604 patients completed the surveys. Psoriasis and psoriatic arthritis affected overall emotional wellbeing in 88% of patients, and they interfered with enjoyment of life in 82%. Most patients reported experiencing anger (89%), frustration (89%), helplessness (87%), embarrassment (87%), and self-consciousness (89%). Many patients also actively concealed physical manifestations of their diseases (83%), and experienced pain (83%) and pruritus (93%) regularly. Of note, 12% of patients were unemployed, and 11% worked part-time. Among unemployed patients, 92% cited psoriasis and/or psoriatic arthritis as the sole reasons for not working. Among working patients, 49% missed work days regularly due to psoriasis. Compared to patients with mild psoriasis, patients with severe psoriasis have 1.8 times greater odds to be unemployed after adjusting for age and gender (Adjusted OR = 1.7, 95% CI 1.4-2.3).	Patients with psoriasis and psoriatic arthritis continue to experience significant impairment of quality of life and work productivity.	
23282291	During extinction a previously learned behavior stops being reinforced. In addition to the decrease in the rate of the instrumental response, it produces an aversive emotional state known as frustration. This state can be assimilated with the fear reactions that occur after aversive stimuli are introduced at both the physiological and behavioral levels. This study evaluated frustration reactions of domestic dogs (Canis familiaris) during a communicative situation involving interactions with a human. The task included the reinforcement and extinction of the gaze response toward the experimenter's face when the dogs tried to obtain inaccessible food. The dog's frustration reactions during extinction involved an increase in withdrawal and side orientation to the location of the human as well as lying down, ambulation, sniffing, and vocalizations compared with the last acquisition trial. These results are especially relevant for domestic dog training situations in which the extinction technique is commonly used to discourage undesirable behaviors.
23280636	This study examined the widely held but insufficiently studied hypothesis of autonomy disturbances in anorexia nervosa.A total sample of 112 participants comprising patients with acute anorexia nervosa (AN), women recovered from anorexia nervosa (REC), clinical controls (CC), and healthy controls (HC) completed measures of dependency and intimacy strivings, as well as measures of frustrations of these same strivings.	In comparison to HC and CC, AN showed a stronger motivation to avoid dependency and lower strivings for intimacy. Compared with HC, but not with CC, AN also showed stronger frustrations of the same motives. Whereas REC did not differ from AN regarding avoidance of dependency, they reported lower frustration of dependency avoidance (i.e., less actual experiences of dependency). Finally, REC reported higher intimacy motivation as well as better satisfaction of intimacy motivation as compared with AN.	The present findings suggest that a pronounced motive of avoiding dependency may be a vulnerability factor for anorexia nervosa that is disorder-specific and trait-like. Frustrations of this motive seem to be associated with psychopathology.	
24922991	Doctor-patient relationships in China have been deteriorating for the past 10 years. Many Chinese doctors are involved in tense and conflictual doctor-patient relationships. Most patients do not trust doctors or other medical staff and physical attacks on these professionals have become a common event. The Balint group offers a better understanding of the doctor-patient relationship in a safe environment and relieves the doctors from the daily stress.This article (1) describes the specifics of Balint work in China, (2) reports experiences from the first International Balint Conference in China, and (3) compares these experiences with the doctor-patient relationship described by Michael and Enid Balint in the 1950s.	Chinese doctors have a great need to communicate, to share their own feelings of powerlessness, helplessness, frustration, and anger. The Balint method is highly appreciated in China. All participants experienced the 2 1/2-day meeting as very helpful. Also, in China, Balint work as relationship work in the analytical group process fosters the ability for introspection alongside openness, unconscious processes, "thinking outside the box," "courage of one's own stupidity," and "beginner's spirit," thus promoting the individuation, the "small but significant change in the personality of the doctor."	Perhaps Balint work in China is a contribution to the integration of traditional Chinese virtues: benevolence, tolerance, magnanimity, and prudence with modern medicine. Balint work could be an alternative to the outcome-oriented pressure to perform and to the machine paradigm of biomedicine.	
24639657	This paper is a qualitative investigation that aims to investigate the lived experience of fatigue in patients with motor neurone disease-a progressive and fatal neurological condition.Fatigue is a disabling symptom in motor neurone disease (MND) that affects a large number of patients. However, the term "fatigue" is in itself imprecise, as it remains a phenomenon without a widely accepted medical definition. This study sought to investigate the phenomenon of fatigue from the perspective of the MND patient.	Ten patients with MND participated in semi-structured recorded interviews at a regional neuroscience center in Liverpool, UK. Transcripts analysis was broadly informed by the principles of interpretative phenomenological analysis (IPA).	Fatigue was unanimously explained to be disabling and progressive phenomenon. Participants described two forms of fatigue: whole-body tiredness or use-dependent reversible muscle weakness related to exertion of limb and bulbar muscles. Both weakness and whole-body tiredness could be experienced simultaneously, and patients used the terms "fatigue" and "tiredness" interchangeably. Alongside descriptions of fatigue themes of Adaptation, Motivation, Avoidance, Frustration and Stress were revealed. Fatigue could be defined as "reversible motor weakness and whole-body tiredness that was predominantly brought on by muscular exertion and was partially relieved by rest."	The results of this study support a multi-dimensional model of fatigue for patients with MND. Fatigue appears to be experienced and explained in two ways, both as an inability to sustain motor function and as a pervasive tiredness. Fatigue was only partially relieved by rest and tended to worsen throughout the day. It is crucial that MND care practitioners and researchers appreciate the semantic dichotomy within fatigue.	
23259934	This study aimed at exploring the experiences of primary health-care providers of their encounters with patients with type 2 diabetes, and their preferences and suggestions for future improvement of diabetes care.Barriers to good diabetes care could be related to problems from health-care providers' side, patients' side or the health-care system of the country. Treatment of patients with type 2 diabetes has become a huge challenge in Oman, where the prevalence has increased to high levels.	Semi-structured interviews were conducted with 26 health-care professionals, 19 doctors and seven nurses, who worked in primary health care in Oman. Qualitative content analysis was applied. Findings Organizational barriers and barriers related to patients and health-care providers were identified. These included workload and lack of teamwork approach. Poor patients' management adherence and influence of culture on their attitudes towards illness were identified. From the providers' side, language barriers, providers' frustration and aggressive attitudes towards the patients were reflected. Decreasing the workload, availability of competent teams with diabetes specialist nurses and continuity of care were suggested. Furthermore, changing professional behaviours towards a more patient-centred approach and need for health education to the patients, especially on self-management, were addressed. Appropriate training for health-care providers in communication skills with emphasis on self-care education and individualization of care according to each patient's needs are important for improvement of diabetes care in Oman.	
23258114	In this study I explored the perceptions and responses of Jewish Israeli social workers to the health inequalities facing their Arab clients. Findings drawn from face-to-face, in-depth interviews with 26 Jewish Israeli social workers employed in the health field show that they were highly aware of the health inequalities. Although they uniformly insisted that there was no discrimination in the hospitals where they were employed, they observed extensive structural and individual discrimination outside the hospital and linguistic and sociocultural impediments to health equality within it. The discrimination provoked feelings of anger and moral outrage, guilt, and shame. Both the discrimination and the linguistic and sociocultural impediments filled them with frustration and led them, both individually and in concert with colleagues, to try to alleviate, circumvent, correct, or compensate for the impediments. Suggestions are made for practice and further research.
23252434	Injuries from explosive devices can cause blast-force injuries, including mild traumatic brain injury (mTBI).This study investigated changes in personality from blast-force mTBI in comparison to blunt-force mTBI.	Clinicians and significant others assessed US veterans who sustained pure blast-force mTBI (n = 12), as compared to those who sustained pure blunt-force mTBI (n = 12). Inclusion criteria included absence of any mixed blast-blunt trauma and absence of post-traumatic stress disorder. Measures included the Interpersonal Measure of Psychopathy (IM-P), the Big Five Inventory (BFI), the Interpersonal Adjectives Scale (IAS) and the Frontal Systems Behaviour Scale (FrSBe).	There were no group differences on demographic or TBI-related variables. Compared to the Blunt Group, the Blast Group had more psychopathy on the IM-P, with anger, frustration, toughness and boundary violations and tended to more neuroticism on the BFI. When pre-TBI and post-TBI assessments were compared on the IAS and FrSBe, only the patients with blast force mTBI had become more cold-hearted, aloof-introverted and apathetic.	These results suggest that blast forces alone can cause negativistic behavioural changes when evaluated with selected measures of personality. Further research on isolated blast-force mTBI should focus on these personality changes and their relationship to blast over-pressure.	
23238531	This study analyzes the effect of weather variables, such as solar radiation, indoor and outdoor air temperature, relative humidity and time spent outdoor, on the behavior of 2-year-old children and their affects across different seasons: winter, spring and summer. Participants were a group of 61 children (33 males and 28 females) attending four day-care centers in Florence (Central Italy). Mean age of children at the beginning of the study was 24.1 months (SD = 3.6). We used multilevel linear analyses to account for the hierarchical structure of our data. The study analyzed the following behavioral variables: Activity Level, Attentional Focusing, Frustration, and Aggression. Results showed a different impact of some weather variables on children's behavior across seasons, indicating that the weather variable that affects children's behavior is usually the one that shows extreme values during the studied seasons, such as air temperature and relative humidity in winter and summer. Studying children and their reactions to weather conditions could have potentially wide-reaching implications for parenting and teaching practices, as well as for researchers studying social relationships development.
23218591	Oncology patients may respond to radiation treatment with anxiety expressed as stress, fear, depression, and frustration. This study aimed to investigate effects of music intervention on reducing pre-radiotherapy anxiety in oncology patients.Quasi-experimental study with purposeful sampling was conducted in the Department of Radiation Oncology, at Far Eastern Memorial Hospital, Taipei, Taiwan. Subjects were assigned into a music group (n = 100) receiving 15 min of music therapy prior to radiation and a control group (n = 100) receiving 15 min rest prior to radiation. Both groups were evaluated for pre- and post-test anxiety using the State-Trait Anxiety Inventory. Physiological indicators of anxiety were measured pre- and post-test.	Baseline State/Trait scores and vital signs were comparable between groups (P > 0.05). Mean change in pre- and post-test State/Trait scores showed significant decreases from baseline to post-test in both groups (all P < 0.05). A statistically significant difference was observed between music therapy and control groups in mean change of State anxiety scores (mean decreases 7.19 and 1.04, respectively; P < 0.001) and Trait anxiety scores (mean decreases 2.77 and 1.13, respectively; P = 0.036). In vital signs, both groups had significant decreases in pre- and post-test heart rate and respiration rate (P < 0.05). A statistically significant difference in mean change of systolic pressure was found between music and control groups (-5.69 ± 0.41 mmHg vs. -0.67 ± 1.29 mmHg, respectively; P = 0.009).	Music therapy decreased State anxiety levels, Trait anxiety levels and systolic blood pressure in oncology patients who received the intervention prior to radiotherapy.	
23208827	Recently, several studies reported a relationship between immune system activation and anger expression. Consequently, the aim of this study was to explore immunitary molecular mechanisms that potentially underlie anger expression. To this end, we applied the Frustration-Aggression Theory in a contact sport model, utilizing the nearing of sporting events to trigger anger feelings. In parallel, we evaluated the activation of immune system at mRNA levels. We enrolled 20 amateur rugby players (age ± SD, 27.2 ± 4.5) who underwent psychological assessment to evaluate anger, with the State-Trait Anger Expression Inventory-2 (STAXI-2), before rugby matches; at the same time blood samples were taken to analyze the variations of gene expression by microarray. During the 2 hr before each game, a significant increase was verified in the Rage State (RS) score compared to the score ascertained 72 hr before. At the same time, we found modulation in expression profile, in particular increased expression of gene that encodes interleukin l-β (IL-1β). In a regression analysis, RS score was related to IL-1β, and the potential risk factors age, body mass index, smoking, and drinking. The levels of cytokine were positively and independently related to RS score. Our results suggest that the nearing of sporting event can trigger anger state feelings and activate immune system in rugby players. We propose the IL-1β as a potential biological marker of anger. However, further research is necessary to clarify the correlation between cytokine and anger.
23182641	This qualitative study explored the phenomenon of fatigue for people with Charcot-Marie-Tooth disease, while acknowledging the triggers, impact and strategies people have developed to manage this symptom in daily life. A phenomenological approach was used to explore the experience of fatigue. Participants were recruited from a support group. Twenty-five people participated in three focus groups. Group interviews were tape recorded and independently transcribed. Transcripts were coded and emerging themes were highlighted. Four areas were explored and themes identified within them. Fatigue descriptions: energy depletion, overwhelming nature, variations in fatigue and fatigue as an abnormal experience; triggers of fatigue: activity, stress and mental concentration; impact of fatigue on: physical abilities, mood, guilt and frustration, isolation and concerns about how they were perceived by others; strategies to manage fatigue: coping with symptoms; planning ahead; deception; and reducing symptoms. This study revealed that fatigue is an overwhelming experience for people with Charcot-Marie-Tooth disease that impacts on many areas of their lives. People may require significant adjustment that could be facilitated by fatigue management approaches. In addition, exercise may have potential to reduce the symptoms of fatigue in some people.
23186117	Operating theatre inefficiency and changeover delays are not only a significant source of wasted resources, but also a familiar source of frustration to patients and health-care providers. This study aimed to prove that the surgical registrar through active involvement in patient changeover can significantly improve operating room efficiency and minimize delays.A two-phase prospective cohort study was undertaken, conducted over the course of 4 weeks at a single institution. The only inclusion criteria comprised patients to undertake endoscopic urological day surgery cases and require general anaesthesia. There were no exclusions. In the first phase (observational, with no intervention), changeover times between cases were documented. The second phase followed a structured intervention, involving the surgical registrar being actively involved in the patient's operative journey. Outcome measures were qualitative measures of operative efficiency. Statistical analysis was undertaken.	There were 42 patients included in this study, with 21 patients in each of its arms. A 48% (P-value < 0.01) reduction in overall case changeover times was demonstrated with the utilization of a structured intervention from 27.7 min (95% confidence interval (CI) 22.8-32.7%) to 15.7 min (95% CI 13.2-18.2%). The intervention results were statistically significant (P-value < 0.05) for all markers of efficiency except for the waiting time in the anaesthetic holding bay (P-value 0.13).	The surgical registrar can improve operating room efficiency by using a structured intervention, ultimately reducing patient changeover times.	
23184920	Rapid access to acute stroke care is essential to improve stroke patient outcomes. Policy recommendations for the emergency management of stroke have resulted in significant changes to stroke services, including the introduction of hyper-acute care.To explore patients' and carers' experiences of gaining access to acute stroke care and identify the factors that enabled or prevented stroke from being treated as a medical emergency.	Qualitative semi-structured interviews were conducted with 59 stroke survivors and carers who had received care at seven UK centres. The interviews were recorded and transcribed verbatim and thematic analysis was undertaken.	Themes emerging showed that participants recognised signs and symptoms, they were satisfied with access to emergency medical services (EMS), and they experienced setbacks in the emergency department and delays caused by the lack of availability of specialist services outside normal working hours. Awareness of the importance of time to treatment was generally attributed to the UK stroke awareness campaign, although some felt the message was not sufficiently comprehensive. This awareness led to increased frustration when participants perceived a lack of urgency in the provision of assessment and medical care.	The stroke awareness social marketing campaign has contributed to public knowledge and was perceived to assist in reducing prehospital delay. It has also resulted in an enhanced knowledge of the significance of rapid treatment on admission to hospital and raised public expectation of EMS and stroke services to act fast. More research is required to assist organisational change to reduce in-hospital delay.	
23182783	Being a hurried driver is associated with a variety of risky driving behaviors, yet the mechanisms underlying this behavior remain unknown. Distress tolerance, defined as an individual's capability to experience and endure negative emotional states, was examined as a predictor of hurried driving among 769 college students. Results indicate that after controlling for age, gender, race, ethnicity, the student's year in school, their grade point average, driving frequency, angry driving, aggressive driving as well as other forms of self-reported risky driving; hurried driving was significantly associated with lower levels of distress tolerance. Hurried drivers also reported greater levels of frustration and impatience with other drivers, suggesting that they have difficulty in withstanding or coping with negative psychological states when driving. Traditional traffic safety campaigns that emphasize enforcement may be less successful with these drivers. The need to develop campaigns that address the affective coping abilities that contribute to this behavioral pattern is discussed.
23169757	The 17q21.31 microdeletion syndrome with its characteristic features including developmental delay, moderate intellectual disability, facial dysmorphisms, and anomalies of the brain and multiple organ systems was recently described. As to its behavioral profile, scarce data from clinical observations have suggested a remarkably amiable, friendly disposition, to some extent comparable to that observed in Angelman and Williams syndromes. The present study focuses on the various aspects of neurocognitive functioning, particularly social cognition, in patients with 17q21.31 microdeletion syndrome. Neuropsychological assessment was performed in three out of the four known Dutch patients with a genetically proven 17q21.31 microdeletion syndrome. Apart from developmental age, cognition and social-emotional functioning was extensively assessed. In addition, data of three intellectually disabled physically healthy reference subjects, recruited from a small outpatient sample, were included. The general cognitive profile of all subjects was in accordance with their lowered intellectual capacities, albeit that in patients with the 17q21.31 microdeletion, a relatively strong memory for social-contextual information was found. Basic emotion perception was intact, but patients with the 17q21.31 microdeletion syndrome showed less social fear and more approaching behavior. Interestingly, alexithymic traits, that is marked difficulties in the recognition and expression of emotions, were more prevalent in reference subjects. Despite the methodological limitations characteristic for research in people with intellectual disabilities, with a neuropsychological assessment strategy, in three patients with 17q21.31 microdeletion syndrome, preliminary evidence for hypersocial behavior with a high level of frustration tolerance was found that may be implicated in its behavioral phenotype.
23165558	Spain has become the country in the European Union with the fourth highest number of overweight and obese children. This condition directly affects physical health as well as mental health. The objective of this research study was to evaluate motivational aspects in one group of obese or overweight adolescents and another group of normal-weight adolescents. For this purpose a descriptive observational study was carried out in an educational institution in Guadix (Granada). The universe was composed of 200 children of ages 10 to 14. A sample of 24 children was selected by means of proportional random sampling with an error of 0.19, and was divided into the following groups (i) 12 normal-weight children; (ii) 12 obese children. Motivation was measured by means of the School Motivation Analysis Test (SMAT), a multidimensional measuring instrument based on Cattell's dynamic model of motivation and emotions. Our study evaluated five motivational parameters: TAO (total autism-optimism), TGI (total general information), TIN (total integration), TPI (total personal interest), and TCO (total conflict). Our results showed that for each of the SMAT variables, the overweight and obese children obtained an average value of 4.5 in contrast to the normal-weight children, who obtained an average value of 5.9. This indicates that overweight and obese children have low motivational states and a higher level of frustration. They also tend to distort reality by alleging the existence of obstacles that prevent them from achieving their goals.
23157646	Strict adherence to a gluten-free diet is the only treatment for coeliac disease. The gluten-free diet is complex, costly and impacts on all activities involving food, making it difficult to maintain for a lifetime. The purpose of this cross-sectional study was to evaluate the difficulties experienced, the strategies used and the emotional impact of following a gluten-free diet among Canadians with coeliac disease.A questionnaire was mailed to all members (n = 10 693) of both the Canadian Celiac Association and the Fondation québécoise de la maladie cœliaque in 2008.	The overall response rate was 72%. Results are presented for the 5912 respondents (≥18 years) reporting biopsy-confirmed coeliac disease and/or dermatitis herpetiformis. Two-thirds never intentionally consumed gluten. Women reported significantly greater emotional responses to a gluten-free diet but, with time, were more accepting of it than men. Difficulties and negative emotions were experienced less frequently by those on the diet for >5 years, although food labelling and eating away from home remained very problematic. Frustration and isolation because of the diet were the most common negative emotions experienced.	The present study quantifies the difficulties experienced, the strategies used and the emotional impact of following a gluten-free diet. It highlights the need to improve the training and education of dietitians, other health providers and the food service industry workers about coeliac disease and a gluten-free diet, with the aim of better helping individuals improve their adherence to a gluten-free diet and their quality of life.	
23153720	While commonly used quality-of-life instruments assess perceived epilepsy-associated limitations in life domains and formally document patient concerns, less is known of community-dwelling adults with epilepsy about their satisfaction with broader life domains, such as satisfaction with housing, education, neighborhood, ability to help others, and achievement of goals. The purpose of this study was to examine satisfaction with life domains in a representative sample of community-dwelling adults with self-reported epilepsy from the 2008 HealthStyles survey. Following adjustment for sex, age group, race/ethnicity, education, and income, people with epilepsy were more likely to report frustration in the domains of achievement (e.g., dissatisfaction with education and life goals), compromised social interactions (dissatisfaction with family life, friends, and social life), and compromised physical capability (dissatisfaction with health and energy level). Life satisfaction and other well-being domains can supplement health indicators to guide treatment and program services for people with epilepsy to maximize their well-being.
23146006	The purpose of this article is to illuminate the dynamics of sibling group support when one sibling has complex needs accompanied by difficult behaviors. A case study of sibling support for a twenty-year-old woman with a disability, a mental health issue, and addictions, drawn from the perspectives of her full brother, her half-brother, and their mother, is presented. The brothers express ambivalence between devotion to supporting their sister and limits to the support they feel able to provide. The limits the brothers place on their support allow them to adhere to their values, preserve their energy and, ultimately, sustain their ability to provide support.
23140484	The purpose of this paper is to explore the context of the sexual health of Latino migrant day labourers in the USA, challenges to sexual health and ways of coping, with attention to conditions of structural vulnerability permeating the lives of this unique Latino population. Given the limited information about this topic and population, ethnographic research employing in-depth semi-structured interviews with 51 labourers, recruited through purposive sampling in the San Francisco Bay Area, was utilised. The sexual health aspirations of the men are deeply embedded in the core value and practice of Latino familismo or, in this case, the central goal of securing a family headed by men as providers and present husbands/fathers. However, such goals are frequently thwarted by the poverty engendering work and prolonged separations from home that characterise predominantly undocumented day labour in the USA. Resulting goal frustration, combined with pent up sexual urges, often lead to sexual risk in spite of efforts to cope with challenges to sexual health. Unless community-, state- and national-level interventions are developed to mitigate the pronounced structural vulnerability of migrant day labourers, individual level interventions to promote sexual health, and decrease risk and distress, are likely to have diminishing returns.
23130521	According to inspection of 206 patients of 60 years old and elder on the basis of neurologic department of the Geriatric Center of Republican Hospital No 3 high prevalence of depression of small and average degree in the persons of advanced age suffering from cerebrovascular diseases is revealed. To estimate the expressiveness of depression the Hamilton's scale including 17 parameters was used.
23123157	in Australia, as in other developed countries, women have consistently reported lower levels of satisfaction with postnatal care compared with antenatal and intrapartum care. However, in Victoria Australia, women who receive private hospital postnatal care have rated their care more favourably than women who received public hospital care. This study aimed to gain a further understanding of this by exploring care providers' views and experiences of postnatal care in private hospitals.qualitative design using semi-structured interviews and thematic analysis.	private maternity hospitals in Victoria, Australia.	eleven health-care providers from three metropolitan and one regional private hospital including eight midwives (two maternity unit managers and six clinical midwives) and three obstetricians.	two global themes were identified: 'Constrained Care' and 'Consumer Care'. 'Constrained care' demonstrates the complexity of the provision of postnatal care and encompasses midwives' feelings of frustration with the provision of postnatal care in a busy environment complicated by staffing difficulties, a lack of continuity and the impact of key players in postnatal care (including visitors, management and obstetricians). 'Consumer care' describes care providers' views that women often approach private postnatal care as a consumer, which can impact on their expectations and satisfaction with postnatal care. Despite these challenges, care providers, particularly midwives, highly valued (and generally enjoyed working in) postnatal care.	this study, along with other Australian and international studies, has identified that hospital postnatal care is complex and characterised by multiple barriers which impact on the provision of quality postnatal care. Further research is needed to evaluate routine postnatal practices and continuity of care within the postnatal period. In-depth qualitative studies investigating women's expectations and experiences of postnatal care in both the public and private sector are also needed.	
23121479	Gastroesophageal reflux disease (GERD) has been related with certain psychological dimensions. The influence of mood, emotional intelligence, and perceived quality of life on clinical symptoms and outcome of antireflux surgery was evaluated in GERD patients with and without hiatal hernia. The study included 61 patients who were diagnosed with GERD between 2003 and 2008: 16 of them without hiatal hernia (group A) and 45 of them with hiatal hernia (group B). All of these patients had undergone laparoscopic antireflux surgery. Patients were clinically examined and evaluated with the following instruments: Short Form (SF)-36 Health Survey, Gastrointestinal Quality of Life Index, Hospital Anxiety and Depression (HAD) Scale, and Trait Meta-Mood Scale (TMMS)-24. Proportions were compared by using the chi-squared test; averages were compared by using the Student's t-test (with Bonferroni's correction). In general, our patients intervened for GERD showed results lower than normal or close to the lower limit of normal in the administered tests. Patients in the group without hernia were younger (P < 0.001) and with lower American Society of Anaesthesiologists risk. They showed higher scores in the SF-36 dimensions: Physical Functioning, Physical Role and Emotional Role, and lower scores in the Social Role (P < 0.001). They showed lower scores in the Emotional dimension of Gastrointestinal Quality of Life Index (P = 0.0068) and worse results in the Hospital Anxiety and Depression subscales of Anxiety (P < 0.001) and Depression (not significant). Men in the group without hernia showed higher scores than men in the group with hernia in the TMMS subscales corresponding to Emotional Clarity and Emotional Repair (P < 0.001). Women in the group with hernia showed higher scores than women in the group without hernia regarding Emotional Clarity (P = 0.0012). GERD patients showed poor results in all the tests, and patients without hiatal hernia compared with patients with hernia showed higher levels of anxiety, which interfered with their social life. Moreover, they showed lower tolerance to stress and higher frustration, fear, and worry. On the basis of such unfavorable phychoemotional results observed with GERD patients (especially those without hernia) in the different tests, we propose that improving our knowledge of the psychological profile of GERD patients - particularly those without hiatal hernia - could help in designing individualized medical and psychological therapies and increase success rates. 
23109495	A large body of research reveals support for Agnew's general strain theory (GST) and Gottfredson and Hirschi's self-control theory, yet the two perspectives make decidedly different predictions concerning the relationships between self-control, negative affect (e.g., anger), and criminal/deviant behavior. Where GST specifies indirect and conditioning effects of self-control and negative affect on criminal/deviant behavior, self-control theory states that the independent effect of indicators of anger would be spurious and should disappear on controlling for self-control. We test these propositions using survey data from a probability sample of young adults. The structural equation models indicate that, although anger is largely the consequence of self-control, self-control and negative affect exert significant direct effects on driving aggression. These results highlight the need to integrate GST and self-control theories to better explain this form of deviant behavior. 
23098031	Chorea Huntington is an autosomal dominantly inherited, neurodegenerative brain disorder that leads to involuntary hyperkinesia, psychotic symptoms and dementia. The illness not only changes the life of the person itself but also the world of the caregivers. The challenges in the care of a person which is affected by Chorea Huntington have an effect on the daily living as an assemblage of natural and social conditions.a multiple case study was conducted. It included semi-structured interviews with three caregivers of people with Chorea Huntington in South Tyrol. The qualitative data was analyzed using the qualitative structured analysis of Mayring (2007).	The objective of this study was to describe the phenomenon of change of life from family members that care people affected by Chorea Huntington in a specific cultural setting (South Tyrol, Italy).	The caregivers reported that the diagnosis of Chorea Huntington leads to negative changes in "relationship and family". Particularly, frustration, aggression, impatience and apathy were perceived as stressful. At the same time they highlight the positive changes through home care. They report that the relationship became more intimate and integral and it was characterized by more cohesion. Family caregivers get valuable support from the home care service, however, they complain that there is no facility in South Tyrol, which is specialized to care people with Chorea Huntington. Therefore, the caregivers have to "give up a lot" and don't have any personal desires, dreams and expectations for the future.	The caregivers have learned independently to deal with their changed life step by step, and to see also the positive effects of the caring role. The life of family caregivers of a person which is affected by Chorea Huntington is characterized by abandonment. A continuous and professional care would be important for the affected and his caregiver. A continuous and professional care is important for both, addressing the care needs of the persons affected by Chorea Huntington and preparing their caregivers for the changing life.	
23079213	Bans on smoking in public areas have increased as knowledge of secondhand smoke dangers has grown. Restrictions on smoking in public areas may lead to less smoking and increased quitting.This study examines the experiences of smokers and recent quitters with local smokefree regulations to better understand the possible mechanisms by which smokefree regulations affect individual tobacco users' patterns of tobacco consumption and quitting.	Fifteen in-depth interviews and thirteen focus groups were conducted with tobacco users and recent quitters formerly enrolled in cessation programs provided by ClearWay Minnesota(SM). Data were collected 3 months after smokefree legislation was adopted in the Minneapolis/St. Paul metropolitan area in 2006, and were stratified by tobacco use status and strength of regulation. Essential themes were extracted using NVivo 8 software in 2011.	Study participants reported that smokefree legislation forced them to confront their addiction. They experienced apprehension, frustration, and panic anticipating smoking restrictions. This motivated some to attempt to quit, whereas others felt punished by and angry at government intrusion. Both current and former tobacco users felt smokefree regulations contributed to stigmatizing smokers. They also reported smokefree legislation reduced the temptation to smoke. The physical absence of cigarette smoke in bars and restaurants appeared to support quit attempts. The inconvenience of smoking outside was reported to have a similar effect.	Essential mechanisms by which bans influenced patterns of tobacco use and quitting include confronting addiction, temptation, inconvenience, and social norms. These findings highlight the success of tobacco control advocates in denormalizing tobacco use, and suggest that some tobacco users may be internalizing negative messages about tobacco.	
23067035	Accidental bowel leakage (ABL) is associated with negative impact on quality of life (QoL) and many women do not seek care.To assess current perspectives and QoL among women with ABL; to identify factors associated with severe impact on condition-specific QoL; and to describe care-seeking for ABL.	Sub-analysis of 1096 women with ABL identified through an internet-based, self-administered survey of 5817 US women ≥ 45 years old.	Severe impact on QoL was defined as response of 'affects very much' or 'greatly' to any of seven domains within Pelvic Floor Impact Questionnaire.	QoL data were available for 85.6% (938/1096) of women with ABL. Domains relating to frustration, emotional health and participation in social activities demonstrated the greatest negative impact, with 39.2% (95% CI 36.1-42.4%) having overall severe impact. More frequent ABL, faecal urgency, nocturnal bowel movements, FI without warning, stress FI, weekly urinary incontinence and underlying bowel disorder were associated with severe impact on QoL. Of the 28.6% (268/938) of women who spoke to a physician about their ABL, the majority did so with a general practitioner or family physician (56.0%, 150/268). Only 19.0% (51/268) consulted an internist or gastroenterologist [27.2% (73/268)].	Nearly 40% of adult women with ABL have severe negative impact on QoL, but less than one-third seek care. More than half of those who seek care do so with their primary care provider. Improved awareness of the prevalence and impact of FI by these providers may decrease barriers and improve QoL.	
23061500	The Healthy Obsession Model (HOM) suggests that successful weight controllers must develop a preoccupation with the planning and execution of target behaviors to reach and maintain healthy weights (e.g., controlled eating, consistent selfmonitoring). This model further posits that committed weight controllers will feel substantial anxiety or frustration when lapses occur, which, in turn, will motivate them to reinstate target behaviors.The present study tested the HOM by examining the perceptions and attitudes of four very successful and four relatively unsuccessful adolescent weight controllers 1 year after completing immersion treatment. We expected that successful weight controllers, more so than unsuccessful weight controllers, would report more elaborate definitions of their healthy obsessions and describe more negative reactions to potential and actual lapses. In-depth interviews were conducted using a version of the Scanlan Collaborative Interview Method.	Reliable coding of the interviews produced results that supported the hypothesis that highly successful weight controllers seem to nurture strong healthy obsessions, including clear definitions of healthy obsessions, heightened commitment based on the emotional impact of excess weight, and negative reactions to lapses. In addition, these adolescent weight controllers seemed motivated by some of the same factors that elite athletes identified in the Sport Commitment Model (e.g., Emotional and Experiential Consequences; Social Support of Parents, Friends, and Peers; Institutional Influences; and Valuable Opportunities).	
23057669	Coordinated, interdisciplinary services, supported by self-management underpin effective management for chronic low back pain (CLBP). However, a combination of system, provider and consumer-based barriers exist which limit the implementation of such models into practice, particularly in rural areas where unique access issues exist. In order to improve health service delivery for consumers with CLBP, policymakers and service providers require a more in depth understanding of these issues. The objective of this qualitative study was to explore barriers experienced by consumers in rural settings in Western Australia (WA) to accessing information and services and implementing effective self-management behaviours for CLBP.Fourteen consumers with a history of CLBP from three rural sites in WA participated. Maximum variation sampling was employed to ensure a range of experiences were captured. An interviewer, blinded to quantitative pain history data, conducted semi-structured telephone interviews using a standardised schedule to explore individuals' access to information and services for CLBP, and self-management behaviours. Interviews were digitally recorded and transcribed verbatim. Inductive analysis techniques were used to derive and refine key themes.	Five key themes were identified that affected individuals' experiences of managing CLBP in a rural setting, including: 1) poor access to information and services in rural settings; 2) inadequate knowledge and skills among local practitioners; 3) feelings of isolation and frustration; 4) psychological burden associated with CLBP; and 5) competing lifestyle demands hindering effective self-management for CLBP.	Consumers in rural WA experienced difficulties in knowing where to access relevant information for CLBP and expressed frustration with the lack of service delivery options to access interdisciplinary and specialist services for CLBP. Competing lifestyle demands such as work and family commitments were cited as key barriers to adopting regular self-management practices. Consumer expectations for improved health service coordination and a workforce skilled in pain management are relevant to future service planning, particularly in the contexts of workforce capacity, community health services, and enablers to effective service delivery in primary care.	
23054386	Near-misses in slot machines resemble jackpot wins but fall just short. Previous research has demonstrated that near-misses are behaviorally reinforcing despite the absence of monetary reward. We assessed the hedonic properties of near-misses by measuring the time between outcome delivery and the initiation of the next spin-the post-reinforcement pause (PRP) and skin conductance responses (SCRs) for losses, near-misses, and a range of wins (5, 15, 25, 50 or 250 credits) while participants (N = 122) played a slot machine simulator. PRPs and SCRs were compared for 40 low frequency and 22 high frequency slots players who were non-problem gamblers, 37 at risk players, and 23 problem gamblers. For winning outcomes, PRPs and SCRs tracked monotonically with win size such that progressively larger wins were associated with progressively larger PRPs and SCRs. Near-misses with jackpot symbols landing on the first two reels had significantly larger SCRs than regular losses, and other types of near misses. Crucially, PRPs for this kind of near-miss were significantly smaller than all wins, and when non-parametric statistics were used, significantly smaller than regular losses. This pattern of large SCRs and small PRPs suggest that these are highly frustrating outcomes that stimulate appetitive components of the reward system to promote continued gambling. 
23045854	The present study assessed the psychometric properties of the Frustration Discomfort Scale for Turkish college students. The Frustration Discomfort Scale (FDS), Procrastination Assessment Scale-Student, and Rosenberg Self-Esteem Scale were administered to a sample of 171 (98 women, 73 men) Turkish college students. The results of the confirmatory factor analysis yielded fit index values demonstrating viability of the four-dimensional solution as in the original. Findings also revealed that, as predicted, the Discomfort Intolerance subscale of Turkish FDS was most strongly correlated with procrastination. Overall results provided evidence for the factor validity and reliability of the Turkish version of the scale for use in a Turkish population.
23033910	Primary health care does not adequately respond to populations known to have high needs such as those with compounding jeopardy from chronic conditions, poverty, minority status and age; as such populations report powerlessness.To explore what poor older adults with chronic conditions who mostly belong to ethnic minority groups say they want from clinicians.	Participants were older adults whose chronic conditions were severe enough to require hospital admission more than twice in the previous 12 months. All participants lived in poor localities in Auckland, New Zealand's largest city.	Forty-two in-depth interviews were conducted and analysed using qualitative description.	An outward acceptance of health care belied an underlying dissatisfaction with low engagement. Participants did not feel heard and wanted information conveyed in a way that indicated clinicians understood them in the context of their lives. Powerlessness, anger, frustration and non-concordance were frequent responses.	Despite socio-cultural and disease-related complexity, patients pursue the (unrealised) ideal of an engaged therapeutic relationship with an understanding clinician. Powerlessness means that the onus is upon the health system and the clinician to engage. Engagement means building a relationship on the basis of social, cultural and clinical knowledge and demonstrating a shift in the way clinicians choose to think and interact in patient care. Respectful listening and questioning can deepen clinicians' awareness of patients' most important concerns. Enabling patients to direct the consultation is a way to integrate clinician expertise with what patients need and value.	
24490196	Pectus Excavatum is the most common congenital deformity of the chest. Although Pectus Excavatum can be associated with heart or lung problems, the main indication for surgical correction of this congenital anomaly is the body image dissatisfaction. The Nuss technique is a minimally invasive procedure that allows the placement of an intrathoracic prosthetic convex bar, previously bended, which mobilize the sternum anteriorly. The aim of this study was to evaluate the degree of satisfaction of the patients and parents after the application of the Nuss technique using the Pectus Excavatum Evaluation Questionnaire. All parameters of psychosocial character - self-image, difficulties in exposing the chest, frustration, sadness, social isolation and ridicule - found a statistically significant improvement after surgical correction of Pectus Excavatum from the perspective of patients and their parents. There was not a marked improvement and consensus regarding the overall physical performance of patients. Which is understandable, since, theoretically, the physical deformity is not responsible for significant limitations on exertion. The current surgical correction of Pectus Excavatum by the Nuss technique allows obtaining aesthetic results of the chest with the resolution of the main problems with body image. Increase awareness of health issues for psychosocial and physical factors which might be involved in this kind of deformities is important, especially when there is a satisfactory solution. 
23018385	The present study investigated the effects of infertility on the spouses' relationship, with the objectives to describe the profile of the studied population, and analyze the effects of infertility on their emotional, sexual and marital life. To do this, a cross-sectional and prospective study was performed in a specialist institution. The sample consisted of 50 infertile couples with a mean of six years of infertility. The women manifested negative feelings in view of the infertility, while the men assumed an attitude of support. The effects on the couples' sexual life were more pronounced in women, and the infertility treatment resulted in positive changes for both spouses. No differences were found regarding the effects of infertility between the women who had undergone more than one treatment and those undergoing treatment for the first time; between the men there were differences in the emotional aspect (frustration and relief) and in the marital relationship (strengthening and maturing).
23009655	Developmental research suggests that adolescents may be highly influenced by their peers to take risks. Although youths with callous-unemotional (CU) traits engage in high-risk behaviors in the form of antisocial behavior and aggression, little is known about their decision making, particularly when their peers are present. Youths high on CU traits may be most susceptible to influence, especially when rewards are involved, or they may be highly rational relative to their low CU peers and less susceptible to social peer pressures. The present study used a gambling task with 675 youths (female n = 348), ages 16 to 20 years (M = 16.9, SD = .8). The majority were White British (64%). We experimentally manipulated whether youths made decisions in groups with peers or individually. All members of the group reported on their CU traits. Using multilevel modeling to control for group-level effects, youths with higher levels of CU traits were found to be less sensitive to accruing rewards on the gambling task than youths low on these traits. When in groups, male participants with higher levels of CU traits made quicker decisions to take risks than male participants lower on CU traits, particularly after punishment. Youths with CU traits are distinct in showing a lack of emotion and this may facilitate heightened rationality in responding to rewards. However, results suggest that male adolescents who are high on CU traits may react to the possible frustration of losing by attempting to gain back rewards quickly when their peers are watching.
22994637	The objective of this study was to investigate how noise-induced hearing loss (NIHL) or noise injury (NI) affects individuals and others of dairy farm communities in New Zealand. Using "grab" or opportunistic sampling at DairyNZ discussion groups and a recreational function, a survey questionnaire was completed by 74 participants from two dairy farming communities in New Zealand. Self-reported hearing difficulties were highlighted by 48% (42) of the 74 participants. The effects of NI on individuals and others included communication difficulties leading to the development of coping strategies, social isolation; decreased employment opportunities, loss of productivity, and increased effort and adjustments by family and work colleagues. Frustration, anxiety, stress, resentment, depression, and fatigue are also negative consequences that may contribute to a loss of quality of life and contribute to further health costs. Increased lateness, absenteeism, sickness and other behavioral aspects were not expressed as normal issues in the workplace, as the majority of the individuals are/were self-employed or working in a family business. This study shows that each year in New Zealand NI results in significant negative social, psychological, and economic consequences for those individuals affected, along with their families, friends, and work colleagues.
22980374	This qualitative study involved action research to explore one woman's narrative of awareness, emotions and thoughts during treatment in an intensive care unit (ICU). The overarching aim is to increase insight into the thoughts, feelings and bio-psychosocial needs of the patient receiving treatment in ICU. Data was collected by means of narrative discourse analysis. Literature on the psychosocial and spiritual implications of ICU treatment is limited, and often patients have no recall of their treatment in an ICU at all. Documenting the illness narrative of this individual case is valuable as the participant could recall a certain amount of awareness, thoughts and emotions. These experiences included delirium, anxiety, helplessness, frustration and uncertainty. Once sedation was decreased, the patient's consciousness increased and she was confronted with thoughts and emotions that were unrealistic and frightening. It was found in this study that the opportunity to share a narrative on the emotions and awareness during treatment in an ICU had cathartic value and the participant suffered little symptoms of post traumatic stress syndrome, often associated with long term treatment in an ICU. Further research on this topic is necessary to improve ICU treatment, not only on a physical level, but with emphasis on the psychosocial and spiritual needs of the patient.
22978475	In 2004, the Malawian Ministry of Health declared a human resource crisis and launched a six year Emergency Human Resources Programme. This included salary supplements for key health workers and a tripling of doctors in training. By 2010, the number of medical graduates had doubled and significantly more doctors were working in rural district hospitals. Yet there has been little research into the views of this next generation of doctors in Malawi, who are crucial to the continuing success of the programme. The aim of this study was to explore the factors influencing the career plans of medical students and recent graduates with regard to four policy-relevant aspects: emigration outside Malawi; working at district level; private sector employment and postgraduate specialisation.Twelve semi-structured interviews were conducted with fourth year medical students and first year graduates, recruited through purposive and snowball sampling. Key informant interviews were also carried out with medical school faculty. Recordings were transcribed and analysed using a framework approach.	Opportunities for postgraduate training emerged as the most important factor in participants' career choices, with specialisation seen as vital to career progression. All participants intended to work in Malawi in the long term, after a period of time outside the country. For nearly all participants, this was in the pursuit of postgraduate study rather than higher salaries. In general, medical students and young doctors were enthusiastic about working at district level, although this is curtailed by their desire for specialist training and frustration with resource shortages. There is currently little intention to move into the private sector.	Future resourcing of postgraduate training opportunities is crucial to preventing emigration as graduate numbers increase. The lesser importance put on salary by younger doctors may be an indicator of the success of salary supplements. In order to retain doctors at district levels for longer, consideration should be given to the introduction of general practice/family medicine as a specialty. Returning specialists should be encouraged to engage with younger colleagues as role models and mentors.	
22974084	People with intellectual disabilities (ID) receive primary care in community-based practices and are encouraged to participate in the physician-patient relationship. However, the nature of this participation is not known.Qualitative data were analysed to obtain perspectives from patients and providers regarding clinic visits. Patient participants were recruited from community organisations, while physician participants were recruited from emails and phone calls to local and regional practices and a national and regional list serve. Analysis methods derived from grounded theory were used.	Twenty-seven women with ID and 22 family physicians were interviewed. Themes important to both groups included time, how the support worker should be used in the encounter and the nature of the physician-patient relationship. Patients expressed frustration at how little time they spent with their physician, and wished that physicians would speak directly to them instead of to their support worker. Physicians felt that patients with ID took too much time, and said that they preferred communicating with the support worker. The interviews also revealed unconscious biases about people with ID.	Patient participation is encouraged for people with ID, but is limited because of both physician and patient factors. Greater awareness of these factors may improve care for patients with ID.	
22973854	Most research on partners' experiences of living with a person with MND is questionnaire-based with no qualitative study focusing on the period between diagnosis and end-of-life care. This study aimed to provide an in-depth qualitative exploration of the experience of living with, and caring for, a partner with MND.   Semi-structured interviews were conducted with eight individuals, and transcripts analysed from an interpretative phenomenological perspective. Two main themes were derived. 'Impact on life' included having concern for partner's safety, having social restrictions, being continually tired, struggling with anger and frustration, loss of intimacy and uncertainty around the future; while 'Adjusting to the situation' included trying to be strong, retaining a sense of normality, appreciation of specialist services, adopting a problem-solving approach, living day to day and ability to remain positive. In conclusion, experiences of stress and loss are illustrated in this sample of partners of those with MND, and it is suggested both these aspects should be integrated into understanding of carers' experiences. Carers appear to inhibit their grief in order to appear strong. Greater understanding of the consequences of this would help in providing appropriate emotional support.
22968775	To investigate, qualitatively, practitioners' perceptions of a 1-day interactive and applied workshop in motivational interviewing (MI). Specifically, participants explored the training's usefulness in supporting perceptions of competence, confidence, and attitudes towards facilitating behaviour change among patients.Ten health practitioners including dieticians, pharmacists, nurses, and social workers participated in this qualitative pilot study. Participants received a 1-day (7.5 hour) workshop focused on MI. In-depth one-on-one interviews were conducted prior to the workshop and at 1 and 4 weeks post-training. Methods were employed throughout to ensure data trustworthiness.	Pre-workshop themes about facilitating patient behaviour change included: persistence; advice-giving; behaviour change as hard work for practitioner; low perceived confidence and competence to help; barriers; and feelings of frustration. Post-workshop themes included a renewed inspiration and motivation to facilitate behaviour change; partnering with patients and giving less advice; experiencing a positive perceived impact on the patients; feeling that behaviour change is easier and less stressful; enjoying higher levels of competence and confidence; and being mindful of practitioner impact.	Participation in the structured, interactive, and applied MI training was deemed effective by practitioners dealing with patient behaviour change. Allied health care practitioners are in a key position to facilitate health behaviour changes that contribute to behaviour-related illness. The integration of similar MI trainings for health practitioners should be further explored with a larger group.	
22965367	Mentors have been recognized as important elements in the personal and professional development of medical students. However, few investigations have sought to understand their development, needs and difficulties. Our objective was to investigate the perceptions of a group of mentors regarding difficulties experienced over time and the resources used to face up to them.Qualitative exploratory study on mentors at Faculdade de Medicina da Universidade de São Paulo (FMUSP). In the FMUSP Mentoring Program, mentors follow and guide students throughout the course, and are responsible for heterogeneous group of students, in relation to the academic year.	Semi-structured interviews were conducted with 14 FMUSP mentors.	For many of the mentors, the difficulties related to initial doubts about the role, frustration with the students' attendance and overloading of daily tasks. To address such difficulties, these mentors used external resources and their own life experience and personal way of dealing with situations. Some mentors did not perceive difficulties for themselves or for students.	Like in other mentoring programs, many difficulties perceived by mentors seem to be derived from the context of medical education itself. However, unlike in other experiences, FMUSP mentors do not feel that there is lack of support for their role, since this is regularly provided in the structure and dynamics of the program. The "difficulty in perceiving difficulties", presented by some mentors, demands further investigation for better and greater understanding.	
22954642	Infant crying is particularly frustrating to caregivers in the first few months of life and the most common trigger for shaking and abuse. The effectiveness of the Period of PURPLE Crying prevention materials (DVD and booklet) designed to increase knowledge and change behaviors related to crying and the dangers of shaking was reported in North America. The aim of this study was to replicate the effectiveness of the PURPLE materials with mothers of newborns in Japan.In a randomized controlled trial, 201 parents received either PURPLE materials or analogous control materials on infant safety via mail within 2 weeks of birth. At 6 weeks, mothers completed a 4-day behavioral diary. At 2 months, participants completed a predefined 20-min structured telephone survey by an independent firm to assess knowledge and behavior.	Scores on crying knowledge scales (out of 100) were significantly higher in the intervention than control groups (56.1 vs. 53.1; difference=3.0, 95% confidence interval [CI]: 1.0-4.9, p<0.005). Percentage of sharing of advice to walk away if frustrated by crying was significantly higher in the intervention than control groups (22.4% vs. 4.1%; difference=18%, 95% CI: 7.4-29.1). Walking away during unsoothable crying was significantly higher in the intervention group than controls (0.085 vs. 0.017 events per day, rate ratio=4.8, 95% CI: 1.1-21.2) by diary. Self-talk behavior scale (out of 100) tended to significance in the intervention group (16.6 vs. 8.9, difference=7.7, 95% CI: -1.0 to 16.4, p<0.1).	Crying knowledge, sharing of walk away information with others and walk away behavior when crying was unsoothable were higher for those who received intervention than control materials. The Period of PURPLE Crying materials may be useful in Japan as well as in North America for informing caregivers about the properties of infant crying and changing some behaviors related to infant crying and shaking. (UMIN Clinical Trials Registry register no. UMIN000001711.).	
22951035	Patients with multiple medically unexplained symptoms commonly seek treatment in primary care. Many of these patients seem to have a psychological 'core' to their illness that affects the way they experience, conceptualise and communicate their distress. There is considerable debate around diagnosis for this group of patients. Existing diagnoses include somatoform disorders in psychiatry and functional disorders in the medical specialties. Some clinicians use the term 'heartsink' patients, which reflects the interpersonal frustration inherent in some therapeutic relationships. A good diagnosis should be clinically useful, helping clinicians and patients understand and manage illness. Diagnosis should also provide a reliable classification for research and evidence-based treatment. The allegory of the botanist and the gardener has been used to describe diagnosis. For the botanist, a good diagnosis produces a taxonomy that is rigorous and reliable. For the gardener, it informs the way a garden is described and understood in a specific context. Clinicians need both: a 'botanical' type of classification to bring rigour to research and therapy, and clinical 'gardening', which allows for multiple perspectives and diagnostic frameworks. Clinical reasoning is a form of research with therapeutic intent. Botany and gardening represent a mixed-methods approach that can enrich diagnosis. The challenge is to integrate multiple perspectives in clinically helpful ways that help us retain both richness and rigour. 
22949013	This investigation examines how self-identified Christians in the Midwest U.S. understand and work for social justice, with a focus on their process of social justice development and the role of religious congregations in promoting social justice. Using a grounded theory analysis of 15 in-depth interviews, results indicated multiple understandings of social justice such as meeting basic needs, fixing social structures and systems to create equal distributions of resources, promoting human rights and dignity, and as a religious responsibility. Participants also described a process of social justice development facilitated by exposure to injustice, mentors, educating others, and the importance of finding a social justice community. Distinct personal barriers to social justice engagement were identified such as resources and negative emotions, whereas congregational leadership was important for congregational involvement. General frustration with congregations was expressed regarding low social justice engagement; however, participants balanced this frustration with hope for the positive potential of congregations to promote social justice. Together these findings show multifaceted understandings of social justice and a dynamic process of social justice development for these self-identified Christians. Implications for future research and partnership with religious individuals and congregations also are discussed.
22939544	This study explores the attitudes of physicians-in-training toward older patients. Specifically, we examine why, despite increasing exposure to geriatrics in medical school curricula, medical students and residents continue to have negative attitudes toward caring for older patients.This study used ethnography, a technique used by anthropologists that includes participant-observation, semi-structured interviews, and facilitated group discussions. Research was conducted at two tertiary-care academic hospitals in urban Northern California, and focused on eliciting the opinions, beliefs, and practices of physicians-in-training toward geriatrics.	We found that the majority of physicians-in-training in this study expressed a mix of positive and negative views about caring for older patients. We argue that physicians-in-trainings' attitudes toward older patients are shaped by a number of heterogeneous and frequently conflicting factors, including both the formal and so-called "hidden" curricula in medical education, institutional demands on physicians to encourage speed and efficiency of care, and portrayals of the process of aging as simultaneously as a "problem" of inevitable biological decay and an opportunity for medical intervention.	Efforts to educate medical students and residents about appropriate geriatric care tend to reproduce the paradoxes and uncertainties surrounding aging in biomedicine. These ambiguities contribute to the tendency of physicians-in-training to develop moralizing attitudes about older patients and other patient groups labeled "frustrating" or "boring".	
22936481	Good doctor-patient communication has a positive impact on patient satisfaction, adherence to treatment, health outcomes and well-being, and it has been linked to reduced anxiety, increased recall, and improved understanding. During the diagnostic phase and the course of the illness, patients exhibit a range of mood changes. These include sadness and worry, frustration and anger, uncertainty, fear of disease recurrence, difficulties in inter-personal relationships, changing roles, and concerns about body image. Medical consultations can be influenced by different expectations concerning the doctor-patient interaction, by individual roles and beliefs, and by a different understanding of health and well-being influenced by cultural and other factors not necessarily associated with the medical situation. Responding to anger and other difficult emotions, dealing with family meetings, or communicating via interpreters are often experienced as demanding situations by health care professionals. This article provides an overview of the difficult doctor-patient interactions and illustrates basic communication skills in responding to challenging situations.
22932731	Time monitoring behavior (TMB) commonly occurs among insomnia patients, often leads to frustration about sleeplessness, and perpetuates insomnia symptoms. Few studies have explored relationships between time monitoring and insomnia, and none have studied the potential relationships between insomnia, TMB, and posttraumatic stress symptoms (PSSs). In this retrospective chart review of 1078 patients seeking care at a sleep medical center, the patients presented with one of three chief sleep complaints (poor sleep quality, 51%; sleep-disordered breathing, 26%; and insomnia, 24%), and 32% reported moderate to severe PSSs. Both insomnia and time monitoring severity were greater in the 350 patients with PSSs compared with the 728 patients with minimal or no such symptoms. Insomnia and time monitoring severity correlated significantly with total posttraumatic stress scores and most strongly with the arousal subscale. Research on interventions to treat TMB may inform relationships between insomnia and posttraumatic stress.
22931000	We investigated how the availability of self-control resources affects risk-taking inclinations and behaviors. We proposed that risk-taking often occurs from suboptimal decision processes and heuristic information processing (e.g., when a smoker suppresses or neglects information about the health risks of smoking). Research revealed that depleted self-regulation resources are associated with reduced intellectual performance and reduced abilities to regulate spontaneous and automatic responses (e.g., control aggressive responses in the face of frustration). The present studies transferred these ideas to the area of risk-taking. We propose that risk-taking is increased when individuals find themselves in a state of reduced cognitive self-control resources (ego-depletion). Four studies supported these ideas. In Study 1, ego-depleted participants reported higher levels of sensation seeking than non-depleted participants. In Study 2, ego-depleted participants showed higher levels of risk-tolerance in critical road traffic situations than non-depleted participants. In Study 3, we ruled out two alternative explanations for these results: neither cognitive load nor feelings of anger mediated the effect of ego-depletion on risk-taking. Finally, Study 4 clarified the underlying psychological process: ego-depleted participants feel more cognitively exhausted than non-depleted participants and thus are more willing to take risks. Discussion focuses on the theoretical and practical implications of these findings.
22930234	Forty people over 60 years of age took part in longitudinal research over the course of a year on the impact of the HIV epidemic in southern Uganda. In this paper we focus mainly on the data from 26 of the 40 who were HIV-positive. While we observed that feelings of depression were frequently experienced by many of the people in our study, the state of 'being depressed' was not constant. Participants regularly expressed economic frustration (because of a lack of money to buy food and other commodities including sugar and soap); medical problems (including those related to HIV) as well as old age, the burden of dependents (including concerns about school fees for grandchildren), feelings of sadness and isolation, and a lack of support from others, as well as stigma, whether real or perceived. However, while worries, sorrow and despondent thoughts were reported in many of the interviews across the study, moods fluctuated moving from happiness and hope, to sadness and despair, from month to month. Concerns regarding the psychological wellbeing amongst older people, including those living with HIV and older carers in Uganda deserve greater attention.
22928674	Temper modulation problems are both a hallmark of early childhood and a common mental health concern. Thus, characterizing specific behavioral manifestations of temper loss along a dimension from normative misbehaviors to clinically significant problems is an important step toward identifying clinical thresholds.Parent-reported patterns of temper loss were delineated in a diverse community sample of preschoolers (n = 1,490). A developmentally sensitive questionnaire, the Multidimensional Assessment of Preschool Disruptive Behavior (MAP-DB), was used to assess temper loss in terms of tantrum features and anger regulation. Specific aims were: (a) document the normative distribution of temper loss in preschoolers from normative misbehaviors to clinically concerning temper loss behaviors, and test for sociodemographic differences; (b) use Item Response Theory (IRT) to model a Temper Loss dimension; and (c) examine associations of temper loss and concurrent emotional and behavioral problems.	Across sociodemographic subgroups, a unidimensional Temper Loss model fit the data well. Nearly all (83.7%) preschoolers had tantrums sometimes but only 8.6% had daily tantrums. Normative misbehaviors occurred more frequently than clinically concerning temper loss behaviors. Milder behaviors tended to reflect frustration in expectable contexts, whereas clinically concerning problem indicators were unpredictable, prolonged, and/or destructive. In multivariate models, Temper Loss was associated with emotional and behavioral problems.	Parent reports on a developmentally informed questionnaire, administered to a large and diverse sample, distinguished normative and problematic manifestations of preschool temper loss. A developmental, dimensional approach shows promise for elucidating the boundaries between normative early childhood temper loss and emergent psychopathology.	
22926196	Newborn screening (NBS) techniques have been developed for several lysosomal storage disorders (LSDs), including Mucopolysaccharidosis type I (MPS I). MPS I is an LSD with a wide phenotypic spectrum that ranges from the severe Hurler phenotype to the attenuated Scheie phenotype. To improve the ethical discussion about NBS for MPS I, we performed an interview study to explore the experiences of MPS I patients and their parents with the timings of their diagnoses.We used a qualitative research approach consisting of 17 interviews with the parents of patients with all MPS I phenotypes and with patients with attenuated forms of MPS I. The interviews were audio-recorded, transcribed and subsequently analyzed to identify the main themes identified by the participants.	Five important themes, focusing on the experienced disadvantages of delayed diagnosis and the advantages and disadvantages of a hypothetical earlier diagnosis, were identified in our group of participants: 1) delayed diagnosis causing parental frustration, 2) delayed diagnosis causing patient frustration, 3) early diagnosis enabling reproductive decision-making, 4) early diagnosis enabling focusing on the diagnosis, and 5) early diagnosis enabling timely initiation of treatment. There was a remarkable similarity in the experiences with timing of diagnosis between parents of patients with the severe and the attenuated forms.	This was the first study to explore the personal experiences of MPS I patients and their parents with diagnostic timing. Our study identified five important themes that are highly relevant to the ethical discussion on expanding NBS programs for MPS I.	
22892359	Fifty-nine heterosexual university males were assessed for Sexual Coercion Proclivity (SCP) and randomly assigned to one of three conditions: Insult/nonsexually coercive fantasy material; no insult/sexually coercive fantasy material; or, insult/sexually coercive fantasy material. Although not differing in terms of anger or anxiety, the high SCP became more frustrated than the low group, particularly when exposed to both insult and sexually coercive (SC) fantasy material. Changes in negative affect predicted anticipated likelihood of engaging in SC among the low SCP group and anticipated enjoyment of SC in the high SCP group. Acculturation accounted for differences observed between Caucasian and Chinese men.
22882168	This article forms part of a larger research project on the dental therapy profession in South Africa. The objective of this study was to determine the level of job satisfaction among dental therapists trained at one South African university.This study was conducted using the qualitative research approach, where purposive and convenience sampling was used to select interviewees. They were asked a single question: "Do you think that dental therapists in South Africa are satisfied within their present careers?" The narrative data was interpreted using thematic analysis, and the data was validated by using the markers of trustworthiness.	All stakeholders believed that dental therapists trained at this university were not satisfied in the private and public sectors. In the private sector, they expressed frustration with their limited scope of practice. In the public service, lack of posts, poorly functioning dental facilities, and inadequate remuneration caused high levels of dissatisfaction. Many dental therapists chose this profession as a stepping stone to dentistry.	The roles and scope of practice of all members of the oral health team needs to be redefined within the context of the primary health care approach. Universities need to recruit students appropriately to fulfill their role within this team. Dental services in the public sector need to be upgraded to meet the oral health needs of the country.	
22880284	To investigate the information-seeking experiences and decision-making roles of Japanese women with breast cancer, to examine the relationship between information-seeking experiences and decision-making roles, and to explore the factors that influenced taking a more active role than the preferred role during the treatment decision-making process.In a cross-sectional study, women with breast cancer were retrospectively administered the Control Preferences Scale and the Information-Seeking Experience Scale. The Chi-Square test was used to compare differences among individual variables in decision-making roles and information-seeking experiences. Logistic regression analysis was used to explore the factors that influenced taking a more active role than the preferred role.	One hundred and four patients with breast cancer participated in the investigation. Eighty-five patients (78%) perceived themselves as having knowledge of breast cancer and most patients (92%) sought information on breast cancer. The preferred roles in decision-making that they reported having before treatment were 18% active, 69% collaborative and 13% passive. The actual roles they perceived having experienced were 27% active, 43% collaborative and 30% passive. Although there was concordance of preferred and actual role for only 59% of the women, most patients reported that they were satisfied with their decision-making. Many women with breast cancer reported negative experiences with information seeking, including wanting more information (49%), expending a lot of effort to obtain the information needed (53%), not having enough time to obtain needed information (55%), frustration during the search for information (44%), concerns about the quality of the information (45%) and difficulty understanding the information received (49%). This study revealed that having a more active actual role than the initial preferred role was associated with emotional expression to the physician, having undergone mastectomy, and the desire for more information.	Most women with breast cancer sought information on breast cancer and expressed a preference for a collaborative relationship with physicians in treatment decision-making. Patients who expressed emotion to their physician, wanted more information, and underwent mastectomy were most likely to change their actual decision-making role toward a more active choice.	
22872527	Over the course of the last century, physicians have written a number of articles about suicide among their own. These articles reveal how physicians have fundamentally conceived of themselves, how they have addressed vulnerability among their own, and how their self-identification has changed over time, due, in part, to larger historical changes in the profession, psychiatry, and suicidology. The suicidal physician of the Golden Age (1900-1970), an expendable deviant, represents the antithesis of that era's image of strength and invincibility. In contrast, the suicidal physician of the modern era (1970 onwards), a vulnerable human being deserving of support, reflects that era's frustration with bearing these unattainable ideals and its growing emphasis on physician health and well-being. Despite this key transition, specifically the acknowledgment of physicians' limitations, more recent articles about physician suicide indicate that Golden Age values have endured. These persistent emphases on perfection and discomfort with vulnerability have hindered a comprehensive consideration of physician suicide, despite one hundred years of dialogue in the medical literature.
22860383	The deaf community is a distinct cultural and linguistic community (the uppercase D is a cultural identification). Compared to the general population, the deaf community, as a social group, experiences poorer health status. Deaf people seek care less frequently than the general population and have fewer interactions with the health system. Their encounters with the health system are often characterized by communication difficulties, fear, mistrust, and frustration. Qualitative research was used to explore the experiences of family caregivers who provided end-of-life care for a deaf person. Key findings indicate that the deaf community has limited understanding of their options for palliative and end-of-life care. Communication and health literacy are key barriers to accessing appropriate end-of-life care. Pain and symptom management, consideration of physical environments, and limited access to bereavement care are common issues faced by deaf people when caring for loved ones at the end of life.
22848982	The purpose of this focused ethnography was to describe the shared experiences of certified registered nurse anesthetists (CRNAs) who were on duty in New Orleans, Louisiana, during Hurricane Katrina as well as to elucidate the psychosocial impact the storm had on them. Ten CRNAs participated in 1 of 3 focus groups that were audio recorded. The audio recordings were transcribed and analyzed using qualitative data analysis computer software (NVivo 8, QSR International, Melbourne, Australia). Six major themes emerged from the study: caught off guard; sense of duty; uncertainty/powerlessness/frustration; group identity and cohesiveness; anger; and life-changing event. The themes represented how the CRNAs appraised and coped with the stressful events surrounding Hurricane Katrina. The psychosocial impact of Hurricane Katrina on the CRNAs resulted mainly in short-term sleep disturbances and increased drinking. Only 2 CRNAs expressed long-term psychosocial effects from the storm. The results of this study should be used to guide policies regarding disaster activation of CRNAs, to educate CRNAs on preparing for disaster duty, and to provide a framework for future disaster studies regarding CRNAs.
22845033	Lichen Sclerosis (LS) is an often unrecognized and misdiagnosed chronic inflammatory skin condition of the anogenital area that affects quality of life, bringing severe discomfort and distress to affected men, women, and children. The purpose of this qualitative study is to explore the lived experiences of women with LS.Content analysis was conducted of data obtained from three public online forums/blogs used by women with LS. A total of 527 postings/entries were analyzed for patterns and themes by four researchers.	Five core themes emerged as a result of this study, revealing feelings of frustration and despair stemming from healthcare providers' lack of knowledge in relation to Lichen Sclerosis, often leading to misdiagnosis, prolonged suffering, and an altered quality of life.	Knowledgeable healthcare providers and additional research into the cause, treatment, and cure of Lichen Sclerosis are needed. Advance-practice nurses stand to play an important role in the areas of education, research, policy making, and clinical practice to advocate for and empower women with LS.	
22844007	Genital warts are one of the most prevalent sexually transmitted infections in the Netherlands and cause both frustration and misinterpretation in young adults. Poor knowledge may be associated with shame and depression. We used questionnaires to study knowledge, perceived nuisance and risk perception in 100 predominantly heterosexual men with clinically-confirmed condylomata acuminata. Our data show that the majority of patients considered having warts as (very) bothersome. Results confirmed the Internet as a widely used information source. Incorrect information on the relationship between warts and both anogenital cancers and infertility was widespread. Results from knowledge questionnaires showed that higher knowledge scores were associated with higher perceived nuisance. We hypothesize that high levels of nuisance related to genital warts may stimulate the need to seek information and therefore increase knowledge. It does not seem likely that an increase of human papillomavirus-related knowledge would increase experiences of nuisance.
22840629	Individuals with psychopathy have an increased tendency toward certain types of aggression. We hypothesized that successful psychopaths, who have no criminal convictions but can be diagnosed with psychopathy in terms of personality characteristics, are skilled at regulating aggressive impulses, compared to incarcerated unsuccessful psychopaths.In this block-designed functional magnetic resonance imaging (fMRI) study, we sought to clarify the neural mechanisms underlying differences in frustration-induced aggression as a function of psychopathy in non-criminal populations. Twenty male undergraduate students who completed a self-report psychopathy questionnaire were scanned while they completed a task in which they either could or could not punish other individuals who made unfair offers of monetary distribution.	Individuals with high psychopathic tendencies were less likely to make a decision to inflict costly punishment on people proposing unfair offers. During this decision-making, psychopathy was associated with less amygdala activity in response to the unfairness of offers. Moreover, the amygdala dysfunction in psychopathic individuals was associated with reduced functional connectivity with dopaminergic-related areas, including the striatum, when punishment was available compared to when it was unavailable.	The possibility that levels of psychopathic traits in a regular population were milder than in incarcerated populations cannot be ruled out.	The findings indicate that amygdala dysfunction underlies affective deficits of psychopathy. We propose that the insensitivity of the amygdala to the affective significance of social stimuli contributes to an increased risk of violation of social norms, but enhances the ability to attenuate impulses toward maladaptive aggression in successful psychopaths.	
22835839	The broaden-and-build theory postulates that positive emotions broaden people's cognitions and actions, and facilitate the building of personal and social resources which enhance resilience in a range of clinical populations. The Broad-Minded Affective Coping procedure (BMAC) is a recently developed clinical technique which utilizes the recall of positive autobiographical memories and mental imagery to elicit positive affect. This study aims to investigate the ability of the BMAC to boost mood among 50 individuals diagnosed currently (n = 31) or previously (n = 19) with Posttraumatic Stress Disorder (PTSD). To assess mood, a series of Visual Analog Scales (VASs) and Likert scales measuring feelings of sadness, calmness, happiness, hopelessness, defeat and frustration were administrated at baseline, immediately following the completion of the BMAC and two hours and two days afterwards. Participants in the BMAC condition demonstrated greater increases in self-reported levels of positive emotions and greater reductions in self-reported levels of negative emotions following the BMAC technique compared to those in the control condition. The results suggest that the BMAC is a useful clinical technique which can be incorporated into other clinical interventions such as cognitive behavioral therapy to elicit positive affect and promote resilience.
22830494	The association between stressful events on warlike deployments and subsequent mental health problems has been established. Less is known about the effects of stressful events on peacekeeping deployments.Two cross sectional studies of the Australian Defence Force were used to contrast the prevalence of exposures reported by a group deployed on a peacekeeping operation (Bougainville, n = 1704) and those reported by a group deployed on operations which included warlike and non-warlike exposures (East Timor, n = 1333). A principal components analysis was used to identify groupings of non-traumatic exposures on deployment. Multiple regression models were used to assess the association between self-reported objective and subjective exposures, stressors on deployment and subsequent physical and mental health outcomes.	The principal components analysis produced four groups of non-traumatic stressors which were consistent between the peacekeeping and more warlike deployments. These were labelled 'separation', 'different culture', 'other people' and 'work frustration'. Higher levels of traumatic and non-traumatic exposures were reported by veterans of East Timor compared to Bougainville. Higher levels of subjective traumatic exposures were associated with increased rates of PTSD in East Timor veterans and more physical and psychological health symptoms in both deployed groups. In Bougainville and East Timor veterans some non-traumatic deployment stressors were also associated with worse health outcomes.	Strategies to best prepare, identify and treat those exposed to traumatic events and other stressors on deployment should be considered for Defence personnel deployed on both warlike and peacekeeping operations.	
22803938	To investigate whether prolonged compulsive mirror-gazing in body dysmorphic disorder (BDD) is characterized by the prioritization of internally referenced (internal) goals for the mirror session, such as feeling right about one's make-up or shaven face, over externally referenced (external) goals, such as seeing that one's make-up is applied, or seeing that there is no more stubble on one's face.Cross-sectional case control.	Twenty-one participants with BDD and 18 community controls (CCs) recalled a recent mirror session in a semi-structured interview and then completed the Mirror-Gazing Goals and Terminating Factors Questionnaire (MGGTFQ), an instrument developed for the present study.	Internal goals were rated as more important in the BDD group than the CC group, but there was no difference between groups in the importance of external goals. The BDD group identified internal goals significantly more frequently than the CC group among their three most important goals. The BDD group reported significantly lower achievement ratings for the three most important goals and were more likely to terminate the session for reasons unrelated to their goals (e.g., frustration). For all participants, the importance of internal goals was positively correlated with the length of the mirror session.	The findings support current recommendations for targeting internal goals in interventions for problematic mirror use. Limitations and future directions are discussed, including the need to establish whether the use of internal goals is causally related to the length of the mirror session.	• BDD patients prioritize internal goals defined by feeling states when they look in the mirror (e.g., they aim above all to feel right about their make-up or shaven face), and then tend not to achieve their goals and end the mirror session for reasons unrelated to their goals (e.g., distress or time constraints). • Educating patients about these potentially problematic 'internal' goals, and encouraging them to aim for alternative goals (e.g., a fixed length of time, or an external goal defined by visual cues) might help patients to reduce the time they spend looking in the mirror. • The study is limited by the correlational design, the reliance on retrospective reporting, and the lack of a clinical control group.	
22799588	Adolescence is an important developmental stage during which both peers and the media have a strong influence. Both peer rejection and the use of morally adverse media are associated with negative developmental outcomes. This study examines processes by which peer rejection might drive adolescents to select antisocial media content by tying together developmental research on peer rejection and research on media effects. Assumed underlying mechanisms are rejection-based anger and frustration and the adolescent's moral judgment. A between-participants experimental design manipulated peer rejection versus acceptance in adolescents (Mage = 13.88 years; N = 74) and young adults (Mage = 21.37 years; N = 75), applying the Cyberball paradigm. Measures included the State Anger Inventory (STAXI) to assess feelings of rejection and the newly devised Media, Morals, and Youth Questionnaire (MMaYQue) to assess media preferences and moral judgment of media content. Using bootstrapping analyses, a double mediation was established: Higher levels of state anger in peer-rejected adolescents induced more tolerable moral judgments of antisocial media content, subsequently instigating a preference for antisocial media content. In contrast, the young adult sample showed no relations between peer rejection and antisocial media preference. Results are discussed within a downward spiral framework of combined peer and media influences.
22791988	Hearing loss is the most common sensory deficit in the elderly, and it is becoming a severe social and health problem. Especially in the elderly, hearing loss can impair the exchange of information, thus significantly impacting everyday life, causing loneliness, isolation, dependence, and frustration, as well as communication disorders. Due to the aging of the population in the developed world, presbycusis is a growing problem that has been reported to reduce quality of life (QoL). Progression of presbycusis cannot be remediated; therefore, optimal management of this condition not only requires early recognition and rehabilitation, but it also should include an evaluation of QoL status and its assessment.
22760899	The participation of humans in clinical cardiology trials remains essential, but little is known regarding participant perceptions of such studies. We examined the factors that motivated participation in such studies, as well as those that led to participant frustration.Patients who had participated in hypertension and coronary arterial disease (phases II, III, and IV) clinical trials were invited to answer a questionnaire. They were divided into two groups: Group I, which included participants in placebo-controlled clinical trials after randomization, and Group II, which included participants in clinical trials in which the tested treatment was compared to another drug after randomization and in which a placebo was used in the washout period.	Eighty patients (47 patients in Group I and 33 patients in Group II) with different socio-demographic characteristics were interviewed. Approximately 60% of the patients were motivated to participate in the trial with the expectation of personal benefit. Nine participants (11.2%) expressed the desire to withdraw, which was due to their perception of risk during the testing in the clinical trial (Group I) and to the necessity of repeated returns to the institution (Group II). However, the patients did not withdraw due to fear of termination of hospital treatment.	Although this study had a small patient sample, the possibility of receiving a benefit from the new tested treatment was consistently reported as a motivation to participate in the trials.	
22752312	To review the negative effects of attention-deficit/hyperactivity disorder (ADHD) in adolescence and adulthood on work productivity and occupational health.A review of the MEDLINE database was carried out to identify direct and indirect effects of ADHD on work, employment and occupational health.	ADHD is associated with higher levels of unemployment versus controls. Adults with ADHD who are employed experience workplace impairment and reduced productivity, as well as behavioural issues such as irritability and low frustration tolerance. Adults with ADHD are also at increased risk of accidents, trauma and workplace injuries, particularly traffic accidents. Indirect effects of ADHD on occupational health include reduced educational achievement and increased rates of substance abuse and criminality. Overall, ADHD in adults has a substantial economic impact as a result of absenteeism and lost productivity. Psychoeducation, combined with stimulant medications if necessary, is recommended as first-line treatment for adults with ADHD. Limited data available suggest that stimulant treatment can improve work productivity and efficacy, and reduce the risks associated with driving, although further studies are necessary.	ADHD can affect the ability to gain and maintain employment and to work safely and productively. As ADHD is a treatable condition, patients, employers and physicians have a role to play in ensuring optimal occupational health.	
22733689	It has often been argued that if patients' success with speech rehabilitation after laryngectomy is limited, it is the result of lacking motivation on their part. This project investigated the role of motivation in speech rehabilitation.In a multicenter prospective cohort study, 141 laryngectomees were interviewed at the beginning of rehabilitation and 1 year after laryngectomy. Speech intelligibility was measured with a standardized test, and patients self-assessed their own motivation shortly after the surgery. Logistic regression, adjusted for several theory-based confounding factors, was used to assess the impact of motivation on speech intelligibility.	Speech intelligibility 1 year after laryngectomy was not significantly associated with the level of motivation at the beginning of rehabilitation (odds ratio [OR], 1.3; 95% confidence interval [CI], 0.7-2.3; p = .43) after adjusting for the effect of potential confounders (implantation of a voice prosthesis, patient's cognitive abilities, frustration tolerance, physical functioning, and type of rehabilitation).	Motivation is not a strong predictor of speech intelligibility 1 year after laryngectomy.	
22731973	Primary care physicians who care for adults with intellectual disability often lack experience with the population, and patients with intellectual disability express dissatisfaction with their care. Establishing a secure primary care relationship is particularly important for adults with intellectual disability, who experience health disparities and may rely on their physician to direct/coordinate their care. The authors conducted semistructured interviews with 22 family physicians with the goal of identifying educational needs of family physicians who care for people with intellectual disability. Interviews were transcribed and coded using tools from grounded theory. Several themes related to educational needs were identified. Physician participants identified themes of "operating without a map," discomfort with patients with intellectual disability, and a need for more exposure to/experience with people with intellectual disability as important content areas. The authors also identified physician frustration and lack of confidence, compounded by anxiety related to difficult behaviors and a lack of context or frame of reference for patients with intellectual disability. Primary care physicians request some modification of their educational experience to better equip them to care for patients with intellectual disability. Their request for experiential, not theoretical, learning fits well under the umbrella of cultural competence (a required competency in U.S. medical education).
22726758	Uneven distribution of the medical workforce is globally recognised, with widespread rural health workforce shortages. There has been substantial research on factors affecting recruitment and retention of rural doctors, but little has been done to establish the motives and conditions that encourage allied health professionals to practice rurally. This study aims to identify aspects of recruitment and retention of rural allied health professionals using qualitative methodology.Six focus groups were conducted across rural NSW and analysed thematically using a grounded theory approach. The thirty allied health professionals participating in the focus groups were purposively sampled to represent a range of geographic locations, allied health professions, gender, age, and public or private work sectors.	Five major themes emerged: personal factors; workload and type of work; continuing professional development (CPD); the impact of management; and career progression. 'Pull factors' favouring rural practice included: attraction to rural lifestyle; married or having family in the area; low cost of living; rural origin; personal engagement in the community; advanced work roles; a broad variety of challenging clinical work; and making a difference. 'Push factors' discouraging rural practice included: lack of employment opportunities for spouses; perceived inadequate quality of secondary schools; age related issues (retirement, desire for younger peer social interaction, and intention to travel); limited opportunity for career advancement; unmanageable workloads; and inadequate access to CPD. Having competent clinical managers mitigated the general frustration with health service management related to inappropriate service models and insufficient or inequitably distributed resources. Failure to fill vacant positions was of particular concern and frustration with the lack of CPD access was strongly represented by informants.	While personal factors affecting recruitment and retention of allied health study participants were similar to doctors, differences also existed. Allied health professionals were attracted by advanced work roles in a context of generalist practice. Access to CPD and inequitable resource distribution were strong 'push' factors in this group. Health policy based on the assumption of transferability between professions may be misguided.	
22681857	Protracted, multi-year wait times exist for bariatric care in Canada. Our objective was to examine wait-listed patients' health status and perceptions regarding the consequences of prolonged wait times using a cross-sectional study design nested within a prospective cohort.150 consecutive consenting subjects wait-listed for multi-disciplinary bariatric assessment in a population-based medical/surgical bariatric program were surveyed. Health status was measured using a visual analogue scale (VAS). A Waiting List Impact Questionnaire (WLIQ) examined employment, physical stress, social support, frustration, quality of life, and satisfaction with care. Multivariable linear regression analysis adjusted for age, sex and BMI identified independent predictors of lower VAS scores.	136 (91%) subjects were women, mean age was 43 years (SD 9), mean BMI was 49.4 (SD 8.3) kg/m2 and average time wait-listed was 64 days (SD 76). The mean VAS score was 53/100 (SD 22). According to the WLIQ, 47% of subjects agreed/strongly agreed that waiting affected their quality of life, 65% described wait times as 'concerning' and 81% as 'frustrating'. 86% reported worsening of physical symptoms over time. Nevertheless, only 31% were dissatisfied/very dissatisfied with their overall medical care. Independent predictors of lower VAS scores were higher BMI (beta coefficient 0.42; p = 0.03), unemployment (13.7; p = 0.01) and depression (10.3; p = 0.003).	Patients wait-listed for bariatric care self-reported very impaired health status and other adverse consequences, attributing these to protracted waits. These data may help benchmark the level of health impairment in this population, understand the physical and mental toll of waiting, and assist with wait list management.	
22681337	The purpose of this article was to describe socio-emotional themes in the stories of 16 Centenarians living in the United Kingdom.Sixteen Centenarians were recruited and interviewed face-to-face by members of the research team. Participants were invited to tell the story of their lives in line with the principles of participatory action research (Koch and Kralik, 2006). The resultant story was returned to the Centenarian and their significant others for their validation and ownership. Stories were further analysed alongside verbatim interview transcripts. The first author wrote her psycho-social interpretation of the socio-emotional content in each person s life. These psycho-social interpretations were combined to provide commonalities in experience.	These six common experiences or themes were: Engagement in the world, Happiness and describing a good life, Stoicism, Sources of support, Sources of frustration and Talking about death. All participants had strong interests. They reported their lives as having been 'good' or 'happy'. They were resilient in the face of stress. Their frustrations pertained to visual or mobility impairments. While they were accepting the death of spouses, siblings and significant others, they were silent about the proximity of their own. In this article, we consider these themes in the light of previous empirical findings and theories.	Centenarians indicated that life had been worth living and that it felt good to be 100 years of age. We explore the limitations of this study and discuss implications of the findings for those involved with the oldest old.	
22676782	Compulsive helpfulness, an anxiety-laden need by the therapist to feel helpful, akin to the notion of rescuing others, is a potential pitfall in developing an effective psychotherapy group. It can be regarded variously: (1) as a reaction formation against feelings of boredom and frustration stimulated by such phenomena as group resistance or the enactment of inauthentic relationships in the group; (2) as a therapist style driven by a transferential reaction to be regarded as competent and worthy; (3) as an induced countertransference enactment tied to group members' frustration and passivity about their own interpersonal inadequacies; (4) and as a manic defense against despair over the feeling that one's loving has not done any good. In this essay, the author explores his struggle to identify and come to terms with compulsive helpfulness as a dominant theme in the early stages of his tenure as leader of a psychotherapy group.
22675906	The field of developmental behavior genetics has added significantly to the collective understanding of what factors influence human behavior and human development. Research in this area has helped to explain not only how genes and environment contribute to individual differences but also how the interplay between genes and environment influences behavior and human development. The current chapter provides a background of the theory and methodology behind behavior genetic research and the field of developmental behavior genetics. It also examines three specific developmental periods as they relate to behavior genetic research: infancy, toddlerhood, and early preschool. The behavior genetic literature is reviewed for key socioemotional developmental behaviors that fit under each of these time periods. Temperament, attachment, frustration, empathy, and aggression are behaviors that develop in early life that were examined here. Thus, the general purpose of this chapter is to provide an overview of how genes and environment, as well as the interplay between them, relate to early socioemotional behaviors.
22651677	Little is known of the possible relationship between a diagnosis of attention-deficit/hyperactivity disorder (ADHD) and sexually offensive behavior in adolescents. Our aim was to understand how adolescents with ADHD who had sexually offended described their childhood experiences and spoke about their diagnostic symptoms. The boys' early lives and relations were unpredictable, and emotional, physical, and sexual limits had been crossed. However, many boys saw themselves or their diagnosis, rather than their parents, school, or "society," as the underlying cause of their behavior. They used different strategies, for example repressing memories or regarding traumatic experiences as normal, to manage their lives. Most boys had difficulty with emotions and expressed sadness or frustration through anger. They spoke of being inattentive and restless in school and impulsive before and during their sexual offenses. The psychiatric assessment was described as a "messy" experience that strengthened their belief that something was wrong with them. Some had incorporated neuropsychiatric language into otherwise limited vocabularies and tended to use their diagnostic symptoms to excuse their offenses. The focus in the assessment on the boys themselves and their behaviors may darken their understandings of themselves, their experiences of abuse, and the offenses they have committed. Further research is needed into the possible consequences of a diagnosis of ADHD on adolescents' self-image and sense of self-control.
22796974	Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopment disorder of childhood that persists into adulthood in the majority of cases. In adults, the clinical picture of ADHD is complex and comorbidity with other psychiatric disorders is the rule. The documentation that the disorder had a childhood onset and the various comorbid symptomatologies present both in childhood and adult life represent the most influential obstacles for the accurate clinical diagnosis of the disorder. In 75% of cases with adult ADHD there is at least one coexisting comorbid disorder, with anxiety and mood disorders as well as substance abuse and impulse control disorders being the most prevalent ones. Adult psychiatrists have limited experience in the diagnosis, treatment and overall management of the disorder. Greece is a member of the European Network Adult ADHD (ENAA), founded in 2003, aiming to increase awareness of the disorder and to improve knowledge and patient care for adults with ADHD across Europe. A clinic where diagnosis as well as treatment recommendations are given after a thorough assessment of adult ADHD patients, is hosted at the First Department of Psychiatry of the Athens National and Kapodistian University. The clinic is in close collaboration with ENAA. The diagnosis of ADHD is given after a detailed evaluation of the patient, based on history taken, self-administered questionnaires and a specific psychiatric interview. The reliable trace of the symptoms' onset back in early childhood, current symptomatology, as well as its impact on at least two major areas of functioning (school, home, work or personal relationships) are pivotal for the assessment procedure. Special attention should be paid in the distinction of symptoms often coexisting with the core symptoms of the ADHD, such as emotional liability, incessant mental activity, avoidance of situations like queuing, especially when there is also frustration, from those indicating a comorbid disorder, e.g. bipolar disorder, major depression, anxiety disorders or personality disorders. Its coexistence with substance abuse requires special attention, as ADHD is quite prevalent in this group. In order to treat an ADHD patient the rule is a multidimensional intervention. Comorbid psychiatric disorders must be treated first. Psychoeducation of the patient is needed in most of the cases as well as the admin istration of specific for the ADHD psychotropic medication. Coaching, Cognitive Therapy and family interventions are proved to be the most efficacious psychosocial treatments. In the context of our university outpatients' clinic an observation study for exploring the occurrence of ADHD among patients with anxiety and depressive disorders took place. 15% of patients with anxiety and depressive disorders received for the first time in their lives the diagnosis of ADHD. The above mentioned indicate the need for further training psychiatrists in the recognition and treatment of adult ADHD.
22641839	This paper aims to build on the existing literature, by presenting some thoughts based on clinical experience with nine families of children referred for intractable contact refusal with one parent following marital separation. This particular group of high-conflict divorce cases engenders an inordinate amount of frustration both within the courts and therapeutic agencies. We outline here our assessment process and therapeutic strategies, as well as consideration of the role of the wider professional system and the courts. We conclude that whether or not direct contact with the rejected parent is achieved, useful therapeutic work can be carried out to assist children in moving on with their lives.
22611330	Competence in quality improvement (QI) is a priority for medical students. We describe a self-directed QI skills curriculum for medical students in a 1-year longitudinal integrated third-year clerkship: an ideal context to learn and practice QI.Two groups of four students identified a quality gap, described existing efforts to address the gap, made quantifying measures, and proposed a QI intervention. The program was assessed with knowledge and attitude surveys and a validated tool for rating trainee QI proposals. Reaction to the curriculum was assessed by survey and focus group.	Knowledge of QI concepts did not improve (mean knowledge score±SD): pre: 5.9±1.5 vs. post: 6.6±1.3, p=0.20. There were significant improvements in attitudes (mean topic attitude score±SD) toward the value of QI (pre: 9.9±1.8 vs. post: 12.6±1.9, p=0.03) and confidence in QI skills (pre: 13.4±2.8 vs. post: 16.1±3.0, p=0.05). Proposals lacked sufficient analysis of interventions and evaluation plans. Reaction was mixed, including appreciation for the experience and frustration with finding appropriate mentorship.	Clinical-year students were able to conduct a self-directed QI project. Lack of improvement in QI knowledge suggests that self-directed learning in this domain may be insufficient without targeted didactics. Higher order skills such as developing measurement plans would benefit from explicit instruction and mentorship. Lessons from this experience will allow educators to better target QI curricula to medical students in the clinical years.	
22610999	A series of studies suggest that bipolar disorder is related to high sensitivity to incentives and that incentive sensitivity (or sensitivity of the approach system) can predict the course of mania. Incentive sensitivity in bipolar disorder seems to be related to two processes: a tendency to invest in difficult-to-attain goals and an over-reactivity to cues of goal progress versus thwarting. Both of those processes appear relevant to symptom generation. Hence, bipolar disorder seems related to a greater emphasis on reaching goals and also a problematic reactivity to reaching those highly desired goals. We suggest directions for treatment development focused on these issues in goal regulation.
22594301	BACKGROUND AND AIM.  Children's dental fear and/or anxiety (DFA) has been associated with declines in oral health and quality of life. The influence of gender on the relationship between DFA and oral health-related well-being in children is analysed. DESIGN.  The decayed, missing and filled permanent teeth (DMFT) index was obtained from 161 school-aged children (7-14 years old). Data from children's self-assessed oral health, oral health-related emotional well-being and dental anxiety were collected using questionnaires. RESULTS.  Low scores of emotional well-being were associated with negative self-assessment of oral health and high levels of dental anxiety. Females reported decreased oral health-related emotional well-being compared with males. The analysis of possible moderating effects confirmed that gender influenced the relationship between oral health and DFA. The DMFT index was not associated with self-assessed oral health status, emotional well-being or DFA. CONCLUSION.  For girls, high levels of DFA were associated with low levels of oral health-related emotional well-being. In contrast, dental fear and/or anxiety did not influence oral health-related emotional well-being in boys.
22591180	It is well accepted that emotion regulation difficulties are a serious concern for children with ASD, yet empirical studies of this construct are limited for this population. The present study describes group differences between high functioning children with autism and their typical peers in frustration and discrete coping strategies for emotion regulation. We also use sequential analyses to test differences in the efficacy of individual coping strategies at regulating children's frustration.Subjects were 20 children with autism (M = 59 months) and 20 developmentally matched typically developing children (M = 50 months). Measures of children's frustration (negative facial expressions and behaviors, negative vocalizations, resignation) and emotion regulation coping strategies were observationally coded from structured video recordings.	Children with autism displayed a higher intensity and duration of resignation, and the group difference became most pronounced when children worked alone during the parent-absent segment of the locked box task. Children with autism used significantly more avoidance and venting strategies, and fewer constructive strategies than typical children. Sequential analyses revealed that social support strategies (orienting and verbalizing to the experimenter) were ineffective for children with autism, while these behaviors, vocal venting, and distraction strategies were all effective for typically developing children.	The results go beyond the recent literature by offering a rich description of children's efforts to regulate their frustration when faced with challenge, and point to important contextual differences in the efficacy of children's coping strategies.	
22587026	The aim of this study was to explore patients' expectations on and experiences from dental implant treatment through deep-interview technique.A qualitative study design was chosen and 17 patients were interviewed by open-ended questions. All patients in the study had a previous history of periodontal disease with, in most cases, many years of treatment. The interviews were transcribed; a coding process was used according to qualitative conventional content analysis.	In the analysis, a core category was identified as "Transition from tooth loss, to 'Amputation', and to implants - negative and positive trajectories". When the patients faced the fact that it was not possible to keep the teeth any longer, a period of fear, shame and denial, which also affected their social life negatively followed. After they received their implants and the chewing ability and appearance became better, it also improved their quality of life.	Treatment with dental implants improved function, enhanced self-esteem, social life and, thus quality of life. In clinical practice, information about dental implants and motivational strategies are needed during the period before getting dental implants. Follow-up is important thereafter, capturing both the pros and cons with implants.	
22580521	Noise is defined as a displeasing and unwanted sound. It is one of the most encountered stressor to which mankind is exposed. Frustration, poor reading, impaired hearing and difficulty in problem solving activities are the common consequences of noise stress. It has been reported to produce atrophy of dendrites and alterations in neurotransmitter levels. Long term exposure to inescapable noise stress induces exhaustion, defeat, annoyance followed by decreased muscle movement, social contacts and mood changes. The present study was aimed to investigate the detrimental effects of noise exposure on behavior of rats and its association with altered neurochemistry. Changes in neurotransmitter levels in different brain regions including hippocampus have been reported following noise exposure and these changes in neurotransmitters levels have also been associated with altered behavior. In the present study, locomotor activity in rats was assessed by open field test (OFT) while anxiety and depressive behavior was monitored by elevated plus maze (EPM) and tail suspension (TST) tests. The results showed that 15 days sub-chronic exposure to noise stress induced anxiety and depression like behavior in male rats. These behavioral deficits observed in the present study suggest that an altered brain serotonergic and dopaminergic activity may be involved in the various psychological disorders following exposure to noise stress.
22579718	Externalizing traits are characterized by exaggerated emotional (e.g., frustration, anger) and behavioral (e.g., drug seeking, reactive aggression) reactions to motivationally significant stimuli. Explanations for this exaggerated reactivity emphasize attention, executive function, and affective processes, but the associations among these processes are rarely investigated. To examine these interactions, we measure fear potentiated startle (FPS; Experiment 1) and neural activation (Experiment 2) in an instructed fear paradigm that manipulates attentional focus, demands on executive functioning, and emotion. In both studies, exaggerated emotional reactivity associated with externalizing was specific to conditions that focused attention on threat information and placed minimal demands on executive functioning. Results suggest that a crucial cognition-emotion interaction affecting externalizing is the over-prioritization and over-allocation of attention to motivationally significant information, which in turn, may impair executive functions and affective regulation.
22579396	In connection with the care received in the intensive care unit (ICU), the patient can experience discomfort and frustration. Earlier studies have shown mechanical ventilation (MV) to be a factor that increases patients' delusional memories in the ICU. The patients who need MV after a physical trauma constitute a vulnerable group who so far has attracted little attention from a long-term perspective.The aim for this study is to describe mechanically ventilated trauma patients over time regarding their memories, psychological recovery and health related quality of life (HRQoL).	In a multicentre study, 41 patients who had received MV, answered a questionnaire with the SF-36, HAD and ICUM tool on two occasions about one and five years after the injury and care in the ICU.	The patients' memories were stable over time and significantly more patients remembered panic and anxiety. 37% remembered pain one year after the trauma and 46% five years thereafter. The majority of the patients remembered the family's presence from their ICU stay. Half of the patients had thoughts regarding why they had so few recollections. One fourth of the patients experienced clear symptoms of anxiety and the same amount had symptoms of depression one year after the injury. In seven of the patients the symptoms of probable anxiety persisted after five years. In six of the patients the symptoms of probable depression persisted after five years. Two of eight dimensions in HRQoL, the physical and emotional role functions, had improved significantly five years after the injury.	Five years after the trauma, the memories from the ICU were still the same and the HRQoL improved in only two out of eight dimensions. A smaller group of patients had remaining symptoms of psychological ill-health. MV in connection with trauma may result in continued reduced health in the long term.	
22578392	Pain is the most common presenting complaint in emergency departments and the primary reason patients seek medical care and take prescription medications. Improving inadequate pain control is a critical goal in emergency health care. As patients' primary health care advocates, emergency nurses play a vital role in resolving under-treated pain in their patients. The purpose of this qualitative study was to explore the perceptions of ED nurses regarding the processes used when managing adult patients' pain and to increase understanding of how these perceptions affect patients' pain management.Participants were recruited from the membership of the local emergency nurses association and 6 hospital-based emergency departments in Northeast Florida. Fifteen emergency nurses with tenure ranging from 1 to 35 years were individually interviewed. Interviews were transcribed verbatim and analyzed using content analysis methodology.	The central core category that emerged highlighted the ED environment as a barrier to demonstrating caring when managing adult patients' pain. The core category was supported by 3 broad themes, each consisting of 3 subcategories: (a) feeling overwhelmed as a result of constant prioritizing and perceived lack of control and adequate staffing, (b) perceived non-cohesiveness of the health care team, including nurses, administrators, and emergency physicians, and (c) frustration concerning abuse of the emergency department, complexity of pain, and unrealistic patient expectations of the nurses' role.	Interventions that improve the ED environment and facilitate the process of pain management are warranted. Implications for accomplishing these interventions clearly exist in nursing education, practice, research, and public policy.	
22573287	Trajectories of baseline RSA (respiratory sinus arrhythmia), an index of reactivity, and vagal withdrawal, an index of regulation, across the preschool period were examined. In addition, maternal emotional support was investigated as a potential time-varying predictor of these trajectories. Physiological measures were obtained during frustration tasks, and a maternal emotional support measure was assessed via maternal report and direct observation. Children's baseline RSA and vagal withdrawal scores were moderately stable across the preschool period. Growth models indicated that children's baseline RSA scores changed linearly over the preschool years, and there was significant variability in withdrawal trajectories. Greater maternal emotional support predicted higher initial withdrawal levels and lower emotional support was associated with the greatest increase in withdrawal over time. This suggests that children of higher emotionally supportive mothers reached higher levels of physiological regulation earlier in development and therefore did not show the same increase across preschool as children of less supportive mothers. Maternal emotional support was not significantly related to trajectories of baseline RSA.
22571460	A reliable observation in neuroimaging studies of cognitive control is the response of dorsal ACC (dACC) to events that demand increased cognitive control (e.g., response conflicts and performance errors). This observation is apparently at odds with a comparably reliable association of the dACC with the subjective experience of negative affective states such as pain, fear, and anxiety. Whereas "affective" associates of the dACC are based on studies that explicitly manipulate and/or measure the subjective experience of negative affect, the "cognitive" associates of dACC are based on studies using tasks designed to manipulate the demand for cognitive control, such as the Stroop, flanker, and stop-signal tasks. Critically, extant neuroimaging research has not systematically considered the extent to which these cognitive tasks induce negative affective experiences and, if so, to what extent negative affect can account for any variance in the dACC response during task performance. While undergoing fMRI, participants in this study performed a stop-signal task while regularly reporting their experience of performance on several dimensions. We observed that within-subject variability in the dACC response to stop-signal errors tracked changes in subjective frustration throughout task performance. This association remained when controlling for within-subject variability in subjective reports of cognitive engagement and several performance-related variables indexing task difficulty. These results fit with existing models characterizing the dACC as a hub for monitoring ongoing behavior and motivating adjustments when necessary and further emphasize that such a function may be linked to the subjective experience of negative affect.
22570399	Family physicians play a crucial role in the management and ongoing care of patients with Alzheimer disease (AD). This article reviews the effects of nonpharmacologic and pharmacologic interventions on the functional abilities and behavior of patients with dementia and how these can be implemented into clinical practice. Nonpharmacologic interventions are recommended as the initial strategy for managing problematic behaviors. Strategies for improving behavior include ensuring that the patient's environment is safe, calm, and predictable; removing environmental stressors; and identifying and avoiding situations that agitate or frighten the patient. Simple interventions include redirecting and refocusing the patient, increasing social interaction, establishing regular sleep habits, eliminating sources of conflict and frustration, and establishing rewards for successes. The effectiveness of long-term behavioral management is largely dependent on the caregiver; as such, it is important to assess the role and needs of the caregiver. Because currently available therapies cannot reverse the pathologic processes of AD, the primary objective of pharmacotherapy is to preserve cognitive and functional ability, minimize behavioral disturbances, and slow disease progression. Cholinesterase inhibitors represent first-line therapy for patients with mild to moderate AD, whereas a glutamate N-methyl D-aspartate antagonist is used in the treatment of moderate to severe AD. Looking forward, there are a number of therapies in development aimed at modifying the disease course; these include amyloid-lowering drugs, τ-based and neuroprotective approaches, acetylcholine agonists, and mitochondrial inhibitors.

22551430	Feelings of powerlessness have been reported to affect nurses' perceived ability to provide competent quality care and have contributed to moral dilemmas and burnout among nurses. Burns nurses are a specific group of nurses who are more likely to experience feelings of powerlessness due to performing traumatic, painful and lengthy large dressing changes and procedures on a daily basis. Nevertheless, nurses' perception of powerlessness is under reported in the area of burn care. The purpose of this descriptive phenomenological study was to examine the feelings of powerlessness by nurses who care for severe burn injury patients. Data were analysed via Colaizzi's phenomenological method. Nurses' feelings of powerlessness were identified and organised into four cluster themes: inadequacy, apprehension, vulnerability and frustration. The findings clearly demonstrate the need to address issues of powerlessness experienced among burns nurses and nurses alike. Burn nurses are often left feeling inadequate during and after burns procedures, due to the level of pain and emotion experienced by patients with severe burn injuries. Emotional intelligence may offer nurses the ability to empower themselves in order to enhance their professional development and leadership capabilities.
22551011	To describe circumstances and consequences of falls occurring among persons with fibromyalgia who had recent falls.Fibromyalgia is a common widespread pain condition that has been linked to increased fall-risk. No published research described experiences of falling in persons with fibromyalgia. Prior to development of fall-risk reduction interventions, it is essential to understand the context of falls and fall experiences in persons with fibromyalgia.	Descriptive longitudinal study.	The study took place during 2009; data were collected via fall diaries and interviews in 18 US women ages 21-69 years.	Over 6 months, 17 of 18 participants fell or had a near-fall. For the 15 women with 6-month fall-prevalence data, median number of falls was 2, with 3 near-falls. Most fall experiences contained intrinsic and extrinsic contributory factors. Participants reported engaging in various activities prior to falls/near-falls. A substantial minority (32-48%) experienced severe symptoms (pain, fatigue, stiffness) at the time. Most falls/near-falls occurred in homes during the day; one resulted in injury. Themes that were identified included the following: always being careful or generally cautious; fear of losing control of one's body, especially related to balance; desire to continue activities counterbalanced with frustration at not being able to because of fear of falling; perception of having become clumsy.	Nurses caring for persons with fibromyalgia should assess for potential fall-risk factors and offer plans for individualized fall-prevention strategies.	
22549299	Despite new treatment therapies and the emphasis on patient activation, nearly 50 % of diabetes patients have hemoglobin A(1c) levels above target. Understanding the impact of unmet treatment goals on the physician-patient relationship is important for maintaining quality care in clinical practice.To explore physicians' and type 2 diabetes patients' views of patients' difficulty achieving diabetes treatment goals.	Qualitative study using in-depth interviews with a semi-structured interview guide.	Nineteen endocrinologists and primary care physicians and 34 patients diagnosed with type 2 diabetes at least two years prior.	In-depth interviews with physicians and patients. A multidisciplinary research team performed content and thematic analyses.	Qualitative analysis revealed two main findings, organized by physician and patient perspectives. Physician Perspective: Physicians' Perceived Responsibility for Patients' Difficulty Achieving Treatment Goals: Physicians assumed responsibility for their patients not achieving goals and expressed concern that they may not be doing enough to help their patients achieve treatment goals. Physicians' Perceptions of Patients' Reactions: Most speculated that their patients may feel guilt, frustration, or disappointment when not reaching goals. Physicians also felt that many patients did not fully understand the consequences of diabetes. Patient Perspective: Patients' Self-Blame for Difficulty Achieving Treatment Goals: Patients attributed unmet treatment goals to their inability to carry out self-care recommendations. Most patients blamed themselves for their lack of progress and directed their frustration and disappointment inwardly through self-depreciating comments. Patients' Perceptions of Physicians' Reactions: Several patients did not know how their physician felt, while others speculated that their physicians might feel disappointed or frustrated.	Physicians' perceived responsibility and patients' self-blame for difficulty achieving treatment goals may serve as barriers to an effective relationship. Physicians and patients may benefit from a greater understanding of each other's frustrations and challenges in diabetes management.	
22548510	Between 15 and 60% of patients are considered "difficult" by their treating physicians. Patient psychiatric pathology is the conventional explanation for why patients are deemed "difficult." But the prevalence of the problem suggests the possibility of a less pathological cause. I argue that the phenomenon can be better explained as a response to problematic interactions related to health care delivery. If there are grounds to reconceive the "difficult" patient as reacting to the perception of ill treatment, then there is an ethical obligation to address this perception of harm. Resolution of such conflicts currently lies with the provider and patient. But the ethical stakes place these conflicts into the province of the ethics consult service. As the resource for addressing ethical dilemmas, there is a moral mandate to offer assistance in the resolution of these ethically charged conflicts that is no less pressing than the more familiar terrain of clinical ethics consultation.
22524290	Healthcare professionals, including speech-language pathologists, generally assume that their clients will be happy after they have "gotten better" or somehow achieved their goals; which is not an unreasonable assumption, and which is a belief shared by the majority of clients. It may not, however, be entirely helpful. Such an approach may well contribute to a range of problems including negative, self-defeating emotions such as frustration which could impede treatment progress. Rather than waiting until success is achieved, happiness and positivity should come first and foremost. By promoting the "primacy of positivity" speech-language pathologists can help their clients better achieve their goals, leveraging off the energy and motivation created.
22520913	Childhood eczema causes significant impact on quality of life for some families, yet non-concordance with treatment is common.To explore parents' and carers' views of childhood eczema and its treatment.	Qualitative interview study in primary care in the south of England.	Carers of children aged ≤5 years with a recorded diagnosis of eczema, who reported that eczema was still a problem, were invited to participate. Thirty-one parents were interviewed from 28  families.	Many parents expressed frustration with both medical care and prescribed treatments. They felt their child's suffering was not 'taken seriously', and experienced messages about a 'trial and error' prescribing approach and assurance  that their child would 'grow out of it' as a further 'fobbing off', or dismissal. Many carers were ambivalent about eczema treatments, mainly topical corticosteroids but also emollients. Dietary exclusions as a potential cure were of interest to most families, although  they perceived healthcare professionals as uninterested in this. Families varied in the extent to which they felt able to manage eczema and the length of time taken to gain control. In some instances, this was linked to not understanding advice or receiving conflicting advice from different  healthcare providers.	Poor concordance with treatments seems unsurprising in the presence of such dissonance between carers' and healthcare providers' agendas. Acknowledging the impact of the condition, greater attention to how key messages are delivered and  addressing carers' treatment beliefs are likely to improve engagement with effective self-care.	
22514146	The aim of this study was to explore the patient's perception of receiving a diagnosis of systemic lupus erythematosus (lupus) and reports on their experience of the period between onset of symptoms and receiving a definitive diagnosis.Focus groups were conducted in seven rheumatology centres. Forty-three participants were purposively selected and data were subjected to thematic deductive analysis.	Focus group data generated three major themes. 'Diagnostic uncertainty and misdiagnosis' describes the frustration for many of experiencing years of often debilitating symptoms that have gone unacknowledged by health professionals and misunderstood by themselves. Some experienced the trauma of being misdiagnosed, which impacted on how they adjusted to their final diagnosis of lupus. 'Consequences of receiving a diagnosis' highlights the feelings of relief for participants at finally having a diagnosis, despite its implications. However, the manner in which this knowledge was delivered was often inappropriate and unsupported, affecting how they adjusted to future management of their condition. 'Impact on individuals' lives' explores how many felt empowered by finally receiving recognition for their symptoms, but the diagnosis of a relatively unknown condition with often invisible symptoms impacted on the response and support they received from those around them.	It is essential health professionals have a greater understanding of the patient experience prior to receiving a diagnosis of lupus. The individual experience from symptom onset to diagnosis has a direct impact on the patient's subsequent acceptance of their diagnosis and response to management and therefore justifies the need for further research in this field.	

22508015	Research shows that drugs and delinquency are frequently linked, the abuse of various types of substance being a widespread practice among young offenders. At the same time, some psychosocial characteristics are associated with both drug abuse and criminal/antisocial behavior. To help us explore the relationship between young offenders' drug abuse and certain psychosocial variables, we examined closed judicial files on young offenders from the Juvenile Justice Service in Jaen (Spain) corresponding to the period 2001 to 2010. From the contents of these judicial files we analyzed demographic variables such as gender and age, as well as psychosocial variables such as drug abuse, peer group, violent behavior, self-control, tolerance to frustration and attributional style. The results show that most of the young offenders use some type of drug, as well as revealing differential patterns of use according to gender. Also observed is a link between drug abuse and deviant peer group, violent behavior and the above-mentioned psychological variables. Finally, we found some differences in these psychological variables depending on the type of drug used.
22506483	It is not well understood how people perceive the difficulty of performing brain-computer interface (BCI) tasks, which specific aspects of mental workload contribute the most, and whether there is a difference in perceived workload between participants who are able-bodied and disabled. This study evaluated mental workload using the NASA Task Load Index (TLX), a multi-dimensional rating procedure with six subscales: Mental Demands, Physical Demands, Temporal Demands, Performance, Effort, and Frustration. Able-bodied and motor disabled participants completed the survey after performing EEG-based BCI Fitts' law target acquisition and phrase spelling tasks. The NASA-TLX scores were similar for able-bodied and disabled participants. For example, overall workload scores (range 0-100) for 1D horizontal tasks were 48.5 (SD = 17.7) and 46.6 (SD 10.3), respectively. The TLX can be used to inform the design of BCIs that will have greater usability by evaluating subjective workload between BCI tasks, participant groups, and control modalities.Mental workload of brain-computer interfaces (BCI) can be evaluated with the NASA Task Load Index (TLX). The TLX is an effective tool for comparing subjective workload between BCI tasks, participant groups (able-bodied and disabled), and control modalities. The data can inform the design of BCIs that will have greater usability.	
22475497	Four conditioned approach experiments with rats assessed for effects of number of acquisition trials on extinction of conditioned responding, when number of acquisition sessions and total acquisition time were held constant. In Experiment 1, 32 trials per acquisition session led to more extinction responding than did 1 or 2 trials per session but less than did 4 trials per session. In Experiment 2, 2 trials per acquisition session led to more spontaneous recovery than did 32 trials per session. These latter findings are reminiscent of the overtraining extinction effect (OEE). Experiment 3 attempted to reduce the OEE with a preconditioning phase of partial reinforcement. Experiment 4 attempted to reduce the beneficial within-subject effects of increasing the number of acquisition trials on extinction observed by Gottlieb and Rescorla (2010) by extinguishing stimuli in different sessions. Overall, results suggest a procedural asymmetry: between-subject, increasing the number of trials between any pair of trials does not lead to greater persistence of responding during extinction; within-subject, it does. Results are discussed from an associative perspective, with a focus on explanations involving either frustration or comparator mechanisms, and from an information processing perspective, with a focus on Rate Estimation Theory.
22473060	To improve understanding of the sources of frustration for people with chronic pain and consider the potential influence of frustration on the chronic pain experience and relationships with health professionals.Qualitative in-depth interviews with a diverse, maximum variation sample of 46 participants with chronic pain, 30 of whom talked about frustration. Analysis paid close attention to how people talked about their frustration as well as what they said.	Frustration is a multi-faceted emotion and its effects are cumulative. Sources of frustration include interference with everyday activities, the interruption of life goals and roles and the unpredictability of pain; here we focus on the frustrations associated with the invisibility of chronic pain and the perceived limitations of diagnosis and pain management (both related to the perceived legitimacy of the condition). Several of the participants who had lived with chronic pain for many years described overcoming, or managing, their frustrations.	If patients think that their pain is not being believed this is clearly a barrier to an effective consultation. Communication with chronic pain patients may improve if the frustration of living with an invisible, debilitating condition that is hard to diagnose and treat is explicitly (and perhaps repeatedly) acknowledged by the health professional.	
22468939	The overtraining extinction effect (OEE), a phenomenon in which extended training facilitates extinction, has been found in mammals and reptiles. However, fish have never shown OEE. No study has yet investigated OEE in newts, a representative amphibian species. We tested whether newts, Cynops pyrrhogaster, show OEE in a straight-array task. All animals received five trials per day and were given a piece of dried worm during reinforced trials. They showed significant acquisition and extinction effects in reinforced and nonreinforced trials. However, we found no difference in extinction performance between a group with 25-trial acquisition and one with 75-trial acquisition, suggesting that OEE was not found in newts. OEE has generally been explained in terms of frustration-related mechanisms. Our results suggest that emotional reactions to nonreward, such as frustration, may not influence behavior in amphibians.
22465852	Children with developmental disabilities may get frustrated in unpredictable hospital environments. Frustration may escalate to challenging behaviors, which are a safety concern and may contribute to staff and patient injuries, use of restraints, and procedure delay or cancelations. The purpose of this article was to describe a pilot staff education program on preventing and managing challenging behaviors of children with developmental disabilities at a pediatric hospital. The 2-hour-long education (1 hour on-line and 1 hour instructor led) content focused on family-centered care and communication skills, including verbal judo™ modified for use in the health care setting. Participants in the instructor-led sessions reported improved knowledge and decreased fear about caring for children with developmental disabilities. Relationships of the education and fewer staff injuries, fewer canceled procedures, and decreased use of restraints merit further study.
22460730	While the link between parenting and delinquency is well established, there is less consensus among scholars with regards to the processes that account for this link. The current study had two objectives. The first was to disentangle the effects of African American parents' use of corporal punishment and verbal abuse on the conduct problems of their preteen children. The second was to investigate the mechanisms that explain this relationship, such as having low self-control or a hostile view of relationships, whereby these harsh parenting practices increase a youth's involvement in problem behavior. Further, we are interested in specifically addressing how these mechanisms may operate differently for males versus females. Analyses utilized structural equation modeling and longitudinal data spanning approximately 2.5 years from a sample of 704 (54.2 % female) African American children ages 10-12. The results indicated that verbal abuse was a more important predictor of conduct problems than corporal punishment. Additionally, we found that the mechanisms that mediated the impact of verbal abuse and corporal punishment on conduct problems varied by gender. For males, most of the effect of verbal abuse was mediated by low self-control, whereas anger/frustration was the primary mediator for females. Implications of these results and directions for future study are also discussed.
22459523	Loneliness is a significant psychosocial concern for patients with cancer, and depression may be an antecedent to loneliness. To date, no studies have directly addressed the relationship of loneliness, depression, and social support among Turkish patients with cancer and their caregivers. The emotional responses that result from a cancer diagnosis vary and may include anxiety, anger, frustration, or depression. Because of the unexpected demands and emotions thrust on them, the caregivers of patients with cancer may be just as likely to experience loneliness or depression following a cancer diagnosis. As a result, this study sought to examine that relationship among a sample of 60 patients with cancer and 60 caregivers.
22445897	The enhancement of emotional memory is clearly important as emotional stimuli are generally more significant than neutral stimuli for surviving and reproduction purposes. Yet, the enhancement of a negative emotional memory following exposure to stress may result in dysfunctional or intrusive memory that underlies several psychiatric disorders. Here we examined the effects of stress exposure on a negative emotional learning experience as measured by a decrease in the magnitude of the expected quantity of reinforcements in an alley maze. In contrast to other fear-related negative experiences, reward reduction is more associated with frustration and is assessed by measuring the latency to run the length of the alley to consume the reduced quantity of reward. We also examined whether the cannabinoid receptors agonist WIN55,212-2 (5 μg/side) and the glucocorticoid receptors (GRs) antagonist RU-486 (10 ng/side) administered into the rat basolateral amygdala (BLA) could prevent the stress-induced enhancement. We found that intra-BLA RU-486 or WIN55,212 before stress exposure prevented the stress-induced enhancement of memory consolidation for reduction in reward magnitude. These findings suggest that cannabinoid receptors and GRs in the BLA are important modulators of stress-induced enhancement of emotional memory.
22445424	To determine symptom-specific distress and quality-of-life impact outcomes among women who had undergone transvaginal repair of symptomatic rectocele.Women who underwent transvaginal repair of symptomatic rectocele at the University of Alabama at Birmingham, USA, between April 2006 and June 2009 were included in a retrospective case series. Minimum follow-up was 1 year post-surgery. Women who underwent concomitant surgery, other than perineoplasty and/or midurethral sling, were excluded. End points were assessed using the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7).	Overall, 113 women underwent repair of symptomatic rectocele, of whom 69 (61.1%) completed preoperative questionnaires and 66 (58.4%) responded to follow-up questionnaires. Mean time from surgery was 31.2±11.2 months. PFDI-20 and PFIQ-7 scores were significantly improved following surgery, with a median pre- and post-surgery difference of 35.4 (P<0.001) and 31.0 (P=0.002), respectively.	Patients who underwent transvaginal repair of symptomatic rectocele reported improvements in symptom-specific distress and impact on quality of life.	
22441996	Once a term used primarily by moral philosophers, "moral distress" is increasingly used by health professionals to name experiences of frustration and failure in fulfilling moral obligations inherent to their fiduciary relationship with the public. Although such challenges have always been present, as has discord regarding the right thing to do in particular situations, there is a radical change in the degree and intensity of moral distress being expressed. Has the plight of professionals in healthcare practice changed? "Plight" encompasses not only the act of pledging, but that of predicament and peril. The author claims that health professionals are increasingly put in peril by healthcare reform that undermines their efficacy and jeopardizes ethical engagement with those in their care. The re-engineering of healthcare to give precedence to corporate and commercial values and strategies of commodification, service rationing, streamlining, and measuring of "efficiency," is literally demoralizing health professionals. Healthcare practice needs to be grounded in a capacity for compassion and empathy, as is evident in standards of practice and codes of ethics, and in the understanding of what it means to be a professional. Such grounding allows for humane response to the availability of unprecedented advances in biotechnological treatments, for genuine dialogue and the raising of difficult, necessary ethical questions, and for the mutual support of health professionals themselves. If healthcare environments are not understood as moral communities but rather as simulated marketplaces, then health professionals' moral agency is diminished and their vulnerability to moral distress is exacerbated. Research in moral distress and relational ethics is used to support this claim.
22431127	The aim of this study was to construct and validate a short self-rating questionnaire for the assessment of ego functions and ability of self regulation.An item pool of 120 items covering 6 postulated dimensions was reduced by two steps in independent samples (n = 136 + 470) via factor and item analyses to the final version consisting of 35 items.	The 5 resulting questionnaire scales "interpersonal disturbances", "frustration tolerance and impulse control", "identity disturbances", "affect differentiation and affect tolerance" and "self-esteem" were well interpretable and showed in confirmatory factor analysis the best fit to the data (CHI²/df = 3.48; RMSEA = 0.73). Total scores were found to differentiate well between diagnostic groups of patients with more or less ego pathology (FANOVA = 9.8; df = 11; p < 0.001), thus proving good concurrent validity. Reliability was shown by testing internal consistency and test-retest correlations.	The "Hannover self-regulation questionnaire" (HSRQ) evidently is an appropriate and reliable screening instrument in order to assess ego functions and capacities of self regulation in an economic and user-friendly means. The scale structure allows differentiated diagnostics of weak vs. stable ego functions and may be used for detailed therapy planning.	
22427282	Pain relief is often the primordial treatment objective in pain patients. However, an exclusive focus upon pain relief may have costs. Evidence is accumulating that persistent attempts to gain control over pain may, paradoxically, hinder successful adaptation to pain and increase frustration and limitations due to pain. To better understand these apparently paradoxical findings, we propose to adopt a motivational perspective on coping with pain. Within this perspective, pain control is recast as an attempt to protect and restore valued life goals threatened by pain. This framework explains why some patients engage excessively in pain control strategies despite the costs associated with this, such as overuse of medication. A clinical implication is that cautiousness is warranted in promoting strategies exclusively aimed at pain relief. Beyond standard medical care, interventions should also be aimed at the improvement of functioning despite pain. Certainly those patients for whom there is no definite or sound cure to pain and who increasingly experience emotional and physical problems due to pain might benefit from paramedical help by psychologists and/or physiotherapists.
22423597	The purpose was to explore the experiences and needs of persons with spinal cord injury (SCI) who can walk.Thematic analysis was undertaken on the transcripts of semistructured interviews with 12 individuals who could walk following SCI.	Experiences shared across the group were related to walking in hospital and community settings, fatigue, frustration and invisible impairments. A need was identified for psychological support whilst in hospital and beyond. Professional and peer support following discharge from hospital were needed to assist with adjusting to their injury. Differences were noted between the experiences and needs of persons who had sustained their injury through a traumatic cause and persons who had sustained their injury through nontraumatic cause and the rehabilitation environment in which participants were hospitalized.	The lived experiences of the general cohort in this small-scale study suggest that innovative strategies/programs be developed to address the needs of walkers within inpatient settings and following their discharge into the community. Programs should include self-help mental health strategies. Programs are required to better inform health professionals of the needs of this subset of the spinal cord injured population. Attention should be drawn particularly towards the needs of persons who had sustained their injury through nontraumatic cause.	
22420798	Our goal in this study was to better understand racial and socioeconomic status (SES) variations in experiences of racial and nonracial discrimination.We used 1999 and 2000 data from the YES Health Study, which involved a community sample of 50 Black and 50 White respondents drawn from 4 neighborhoods categorized according to racial group (majority Black or majority White) and SES (≤ 150% or > 250% of the poverty line). Qualitative and quantitative analyses examined experiences of discrimination across these neighborhoods.	More than 90% of Blacks and Whites described the meaning of unfair treatment in terms of injustice and felt certain about the attribution of their experiences of discrimination. These experiences triggered similar emotional reactions (most frequently anger and frustration) and levels of stress across groups, and low-SES Blacks and Whites reported higher levels of discrimination than their moderate-SES counterparts.	Experiences of discrimination were commonplace and linked to similar emotional responses and levels of stress among both Blacks and Whites of low and moderate SES. Effects were the same whether experiences were attributed to race or to other reasons.	
22418945	The current study examined temperament characteristics as risk factors for restraint and seclusion (R/S) events in psychiatrically hospitalized youth, extending work that has sought to identify R/S risk factors and research examining temperament-behavior problem associations that has largely relied upon community samples. It was anticipated that children with poor effortful control (EC) and greater frustration would have more instances of R/S during psychiatric hospitalization. The contribution of children's fearfulness to R/S was also examined. A measure of temperament was completed by youths' clinicians and youths (n = 52) completed objective measures of EC. The frequency of R/S events for each participant was obtained from hospital records. After controlling for R/S risk factors, lower EC and higher fearfulness predicted increased R/S occurrences during the first 2 weeks of hospitalization and over the course of children's entire hospitalization. These findings indicate that temperament should potentially be considered in individualized treatment plans targeting the prevention and/or reduction of R/S. Additional implications of the findings are also discussed.
22418400	Psychopathology is a risk factor for suicidal behavior. It is likely that psychiatrists will have to deal with an attempted or completed suicide by a patient at some point in their careers. The goal of this study was to assess psychiatrists' emotional reactions to patients' suicidal behavior.Data were collected using a questionnaire that was administered to psychiatrists after a completed or attempted suicide by one of their patients.	Thirty-four psychiatrists participated in the study and reported on 62 attempted suicides and 11 completed suicides. All of the participants reported at least one emotion following the event. After an attempted suicide, trainees were more likely than consultants to experience psychological pain, guilt, self-doubt, and frustration. Being a trainee was also associated with psychological pain, guilt, fear, self-doubt, and frustration in regression analysis. Shock, disbelief, fear, self-doubt, and embarrassment were associated with completed rather than attempted suicides.	Attempted and completed suicides have a significant impact on psychiatrists. The impact of an attempted suicide is usually less severe. The patterns of reaction differ between consultant and trainee psychiatrists.	
22410065	This study aimed to explore the dilemmas of Taiwanese overseas liver transplant recipient families (OLTRF) across three overseas liver transplant (OLT) stages in Taiwan and Mainland China.An exploratory qualitative method was employed using a purposive sample of OLTRF, who received guided face-to-face, semistructured interviews. Data were subjected to content analysis.	Nineteen OLTRF (15 female, 4 male) aged between 29 and 71 years (mean 55.1) for 19 patients with end-stage liver diseases were interviewed. OLT stages including predeparture stage (first stage), stay in China stage (second stage), and reentry to Taiwan stage (third stage). Ten kinds of dilemmas were encountered: (1) unable to get transplantation immediately (first to second stages); (2) dilemma of choosing overseas transplantation (first to second stages); (3) uncertainty about the transplantation outcomes (second to third stages); (4) care pressure (second to third stages); (5) poor diet adaptation (second to third stages); (6) lack of trust in the medical care quality (second stage); (7) worry about not fulfilling family responsibilities (second stage); (8) lack of information (all stages); (9) financial pressure (all stages); and (10) frustration when seeking medical care (all stages).	Taiwanese OLTRF's perspectives of their dilemmas through the OLT process were first revealed in this study. Both Western and Eastern health professionals might be empowered by better understanding of OLTRF's living experiences and concerns during the stages of overseas liver transplantation.	
22407743	Supporting dementia carers is an identified target of the UK government, yet we know little about such family carers' grief before and after the death of the person with dementia for whom they care. We systematically review the existing literature on characteristics, prevalence, predictors and associations of grief in dementia carers before and after death.We searched electronic databases and found 31 publications meeting predetermined criteria.	Grief in dementia carers, which may be normal or complicated, is a complex reaction to losses occurring before and after death. Carers experience anticipatory grief as multiple losses for themselves (companionship, personal freedom and control) and the person with dementia. Anticipation and ambiguity about the future, anger, frustration and guilt are core features. Anticipatory grief is greatest in moderate to severe stage dementia and spouse carers, especially when the person with dementia is institutionalised. There was poor quality evidence about the prevalence of grief; studies reported anticipatory grief between 47% and 71%, and complicated grief after death is estimated around 20%. Carer depression increases with anticipatory grief. Being a spouse carer and being depressed are the strongest predictors of complicated and normal grief after death.	Grief in dementia carers can be expected; however, those at risk of distressing anticipatory and complicated grief may be identified and targeted for intervention when necessary. Higher quality research from a wider range of samples and countries is needed to explore this complex and emergent topic.	

22403198	The objective of this study was to investigate the emotional responses and coping strategies that family physicians and their office staff reported in response to a patient safety incident.Two questions contained in a patient safety incident report developed for a study of patient safety in family practice were analyzed. The questions asked reporters to indicate their emotional response to a patient safety incident and how they coped with it. A total of 264 confidential patient safety incident reports collected from September 2007 to August 2010 were analyzed.	An emotional response was reported on 82.4% of reports. Of those reports on which an emotional response was reported, a coping strategy was reported on 62.8%. The top 4 reported emotional responses were frustration (48.3%), embarrassment (31.5%), anger (12.6%), and guilt (10.1%). Physicians reported an emotional response more often than clinic staff. An emotional response was reported more often when there was a possibility of harm. Coping strategies were reported as follows: 52% talked to someone about the incident, 37.2% did nothing in response to the incident, 17.9% told the patient about the incident, and 3.6% did something else. Female physicians reported using coping strategies less often than male physicians. A coping strategy was reported more often when there was a possibility of harm.	All members of the health care team report experiencing emotions related to patient safety incidents in their practice. Incidents with minor or no harm still invoked emotional responses from the providers. It is important to understand the impact that patient safety incidents have on the medical clinic as a whole.	
22396443	This study aims to gather descriptions from multiethnic Asian breast cancer patients on their experiences and impact of chemotherapy-associated cognitive changes on their daily lives and their coping strategies.Forty-three chemotherapy-receiving breast cancer patients participated in eight English or Chinese structured focus group discussions, conducted by trained psychosocial oncologists and medical social workers.	Participants were unfamiliar and averse to both English and Chinese-translated equivalent of the term 'chemobrain'. Participants viewed this phenomenon holistically as a by-product of the physical (fatigue and aging) and psychosocial (anxiety and mood changes) adverse effects associated with chemotherapy. Most participants encountered memory loss, difficulty in decision making and speech problems after receiving chemotherapy. Married participants expressed frustration as cognitive deterioration limited their conservative roles as homemakers. Despite knowing the potential neurocognitive effects, participants valued the benefits of chemotherapy. Identified coping strategies included playing mahjong for mind stimulation and management of psychosocial factors, such as practicing qi gong, to regulate their moods and to take complementary alternative medicines to reduce the severity of their fatigue.	The phenomenon 'chemobrain' is unfamiliar to most Asian cancer patients yet it has significantly impacted their daily lives. Our results suggested that a culturally relevant approach should be adopted to evaluate and manage cognitive changes in these patients.	
22392563	A picture archiving and communication system (PACS) is a medical imaging technology which provides economical storage of and convenient access to images from multiple modalities (source machine types). PACS have been widely introduced as a credible alternative to the traditional film-based radiological service. This study was planned and conducted to determine the physicians' views and assessments on PACS in two public hospitals in Turkey. A questionnaire was prepared by viewing the literature related to PACS. The questionnaires were distributed several times to a total of 150 physicians two public hospitals in Ankara, Turkey. The overall response rate is 46%. Some questions required a graduated score in response and others an open ended response. The majority of physicians judged PACS to be a major advance for their hospitals with less frustration than using film high quality images and an improvement in their working lives and patient care. They reported that PACS gave them to radiology reports in short time. Also physicians believed that PACS has improved their consultations. Open ended questions were prepared with concerning the benefits and disadvantages of PACS. The assessments of the physicians demonstrated many more benefits than disadvantages of PACS in their hospitals. PACS has been accepted well by a wide percentage of hospital physicians. PACS evolves over time components are frequently replaced and so the users must expect continuous learning about new updates and improved functionality. The implementation of the PACS clearly contributes to an increase in the productivity of health professionals and physicians.
22371147	To examine the factor structure of temperament in 5-10-year-olds with Williams syndrome, an exploratory factor analysis was conducted on the responses of parents of 192 children on the children's behavior questionnaire. Four factors were identified. Two corresponded to factors reported for typically developing children: effortful control and extraversion/surgency and two corresponded to the temperament constructs of withdrawal/inhibition and irritability/frustration and activity, observed in typically developing infants. Parents of 109 of the 192 participants also completed the anxiety disorders interview schedule, parent version. Children with an anxiety disorder other than specific phobia differed significantly from children without an anxiety disorder on all factors except extraversion/surgency. Children with attention deficit hyperactivity disorder (ADHD) differed significantly from children without ADHD on effortful control and extraversion/surgency.
22370766	Mental illness is common and associated with poor outcomes for co-occurring medical illness. Since primary care physicians manage the treatment of complex patients with both mental and medical illnesses, their perspectives on the care of these patients is vital to improving clinical outcomes.To examine physician perceptions of patient, physician and system factors that affect the care of complex patients with mental and medical illness.	Inductive, participatory, team-based qualitative analysis of transcripts of in-depth semi-structured interviews.	Fifteen internal medicine physicians from two university primary care clinics and three community health clinics.	Participant characteristics were balanced in terms of years in practice, practice site, and gender. Physicians identified contributing factors to the complexity of patient care within the domains of patient, physician and system factors. Physicians identified 1) type of mental illness, 2) acuity of mental illness, and 3) communication styles of individual patients as the principal patient characteristics that affected care. Physicians expressed concern regarding their own lack of medical knowledge, clinical experience, and communication skills in treating mental illness. Further, they discussed tensions between professionalism and emotional responses to patients. Participants expressed great frustration with the healthcare system centered on: 1) lack of mental health resources, 2) fragmentation of care, 3) clinic procedures, and 4) the national healthcare system.	Physicians in this study made a compelling case for increased training in the treatment of mental illness and improvements in the delivery of mental health care. Participants expressed a strong desire for increased integration of care through collaboration between primary care providers and mental health specialists. This approach could improve both comfort in treating mental illness and the delivery of care for complex patients.	
22369055	To enhance communicative ability and thereby the possibility of increased participation of persons with aphasia, the use of communication strategies has been proposed. However, little is known about how persons with aphasia experience having conversations and how they perceive their own and their conversation partner's use of communication strategies.To explore how people with aphasia experience having conversations, how they handle communication difficulties, and how they perceive their own and their communication partners' use of communication strategies.	Semi-structured interviews were conducted with four women and seven men with chronic aphasia (n = 11). Interviews were video-recorded, transcribed verbatim and analysed by qualitative content analysis.	Informants appreciated having conversations despite the fact that they perceived their aphasia as a serious hindrance. Different factors related to the informants, the conversation partners, the conversation itself and the physical environment were perceived to impact on conversations. The importance of the communication partners' knowledge and understanding of aphasia and their use of supporting conversation strategies were acknowledged by the informants. The informants' views on using communication aid devices or strategies varied considerably. Four themes that characterized the informants' narratives were: loss and frustration, fear and uncertainty, shared responsibility based on knowledge, and longing for the past or moving forward.	The informants longed to regain their former language ability and role as an active participant in society. To enhance participation of persons with aphasia, it is suggested that communication partner training should be an important and integral part of aphasia rehabilitation. Important elements of such training are reflecting on communication behaviours, training in real-life situations, and acknowledging each individual's special needs and preferences. To deal with the consequences of aphasia, counselling and psychological support may be needed.	
25363640	Research has found that exposition to red is associated with physiological activation and fighting spirit. A field experiment was conducted to explore whether the color of cars is related to an aggressive response. Drivers waiting at a traffic light were blocked by an experimental car. The color of the car varied (blue, red, green, black, and white). The amount of time that elapsed until the drivers responded by honking their horns or beaming their headlights was the dependent variable. It was found that the red car elicited early aggressive response. 
22356720	The aim of this study was to describe how patients perceive their recovery following open tibial fractures using a qualitative approach.Following the appropriate ethical approval, adult patients with a diagnosis of open tibial fracture were recruited after completion of their surgical treatment and discharge from Morriston Hospital, a centre with orthoplastic surgical care. A purposive sampling method was employed to ensure that a range of injuries as well as clinical outcomes were included. All patients took part in an in-depth semi-structured interview, exploring aspects of their injury, treatment, rehabilitation and psychosocial and financial situations. Interviews were completed with two interviewers present and were recorded for verbatim transcription. Interview transcripts were analysed to identify items important to patients during their recovery.	Nine patients with a mean injury to interview interval of 2.3 years were interviewed. A total of 538 items were identified and subsequently mapped onto 18 categories: pain; mobility; flexibility; temperature (effects on symptoms); fear; appearance; sleep; diet/weight; employment; social; finance; impact on others; self-care; recovery (patient perceptions of recovery); frustration; goal setting (by patients and health-care providers); and adaptation (both physical and mental).	There is a wide range of factors that our cohort found important during their recovery from open tibial fracture. Despite being considered as 'healed' by the medical staff, patients did not report a corresponding full recovery and return to pre-injury normality. The categories identified will enable the development of a patient-reported recovery scale to be used in lower-limb trauma.	
22349917	This report examines day-to-day variability in rheumatology patients' ratings of pain and related quality-of-life variables as well as predictors of that variability. Data from 2 studies were used. The hypothesis was that greater psychological distress (i.e., depression and anxiety) and poorer coping appraisals (i.e., higher pain catastrophizing and lower self-efficacy) are associated with more variability. Electronic daily diary ratings were collected from 106 patients from a community rheumatology practice across 28 days (study 1) and from 194 osteoarthritis patients across 7 days (study 2). In multilevel modeling analyses, substantial day-to-day variability was evident for all variables in both studies, and individual patients differed considerably and somewhat reliably in the magnitude of their variability. Higher levels of depression significantly predicted greater variability in pain, as well as in happiness and frustration (study 1). Lower self-efficacy was associated with more variability in patients' daily satisfaction with accomplishments and in the quality of their day (study 2). Greater pain catastrophizing and higher depression predicted more variability in interference with social relationships (study 2). Anxiety was not significantly associated with day-to-day variability. The results of these studies suggest that individual differences in the magnitude of symptom fluctuation may play a vital role in understanding patients' adjustment to pain. Future research will be needed to examine the clinical utility of measuring variability in patients' pain and well-being, and to understand whether reducing variability may be an important treatment target.
22341092	to offer a critical discussion from a public health perspective of service user's experiences of antenatal care services.a qualitative, descriptive study using 18 group (n = 86) and six individual semi-structured interviews (n = 6) with thematic networks analysis conducted.	ninety-two participants recruited from organisations/groups who work with vulnerable populations and/or community groups were consulted in the North West of England.	analysis from a public health perspective suggested four key areas: antenatal care attendance, the frequency of antenatal appointments, the location of antenatal care and the provision of risk information. The benefits of universal access to antenatal care were mainly evident to participants. The need for targeting those with identified clinical risk was valued, but participants expressed frustration at a 'one-size fits all' approach for others, which failed to adequately consider their psychosocial and educational needs. In some women, this failure prompted non-compliant behaviour. Concerns were somewhat compensated for by community-based antenatal services.	inequities in antenatal care persist with service users from vulnerable population groups continuing to express that these services do not meet their needs. Neither a targeted approach based on clinical needs nor a population-based approach, which service users feel limits access, meet their expectations. Proportionate universalism offers a new paradigm in public health with level of service proportionate to need. Such an approach may facilitate health-care staff to meet the expectations of vulnerable families who may require more psychosocial and educational support.	
22337743	To explore conceptions of continuity of care among family physicians in traditional practices, family medicine-trained physicians working in episodic care, and family medicine residents to better understand the emotional effects on physicians of establishing long-term relationships with patients as a starting point for developing a tool to measure the qualitative connections between physicians and their patients.Qualitative descriptive study using focus groups.	Traditional family practice, family medicine residency training, and episodic-care settings in Kingston, Ont.	Three groups of first-year family medicine residents (n = 18), 2 groups of family physicians in established traditional practice (n = 9), and 2 groups of family physicians working in episodic-care settings (n = 10).	Using focus groups, a semistructured discussion guide, and a phenomenologic approach, we explored residents' and practising physicians' conceptions about continuity of care, predominantly exploring the emotional effects on physicians of providing care for a group of patients over time.	Providing care for patients over time and developing a deep knowledge of, and often a deep connection to, patients affected physicians in various ways. Most of these effects were rewarding: feelings of connection, trust, curiosity, enhanced professional competence (diagnostically and therapeutically), personal growth, and being cared for and respected. Some, however, were distressing: anxiety, grief, frustration, boundary issues, and negative effects on personal life.	Family physicians experience myriad emotions connected with providing care to patients. Knowledge of what physicians find rewarding from their long-term connections with patients, and of the difficulties that arise, might be useful in further understanding interpersonal continuity of care and the therapeutic relationship, and in informing resident education about developing therapeutic relationships, evaluating resident educational experiences with continuity of care, and addressing physician burnout.	
22331610	This study examined adolescent narcissism, temperament (frustration and affiliation), and social goals in association with peer-reported physical and relational aggression (N = 384; 12-14 years). Narcissism was positively associated with dominance goals and negatively with closeness goals for peer interaction. Moreover, narcissism was positively associated with physical aggression via dominance goals for boys, and with relational aggression via dominance goals for both genders. Temperamental frustration and affiliation were both positively associated with relational aggression, but also interacted in their associations with this variable; affiliation was positively associated with relational aggression only at high levels of frustration. Supporting and extending existing research, the present findings suggest that adolescent personality and social goals are meaningfully associated with physical and relational aggression in the peer context. 
22323376	When physicians interview patients with ambiguous or nonspecific symptoms, they often try to reassure them with the purpose of explaining that no dangerous illness or disease is causing the symptoms. Unfortunately the evidence suggests that patients with benign (back) pain instead feel misunderstood, frustrated and unsatisfied with the consultation. Validation is a communication method that focuses on understanding and empathy as a platform for problem solving and it may be applicable for interviews in medical settings. The aim of this study was to examine the effects of validation on patient satisfaction, pain and affect. To this end 28 nurses with (re)current back pain were recruited and randomly assigned to be interviewed in a validating or invalidating condition. Patient satisfaction, affect, pain, disability, pain catastrophizing, and fear of movement were assessed immediately after the interview. The results show that the participants in the validated group were more satisfied with the interview than participants in the invalidating condition. Moreover, they showed a significant decrease on all measures of negative affect as well as for pain. For example, there was a significant between group difference in frustration where frustration decreased in the validation group, while it increased in the invalidation condition. A validating communication style seems to be beneficial for enhancing patient satisfaction, as well as diminishing negative affect and pain intensity ratings. Our results suggest that validation might be a viable technique to use in clinical examinations of patients suffering pain.
22317698	Gravediggers have death as object of their work. Their activities are painful, physically and mental demanding, as well as unhealthy. Literature is scarce about this theme. The aim of this study is to evaluate gravediggers' work activities and health consequences. The methodological frame which guided this study was Dejours' psychic suffering and its association with the psychodynamic aspects of work. Data collection took place in April-May 2011 in one public and one private cemetery of São Paulo, Brazil. Four male workers, aged between 45 to 60 years old were interviewed. Their work activities were observed during a workday. Participants reported their life dreams, defense mechanisms and frustration. The discourse of gravediggers showed serious problems associated to physical and mental demands, public invisibility and/ or social devaluation of work. The most important physical symptom was body pain. In spite this is a preliminary study, it was possible to raise a number of work stressors and health outcomes of gravediggers, an "invisible" worker of our society.
22317381	Abstract : There is good evidence that shift work has negative effects on workers health, safety and performance. It is quite appropriate that attention is paid to this very important feature of socio-technical systems, which may adversely affect mental and physical health, social life and safety of shift workers. Research into the impact of shift work on professionals has consistently identified a range of negative outcomes in physical, psychological, and social domains (Akerstedt, 1988; Costa, Lievore, Casaletti, Gaffuri, & Folkard, 1989; Kogi, 2005; Paley & Tepas, 1994). Hospitals, the biggest employer in the health care field, employ more night shift workers than any other industry. It can therefore be inferred that in medical domain high percentage of workforce may be affected by problems related to shift work. Thus the present study will provide knowledge base for the problems faced by the female nurses. The present study was undertaken with an objective of getting an insight into the problems faced by female nurses in shift work. . It was found that the female nurses in India worked on roaster pattern of change in shift every seven days. They did not have a say in the change of duties, it could only be done on mutual grounds. Partners of younger group did not much adjust to their shift pattern this created stress among the nurses.The results showed that the female nurses in both the age groups i.e. 30-45 years and 45-60 years faced many problems related to health and well being, fatigue, social and domestic situations. They could not give much time to their children in particular. Travelling in nights was risky for them. Common problem was the insufficient sleep during night shifts. The nurses had to cater to the needs of the family, children in particular along with the adjustments to be made due to shift work. They had to sometimes do the night duties and attend social functions as a part of their duty. Children and husband in some cases did not cooperate this lead to frustration. When asked as to whether they would could shift job if they get regular one more than 50 % said yes this means that there need to be come training and intervention for the shift workers and their family so that the problems faced and their impact on personal health of the female nurses could be reduced.
22273345	The purpose of this study is to describe the everyday life experiences of fathers of adult children who have various forms of long-term mental illness. Ten fathers were interviewed. Content analysis revealed one main theme: Maintaining a strong façade while balancing on a thin line, and two sub-themes: (1) A constant struggle and (2) A feeling of powerlessness. The fathers demonstrated great engagement and good will to participate in their child's life. A sense of powerlessness and frustration at not having or being allowed freedom of action emerged. Cooperation between children, parents, the care service providers, and the authorities could increase the parents' abilities to provide adequate support to the child as well as helping them to understand and make the incomprehensible manageable.
22272759	Young Black men who have sex with men (BMSM) are disproportionately affected by HIV/AIDS in the USA and continue to experience rapidly increasing HIV incidence. We designed a tailored, theory-based interactive HIV/STI prevention website for young BMSM, called HealthMpowerment.org (HMP) and conducted a small pilot trial comparing HMP to currently available HIV/STI websites. We present findings demonstrating feasibility and acceptability of delivering the intervention to the target population of young BMSM. Retention rates were 90% and 78% at one- and three-month follow-ups, respectively. Evaluation immediately after the intervention's completion revealed that participants who used the HMP website reported high levels of user satisfaction and interest and low levels of website difficulty and frustration. At the end of the intervention, there was a trend in increased behavioral intentions to use condoms and engage in preparatory condom use behaviors in the intervention group compared to the control group (p=0.10). We observed a reduction in mean scores on the CES-D scale among those in the intervention group that was not seen in the control group at the one-month follow-up, though this was not statistically significant. Feedback from exit interviews with study participants suggested that HMP is relevant to the prevention needs of young BMSM. Overall, the findings support the acceptability and feasibility of delivering this prevention program to a group that has few interventions despite bearing a significant burden of the epidemic. Future trials, combining Internet and mobile phone technologies, are planned to test HMP among larger and more diverse populations of young BMSM.
22256691	The purpose of this article is to describe the experiences of parents regarding the fostering of self-management of diabetes mellitus with their middle adolescents with type 1 diabetes mellitus (T1DM). A purposive sample of parents of 16- to 18-year-old adolescents with T1DM from 23 families who attended the endocrinology clinic of a children's hospital were interviewed about their experience with their adolescent's diabetes management and how they supported or inhibited their adolescent's diabetes self-management. Qualitative description was used to analyze the transcripts of audio-recorded interviews. Parents often described having negative experiences involving struggle, frustration, and worry about adolescent self-management. Parents supported their adolescent's self-management primarily by reminding, recognizing positive aspects of the adolescent's diabetes management, and granting more freedom. Conversely, parents inhibited their adolescents' diabetes management by scolding and judging, checking and nagging, and becoming emotional. Clinicians can help parents share their experiences, cope with their emotions, and practice effective strategies to motivate adolescent diabetes self-management in the transition to later adolescence.
22245122	In consummatory successive negative contrast (cSNC), when rats receive 32% of sweetened water and are unexpectedly exposed to 4% of the same solution, they consume less than those who received 4% regularly. In consummatory extinction (cE), rats receiving a 32% or 4% sugar solution stop lapping when presented with an empty tube. In both cases, these situations trigger an aversive emotional reaction similar to fear and anxiety called frustration or negative contrast effect. Isolation conditions in adulthood increase anxiety responses. We describe an experiment in which isolated or grouped rats in adulthood are evaluated in an elevated plus maze (EPM), in cSNC and cE. Results show that rats in groups express less anxiety and activity in EPM and more persistence in cE than isolated rats. There are no differences between the two housing conditions in cSNC. We discuss these results on the basis of frustration theories.
22239758	Psychosocial competence and frustration tolerance are important characteristics of skilled medical professionals. In the present study we explored the usefulness of applying a comprehensive motivational theory (Goal orientations), for this purpose. According to goal orientation theory, learning motivation is defined as the general goals students pursue during learning (either mastery goals - gaining new knowledge; or performance goals - gaining a positive evaluation of competence or avoiding negative evaluation). Perceived psychosocial abilities are a desirable outcome, and low frustration tolerance (LFT), is a negative feature of student behavior. The hypothesis was that the mastery goal would be positively associated with psychosocial abilities while performance goals would be positively associated with LFT.143 first-year medical students completed at the end of an annual doctor-patient communication course a structured questionnaire that included measures of learning goal orientations (assessed by Pattern of Adaptive Learning Scale - PALS), psychosocial abilities (assessed by Psychological Medicine Inventory- student version -PMI-S) and Low Frustration Tolerance (LFT).	All study variables were found reliable (Cronbach's α ranged from .66 to .90) and normally distributed. Hierarchical multiple regression analysis revealed significant associations supporting the hypotheses. The mastery goal orientation was positively associated with perceived psychosocial abilities (PMI-S) (β = .16, p < .05) and negatively associated with low frustration tolerance (β = -.22, p < .05) while performance goal orientation was significantly associated with low frustration tolerance (β = .36, p < .001).	The results suggest that the goal orientations theory may be a useful theoretical framework for understanding and facilitating learning motivation among medical students. Limitations and suggestions for practice within medical education context are discussed.	
22233116	Hip replacements are one of the most common operations for individuals with hip osteoarthritis. There have been numerous quantitative studies investigating the recovery from joint replacement surgery and these show how effective and satisfied patients are. However, little qualitative work has been conducted to explore patients' actual experiences. Therefore, this study aimed to detail the experiences of individuals undergoing a total hip replacement (THR) to determine whether their expectations were met.The qualitative study was nested within a longitudinal study (n = 215) that was investigating biomedical and psychosocial outcomes from THR. We interviewed a purposive sample of individuals (n = 25) 6 months after THR to explore their experiences of having a THR.	Participants were aged 48-82 years. They felt disabled following the THR and some had unrealistic expectations of recovery. Most of them received minimal information and health professional support. Participants had to overcome a number of challenges such as diminished confidence, frustration over slow progress and reduced physical functioning.	Individuals undergoing THR need to have the opportunity to discuss their expectations of THR, so there is no "false optimism". Support requirements, following THR, need to be reviewed as they were often underestimated by patients and health professionals.	

22227763	The delivery of psychiatric services may be affected by clinicians' negative reactions to treatment-resistant or stigmatized patient groups. Some research has found that clinicians across professional disciplines react negatively to patients with eating disorders, but empirical data related to this topic have not been systematically reviewed. The authors sought to review all published empirical studies of clinician reactions to patients with eating disorders in order to characterize negative reactions to these patients and identify patient or clinical factors associated with negative reactions.The authors conducted a comprehensive online search for all published studies of clinician reactions in regard to patients with eating disorders. The reference lists of articles found in the literature search were examined to identify additional studies.	Twenty studies, published between 1984 and 2010, were found. Clinician negative reactions in regard to patients with eating disorders typically reflected frustration, hopelessness, lack of competence, and worry. Inexperienced clinicians appeared to hold more negative attitudes toward patients with eating disorders than toward other patient groups, but experienced psychotherapists did not experience strong negative reactions to patients with eating disorders. Medical practitioners consistently reported strong feelings of lack of competence in treating eating disorders. Negative reactions to patients with eating disorders were associated with patients' lack of improvement and personality pathology and with clinicians' stigmatizing beliefs, inexperience, and gender.	Research about the impact of negative clinician attitudes toward patients with eating disorders on psychiatric service delivery, including multivariate analyses using larger samples, comparison groups, validated instruments, and experimental methods, is much needed.	
22226156	This paper investigates the link between disability and subjective wellbeing, using data from the 2009 Disability and Use of Time supplement to the Panel Study of Income Dynamics, the longest running national panel study in the United States. Disability is construed broadly to include both the presence of any physical, cognitive, or sensory impairment or activity limitation and also the severity of underlying impairments. Subjective wellbeing is measured using two distinct approaches: reports of life satisfaction and of moment-to-moment wellbeing-both positive and negative-on the previous day. The latter, collected through 24-h time diaries, also offers for the first time the ability to explore the role of participation in particular kinds of activities linking disability to subjective wellbeing. The analytic sample included married persons ages 60 and older and their spouses (n = 751 married individuals) who completed 1498 diaries. Several new findings emerged: no matter what the measure of wellbeing, older married adults with disability report worse subjective wellbeing than those without, and neither different demographic and socioeconomic profiles nor differences in participation fully account for these disparities. Influences of disability on global life satisfaction and episodic reports of happiness were relatively small and of comparable size. However, notably sizeable differences were identified in the cumulative number of pleasant minutes experienced yesterday by disability status - on the order of 71 fewer minutes on average for those with a disability of average severity. Differences appear to be more strongly linked to somatic symptoms of pain and feeling tired than to differential intensity of experiencing happiness, sadness, frustration, or worry. We also found limited support for the notion that participation partially mediates the relationship between disability and global, but not episodic, subjective wellbeing.
22221066	This article is a report on a phenomenological study of Chinese mothers' experiences of caring for their children who were living with atopic eczema.A mother's attitude and personality may have a direct influence on her child's adherence to treatment for atopic eczema. Thus, good communication between healthcare professionals and the mother is essential. Treatment and care should also be culturally appropriate.	Using an interpretive phenomenological method, 14 interviews were conducted in Hong Kong, China from September 2007 to August 2008, with nine mothers caring for their children who were living with atopic eczema. Crist and Tanner's circular process of hermeneutic interpretive phenomenology was chosen to guide the data analysis.	Mothers' coping patterns involved persistently dealing with enduring demands and seeking alternative therapies that were aimed at curing the disease. Four themes finally emerged from the data: (1) dealing with extra mothering, (2) giving up their life, (3) becoming an expert and (4) living with blame and worry. Mothers' coping patterns involved persistently finding ways to relieve their children's suffering with the aim of curing the disease and dealing with their own emotions related to the frustration resulting from giving up their life and living with blame and worry.	The study findings provide nurses with an empathic insight into mothers' feelings and the enduring demands of caring for children with atopic eczema, and help nurses to develop culturally sensitive interventions, reinforce positive coping strategies, increase family function and improve health outcomes.	
22218267	The aim of this study was to explore and define the different dimensions of professional stigma attached to obese patients by dietitians. Four focus groups were conducted with 23 Israeli dietitians. Findings showed that while treating obese patients, dietitians underwent a stigmatization process involving cognitive, emotional, and behavioral phases. Obese patients with an internal locus of control, who took responsibility for their failure to diet, triggered positive feelings (e.g., pity and empathy), whereas obese patients with an external locus of control, who blamed others for their failure, triggered negative feelings (e.g., anger and frustration). Participants' emotional rejection of obese patients was manifested in three behavioral dimensions: instrumental avoidance (e.g., shorter sessions); professional avoidance (e.g., less energy and effort); and interpersonal avoidance (negative tone and evasive verbal and body language). Continuing education for dietitians is recommended to assist them in dealing with their negative feelings and behaviors toward resistant obese patients.
22218019	: Alex is a 9-year-old boy brought to you, his primary care provider, for a "fifth opinion." You have cared for Alex since he was adopted from a Romanian orphanage at 3 years of age. He has been physically healthy with normal growth parameters and no evidence of fetal alcohol syndrome. Alex has long-standing history of social difficulties, impulsivity, lying, controlling, manipulative behaviors, violent outbursts at home with subsequent lack of remorse, and excessive chatter. You referred Alex to an interdisciplinary child development clinic 2 years ago, where he was diagnosed with reactive attachment disorder (RAD) and attention deficit hyperactivity disorder (ADHD). He was noted to have normal cognitive and language skills. Attachment therapy, stimulant therapy, and school accommodations for ADHD were recommended.Alex received some individual counseling with the school psychologist for a year after the first evaluation, with little improvement in core behaviors. The following year, Alex established care with a psychiatrist and a private counselor. The psychiatrist prescribed a succession of stimulants, each of which worked for only a short time and then had waning effect. The counselor worked with Alex and his parents on managing Alex's behavior, which the family reports has been somewhat helpful.Alex's parents express great frustration and sadness that parenting Alex has been such an ongoing struggle since he was adopted. They note that Alex is superficially friendly, chatty, and charming, with everyone he encounters, including strangers, but he never progresses past such superficial interaction, even with his adoptive parents. The parents express that they are deeply wounded that Alex is not more loving and is not more appreciative of the fact that they rescued him from the orphanage.His parents asked his pediatric clinician about Autism as they observe Alex's lack of real affection and social connection with parents or peers. They also note that Alex has difficulty verbalizing his feelings and that he lies frequently, chatters tangentially, and he can watch the Discovery channel for hours. A neurologist, to whom Alex was referred to evaluate staring spells, reassured the family that the spells did not seem to be epilepsy and also diagnosed Alex with "Asperger's syndrome." The school psychologist, after 2 years of equivocation, recently made Alex eligible for autism spectrum services.During the interview and examination, Alex is funny, friendly, and a bit silly. He uses normal eye contact, seems to enjoy the neuromotor examination, and is eager to show you his cool, new handshake. He engages in easy banter, using normal vernacular and prosody. After the visit, you call the therapist to express your opinion that the RAD diagnosis is valid after all and to ask whether the family is engaged in attachment therapy. The therapist refutes the RAD diagnosis, endorsing Asperger's syndrome (AS) instead and notes that Alex is making good progress in school and in therapy, where he is learning pragmatic skills and basic social skills with the use of social stories.Where do you head next?
22212035	The analytic state of consciousness is a particular regressive altered state in the patient characterized by an increased sensitivity and reactivity to impressions arising from both the inner world and the analyst, a heightened sense of dependence and vulnerability, a permeability of boundaries in regard to the analyst, and a shift toward functioning on the basis of omnipotent fantasy in the analytic relationship. These changes are accompanied by a feeling of realness of one's psychic reality, but without any true loss of reality testing. Based on an analysis of the structure of play, this state can itself be understood as a kind of play; it serves as a foundational transference underlying more specific transference manifestations; and it is central to the analytic process. Over time, in response to physical aspects of the analytic setting, its safety, the analyst's emotional accompaniment, and a generally restrained analytic stance (an issue I discuss in some detail), it emerges in a more developed form that promotes symbolization and ownership of aspects of self, greater emotional presence, and a deeper sense of meaning in one's experience. Additionally, the concept of the analytic state of consciousness provides a new look at the role of abstinence and frustration in analytic process.
22211849	The main premise of this hypothesis is that breast cancer is caused by sexual frustration. Sexual frustration is triggered by multiple forms of dissonance between the absence or lack of sexual reward and the (un)conscious motivation to obtain these sexual rewards. I assume that neural and hormonal processes are capable of adjusting or distorting biologically active forms of specific sex hormones depending on experienced sexual stimuli. I hypothesize that prolonged sexual frustration will ultimately lead via aberrantly metabolized sex hormones to the development of breast cancer. Human female sexual behavior research links sexual frustration with breast cancer risk. The distinction between human female sexual behavior and reproduction is crucial to understand breast cancer risk. Current explanations are focused on reproduction. However, human female sexual behavior is causal in breast cancer development and androgens rather than estrogens are crucial for sexual behaviors in women. Social learning is the main determinant of human sexual behaviors that is why cultural and social processes are very important to understand breast cancer risk. Epidemiologists should evaluate breast cancer risk based on cultural female attitudes towards sexually related issues. Female mate choices should be examined for (un)conscious cultural, ethnic, religious, and socio-economic pressure to make a thorough assessment of breast cancer risk. Closer examination of (un)conscious female copulation strategies reveal that they are potential sources of sexual frustration in specific groups of women. Postmenopausal women seem vulnerable for self-fulfilling prophecies about post reproductive sexuality, body image, and negative perceptions of menopause which may cause sexual frustrations.
22210523	Frustration is an emotional response that can be induced by the sudden devaluation of a reinforcer in the presence of greater reinforcement expectancies (e.g. instrumental successive negative contrast, iSNC). This emotional response seems to be similar to anxiety and can be attenuated by previous experiences of reward loss (e.g. partial reinforcement, PR, as opposed to continuous reinforcement, CR). In this study we used iSNC and PR procedures in order to compare the performance of two strains of rats psychogenetically selected on the basis of their emotional reactivity: the inbred Roman High- (RHA-I, low anxiety) and Low- (RLA-I, high anxiety) Avoidance rats. Animals were exposed to a straight alley, where they were changed from 12 pellets in the preshift phase (presented in 100% of trials-CR vs. 50% of trials-PR) to 2 pellets in the postshift phase, or exposed to 2 pellets throughout the training. The results indicated that the iSNC only appeared in RLA-I rats exposed to CR, as opposed to RLA-I animals exposed to PR and to RHA-I rats exposed to PR or CR. These data seem to support the implication of emotional responses in both iSNC and PR situations, and indicate that the behavioral reactivity to reward loss experiences is modulated by genetic variables.
22205038	Parental input has been described as influential in early childhood stuttering yet the exact nature of this influence remains equivocal. The present study aimed to examine whether quantitative measures of parenting styles, parent and peer attachment patterns, and parent- and self-reported child behaviour could differentiate between school-aged children who stutter (CWS) (n=10) and their fluent peers (n=10). In addition, qualitative individual semi-structured interviews with all CWS were conducted to gain insight into their life experiences and reflections in relation to stuttering. The interviews were classified into ancillary themes of school, peers and parents. Quantitative findings revealed that CWS perceived their parents with significantly lower attachment, particularly in relation to trust, and parents of CWS perceived their children with significantly higher maladjustments than fluent counterparts. Qualitative themes emerged pertaining to attitudes, perceptions and relationships with teachers, peers and parents, with consistent experiences of teasing and bullying reported as a consequence of the stutter. The majority of participants recounted frustration with the nature in which their parents attempted to remediate their stuttering. Collectively, these findings highlight imperative management considerations for school-aged CWS and their parents. The usefulness of quantitative and qualitative research paradigms is also emphasised.The reader will be able to: (1) identify themes associated with the impact a childhood stutter has on parent and peer relationships; (2) identify how the quality of the parent child relationship is influenced by parenting styles and attachment; and (3) discuss the clinical implications of the results for children who stutter and their families.	
22194083	The aim of this study was to explore the role of affect management in postpartum relapse to smoking. Between January and October 2005, 65 women who smoked prior to pregnancy but not during the last month of pregnancy were recruited from Brigham and Women's Hospital in Boston, MA, and followed for 24 weeks. Surveys administered at baseline, 2, 6, 12, and 24 weeks postpartum assessed smoking status and symptoms of depression (Beck Depression Inventory, BDI) and anxiety (Beck Anxiety Inventory, BAI). Qualitative interviews were conducted when women relapsed or achieved an elevated BDI or BAI score. Elevated BDI or BAI scores did not predict relapse, suggesting that symptoms that make women vulnerable to relapse may not be fully captured by these instruments. Women described feelings of anger or frustration as part of the relapse experience. Women with elevated BDI or BAI scores who did not relapse were more likely to normalize their mood symptoms as part of the postpartum experience and described more adaptive and active coping strategies. Interventions designed to prevent postpartum relapse to smoking may need to target a broader range of negative affect and mood management strategies to increase the likelihood of efficacy.
22190539	Subjective workload in healthcare employees is suspected to be important for the performance and safety of healthcare delivery. This study investigates associations between workflow interruptions and hospital doctors' capability to manage their perceived workload in a safe and efficient manner.To examine the relationship of observed workflow interruptions with hospital doctors' perceived workload during day clinical shifts.	A prospective study of 43 full shift observations with 29 doctors working in internal medicine and surgical specialties. Workflow interruptions were assessed via observation using a previously validated observation instrument. Doctors assessed their workload twice throughout their day shift using three items of the validated NASA-Task Load Index (NASA-TLX; mental demands, effort, frustration).	Hospital doctors were on average disrupted 3.66 times per hour. Most frequent were interruptions by nursing staff, telephone/beeper interruptions and by fellow doctors. Senior doctors reported higher workload than their junior colleagues. Overall workflow interruptions were significantly related to doctors' workload (β = 0.22; p = 0.03). Further analyses revealed that doctors' workload was associated particularly with interruptions by nursing personnel (β = 0.23; p = 0.03).	Frequent workflow interruptions may be linked with increased workload in doctors. Healthcare environments need to be better designed to reduce unnecessary interruptions and distractions so that hospital doctors can manage clinical work efficiently and safely.	
22185368	Distress intolerance (DI) - the perceived inability to tolerate distressing states - is an important variable in substance abuse, with links to coping motives and return to use following a quit attempt. Recent research suggests that DI is a heterogeneous construct that varies based on the domain of distress (e.g., pain, anxiety).To evaluate whether elevations in DI in substance-dependent (SD) patients varied based on the domain of distress.	Individuals (N = 55) with a diagnosis of illicit drug dependence and an affective disorder equated comparison (CO) group were administered three measures of DI - assessing pain, frustration, and respiratory discomfort.	The SD group demonstrated significantly greater frustration intolerance, but not greater pain intolerance or respiratory discomfort intolerance relative to the CO group.	When controlling for the presence of an affective disorder, SD patients exhibited elevated frustration intolerance, suggesting that this may be a particularly difficult type of distress for this group.	DI is linked to important clinical outcomes and can be modified with treatment. Identification of intolerance of specific domains of distress associated with select disorders may help to better target such interventions.	
22179785	Young adult cancer survivors are often unaware of their fertility status and uninformed regarding their fertility and fertility preservation options. This qualitative research study explores the fertility and parenthood concerns of reproductive-age female cancer survivors and how they make parenthood decisions.Population- and clinic-based recruitment methods were used to identify a diverse group of survivors between the ages of 18 and 34 years. Our final sample size included 22 participants who attended one of seven focus groups. We used cross-case, inductive analysis to identify themes.	The following main themes were identified: (1) A hopeful but worried approach to fertility and parenthood, (2) Frustration with a lack of choice or control over fertility, (3) Young survivors want information about their fertility, (4) Young survivors want better continuity of care in survivorship, (5) Cancer diagnosis and related fertility problems introduce relationship challenges, and (6) Decisions about parenthood are complicated.	The diverse group of young cancer survivors in this study identified several common needs and concerns regarding fertility and parenthood. This study illustrates that young survivors could benefit from improved information regarding their fertility and parenthood options throughout survivorship, better coordination of medical care, and support navigating many emotional and practical issues that arise when considering their reproductive and parenthood options.	
22167802	Structural balance theory affirms that signed social networks (i.e., graphs whose signed edges represent friendly/hostile interactions among individuals) tend to be organized so as to avoid conflictual situations, corresponding to cycles of negative parity. Using an algorithm for ground-state calculation in large-scale Ising spin glasses, in this paper we compute the global level of balance of very large online social networks and verify that currently available networks are indeed extremely balanced. This property is explainable in terms of the high degree of skewness of the sign distributions on the nodes of the graph. In particular, individuals linked by a large majority of negative edges create mostly "apparent disorder," rather than true "frustration."
22142916	The past decade has experienced great success in publicizing and decreasing the nursing shortage. Articles describing the shortage continue with impressive but disparate projections of its dimension. New degree programs have been created and established programs expanded as increasing numbers of students answer the call, and there are signs that the publicity has succeeded. Recent graduates have experienced difficulties finding employment or postgraduate training positions, which prompt a more detailed look at the numbers. Previously published research projects the nurse shortage for the year 2025 to lie somewhere between 500,000 and 1,000,000 nurses. If it is presumed that these numbers refer to RNs only, then the net of dropout, retirement, and graduation rates suggests that this projected shortage could be misleading. Articles describing the shortage typically exclude detailed supply-and-demand statistics to support their projections. The projected 2025 deficit of nurses is estimated by one source at 500,000. Currently, nursing programs are graduating more than 100,000 and boarding 50,000 new 4-year-degree RNs per year. According to the National Health Service, more than 10,000 nurses retire each year, yielding a net addition of 40,000 new nurses per year, which yields a net supply by 2025 of 600,000. It seems that the more than 3,000 nursing schools are already graduating enough nurses to carry the loss. The universities have increased the supply of nurse graduates; now, the real shortcoming lays in the dearth of nurse residency programs that help transition the new nurses from the books to the bedside. Most nursing jobs require a year of experience, a luxury allowed by the increased graduates and decreased shortage. The real crisis now appears to be a logjam caused by the increased supply with the near absence of transition training. The resulting frustration of the new graduates, if not fixed, is likely to have adverse affects on retention and supply.
22136635	A detailed behavioral profile associated with focal congenital malformation of the ventromedial prefrontal cortex (vmPFC) has not been reported previously. Here we describe a 14 year-old boy, B.W., with neurological and psychiatric sequelae stemming from focal cortical malformation of the left vmPFC.B.W.'s behavior has been characterized through extensive review Patience of clinical and personal records along with behavioral and neuropsychological testing. A central feature of the behavioral profile is severe antisocial behavior. He is aggressive, manipulative, and callous; features consistent with psychopathy. Other problems include: egocentricity, impulsivity, hyperactivity, lack of empathy, lack of respect for authority, impaired moral judgment, an inability to plan ahead, and poor frustration tolerance.	The vmPFC has a profound contribution to the development of human prosocial behavior. B.W. demonstrates how a congenital lesion to this cortical region severely disrupts this process.	

22116257	Different studies considered the mechanisms involved in the maintenance of binge eating in bulimia nervosa (BN) and binge eating disorder (BED), suggesting different pathways. The present 3-year follow-up study evaluated the relationships between psychopathological variables, and objective and subjective binge eating episodes in the two syndromes.85 BN and 133 BED patients were studied. Objective and subjective binge eating, and psychopathological data were collected in a face-to-face interview, and by means of different self-reported questionnaires. The same assessment was repeated at baseline (T0), at the end of an individual cognitive-behavioral treatment (T1), and 3 years after the end of treatment (T2).	At baseline, BN and BED patients showed different emotions associated with binge eating: anger/frustration for BN and depression for BED patients. Objective binge eating frequency reduction across time was associated with lower impulsivity and shape concern in BN patients, and with lower emotional eating and depressive symptoms in BED patients. Lower subjective binge eating frequency at baseline predicted recovery, in both BN and BED patients. Recovery was associated with lower impulsivity and body shape concern at baseline for BN patients, and lower depression and emotional eating for BED patients.	Eating psychopathology, psychiatric comorbidity, impulsivity and emotional eating have a different pattern of association with objective and subjective binge eating in BN and BED patients, and they act as different moderators of treatment. A different target of intervention for these two syndromes might be taken into account, and subjective binge eating deserves an accurate assessment.	


22078771	To describe how Aboriginal women in an urban setting perceive dietary treatment recommendations associated with gestational diabetes mellitus (GDM).Semi-structured explanatory model interviews explored Aboriginal women's illness experiences with GDM.	Twenty-nine self-declared Aboriginal women who had received a diagnosis of GDM within the last 5 years in Winnipeg, Manitoba.	Factors influencing Aboriginal women's prenatal food perceptions with GDM.	Thematic analysis was used through coding linkages and matrix queries to assist in identifying and categorizing patterns or relationships.	Participants associated fear, anxiety, and frustration with GDM. Emotional reactions appeared alongside negative relationships with food and other prescribed lifestyle treatments. Collectively, these results suggested that the experience of living with GDM can be overwhelming, as suggested by some of the complex factors influencing women's perceptions and reported behaviors. Discussions indicated many felt socially isolated and had a poor self-image and sense of failure resulting from ineffective GDM management practices.	Future efforts should focus on self-efficacy and security in Aboriginal women's own interpretation of GDM, providing them with the understanding that there is potential for prevention and change.	
22072217	The current study examined the moderating effect of children's cardiac vagal suppression on the association between maternal socialization of negative emotions (supportive and nonsupportive responses) and children's emotion regulation behaviors. One hundred and ninety-seven 4-year-olds and their mothers participated. Mothers reported on their reactions to children's negative emotions and children's regulatory behaviors. Observed distraction, an adaptive self-regulatory strategy, and vagal suppression were assessed during a laboratory task designed to elicit frustration. Results indicated that children's vagal suppression moderated the association between mothers' nonsupportive emotion socialization and children's emotion regulation behaviors such that nonsupportive reactions to negative emotions predicted lower observed distraction and lower reported emotion regulation behaviors when children displayed lower levels of vagal suppression. No interaction was found between supportive maternal emotion socialization and vagal suppression for children's emotion regulation behaviors. Results suggest physiological regulation may serve as a buffer against nonsupportive emotion socialization.
22071689	This letter is to report and discuss two cases of psychogenic paralysis after spinal surgery in order to increase the vigilance and assist in the diagnosis and treatment of this uncommon disorder. The medical records for two middle-aged men who presented complete loss of extremities function after spinal surgery were reviewed retrospectively. None had a history of a previous hysterical seizure. Both of the patients' symptoms and signs differ from the correct anatomic pattern of a neurological deficit. Both of them spontaneously recovered and discharged from the hospital uneventful eventually. The orthopedic surgeons must recognize hysterical paralysis to avoid unnecessary surgery. A heightened awareness of a nonanatomic functional deficit on physical examination could help to reduce frustration and delay in diagnosis associated with this disorder. Rapid recovery should be expected, but the surgeon should administrate proper treatment.
22070785	People sexually abused in childhood are at higher risk than non-abused people of medically unexplained symptoms such as irritable bowel syndrome or chronic pain, with mental ill health and high healthcare use. Friction and frustration, with high, unproductive healthcare costs, can often develop between these patients and health-care professionals such as general practitioners and nursing staff. The aim of this integrative literature review was to seek a sound evidence base from which to develop helpful interventions, improve relationships and identify gaps in knowledge. It found some theories about interconnections among childhood sexual abuse mental health and medically unexplained symptoms, such as 'somatization' or 'secondary gain', were used prejudicially, stigmatizing survivors. Conflicting theories make more difficult the search for effective interventions. Researchers rarely collaborated with sexual abuse specialists. Emphasis on identifying key risk factors, rather than providing support or alleviating distress, and lack of studies where survivors voiced their own experiences, meant very few targeted interventions for this group were proposed. Recommendations to enable effective interventions include making abuse survivors the prime study focus; qualitative research with survivors, to assist doctors and nursing staff with sensitive care; case histories using medical records; prospective studies with sexually abused children; support for the growing field of neurobiological research.
22066151	This article argues that early Chinese physicians had already related female ailments to their sexual frustration. Moreover, many physicians paid more attention to non-reproductive women – nuns, widows, and unmarried women – as if they were more prone to suffer from unfulfilled desires and sexual frustration and, as a result, produce the sexual dreams and monstrous births that were described in the medical literature of medieval China as physical ailments. The earlier body-oriented etiology of these female illnesses gradually shifted to emotion-oriented perspectives in late imperial China. In particular, the sixteenth- and seventeenth-century doctors began to categorize women's sexual frustration as "yu disorders" or "love madness." In this article I will show not only the changing medical views of female sexual madness throughout the ages, but how these views were shaped by the societies in which both the doctors and patients were situated.
22044082	Anger and anger rumination are considered to be detrimental to both physical and psychological well being. Furthermore, perfectionism, as a personality construct, seems to be related to various types of maladjustment. Whereas perfectionism has been characterized as being positive when an individual derives pleasure from striving for excellence yet recognizes and accepts individual limitations, it is deemed negative when the individual has unrealistic expectations and is never satisfied with his or her performance. The present study examined whether positive and negative perfectionism was associated with anger and anger rumination. The Farsi version of the Positive and Negative Perfectionism Scale and the Farsi version of the Anger Rumination Scale, as well as Spielberger's State-Trait Anger Scale were completed by 384 Iranian students. Results showed that anger and anger rumination were, as expected, associated negatively with positive perfectionism and associated positively with negative perfectionism. Positive perfectionism enables individuals to strive for success in a flexible manner and, thus, to experience satisfaction and pleasure rather than dissatisfaction, frustration, and anger. Conversely, negative perfectionism makes individuals vulnerable to emotional distress such as predisposition to experience anger and anger rumination through setting high standards for performance, overgeneralization of perceived failures, negative self-evaluation, self-blame, and measuring self-worth in terms of unachievable goals of accomplishment and productivity. Hence, perfectionism may be regarded as having both adaptive and maladaptive aspects with regard to health.
22036800	The personality trait of Persistence is highly valued by conscientious overachievers, but it has both psychological costs and benefits. The interactions among multiple personality factors influencing the development of mood and anxiety disorders have been confounded in prior clinical samples, but can be disentangled in terms of their underlying brain circuitry and influence on perception of emotional stimuli.285 individuals who represented the full range of personality variation in a large sample of adult volunteers from the general community of Israel were selected for follow-up by psychiatric interviews, cognitive testing, and medical examinations. The Temperament and Character Inventory (TCI) measured profiles of traits that distinguished individuals with diagnoses of mood and/or anxiety disorders using linear discriminant analysis and non-linear profile analysis.	High Harm Avoidance and low Self-directedness strongly distinguished people with mood and/or anxiety disorders from those with neither. High Persistence distinguished people with only anxiety disorders from those with mood disorders. High Persistence was associated with greater health and happiness overall, but also led to more negative emotions than in people with low Persistence unless they were both unusually tolerant of frustration (i.e., low in Harm Avoidance) and self-accepting of personal limitations (i.e. high in Self-directedness).	Subjects were volunteers over 40 years of age at assessment.	People who are highly persistent (i.e., persevering, ambitious, perfectionistic) are more likely to have anxiety disorders than mood disorders, even when they have other traits increasing risk for both (i.e., high Harm Avoidance and low Self-directedness). High Persistence increases both positive and negative emotions in most people. However, high Persistence reduces negative emotions and increases positive emotions if a person is easy-going (i.e., "happy-go-lucky" when low in both Harm Avoidance and Self-directedness).	
22026570	Mechanical ventilatory support seriously affects speaking and communication, and earlier studies show that many ventilator-supported patients experience difficulties and frustration with their speech and voice production. Since there is a growing number of individuals who require mechanical ventilatory support and there is a paucity of studies that examine ventilator-supported communication, this research area needs to be developed to ensure adequate health services for this population. The present study focused on ventilator-supported communication from the point of view of individuals receiving home mechanical ventilation (HMV).The specific aim was to examine the communication experience of individuals receiving HMV.	A qualitative approach was adopted for this study, and data were collected by means of semi-structured interviews. Qualitative content analysis was used to structure, condense and interpret the data. The participants were recruited from the National Respiratory Centre (NRC) in Sweden, and included 19 individuals receiving HMV.	The main theme A long and lonely struggle to find a voice and six subthemes detailing different facets of it emerged from data analysis: Managing changed speech conditions, Prioritising voice, A third party supporting communication, Using communication to get things done, Depending on technology, and Facing ignorance. Important aspects influencing the ventilator-supported individuals' communicative performance (speech, support from others and technological solutions) are discussed.	The study revealed that healthcare practitioners involved in the care of individuals receiving HMV need to improve their understanding and knowledge of issues related to ventilator-supported communication. Individuals receiving HMV encounter a needlessly long and lonely struggle to achieve effective communication. They face numerous challenges regarding their communication, and they need to be heard in both literal and figurative senses. To overcome these challenges they need support from competent healthcare practitioners and personal assistants, and continuous follow-up by speech and language therapists tailoring communicative solutions to fit individual needs.	
22022393	Family caregivers of people with mental disorders are frequently involved in involuntary hospital admissions of their relatives.To explore family caregivers' experience of involuntary admission of their relative.	30 in-depth interviews were conducted with family caregivers of 29 patients who had been involuntarily admitted to 12 hospitals across England. Interviews were analysed using thematic analysis.	Four major themes of experiences were identified: relief and conflicting emotions in response to the relative's admission; frustration with a delay in getting help; being given the burden of care by services; and difficulties with confidentiality. Relief was a predominant emotion as a response to the relative's admission and it was accompanied by feelings of guilt and worry. Family caregivers frequently experienced difficulties in obtaining help from services prior to involuntary admission and some thought that services responded to crises rather than prevented them. Family caregivers experienced increased burden when services shifted the responsibility of caring for their mentally unwell relatives to them. Confidentiality was a delicate issue with family caregivers wanting more information and a say in decisions when they were responsible for aftercare, and being concerned about confidentiality of information they provided to services.	Compulsory admission of a close relative can be a complex and stressful experience for family caregivers. In order for caregivers to be effective partners in care, a balance needs to be struck between valuing their involvement in providing care for a patient and not overburdening them.	
22005710	The patient empowerment paradigm has been promoted as a critical component of diabetes care. The present study explores how patients in an urban, public-sector clinic perceive patient empowerment as it applies to their treatment, interactions with clinicians, and self-care behaviors.Semi-structured interviews were conducted with 29 individuals and analyzed through an inductive approach.	Patient empowerment was described as taking responsibility for self-care behaviors. Participants reported they that must be internally driven to maintain their self-care regiment, and placed moral value on their performance. Some participants asked questions during healthcare encounters, but fewer reported setting the agenda or making meaningful decisions regarding their care.	Gaps in individuals' perception of empowerment were identified, along with barriers such as frustration, fatigue, financial concerns, transportation, and scheduling difficulties.	Increasing patient empowerment in socially disadvantaged settings will require careful communication to elicit questions, present all available treatment choices, and encourage individuals to take responsibility without placing blame on them for instances of poor glycemic control.	
22001872	Testosterone (T) is generally theorized within a trade-off framework that contrasts parenting and low T with competitive challenges and high T. Paradoxically, baby cues increase T, prompting questions of whether T or its behavioral expression has been mischaracterized. We tested 55 men using a novel interactive infant doll paradigm, and results supported our hypotheses: We showed for the first time that baby cries do decrease T in men, but only when coupled with nurturant responses. In contrast, baby cries uncoupled from nurturant responses increased T. These findings highlight the need to partition infant cues and interactions into nurturant versus competitive-related contexts to more accurately conceptualize T, as per the Steroid/Peptide Theory of Social Bonds. This experiment also supports the utility of this paradigm for studying effects of infant interactions on hormonal responses, which may provide critical insights into ameliorating the darker sides of caregiving (e.g. anger, frustration, violence) and enhancing the positive sides (e.g. intimacy, nurturance, reward).
21967394	Although the characteristics of premature ejaculation (PE) are established, the exact aetiology is largely unknown. Genetic, neurobiological, pharmacological, psychological, urological and endocrine factors have all been proposed. In addition PE and erectile dysfunction are often co-morbid.This article provides an overview of the proposed biological and psychological aetiologies of PE.	Review of the literature.	Current data on the pathophysiology of PE.	This review shows that most of the proposed biological and psychological aetiologies of PE are not evidence-based and/or that attempts to confirm them have given conflicting results. There are good data to support roles for genetic and psychological factors, either causal, or secondary to PE for the latter, in lifelong PE. Conversely, more evidence-based data support the responsibility of opioid substance withdrawal, prostatic inflammation or hyperthyroidism in some cases of acquired PE, in addition to a probable role of psychological factors.	The determinants of PE are certainly complex and multifactorial, while each partner's reaction to the frustration caused by the sexual dysfunction may exacerbate or perpetuate it. It is important to understand, as far as possible, the aetiology in the individual patient to ensure appropriate assessment and treatment. It should be noted that identification of an aetiological factor does not necessarily mean the cause of the PE has been completely explained, and the patient may require a combination of treatment approaches.	
21955765	This study explored whether motivational, emotional, and behavioral aspects of self-regulated learning (SRL) are associated with academic performance in medical school.Across two academic years (2008-2009 and 2009-2010), 248 (73%) of 342 second-year students in an introductory clinical reasoning course completed surveys assessing 10 SRL constructs. Performance was operationalized as students' average grade on three course exams, and a tercile split was used to compare those in the lowest and highest third of achievement using a one-way multivariate analysis of variance.	Findings revealed differences in the beliefs and emotions of the two extreme groups, F(10,136) = 2.08, P = .03. Compared with high-performing students, low performers reported lower task value (Cohen d = -0.33) and self-efficacy beliefs (d = -0.33) as well as greater anxiety (d = 0.63), frustration (d = 0.54), and boredom (d = 0.44).	Low-performing medical students in a clinical reasoning course demonstrated deficiencies in key SRL measures, providing insight for future, tailored remediation strategies.	
21991562	No study to date has looked at the symptoms of chronic catarrh as defined by the patients themselves. We looked to explore the catarrh experience through the eyes of patients using a qualitative approach.Forty-eight patients referred to Secondary Care with chronic catarrh, postnasal drip or persistent throat clearing completed an open-ended questionnaire from which a comprehensive symptom list was generated. Nineteen of these patients undertook semi-structured interviews to explore symptomatic themes relating to their catarrh using grounded theory analysis.	A standardised list of 38 catarrh-related symptoms was generated covering a wide topography. A common theme amongst interviewees was the frustration of being unable to expectorate mucus rather than expelling too much.	Difficulties exist in establishing whether the extensive list of symptoms associated with catarrh is a result of differing experiences for patients or simply differing lexicon describing the same experience. Many of these symptoms are not included in the most commonly used nose/throat symptom instruments. Furthermore a distinction should be made between patients with true rhinitis who expel mucus and those who present with apparent postnasal drip or throat clearing but who cannot expectorate, whose management ought be focused more on symptom-coping strategies rather than medication or investigation.	
21988443	The aims of this research were to explore and describe registered nurses' experiences of interacting with patients with mental health challenges in the medical wards of a public hospital in Johannesburg.Nurses are the major providers of hospital care and have become an important resource in the delivery of mental health care to patients with mental health challenges. However, the attitude and ability of many nurses in providing this care have been shown to be poor.	In-depth phenomenological interviews were conducted with eight female registered nurses working in four medical wards where they interact with patients with mental health challenges.	From the findings it is clear that registered nurses experienced frustration, unhappiness, fear and perception of danger when interacting with patients with mental health challenges in their wards. This could be attributed to a lack of knowledge and skills in mental health.	Registered nurses have negative experiences with interaction with patients with mental health challenges in medical wards because of a lack of knowledge and skills in mental health.	Ward managers can facilitate the psychological empowerment of registered nurses.	
21982621	Based on Self-Determination Theory, this study aimed to gain further insight in the pathway from eating regulation to bulimic symptoms by (a) examining diet-specific need frustration as an intervening mechanism, (b) investigating the associations between different types of goals underlying eating regulation and diet-specific need frustration and bulimic symptoms, and (c) considering body dissatisfaction as an antecedent of eating regulation and eating regulation goals. In a sample of 244 female adolescents, SEM analyses showed that (a) the association between eating regulation and bulimic symptoms can be accounted for by need frustration, (b) appearance-focused and health-focused eating regulation are associated differentially with need frustration and bulimic symptoms, and (c) body dissatisfaction is related positively to eating regulation and appearance-focused eating regulation. These findings suggest that the goals underlying one's eating regulation and the concept of need frustration help to understand when and why eating regulation is associated with bulimic symptoms.
21981889	Prison is typically considered as a dangerous setting partly because of promiscuity and violence, which leads to a whole series of suffering and frustration among prisoners. Due to their occupation, prison guards must ensure the safety of the inmates, their colleagues, as well as any other persons working in prison and in the prison setting. Thus, correctional guards are the "Bumper excitement" of prison violence and suffer from stressful and traumatic events. Indeed, inmates' sufferings and frustration are firstly expressed towards them because they share daily relationships with inmates. In addition, correctional guards are faced with the high inmate suicide risk. One potential consequence of these chronic stressful situations is burnout. Burnout is described as a three-dimensional syndrome composed of emotional exhaustion, depersonalization and sense of lack of personal accomplishment. Burnout is a severe psychological suffering, which can lead to depression. It has been initially identified among persons who are working with patients. Nevertheless, research shows that burnout is not a psychopathology of work but of the relationship with others. In other terms, burnout seems to arise when people share stressful, chronic and violent relationships with someone else. Burnout doesn't appear per se in any international classification of mental disorders: clinicians often use the diagnosis of adjustment disorder.Our aim is to assess the impact of victimization on burnout among guards in French prisons. Prison guards were chosen for two major reasons. First, the custodial role of correctional officers is typically described as a stressful occupation, sensitive to burnout. Second, prison is generally considered "dangerous". Indeed, victimizations and aggressions frequently occur. Consequently, we hypothesize that burnout levels will be high for prison guards. We also hypothesize that the intensity of the victimizations (verbal, physical or armed aggression) will heighten burnout levels.	Two hundred and thirty-five prison guards were involved. Among these 235 correctional guards, there were 46 women and 188 men, ranging from 22 to 56 years old. Victimizations were very common: more than 87 % had experienced an aggression, whether verbally, physically or armed. They were asked to fill out the French form of the Maslach burnout Inventory (MBI). The MBI is a 22-item self-report measurement that assesses the three dimensions of burnout: emotional exhaustion, depersonalization and personal accomplishment. Items are rated on a 7-point scale ranging from 0 ("never") to 6 ("every day"). We have statistically created a new global level of burnout with the three dimensions. It is called "burnout level". We have assessed two sets of independent variables (VI): demographic VI (age, sex, tenure, level of studies) and correctional VI (penal status of prison, victimizations). Regarding our dependent variables, we have four levels which are (1) global burnout (GB), (2) emotional exhaustion (EE), (3) depersonalization (D), and (4) personal accomplishment (PA). For the purpose of our study, we carried out variance analyses (Anova) in order to compare the averages of our groups of subjects. Further to Anova, we chose the Bonferroni/Dunn post hoc test.	The results indicate that demographic variables such as age, sex or level of studies have no significant effect on GB, EE, D and PA levels. Tenure has a significant effect on GB and D levels. Concerning correctional variables, results show that the penal status of prison has a significant effect on GB and EE. Prison guards working with inmates incarcerated for more than 5years report higher GB and EE than their counterparts working with inmates not already convicted. Victimizations have a significant effect on GB, EE, D and PA levels. Prison guards with physical or armed aggressions report higher global GB, EE, D and PA levels than prison guards without aggressions. Furthermore, prison guards with physical or armed aggressions report higher global GB and D levels than prison guards with verbal aggressions. Two major points are highlighted by our study. First, characteristics of prison and inmates are related to burnout among prison guards. Second, victimizations lead to burnout.	
21975194	Laboratory tasks that measure various facets of impulsivity derived from self-report questionnaires are important for elucidating the behavioral consequences of impulsivity in humans and for back-translating these facets to non-human species. Negative urgency, or mood-based rash action, is a self-report facet of impulsivity linked to problem substance use; however, a valid behavioral task is lacking.The current studies were designed to bridge self-report questionnaire and behavioral measures of negative urgency in humans and to determine if this could be back-translated to rats.	Humans scoring high in negative urgency showed greater behavioral responding and increased frustration following unexpected reward omission on a monetary-based task compared to subjects low in negative urgency. Rats also showed elevated responding for either sucrose pellets or intravenous amphetamine following unexpected reward omission.	These results suggest that impulsive behavior engendered by unexpected reward omission may represent a valid behavioral model of negative urgency linked to substance abuse.	
21966772	Obesity is a condition strongly associated with polycystic ovary and other conditions that interfere with or complicate the treatment of assisted reproduction.To examine, from a phenomenological point of view, the perception of infertile women obesity problem before undergoing assisted reproduction treatment. This analysis should help to design a psychotherapeutic strategy focused on this problem.	One hundred patients with infertility, with a BMI equal to or greater than 30, candidates for assisted reproductive treatments in the service of Human Reproduction, Centro Médico Nacional 20 de Noviembre, ISSSTE. The phenomenological qualitative analysis was performed in 72 women who agreed to be interviewed in depth. The phenomenon is to study obesity in infertile women candidates for assisted reproduction treatment.	Obese infertile women subject to assisted reproduction treatment perceive their difficulty losing weight is closely associated with infertility. Most patients had social feelings of worthlessness, sadness, worthlessness, and family rejection. The inability to obtain a steady weight loss is regarded as a minor frustration that sterility.	It is very important to perform intensive, multidisciplinary labor, which is focused on concepts associated with psychological distress, such as: management of depression by sterility, control of anxiety and stress, control of social pressures and management of the illusion of motherhood. Also rely on specialists of eating habits and exercise.	
21962755	This prospective study investigated and compared psychiatric features of 25 consecutive patients with psychogenic nonepileptic seizures (PNES) on the basis of presence of reported trauma. The "trauma" group comprised 19 patients (76%) and the "no-trauma" group comprised 6 patients (34%). We compared history of PNES, psychiatric comorbidity, alexithymia, and symptoms of dissociation. The study clearly characterized two distinct profiles of patients with PNES on the basis of trauma history. Patients with trauma had at least one psychiatric comorbidity or antecedent (vs 0% in the no-trauma group NT, P<0.001) and a higher median score of dissociation (P<0.001). Patients without trauma had more frequent "frustration situations" as a factor triggering PNES and subsequent sick leaves as perpetuating factors (P=0.001). Trauma antecedents correlated with a high rate of psychiatric comorbidity and a strong dissociative mechanism. Patients without trauma had no psychiatric comorbidity and a weaker dissociative mechanism.
21957917	The role of occupational therapists in palliative care is largely undocumented in Western Australia (WA). Little is known about the services occupational therapists provide or the needs of people who are dying and their carers in relation to these services. The aims of this study were as follows. First, to determine the number of occupational therapists employed and the range of services they provide in palliative care in WA. Second, with particular reference to self care, leisure, productive roles and occupations, to explore the daily experiences of people who were dying as well as their primary carers to determine the services that might be offered by occupational therapy to this population.Semi-structured interviews were used to gather information from carers (n=10 metro, n=4 rural) and occupational therapists (n = 13 metro, n = 5 rural). Data were analysed qualitatively using grounded theory to develop categories. Themes were defined using the constant comparison method.	Four themes emerged that impacted people who were dying and their carers. These were; ongoing disengagement from usual activities with resultant occupational deprivation; disempowerment of both people who are dying and their carers within palliative care services; 'occupation' not being addressed adequately in palliative care, and occupational therapists experience frustration with limited opportunities to contribute to the care of people who are dying.	This paper highlights gaps in service provision in WA to people who are dying and their carers. It provides direction for occupational therapists to offer an occupation-focussed approach to the care of this vulnerable group.	
21951646	The study analyzes the way in which adolescents' temperamental characteristics interact with parental control to shape adolescent decision making development. A sample of high-school Chilean adolescents (N = 391) answered a self-report questionnaire that included measures of behavioral autonomy (the extent to which adolescents make decisions in personal and prudential domains), parental behavioral and psychological control, and temperamental characteristics. A path analysis model indicated that adolescents' anger-frustration had a direct association with decision-making in the personal and prudential domains; fearfulness had an inverse association with adolescent decision-making, but only in the prudential domain. Perceived psychological control was associated with adolescents' reduced decision-making autonomy in the personal domain, while perceived behavioral control was associated with less adolescent autonomy in both personal and prudential domains. Additionally, a moderation effect was found such that the association of parental behavioral control on decision-making in the prudential domain was dependent on the adolescent fearfulness level.
21949420	Psychological factors such as depression affect recovery after whiplash-associated disorders. This study examined the prevalence of pain-related emotions, such as frustration, anger, and anxiety, and their predictive value for postcrash pain recovery during a 1-year follow-up.A population-based prospective cohort study design was used. Self-reported pain-related depression, anxiety, fear, anger, and frustration were assessed using 100-mm visual analog scales (VASs) at 6 weeks after crash in 2986 persons with traffic-related whiplash-associated disorder. Multivariable logistic regression was used to assess the relationship between the intensity of these pain-related emotions and pain recovery at 4 and 12 months after crash. Pain was measured at all time points on a 100-mm VAS, and pain recovery was defined as a score of 10 or lower.	Pain-related frustration was the most intense, with a mean score of 52. Only 3% of the cohort reported having no pain-related frustration, and 4% reported no pain-related anxiety. Multivariable logistic regression models revealed that each pain-related emotion increased the risk of failing to recover (odds ratios for each point increase on the 100-mm VAS), ranging from 1.011 to 1.015. Specifically, with each 10-point increase in pain-related emotion, the odds of failing to achieve pain recovery at 4 months was increased by 14% (p < .001) for depression, 15% (p < .001) for anxiety, 11% (p < .001) for fear, 12% (p < .001) for anger, and 11% (p < .001) for frustration.	These findings suggest that it may be beneficial for health care providers to address emotional status related to pain in the first few weeks after a whiplash injury.	
21948245	Chronic neuropathic pain may require a neurosurgical treatment, but for reasons that have not been fully explored yet, a significant number of patients do not benefit from the intervention. We compared the resting EEG of 15 healthy controls to the EEG of 23 chronic neuropathic pain patients before and 12 months after treatment by the central lateral thalamotomy (CLT). A patient subgroup had a high (n = 14, pain relief (PR)  ≥ 50%) and another subgroup a low (n = 9, PR < 50%) postoperative PR. EEG spectral power and source localization of the high PR patients were normalized postoperatively. In contrast, low PR patients showed postoperative maintenance of insular, cingulate and prefrontal overactivities, and their frustration values were positively correlated with cingulate and prefrontal activity. These findings demonstrate a normalizing effect of CLT on cortical activity and suggest that treatment resistance is associated with a frustration-based dynamics.
21942577	We investigated the temporal dynamics of students' cognitive-affective states (confusion, frustration, boredom, engagement/flow, delight, and surprise) during deep learning activities. After a learning session with an intelligent tutoring system with conversational dialogue, the cognitive-affective states of the learner were classified by the learner, a peer, and two trained judges at approximately 100 points in the tutorial session. Decay rates for the cognitive-affective states were estimated by fitting exponential curves to time series of affect responses. The results partially confirmed predictions of goal-appraisal theories of emotion by supporting a tripartite classification of the states along a temporal dimension: persistent states (boredom, engagement/flow, and confusion), transitory states (delight and surprise), and an intermediate state (frustration). Patterns of decay rates were generally consistent across affect judges, except that a reversed actor-observer effect was discovered for engagement/flow and frustration. Correlations between decay rates of the cognitive-affective states and several learning measures confirmed the major predictions and uncovered some novel findings that have implications for theories of pedagogy that integrate cognition and affect during deep learning.
21940093	Emotion regulation is a key social skill and children who fail to master it are at risk for clinical disorders. Specific styles of emotion regulation have been associated with particular patterns of prefrontal activation. We investigated whether anxious aggressive children would reveal a different pattern of cortical activation than non-anxious aggressive children and normally-developing children. We examined the magnitude and timing of source activation underlying the N2-an ERP associated with inhibitory control-during a go/nogo task with a negative emotion induction component (loss of earned points). We estimated cortical activation for two regions of interest-a ventral prefrontal and a dorsomedial prefrontal region-for three 100-ms windows over the range of the N2 (200-500 ms). Anxious aggressive children showed high ventral prefrontal activation in the early window; non-anxious aggressive children showed high ventral prefrontal activation in the late window, but only for the duration of the emotion induction; and normally-developing children showed low ventral prefrontal activation throughout. There were no group differences in dorsomedial prefrontal activation. These results suggest that anxious aggressive children recruit ventral prefrontal activation quickly and indiscriminately, possibly giving rise to their rigid, threat-oriented approach to conflict. The late ventral prefrontal activation seen for non-anxious aggressive children may underlie a more delayed, situation-specific, but ineffective response to frustration.
21936734	Inpatient rehabilitation is an integral part of the continuum of care for people with severe acquired brain injury (ABI), and may extend for weeks or months. However, there is a lack of research describing the experience of inpatient brain injury rehabilitation. The purpose of this study was to describe and interpret the inpatient brain injury rehabilitation experience from the perspective of patients and their caregivers. Qualitative content analysis of semi-structured interviews from a purposeful sample of 20 patients and 18 of their family caregivers generated in-depth descriptions of the inpatient experience. Three themes were identified; "rehabilitation context/environment", "activity/occupation", and "support and adjustment". The findings provide a greater understanding of rehabilitation from an insider perspective and can assist rehabilitation teams to better meet the needs of people with ABI. Specifically, the need for a therapeutic environment, meaningful occupations and family-centredness in inpatient settings were highlighted by this study.
21926386	In this article we present the findings of a qualitative examination of 30 mothers of very-low-birth-weight babies. Interviews conducted with the mothers when the babies were still in neonatal hospitalization show that virtually all the mothers described their delivery both as a traumatic event, and as a nonevent in which they felt that they barely participated. Most of them blamed themselves for not carrying full term, some blamed others, and some believed the premature delivery saved their baby's life. Following their truncated pregnancies, their "nonparticipation" in the delivery, and their separation from their newborn immediately after the delivery, virtually all the women reported difficulty grasping that they were mothers. Many reported a sense of loss, emptiness, and frustration that the baby was no longer inside. The women took a variety of measures, including magical means and parenting behaviors, to safeguard their vulnerable babies and to become mothers within the constraints of the neonatal unit.
21920645	expectant fathers often attend pregnancy ultrasound but their needs are poorly examined, especially in connection with adverse findings.to explore men's expectations of routine ultrasound and experiences when soft markers were discovered.	a qualitative study at Uppsala University Hospital in Sweden where semi-structured, in-depth interviews were conducted with 17 expectant fathers 6-12 weeks after the discovery of a soft marker at the routine ultrasound scan.	five major themes emerged: (1) 'immediate reaction: frustration and thoughts about consequences', (2) 'need for facts to gain control', (3) 'concern about the partner', (4) 'in retrospect: almost okay but routines need changing' and (5) 'amniocenteses or not: a joint decision with several considerations'.	these findings contribute important knowledge about men's needs related to pregnancy ultrasound with unexpected findings, and their role in decision-making concerning fetal diagnostics. Our results show that men enter a role of a kind of fact manager and have both a psychological need as well as the capacity to perceive important information during the process following the detection of a soft marker in the fetus. Practitioners conducting pregnancy ultrasound should therefore have relevant knowledge to be able to provide immediate information about soft markers, including risk assessment for chromosomal defects. In addition to this, written information about soft markers should be available to expecting parents in this situation.	
21912269	A left ventricular assist device (LVAD) is used as a bridge to transplantation in patients with acute heart failure. The device is a major bodily invasion that challenges everyday life. Only few studies have explored the psychosocial adjustments of patients living with an LVAD.The aim of this study was to explore the lived experience of patients with LVADs.	The present study had a qualitative explorative design using in-depth interviews of 10 adult patients that had experienced life with an LVAD from 2008 to 2010 in Denmark. We constructed an interview guide with themes relating to the chronology of the illness trajectory. Data were managed by the qualitative computer package NVivo 8. As a theoretical framework, we chose a life-stage model for the main theme: Life With LVAD. The model describes the developmental tasks in each age group, and we looked at the physical, psychological, social, and vocational adjustments of patients with LVADs.	Despite the suddenness of onset and gravity of illness, the patients in our study coped well with their situation. While bridging to transplantation, the patients experienced the ambivalence of gratitude and frustration toward the LVAD, and during preparation for cardiac transplantation, they experienced the ambivalence of hope and fear. Some resolved their emotional ambiguity by procrastination in relation to vocational adjustments that were necessary due to their illness. Older patients with occupational security were quicker to resume work and everyday life.	Patients with LVADs succeeded somewhat in reestablishing their lives, but the younger individuals still need to consider vocational options. Some patients need help to get out of the sick role that kept them on disability benefits. The patients all relied on support from close family: parents, spouses, and children.	
21908475	There is significant variation in symptom tolerance before seeking healthcare advice and it has recently been postulated that there may be a similar variation in the degree to which individuals tolerate deviations in physiological body sensations before considering them symptoms. This study looked to explore this transition from sensation to symptom more closely using the clinical entity of chronic catarrh - a frequently presenting problem which represents a putative alteration of a physiological process.Qualitative study using semi-structured interviews.	19 adult patients presenting with chronic catarrh, persistent throat clearing or post-nasal drip.	Secondary care institute in North of England.	Subjects' accounts revealed three changes in perception of nasopharyngeal mucus that triggered the transition from sensation to symptom: an apparent change in viscosity, quantity, or constancy. Such changes were invariably deemed to have a consequence (threat to wellbeing, social impact, or source of frustration) and invariably drew a response from the sufferer to limit these consequences.	Symptoms representing an aberration of normal body sensations likely develop over time in a series of recognizable phases. Discriminatory markers appear to exist which delineate those body sensations accepted and those considered symptoms. These are discussed with the use of a novel symptom evolution pathway diagram.	
21905039	Although numerous experiments have shown that exposure to violent video games (VVG) causes increases in aggression, relatively few studies have investigated the extent to which this effect differs as a function of theoretically relevant individual difference factors. This study investigated whether video game content differentially influences aggression as a function of individual differences in trait anger. Participants were randomly assigned to play a violent or nonviolent video game before completing a task in which they could behave aggressively. Results showed that participants high in trait anger were the most aggressive, but only if they first played a VVG. This relationship held while statistically controlling for dimensions other than violent content on which game conditions differed (e.g. frustration, arousal). Implications of these findings for models explaining the effects of video games on behavior are discussed.
21904087	The impact of untreated adult attention-deficit/hyperactivity disorder (ADHD) in the workplace can be substantial, and employees with ADHD often confront frustration, employer disappointment, and low performance ratings. As a result, adults with ADHD may seek treatment from primary care providers to improve occupational performance. Previously considered a behavior disorder primarily affecting children and adolescents, ADHD in adulthood presents primarily as a cognitive disorder. Self-management deficits play a greater role in adult ADHD, particularly with respect to occupational and interpersonal functioning. Although specialized resources are available to assist adults with ADHD, many afflicted individuals may be unaware or unable to access them. Primary care providers who may be treating adults with ADHD are in a unique position to help them obtain the care and support needed to build appropriate skills and manage occupational issues. In this review, a literature search of the past 10 years was conducted to identify articles concerning ADHD and its impact on individuals in the workplace. The influence of ADHD on occupational functioning is discussed in the context of self-management impairments, diagnosis and assessment, and management strategies. With early and successful intervention, adults with ADHD may be able to become more aware of the impact of ADHD on work performance and achieve successful occupational experiences.
21902832	Self-management support is seen as a cornerstone of good diabetes care and many countries are currently engaged in initiatives to integrate self-management support in primary care. Concerning the organisation of these programs, evidence is growing that engagement of health care professionals, in particular of GPs, is critical for successful application. This paper reports on a study exploring why a substantial number of GPs was (initially) reluctant to refer patients to a self-management education program in Belgium.Qualitative analysis of semi-structured face-to-face interviews with a purposive sample of 20 GPs who were not regular users of the service. The Greenhalgh diffusion of innovation framework was used as background and organising framework.	Several barriers, linked to different components of the Greenhalgh model, emerged from the interview data. One of the most striking ones was the limited readiness for innovation among GPs. Feelings of fear of further fragmentation of diabetes care and frustration and insecurity regarding their own role in diabetes care prevented them from engaging in the innovation process. GPs needed time to be reassured that the program respects their role and has an added value to usual care. Once GPs considered referring patients, it was not clear enough which of their patients would benefit from the program. Some GPs expressed the need for training in motivational skills, so that they could better motivate their patients to participate. A practical but often mentioned barrier was the distance to the centre where the program was delivered. Further, uncertainty about continuity interfered with the uptake of the offer.	The study results contribute to a better understanding of the reasons why GPs hesitate to refer patients to a self-management education program. First of all, the role of GPs and other health care providers in diabetes care needs to be clarified before introducing new functions. Feelings of security and a basic trust of providers in the health system are a prerequisite for participation in care innovation. Moreover, some important lessons regarding the implementation of an education program in primary care have been learned from the study.	
21900438	Patients with chronic non-cancer pain (CNCP) are common and have a high degree of morbidity. Previous studies document clinician frustration and variability in CNCP management. We conducted this study to gather in-depth clinicians' views about factors that affect management of CNCP.We conducted a survey in the Primary Care MultiEthnic Network, a consortium of PBRNs of primary care clinicians practicing in low-income, medically underserved communities, and in a network of private primary care offices.	Of 792 clinicians surveyed, 497 (63%) participated. Responses and accompanying narrative comments clustered around 5 themes: (1) barriers to and uncertainties in optimal management; (2) the complex biopsychosocial nature of CNCP; (3) seriousness of prescription opioid abuse; (4) effort and burden required to properly manage CNCP; and (5) clinician commitment to provide care for CNCP patients and benefits of expanded care model for CNCP. One-third reported a severe outcome (death or life-threatening event) in a CNCP patient for whom they had prescribed opioids. Roughly one-third do not initiate prescribing of opioids.	Guidelines and increased continuing medical education alone are unlikely to be the solutions to the challenges of CNCP management. Increased evidence for recommendations and resources for more comprehensive care management are needed.	

21876901	Currently, we are experiencing a paradigm shift in relation to how we understand health and care. The biomedical model has been replaced by a vision of an integral being, and care emphasis is being placed on health promotion and disease prevention. However, the discourse of personal responsibility for health can generate in patients feelings of guilt, shame, fear and paranoia, while in professionals it can cause feelings of powerlessness and frustration. These feelings disrupt attachments and, thus, reduce the effectiveness of care. The objective of this theoretical study is to propose a dialogue between Psychology, with social constructionist sensitivity, and Nursing, to examine the possibilities of improving care from this approach. As an alternative to the discourse of personal responsibility, relational responsibility and understanding health and care in the long time, lived time and short time, is proposed.

21860324	Apathy is one of the most challenging and prevalent behavioral symptoms of dementia. It is associated with increased disability and caregiver frustration as well as reduced quality of life, rehabilitation outcomes and survival after nursing home admission. A literature search to set criteria yielded 56 nonpharmacological intervention studies with outcomes relevant to apathy in dementia. Studies were rated according to quality and categorized into 7 groups: exercise, music, multisensory, animals, special care programming, therapeutic activities and miscellaneous. Despite a lack of methodological rigor, it is apparent that nonpharmacological interventions have the potential to reduce apathy. This review indicates that therapeutic activities, particularly those provided individually, have the best available evidence for effectiveness in dementia. Recommendations are provided for quality research.
21860138	The objective of the study is to investigate the prevalence and risk factors of non-consensual sex/rape in Benin.We surveyed 580 females in the University Community of Benin, 414 questionnaires were sufficiently completed for analysis.	Seventy-six (18.4%) respondents reported that they had been victims of non-consensual sex (NCS), 36 in their current relationship. The unmarried single respondents had the lowest mean age at NCS experience of 18 years, while the divorced victims had the highest mean age of 32.5 ( P = 0.000). There was a major exposure peak age at 19 years with a smaller peak at 25. The majority of sex offenders were their present partners and next the husbands (22.2%). The father was the perpetrator on one (2.78%) occasion, while armed robbers raped two of the victims. Eighteen of the seventy-six respondents made a formal report. Cumulatively, 95.4% of the respondents felt it was futile reporting, four (5.3%) felt it was not all a bad experience. The risk of being infected with the HIV/AIDS virus was the worst fear. Ninety-five of four hundred and fourteen respondents want the public and parents to be educated, 64 would like the penal code to be tougher and better implemented, while 64 (14.0%) crave for a dress code for the University community.	The self-reported incidence of NCS is high, majority were not formally reported as most of the sex offenders were the (ex)partners of the victims. There was a major exposure peak age at 19 with a smaller peak at 25 years. There was a condoned sense of futility and frustration in reporting.	
21856334	The development of avoidance learning depends on dopamine release in forebrain regions. Previous studies indicated that rewarding brain stimulation facilitated two-way active avoidance learning. However, it is not clear whether the temporal relationship of brain stimulation to the training session (before, during or after) is important. To investigate the role of stimulation condition (no stimulation, self-stimulation only, or self-stimulation plus avoidance stimulation) and sequence of self-stimulation training (before or after avoidance training), we used a 3×2 factorial design, in which every level of stimulation was paired with every level of sequence for a total of 6 different groups. The results suggest that self-stimulation either before or after avoidance learning improved acquisition performance, but acquisition was maximal when stimulation was also given during acquisition trials. Importantly, the sequence of self-stimulation (before or after each acquisition session) was irrelevant to this beneficial effect. However, stimulation had no apparent effect on long-term retention when tested 10 days later under conditions of no stimulation, except that the performance of the group that had previously received avoidance-contingent stimulation deteriorated over the course of 60 trials. This may reflect frustration from the omission of expected reward. These results are relevant for optimizing brain stimulation to improve learning.
21849945	To determine the characteristics of urinary incontinence and its impact on the quality of life in adult women with urinary incontinence who presented to a tertiary care clinic of Vojvodina from September 2008 to May 2009 for treatmentWe used a prospective case-control study. Cases were defined as patients (47) with urinary incontinence symptoms. Controls (50) were defined as patients without urinary incontinence who presented to a tertiary care gynecology clinic for other reasons. Both, cases and controls, completed two questionnaires recommended for the evaluation of symptoms, The Urinary Distress Inventory, and quality of life impact The Urinary Impact Questionnaire.	There was a significant correlation between aging (r=0.614; p<0.01), body mass index (r=0.357; p<0.01) and menopause (r= -0.572; p<0.01) and urinary incontinence. All patients had symptoms of stress incontinence, 61.7% had urge incontinence symptoms, 21.3% voiding difficulty and 85.1% dysuria. Ninety-four patients believed that urinary incontinence impaired their quality of life: 50% of patients reported an impaired ability to do household activities, 59.1% avoided social activities, 70.4% reported an impaired ability to travel more than 30 minutes by car or bus, 88.6% avoided leisure activities, 45.5% of patients had impaired emotional health and 34% felt frustrated.	The dominant type of urinary incontinence in more than half of the respondents was a mixed type, with moderate to very severe problems. Symptoms of urinary incontinence interfere with the performance of everyday household and social activities, causing the appearance of anxiety, depression and frustration, and in more than 50% of women leads to reduced quality of life.	
21846282	The cognitive task demands of office workers and the self-control demands of their work roles were measured in a sample of 196 employees in two different office layouts using a self-report questionnaire, which was circulated electronically. Multiple linear regression analysis revealed that both factors were associated with mental well-being, but not with physical well-being, while controlling for exposure to psychosocial stressors. The interaction between cognitive task demands and self-control demands had the strongest association with mental well-being, suggesting that the deleterious effect of one was greater when the other was present. An exploratory analysis revealed that the association was stronger for employees working in a large open-plan office than for those working in smaller offices with more privacy. Frustration of work goals was the cognitive task demand having the strongest negative impact on mental well-being. Methodological limitations and scale psychometrics (particularly the use of the NASA Task Load Index) are discussed. STATEMENT OF RELEVANCE: Modern office work has high mental demands and low physical demands and there is a need to design offices to prevent adverse psychological reactions. It is shown that cognitive task demands interact with self-control demands to degrade mental well-being. The association was stronger in an open-plan office.
21844402	This study focused on whether developmental communication disorders exist in American Sign Language (ASL) and how they might be characterized. ASL studies is an emerging field; educators and clinicians have minimal access to descriptions of communication disorders of the signed modality. Additionally, there are limited resources for assessing ASL acquisition. This article is designed to raise clinicians' awareness about developmental communication disorders in ASL and categorize types of atypicality that have been witnessed.We conducted 4 focus groups and one 1-on-1 interview with a total of 22 adults (7 Deaf, 15 hearing) who work at bilingual-bicultural (ASL-English) schools for the Deaf. Experiences of these educators and language professionals were analyzed qualitatively using a combination of grounded theory (Charmaz, 2001; Strauss & Corbin, 1998) and a modified van Kaam approach (Moustakas, 1994).	Participants confirmed observations of children with suspected communication disorders and considered the prevalence, possible etiologies, and psychosocial aspects of such disorders in ASL. They reported frustration at the lack of diagnostic tools for reliable identification and intervention strategies to be used in educational settings.	This work provides us with practitioner accounts proving that developmental communication disorders do exist in ASL. Future reports will describe primary data from signers with atypical language attributes.	
21844249	Redirected behaviors occur when some course of action is thwarted or inhibited (frustration). They also occur as adjunctive behaviors in operant conditioning tasks, where they might reflect frustration about unrewarded responses. Because frustration is associated with stress, which could interfere with learning and memory, we studied whether the occurrence of redirected behavior is correlated with learning success in a series of visual-cue discrimination tasks. Eleven hens, aged 34 wk, were tested on acquisition, reversal, extinction, and relearning of a simple visual discrimination task. The experimenters randomly assigned red and blue cardboard discs as discriminative stimuli. A correct response was recorded when a hen pecked at the correct disc. The learning criterion was 90% correct responses in 20 trials in 2 consecutive task sessions. The following data were documented: number of pecks needed to achieve the learning criterion, latency in choosing, pecks at the experimenter, and pecks at the surroundings. The behavioral responses were analyzed using linear mixed model ANOVA. Redirected pecking at the surroundings was a significant indicator of learning failure in that the more the hens performed this behavior, the more trials they needed to complete the discrimination tasks (P = 0.012). The number of pecks at the experimenter during the tasks significantly influenced learning success (P = 0.020), with hens directing more pecks at the experimenter during reversal, reaching the learning criterion in fewer trials (P = 0.027). The more the hens pecked at the experimenter during acquisition and extinction, however, the more trials they needed to meet the learning criteria (acquisition: P = 0.048; extinction: P = 0.003). Thus, laying hens are susceptible to the effects of frustration as measured in terms of redirected pecking elicited by operant procedures in visual discrimination tasks. In general, any situation in which a desirable goal is obstructed or an expected reward is omitted may lead to frustration-related activities, such as redirected behavior, which could in turn lead to abnormal behavior and welfare issues for the animals.
21832273	The identification of individual characteristics that predict success in smoking cessation is necessary to improve the effectiveness of smoking cessation efforts. The aim of this study was to identify the factors that predict success in smoking cessation in people who attended 2, 3, 4, or 5 sessions of a smoking cessation program.The participants comprised 2,471 people who attended at least 2 consultations during a 5-week smoking cessation program. Success in smoking cessation was defined as self-reported abstinence and having an exhaled carbon monoxide level ≤10 parts per million at the final consultation. Baseline characteristics were compared using univariate analysis of variance and the chi-square test. A stepwise multivariate logistic regression model was used to analyze the effect of baseline characteristics and the slopes of the withdrawal symptoms on the success in smoking cessation.	Participating in a higher number of sessions gradually increased the chance of smoking cessation from 12.1% to 61.2% (p < .0001). Logistic regression analysis revealed that the independent predictors of success in smoking cessation were being male; low nicotine dependence; smoking few cigarettes per day at baseline; having no history of depression; having low values for craving for cigarettes, irritability, frustration, anger, or nocturnal awakening at baseline; decreased craving for cigarettes and restlessness with time; and use of nicotine replacement therapy (NRT). People who attended more sessions tended to be older.	Attending more sessions of a smoking cessation program, NRT, and coping with withdrawal and psychosocial symptoms increases the chance of short-term success in smoking cessation.	
21823909	Despite the need for HIV-positive children to adhere effectively to antiretroviral treatment (ART), a guiding theory for pediatric ART in resource-limited settings is still missing. Understanding factors that influence pediatric ART adherence is critical to developing adequate strategies. In-depth qualitative interviews were undertaken in Kinshasa, Democratic Republic of the Congo, with 20 sets of HIV disclosed and nondisclosed children along with respective caregivers to better characterize barriers, facilitators, and adherence experiences in children taking ART. Commonly cited barriers included lack of food or nutritional support, lack of assistance or supervision for children, lack of assistance for caregivers, and being unable to remember to take medicines on a consistent basis. Facilitators included having a strong caregiver-child relationship and support system along with strategies for maintaining adherence. Similar themes arose within the child-caregiver sets, but were often characterized differently between the two. Children who were aware of their HIV status displayed fewer instances of frustration and conflict concerning taking medicines and within the child-caregiver relationship. Continued study on pediatric ART adherence should account for differing perspectives of children and caregivers, as well as between status disclosed and nondisclosed children. Areas of future intervention should focus on child-caregiver relationships, disclosure of HIV status, and available nutritional and psychosocial support for children and their caregivers.
21820778	the active engagement of fathers in maternity care is associated with long-term health and social benefits for the mother, baby and family. The maternity care expectations and experiences of expectant and new fathers have received little attention to date.to identify and synthesise good quality qualitative research that explores the views and experiences of fathers who have encountered maternity care in high resource settings.	based on a pre-determined search strategy, relevant databases were searched for papers published between January 1999 and January 2010. Backchaining of the reference lists in included papers was undertaken.	good quality qualitative research studies exploring fathers' involvement in maternity care through pregnancy, birth, and up to 6 months postnatally, that were undertaken in high resource countries. No language restrictions were imposed. ANALYTIC STRATEGY: the analysis was based on the metaethnographic techniques of Noblit and Hare (1988) as amended by Downe et al. (2007).	from 856 hits 23 papers were included. The emerging themes were as follows: risk and uncertainty, exclusion, fear and frustration, the ideal and the reality, issues of support and experiencing transition.	fathers feel themselves to be 'partner and parent' but their experience of maternity care services is as 'not-patient and not-visitor'. This situates them in an interstitial and undefined space (both emotionally and physically) with the consequence that many feel excluded and fearful.	fathers cannot support their partner effectively in achieving the ideal of transition to a successful pregnancy, joyful birth and positive parenthood experience unless they are themselves supported, included, and prepared for the reality of risk and uncertainty in pregnancy, labour and parenthood and for their role in this context.	
21819849	Horse riders represent a significant group of vulnerable road user and are involved in a number of accidents and near misses on the road. Despite this horse riders have received little attention both in terms of academic research and transport policy. Based on literature on vulnerable road user safety, including attitudes to road user safety and behaviour of drivers and their relationship with cyclists and motorcyclists, this paper examines the attitudes and reported behaviour of drivers and horse riders. A total of 46 participants took part in six focus groups divided into four groups of drivers with little or no horse riding experience and two groups of frequent horse riders. Each group investigated five key topic areas stemming from the literature review on vulnerable road users including hazard perception, risk perception, emotion, attitudes to sharing the road and empathy. It was found that drivers and horse riders are not always aware of the same hazards in the road and that this may lead drivers to under-estimate the risk when encountering horses. Drivers often had good intentions to overtake horses safely, but were unaware of how vulnerable passing very wide and slow made them feel until they had begun the manoeuvre and hence quickly reduced such feelings either by speeding up or cutting in too soon. However, other than this, drivers had good skills when encountering horses. But these skills could be impeded by frustration when encountering a slow moving horse which was further compounded by a feeling, mainly by younger drivers, that horse riding was for leisure and as such should not get in the way of necessary work journeys. There is a need for drivers to be more aware of the potential hazards a horse rider faces on the road and these could be achieved through inducing empathy amongst drivers for horse riders, creating nudges for drivers in the environment and better education for drivers.
21801262	Since the development of inclusion and integration, parents have increasingly become the major, and sometimes the only, carers of their children with disabilities. Many families speak of stress and frustration with service and community support, and some have turned to residential and specialised day care services to overcome challenges. The need for, and experiences of, such services needs to be examined not just in terms of the child but also in terms of family impact.The study involved interviewing parents on a 1:1 basis and in a focus group to examine the perceptions of family life, along with their later experience of full-time day and residential care. The children had multiple diagnoses of intellectual disability plus major challenging behaviour.	The results describe the major challenges facing families when the children spent most or all of their time at home. This contrasted starkly with the changes in perceived family life once the children were in residential care and day support. Improvements in behaviour of the children were noted and children began to return home for periods of time. Parent noted increased stability of family life, involvement of siblings in more normal community life and increased opportunities for spouses to function more effectively in one or more life domains. Family members perceived a major improvement in overall quality of life.	The results are consistent with findings in other family quality of life studies in terms of family experience, and the types of challenges faced when the child was at home, including when excluded from the regular education system. Extensive support in raising children is required by parents and without this there is a deleterious effect on family life. Many families experienced exclusion within their home communities. Full-time day and residential support were provided, allowing the family to function more effectively and later to provide a more natural home environment for the child. The article raises questions of policy concerning family well-being, as well as the needs of the child.	
21776834	Routine screening for intimate partner violence (IPV) has been widely introduced in health settings, yet screening rates are often low. A screening policy was introduced statewide in Australia in antenatal, mental health, and substance abuse services. Annual snapshot indicates a sustained screening rate of 62%-75% since 2003. Focus group research with health care workers from 10 services found that initial introduction of screening was facilitated by brief, scripted questions embedded into assessment schedules, training, and access to referral services. Over time, familiarity and women's favorable reactions reinforced practice. Barriers remain, including lack of privacy, tensions about limited confidentiality, and frustration when women remain unsafe. Screening added to the complexity of work, but was well accepted by workers, and increased awareness of and responsiveness to IPV.
21764459	This study investigated the importance of emotion-eliciting context (positive and negative) and mother's behaviors (constrained and involved) on toddlers' emotion regulation behavioral strategies, emotional expressiveness and intensity, during three episodes eliciting fear, frustration/anger and positive affect. Fifty-five children between 18 and 26 months of age and their mothers participated in the study. Toddlers' regulatory strategies varied as function of emotion-eliciting context (children exhibited behavioral strategies more frequently during positive affect and frustration/anger episodes and less frequently during fear episodes) and maternal involvement. Toddlers' expression of emotion varied as function of emotion-eliciting context (children exhibited more emotional expressions, both negative and positive during fear and frustration/anger episodes compared to positive affect episodes). Toddlers' expression of emotion was not strongly related to maternal involvement, however, the intensity of emotional expression was related to the interaction of context and maternal involvement.

21752299	The use of opioid medications as treatment for chronic non-cancer pain remains controversial. Little information is currently available regarding healthcare providers' attitudes and beliefs about this practice among older adults. This study aimed to describe primary care providers' experiences and attitudes towards, as well as perceived barriers and facilitators to prescribing opioids as a treatment for chronic pain among older adults.Six focus groups were conducted with a total of 23 physicians and three nurse practitioners from two academically affiliated primary care practices and three community health centers located in New York City. Focus groups were audiotape recorded and transcribed. The data were analyzed using directed content analysis; NVivo software was used to assist in the quantification of identified themes.	Most participants (96%) employed opioids as therapy for some of their older patients with chronic pain, although not as first-line therapy. Providers cited multiple barriers, including fear of causing harm, the subjectivity of pain, lack of education, problems converting between opioids, and stigma. New barriers included patient/family member reluctance to try an opioid and concerns about opioid abuse by family members/caregivers. Studies confirming treatment benefit, validated tools for assessing risk and/or dosing for comorbidities, improved conversion methods, patient education, and peer support could facilitate opioid prescribing. Participants voiced greater comfort using opioids in the setting of delivering palliative or hospice care versus care of patients with chronic pain, and expressed substantial frustration managing chronic pain.	Providers perceive multiple barriers to prescribing opioids to older adults with chronic pain, and use these medications cautiously. Establishing the long-term safety and efficacy of these medications, generating improved prescribing methods, and implementing provider and patient educational interventions could help to improve the management of chronic pain in later life.	
21736926	Reinforcement Omission Effects (ROEs), indicated by higher rate of responses after nonreinforced trials in a partial reinforcement schedule, have been interpreted as behavioral transient facilitation after nonreinforcement induced by primary frustration, and/or behavioral transient inhibition after reinforcement induced by demotivation or temporal control. The size of the ROEs should depend directly on the reinforcement magnitude. The present experiment aimed to clarify the relationship between reinforcement magnitude and the omission effects manipulating the magnitude linked to discriminative stimuli in a partial reinforcement FI schedule. The results showed that response rates were higher after omission than after reinforcement delivery. Besides, response rates were highest immediately after the reinforcement omission of a larger magnitude than of a smaller magnitude. These data are interpreted in terms of ROEs multiple process behavioral facilitation after nonreinforcement, and behavioral transient inhibition after reinforcement.
21729092	Attention deficit hyperactivity disorder (ADHD) is one of the most common behavioral disorders in children. Symptoms of ADHD include hyperactivity, low frustration tolerance, impulsivity, and inattention. While the biological pathways leading to ADHD are not clearly delineated, a number of genetic and environmental risk factors for the disorder are recognized. In the early 1970s, research conducted by Dr. Benjamin Feingold found that when hyperactive children were given a diet free of artificial food additives and dyes, symptoms of hyperactivity were reduced. While some clinical studies supported these findings, more rigorous empirical studies conducted over the next 20 years were less positive. As a result, research on the role of food additives in contributing to ADHD waned. In recent years, however, interest in this area has revived. In response to more recent research and public petitions, in December 2009 the British government requested that food manufacturers remove most artificial food dyes from their products. While these strictures could have positive effects on behavior, the removal of food dyes is not a panacea for ADHD, which is a multifaceted disorder with both biological and environmental underpinnings.
21717789	Modified radical mastectomy (MRM) and breast-conserving surgery (lumpectomy, quadrantectomy - BCS) have shown equivalent clinical outcome in early stage breast cancer. On the other hand, quality of life and, probably, survival time of these patients are negatively influenced by fear of cancer recurrence, leading to episodes of anxiety, depression, and frustration, and, subsequently, physical, marital, sexual, and social functioning disorders. The aim of the present study was to analyze the dynamics and qualitative changes in psychosocial morbidity outcomes in breast cancer survivors one and three years after MRM versus BCS.A survey evaluating psychosocial morbidity of patients was performed by distributing Slovak version of the standardised EORTC-QLQ.C30:3 and EORTC-QLQ-BR23 questionnaires provided by the European Organisation for Research and Treatment of Cancer. The survey was performed in both arms of breast cancer patients surviving one and three years after MRM versus BCS.	Patients surviving one year post MRM or BCS scored their quality of life rather low (2-4, very bad - acceptable), while 78% patients surviving three years after BSC scored considerably higher (5-6, good - very good). However, 22% of patients in this arm considered their quality of life bad, scoring comparably with patients in the MRM arm. While psychosocial burden and behavioural risk profile remain fully expressed in MRM-treated breast cancer patients three years post surgery, the patients surviving three years after BCS suffer from significant emotional dysfunction.	The shift in the quality and intensity of psychosocial dysfunction symptoms in breast cancer patients surviving three years after BCS requires greater attention related to the need for appropriate community-based psychosocial interventions and psychosocial prevention due to the negative impact of continuing and even accelerated psychosocial distress on the quality of life of surviving patients and remission period of the malignant disease.	
21688932	This study examined the relationship of operator personality (Five Factor Model) and characteristics of the task and of adaptive automation (reliability and adaptiveness-whether the automation was well-matched to changes in task demand) to operator performance, workload, stress, and coping. This represents the first investigation of how the Five Factors relate to human response to automation. One-hundred-sixty-one college students experienced either 75% or 95% reliable automation provided with task loads of either two or four displays to be monitored. The task required threat detection in a simulated uninhabited ground vehicle (UGV) task. Task demand exerted the strongest influence on outcome variables. Automation characteristics did not directly impact workload or stress, but effects did emerge in the context of trait-task interactions that varied as a function of the dimension of workload and stress. The pattern of relationships of traits to dependent variables was generally moderated by at least one task factor. Neuroticism was related to poorer performance in some conditions, and all five traits were associated with at least one measure of workload and stress. Neuroticism generally predicted increased workload and stress and the other traits predicted decreased levels of these states. However, in the case of the relation of Extraversion and Agreeableness to Worry, Frustration, and avoidant coping, the direction of effects varied across task conditions. The results support incorporation of individual differences into automation design by identifying the relevant person characteristics and using the information to determine what functions to automate and the form and level of automation.
21678184	HIV-related stigma in African and Afro-Caribbean diaspora communities in the Netherlands was investigated. Interviews with HIV-positive and HIV-negative community members demonstrated that HIV-related stigma manifests as social distance, physical distance, words and silence. The psychological consequences of HIV-related stigma among those diagnosed with HIV reported were emotional pain, sadness, loneliness, anger, frustration and internalised stigma. The social consequences included decreased social network size, limited social support and social isolation, and resulted from not only enacted stigma but also self-imposed social withdrawal. Also, poor treatment adherence was a health-related consequence. People living with HIV employed both problem-focused and emotion-focused coping strategies to mitigate the negative consequences of stigma. Problem-focused coping strategies included selective disclosure, disengagement, affiliating with similar others, seeking social support and, to a lesser extent, activism. Emotion-focused strategies included distraction, positive reappraisal, religious coping, external attributions, disidentification and acceptance. HIV-related stigma clearly permeates African and Afro-Caribbean communities in the Netherlands, and should be targeted for intervention.
21671828	The ability to drive safely is commonly affected by traumatic brain injury (TBI). Driving is a role and activity that is highly valued and also associated with successful community reintegration after TBI. Relatively little is understood about the processes of interruption to driving and potential return to driving that can be experienced by people with TBI and their family members (FMs). Exploring the way in which driving interruption, return to driving and permanent cessation of driving happen for people with TBI, their FMs and health professionals (HPs) who work with them can enable a fuller understanding of the experiences and needs and enhance the rehabilitation approaches in this situation.A descriptive phenomenological approach was used to explore the experience with the aim of improving services for people with TBI. Semi-structured interviews about driving and driving cessation were conducted with 15 people with TBI, 10 FMs and 10 HPs who had experience in driving and driving cessation issues.	The findings reveal experiences of the process of driving and driving cessation contextualised within experiences of the accident and treatment process. Participants identified key times of need in relation to driving: being told about driving restrictions, understanding driving restrictions, the 'on hold' period, and returning to driving.	The processes surrounding driving and driving cessation after TBI are complex. Informational, support and practical needs differ at the different times. There are key times where people may need further support to improve rehabilitation outcomes. Rehabilitation approaches may particularly need to provide clear, consistent information about driving restrictions, and the process required for returning to driving. While recovery time appears necessary for allowing a safe return to driving, active support for continued involvement in the community using alternative transport may reduce the frustration and disengagement experienced by people in the 'on hold' period.	
21670135	The aim of this paper is to examine perceptions of Foundation Year trainees, consultants and senior nurses about the introduction of the Foundation Programme. Specifically, to examine whether Foundation trainees acquire appropriate skills, experience and responsibility. Semi-structured interviews were conducted with 23 F1 doctors, 22 F2 doctors, 23 consultants and 25 nurses from across Scotland in a broad range of specialties. In the summer of 2007 trainees, consultants and nurses broadly agreed that Foundation offers good experience but some issues were highlighted. Certain specialties were seen as offering insufficiently generic experience and consultants, in particular, were concerned that four-month rotations are too short. Frequent moving around for trainees was seen as detrimental for seeing cases through and continuity of care was now perceived to be provided by nurses and consultants rather than junior doctors. Levels of responsibility could vary widely from post to post and tended to be specialty-dependent. As a result, some F2s reported frustration that they were not given sufficient responsibility for their stage of training. Nights were recognized as a valuable learning opportunity and most trainees were supportive of night work being made available in F1 and F2. In conclusion, in order to maximize the possibilities of the Foundation years and ensure that trainees can meet the required Foundation competencies, specialties that offer narrow experience need to be matched with 'busy' specialties that can offer broader experience. Night work should be retained, but perhaps not introduced right at the start of F1. Trainees feeling that they are being given insufficient experience, particularly in the F2 year, need to be proactive in addressing this if possible. There is a perception among some consultants and nurses that a process of 'delayed skilling' is taking place, attributable more to reduced hours than Foundation per se. There is a need to follow trainees through to specialty training to ascertain if Foundation has adequately prepared them for run-through training.

21631386	Interactive voice response (IVR) systems use computer-based voice recognition and software algorithms to conduct human/computer interactions. In recent years, there has been a proliferation of IVR applications in business and healthcare. The available evidence suggests that older people have negative attitudes towards IVR and experience significant difficulties using these systems.The goal of this project was to identify areas of difficulties in IVR use by older people and propose strategies for improvement.	During two focus groups, we examined older people's perceptions of IVR systems and the most common difficulties experienced by seniors in interacting with these systems. We also recorded their suggestions for improvement of IVR.	Frequency and chi square analyses were performed on the focus groups data. Some of the difficulties reported by participants in this study were congruent with previous findings, but we also uncovered some additional problems, such as frustration for not being able to reach an operator, being asked to wait too long on hold, being unable to recover from mistakes, and an absence of shortcuts in the systems. In addition, significant number of participants indicated that they prefer a system that adjusts to them automatically as opposed to a system that allows for adjustment.	Generally, our findings suggest that the poor acceptability of IVR systems by older people could be improved by designing IVR algorithms that detect difficulties during an ongoing IVR exchange and direct people to different algorithms adapted for each person.	
21607883	Although it is generally acknowledged that experiences of frustration, confusion, and anxiety are embodied phenomena, very little is known about how these processes modulate presumably unconscious, but constantly present, subtle bodily movement. We addressed this problem by tracking the low-level dynamics of body movement, using 1/f noise, pink noise, or "fractal scaling", during naturalistic experiences of affect in two studies involving deep learning and effortful problem-solving. Our results indicate that body movement fluctuations of individuals experiencing cognitive equilibrium was characteristic of correlated pink noise, but there was a whitening of the signal when participants experienced states that are diagnostic of cognitive distress such as anxiety, confusion, and frustration. We orient our findings within theories that emphasise the embodied nature of cognition and affect and with perspectives that view affective and cognitive processes as emergent products of a self-organising dynamical system (the brain) that is inextricably coupled to the body.
21602250	To explore the healthcare experiences of families affected by Huntington disease (HD), a fatal neurodegenerative genetic disorder, and elicit their suggestions for improvement in the quality of care provided to them.24 semi-structured interviews were completed with members of families affected by HD in Eastern Canada. The sample was chosen to reflect a wide range of experiences with HD (e.g. patients, caregivers, family members at risk, but asymptomatic).	Complex needs for healthcare services and emotional supports were found. Participants expressed frustration at the lack of knowledge about HD displayed by their family physicians. They described numerous difficulties accessing appropriate healthcare and other supports, and anticipated access difficulties in the future. Participants offered several suggestions to improve the quality of care to their families, including better education of healthcare professionals about the complex nature of HD and the provision of regular follow-up support.	Health service planners and policy makers must recognize that HD is a debilitating, complicated illness requiring a high degree of care. Sustained follow-up support from knowledgeable healthcare professionals is required from the initial discovery of HD in the family, throughout a lengthy disease trajectory that normally ends with institutionalization.	
21593016	This study examined relations between cardiac reactivity, family violence exposure (i.e., child maltreatment [CM] and inter-partner violence [IPV]), and preschool children's emotional adjustment. A sample of 92 mother-preschooler dyads was drawn from predominantly low-income, rural communities. Dyads participated in a laboratory session in which children's Electrocardiograph (ECG) monitoring occurred during a resting baseline, joint-challenge, and individual emotional and cognitive tasks. Mothers consented to review of Children & Youth Services (CYS) records for CM and completed an IPV measure. Mothers rated children's emotional adjustment, and observers rated children on their frustration and positive affect. Children's vagal suppression was shown to moderate relations between family violence exposure and emotional adjustment. Findings indicated that children greater in vagal suppression showed better emotional adjustment when from families low in violence. However, regardless of children's level of vagal suppression, all children showed poorer emotional adjustment when from families high in violence.
21586642	This study explored the woman's experience of her partner's erectile dysfunction (ED) focusing particularly on sexual experiences, relationship satisfaction, and communication. One hundred women completed a semi-structured interview, providing information about how ED impacted her relationship with her partner. For some women, there was a sense of hopelessness and frustration surrounding their sex lives, while for others, her partner's ED had led to efforts towards increasing non-physical intimacy and sexual communication. These findings demonstrate the importance of the relationship, including communication between the partners, in a women's experience of her partners' ED.
21574687	Despite current interest in dog (Canis familiaris) cognition, very little is known about how dogs represent objects and how they compare with other species, such as the great apes. Therefore, we investigated how dogs and great apes (chimpanzees [Pan troglodytes], bonobos [Pan paniscus], orangutans [Pongo pygmaeus], gorillas [Gorilla gorilla]) individuate objects in a classical violation of expectation paradigm. We used a container (magic cup) with a double bottom that allowed us to change the type of food that subjects had seen being placed in the container. Using a 2 × 2 design, we varied whether subjects received a generally preferred food and whether the food was substituted (surprise trials) or not (baseline trials). Apes showed increased begging and looking behaviors and dogs showed increased smelling behavior. Both species stayed near the experimenter more frequently in the surprise trials compared with baseline trials. Both species reacted to positive (i.e., good food substituted for bad food) and negative (i.e., bad food substituted for good food) surprises. These results suggest that apes and dogs were able to individuate objects according to their properties or type in comparable ways. In addition, we looked for frustration and elation effects, but subjects' behaviors were not influenced by the food they saw and which they received in previous trials.
21568624	Asthma is the most common chronic illness of childhood and the leading cause of hospitalization in young children. Asthma negatively impacts physical health, psychosocial wellbeing, and quality of life for affected children but the psychosocial support needs of children with asthma and severe have not been studied from their point of view.The objective of this study was to assess the support and education needs and preferred interventions of allergic children with asthma and/or severe allergies.	Qualitative constant comparative content analysis was used to identify major themes from semi-structured individual interviews with 20 children with asthma and allergies and 35 parents.	Children expressed frustration with the limitations imposed by asthma and allergies on their regular activities and normal lives. Parents believed that peer support--someone to whom their child could relate as a role model--could improve both their children's and their own coping.	Parents and children preferred a combination of in-person meetings and Internet support to enhance the capacity of children, reduce children's anxiety, increase their self-care skills, and self-confidence. In addition they believed a support intervention was a stepping stone to developing a community of support for children with asthma, allergies, and anaphylaxis.	
21564360	To establish adolescents' beliefs regarding the need for structured diabetes education and their views on how such a programme should be organised and what topics need to be addressed.Structured diabetes education programmes have become common place in diabetes care in recent years. Despite the use of these programmes in adult patients, to date, there exists no tried or tested programme for adolescents. Prior to the development of programmes for this age group, there is a need to establish their views on programme content, delivery mechanisms and how best to introduce structured education in this population.	An exploratory qualitative study.	Five focus group interviews were undertaken across three acute Hospital Trusts in Northern Ireland. A total of 21 adolescents between 13-19 years were interviewed. Data were analysed by means of a thematic content analysis framework.	All participants expressed a need for a structured education programme specifically tailored to their needs. The complexity of existing diabetes regimens brought with it feelings of frustration and guilt for the majority of adolescents. Many felt isolated and alone. Dietary management and insulin adjustment were seen as very complex.	Participants favoured a structured diabetes education programme that was short in duration, practical in nature, positive in outlook and relevant to daily life. Relevance to clinical practice.  Programmes should address the specific needs of adolescents, be delivered in a practical manner and be realistic for everyday use.	
21558848	Breast cancer survivors with lymphedema face a lifetime of stressful physical and emotional symptoms and challenging self-care demands. An in-depth understanding of the perceptions and feelings surrounding life with lymphedema is critical to developing effective supportive care approaches.The objective of the study was to explore perceptions and feelings related to lymphedema in breast cancer survivors.	The expressive writings of 39 individuals were evaluated for this descriptive qualitative study. Data were analyzed using conventional content analysis.	Qualitative analyses produced 4 major themes: (1) marginalization and minimization, (2) multiplying losses, (3) yearning to return to normal, and (4) uplifting resources. Subthemes for each major theme were also identified.	The lymphedema experiences of breast cancer survivors reveal perceptions of marginalization from healthcare providers who are not well informed about lymphedema management and minimizing its impact. Multiple distressing losses confront these patients on a daily basis, including body image disturbances, loss of functionality and control over time, permanent uncertainty, and adverse effects on relationships. The daily challenges of lymphedema often result in cumulative frustration and resentment that contribute to failure to perform self-care. Normalcy has been lost, never to return. These women find solace, encouragement, and hope to meet the challenges of lymphedema through support from others and their spiritual beliefs.	Healthcare providers need greater awareness of the physical and psychosocial effects of lymphedema in breast cancer survivors. Nurses have unique opportunities to serve as advocates for reducing perceived marginalization and promoting effective self-care and other activities that promote psychological well-being and reduce physical deterioration.	
21558305	Patient satisfaction is an important measurement in healthcare for administrators, clinicians and patients.This study investigated the role of gait deviation in patient satisfaction following lower-limb amputation and prosthesis prescription.	A cross-sectional study was done.	Twenty community-based unilateral lower-limb amputees, 12 transtibial and 8 transfemoral, were recruited from support groups. Participants completed the prosthesis evaluation questionnaire (PEQ) with embedded satisfaction-related questions, the timed-up-and-go test and the six-minute walk test, and also underwent quantitative three-dimensional analysis. Kinematic deviation was summarized using the gait profile score (GPS).	Satisfaction levels were generally high (median 80 + /100). Sociodemographic variables did not correlate significantly with any of the satisfaction measures (-0.35 ≤ r ≤ 0.54). Satisfaction correlated strongly with the PEQ scales, particularly ambulation, prosthetic utility, frustration, perceived response and social burden (r ≥ 0.70). By contrast, the relationships between satisfaction and performance-based outcome measures were not significant (-0.45 ≤ r ≤ 0.43), and the GPS did not correlate with any satisfaction measures (-0.23 ≤ r ≤ 0.15).	In this study of high functioning amputees, gait deviation was unimportant to the amputee, while self-reported functional ability and attitudes toward the prosthesis were the strongest correlates of satisfaction following lower-limb amputation.	For the high functioning individuals with lower-limb amputation in this study, gait deviation was not a significant correlate of patient satisfaction. RESULTS suggest that improving self-perceived functional ability and attitudes toward the prosthesis, rather than minimizing gait deviation, will improve patient satisfaction.	
21558282	Traumatic brain injury (TBI) is associated with complaints including headaches, restlessness, memory problems, or irritability, which are assumed to be a consequence of the TBI. The current study is a first attempt to establish the prevalence of common TBI complaints reported by non-brain-injured children aged 11-13. In a 38-item self-report questionnaire, 124 children reported high base rates for symptoms over the past year, especially "grumpy/cross" (79.4%), "frustration" (74.0%), and "fatigue (mental or physical)" (72.2%). This was comparable with base rate information reported by Lees-Haley and Brown (1993) for non-brain-injured adults for a longer period (24-month period). Approximately 20% of children reported five or more symptoms on a daily or weekly basis. They were most likely to be in behavioral and emotional rather than somatic or cognitive domains. Therefore, further research is needed to establish base rate information in order to clarify the true significance of symptom reporting and caution is recommended in interpretation of these symptoms in neuropsychological assessment of TBI in children.
21558108	Burnout is a phenomenon characterized by fatigue and frustration, usually related to work stress and dedication to a cause, a way of life that does not match the person's expectations. Although it seems to be associated with risk factors stemming from a professional environment, this problem may affect any person. Palliative care is provided in a challenging environment, where professionals often have to make demanding ethical decisions and deal with death and dying. This article reports on the findings of a systematic review aimed at identifying described burnout levels in palliative care nurses and physicians, and the related risks and protective factors. The main findings indicate that burnout levels in palliative care, or in health care settings related to this field, do not seem to be higher than in other contexts.
21546616	The effect of infertility on the psychological well-being of couples has  been the subject of increasing attention in recent years. The frustration of  couples of a relatively young age (ie, in their fourth decades) provokes not  only anxiety and depression but also negative effects on the relationships.  The objective of this study was to evaluate the effect of a diagnosis of male  infertility on anxiety and depression in the men themselves and in fertile  female spouses. The prospective cross-sectional study consisted of 264  participants, 72 males diagnosed with nonobstructive azoospermia (NOA) and  their fertile spouses and 60 fertile couples attending our university between  January 1, 2009, and April 30, 2010. The Beck Anxiety Inventory, Beck  Depression Inventory (BDI), and hormone levels were measured during initial  and follow-up visits. In NOA men, follicle-stimulating hormone and luteinizing  hormone were positively associated with anxiety, in contrast to testosterone,  which was inversely associated with anxiety. After the diagnosis of NOA,  producing no testicular sperm, the panic intensity among men increased  significantly, whereas their spouses exhibited less panic. By contrast,  fertile female partners of NOA men reported higher BDI scores after the  initial diagnosis of azoospermia, whereas their partners recorded higher  levels of depression after the absence of testicular sperm was discovered.  Insomnia was the most common complaint for both sexes after the diagnosis of  azoospermia. Hormonal abnormalities had a negative effect on the quality of  life. Physicians and clinicians should acknowledge the immense psychosocial  effect of the diagnosis of male infertility on both males and their fertile  female partners.
21544659	This study compared the well-being among mothers of children with congenital heart defects (CHD) with mothers of children without CHD (controls), at pregnancy and at 6 months postpartum.We linked prospective data from the Norwegian Mother and Child Cohort Study (MoBa), conducted by the Norwegian Institute of Public Health, with a nationwide medical CHD registry. In the MoBa cohort of 61,456 mothers, we identified 212 mothers of infants with mild (n = 92), moderate (n = 50), or severe CHD (n = 70). Subjective well-being was operationalized by means of maternal life satisfaction, joy, and anger at the 30th week of gestation and at 6 months postpartum.	Subjective well-being in mothers of children with CHD remained unchanged and similar to that of controls on satisfaction with life (P = 0.120) and feelings of joy (P = 0.065). However, at child age 6 months, mothers of infants with severe CHD reported slightly elevated feelings of anger compared with controls (P = 0.006).	Joy and life satisfaction remained intact among mothers of children with CHD. Yet, elevated feelings of anger in mothers of children with the most severe CHD suggest that they may experience more frustration.	
21519210	Asking a nurse to float has traditionally been fraught with anxiety, fear, and frustration. Floating can result in nursing dissatisfaction and high turnover rates. The authors discuss a strategy to minimize nurse anxiety and enhance nurse autonomy. The strategy has been successful for more than 6 years and contributed to a positive trend in nursing satisfaction with a very low turnover rate.
21517883	To explore and interpret the lived experience of a Taiwanese nurse working in a U.S. hospital.Hermeneutic phenomenology was applied to obtain information through in-depth telephone interviews.	Four themes emerged from the analysis and interpretation: (a) frustration in language and communication; (b) cultural differences in patient care; (c) support from work environment; and (d) advantages of working in the U.S. nursing system. The main issue causing the participant's unhappiness was the language and communication barrier.	These findings are relevant to nurses and administrators who work with international nurses who wish to understand international nurses' frustration, needs, and work values. Appropriate support can tremendously help international nurses adjust to a foreign work environment.	
21510151	When a mother and newborn must be separated because of the child's admission to the neonatal intensive care unit, feelings of disconnection, frustration, and fear can ensue. One way to increase involvement and decrease stress for mothers interested in breastfeeding is early initiation of breast pumping to stimulate milk production and provide essential nutrition for the infant when stable. Postpartum nurses are in an ideal position to teach new mothers about breast pumping, especially during evening and night shifts when a lactation consultant may not be available. This article provides a guide for the postpartum nurse to increase understanding of the psychological and readiness indicators for patient learning.
21509913	The aim was to identify risk indicators from preadolescence (age period 10-12) that significantly predict unfavorable deviations from normal anxiety development throughout adolescence (age period 10-17 years).Anxiety symptoms were assessed in a community sample of 2,220 boys and girls at three time-points across a 5-year interval. Risk indicators were measured at baseline and include indicators from the child, family, and peer domain. Associations with anxiety were measured with multilevel growth curve analyses.	A stable difference in anxiety over adolescence was found between high and low levels of a range of child factors (frustration, effortful control), family factors (emotional warmth received from parents, lifetime parental internalizing problems), and peer factor (victims of bullying) (P <.001). In contrast, the difference in anxiety between high and low levels of factors, such as self-competence, unfavorable parenting styles, and bully victims, decreased over adolescence (P <.001). For other family factors, associations were weaker (.05 <P <.001). Associations with parental education and family composition were not significant. Adjustment for concurrent depressive symptoms attenuated the associations, but those that were significant at P <.001 remained to be so. Specificity for anxiety subtypes (generalized anxiety, separation anxiety, social phobia, panic, and obsessive-compulsive symptoms) was reported for each association.	Several child, family, and peer factors measured in preadolescence were risk indicators of high levels of anxiety symptoms throughout adolescence. Some factors (such as rejective parenting) were vulnerability indicators for anxiety in early adolescence only, whereas other factors (such as peer victimization) were indicators of long-term elevated anxiety levels.	
21507423	We investigated the associations of appraisal and coping styles with emotion regulation in a community sample of preadolescents (N=196, 9-12 years of age), with appraisal, coping styles, and emotion regulation measured at a single time point. In a previous study, we identified five frustration and four anxiety emotion regulation profiles based on children's physiological, behavioral, and self-reported reactions to emotion-eliciting tasks. In this study, preadolescents' self-reported appraisal and coping styles were associated with those emotion regulation profiles. Overall, findings revealed that children who were more effective at regulating their emotions during the emotion-eliciting tasks had higher levels of positive appraisal and active coping when dealing with their own problems. Conversely, children who regulated their emotions less effectively had higher levels of threat appraisal and avoidant coping.
21501506	Intimate partner violence against women is a prevailing public health problem in Tanzania, where four of ten women have a lifetime exposure to physical or sexual violence by their male partners. To be able to suggest relevant and feasible community and health care based interventions, we explored community members' understanding and their responses to intimate partner violence.A qualitative study using focus group discussions with 75 men and women was conducted in a community setting of urban Tanzania. We analysed data using a grounded theory approach and relate our findings to the ecological framework of intimate partner violence.	The analysis resulted in one core category, "Moving from frustration to questioning traditional gender norms", that denoted a community in transition where the effects of intimate partner violence had started to fuel a wish for change. At the societal level, the category "Justified as part of male prestige" illustrates how masculinity prevails to justify violence. At the community level, the category "Viewed as discreditable and unfair" indicates community recognition of intimate partner violence as a human rights concern. At the relationship level, the category "Results in emotional entrapment" shows the shame and self-blame that is often the result of a violent relationship. At the individual level, the risk factors for intimate partner violence were primarily associated with male characteristics; the category "Fed up with passivity" emerged as an indication that community members also acknowledge their own responsibility for change in actions.	Prevailing gender norms in Tanzania accept women's subordination and justify male violence towards women. At the individual level, an increasing openness makes it possible for women to report, ask for help, and become proactive in suggesting preventive measures. At the community level, there is an increased willingness to intervene but further consciousness-raising of the human rights perspective of violence, as well as actively engaging men. At the macro level, preventive efforts must be prioritized through re-enforcement of legal rights, and provision of adequate medical and social welfare services for both survivors and perpetrators.	
21491355	Dyspnea (breathing discomfort) is a serious and pervasive problem that can have a profound impact on quality of life. It can manifest in different qualities (air hunger, physical exertion, chest/lung tightness, and mental concentration, among others) and intensities (barely noticeable to intolerable) and can influence a person's emotional state (causing anxiety, fear, and frustration, among others). Dyspnea can make it difficult to perform daily activities, including speaking and swallowing. In fact, dyspnea can cause people to change the way they speak and swallow in their attempts to relieve their breathing discomfort; in extreme cases, it can even cause people to avoid speaking and eating/drinking. This article provides an overview of dyspnea in general, describes the effects of dyspnea on speaking and swallowing, includes data from two survey studies of speaking-related dyspnea and swallowing-related dyspnea, and outlines suggested protocols for evaluating dyspnea during speaking and swallowing.
21490175	The present study examined the role of negative emotions on driving performance in relation to ADHD, by comparing young adults scoring high on measures of ADHD (n = 20) with a control group (n = 22).The authors used cardiorespiratory physiological measures, simulated driving behavior, and self-report to examine how participants with high and low ADHD symptoms responded to frustration and to determine how frustration affected simulated driving performance.	Groups did not differ in operational driving skills, but participants with high ADHD symptoms reported more frustration and exhibited more impairment at the tactical level of driving performance than the controls. There was significant suppression of respiratory sinus arrhythmia from resting baseline during tasks, but it did not differ between groups during driving.	This article proposes that remedial driver training for ADHD populations should focus more on the control of negative emotions rather than on attention or fundamental driving skills.	
21489057	The relationship between recurrent headache and reduced psychological well-being among adolescents has been well documented. Evidence also suggests that headache is associated with greater impediment to successful goal pursuits, which in turn is related to reduced well-being. The aim of this study was to investigate both the independent and interactive effects of headache and self-regulatory processes on daily positive and negative affect.In order to be able to investigate both concurrent and prospective relationships a daily diary design was employed. Independent variables were headache occurrence, daily goal frustration, and strategies to cope with these setbacks. Dependent variables were daily negative and positive affect. Eighty-nine adolescents from the general population aged 13-21 completed an on-line diary for 3 weeks. Data were analysed using multi-level modelling.	Negative affect was related to same day headache occurrence, high daily goal frustration, rumination, catastrophizing, other blame, and low coping efficacy beliefs. Furthermore, in the context of headache, coping efficacy appears to buffer the effects of goal frustration on same day negative affect. Negative affect on the next day was predicted by high daily goal frustration, rumination, catastrophizing, and low coping efficacy. In contrast, positive affect was related to no same day headache occurrence; low daily goal frustration, and high acceptance, positive refocusing, and coping efficacy. Positive affect on the following day was related to low daily goal frustration, rumination, and high positive refocusing.	Daily goal frustration and cognitive coping strategies may provide important targets for interventions aimed at adolescent with reduced well-being due to headache.	
21480707	We examined direct and indirect pathways from marital hostility to toddler anger/frustration via harsh parenting and parental depressive symptoms, with an additional focus on the moderating role of genetic influences as inferred from birth parent anger/frustration. Participants were 361 linked triads of birth mothers, adoptive parents, and adopted children who were 9 (T1) and 18 (T2) months old across the study period. Results indicated an indirect effect from T1 marital hostility to T2 toddler anger/frustration via T2 parental harsh discipline. Results also indicated that the association between marital hostility and toddler anger was moderated by birth mother anger/frustration. For children whose birth mothers reported high levels of anger/frustration, adoptive parents' marital hostility at T1 predicted toddler anger/frustration at T2. This relation did not hold for children whose birth mothers reported low levels of anger/frustration. The results suggest that children whose birth mothers report elevated frustration might inherit an emotional lability that makes them more sensitive to the effects of marital hostility.
21477284	Parkinson disease (PD) causes physical disability that negatively affects the quality of life of the sufferer's and their families. There are no Parkinson's disease (PD) social science studies published from Africa. This paper presents findings from a qualitative research study on how PD is perceived and treated in a population of approximately 161,000 within a demographic surveillance site in rural Tanzania.We conducted in-depth interviews with 28 PD sufferers, 28 carers, 4 health workers and 2 traditional healers. In addition, 6 focus group discussions were conducted in 3 villages to investigate wider community views of PD.	PD sufferers expressed frustration with the physical, psychological, social and economic consequences of the illness. Feelings of a diminished quality of life characterised by dependency, stigma and social isolation were common. Additionally, a handful of male sufferers related their sexual incompetence to the illness. Carers complained of lost income opportunities and social isolation resulting from caring for sufferers. Misconceptions about the cause, symptoms and appropriated PD treatment were widespread. Only 2 PD sufferers had commenced western type treatment through outsourcing drugs from other parts of the country and outside of Tanzania.	This study highlights the urgent need for PD awareness and treatment interventions in such settings. Such interventions need to address the concerns and needs of sufferers, their carers and the wider community, including the health care system.	
21461681	Accounting for both bidirectional and interactive effects between parenting and child temperament can fine-tune theoretical models of the role of parenting and temperament in children's development of adjustment problems. Evidence for bidirectional and interactive effects between parenting and children's characteristics of frustration, fear, self-regulation, and impulsivity was reviewed, and an overall model of children's individual differences in response to parenting is proposed. In general, children high in frustration, impulsivity and low in effortful control are more vulnerable to the adverse effects of negative parenting, while in turn, many negative parenting behaviors predict increases in these characteristics. Frustration, fearfulness, and effortful control also appear to elicit parenting behaviors that can predict increases in these characteristics. Irritability renders children more susceptible to negative parenting behaviors. Fearfulness operates in a very complex manner, sometimes increasing children's responses to parenting behaviors and sometimes mitigating them and apparently operating differently across gender. Important directions for future research include the use of study designs and analytic approaches that account for the direction of effects and for developmental changes in parenting and temperament over time.
21461367	Since clinical and biochemical observations point to much overlap between depression and aggression, both characterised by intolerance to frustration, a questionnaire was developed to test if different patterns of depressive and aggressive reactions elicited by exposure to negative events and deprivation from expected positive ones in human and nonhuman conditions, respectively, would result in specific response patterns in depressive and aggressive persons. The questionnaire was tested for internal consistency in a pilot healthy sample and for correlations of responses with the personality factors of Aggression and Depression in 60 abstinent male alcoholics. Aggressive and depressive responses were highly correlated across all stimulus conditions, and not specifically but rather equally associated with the personality factors of Aggression and Depression, confirming the close association between these dimensions.
21460257	An important step in using culture to increase colorectal cancer screening is the development and use of a reliable and valid measure. Measurement items that work well are defined as those that use clear and simple language, do not result in significant missing data, do not yield unexpected frequencies or patterns of association, and capture an important component of the underlying construct. The authors' work to develop such a measure includes cognitive response testing. This article describes 41 African American participants' reactions to and processing of items that have been used in the public health literature to assess cultural attitudes believed to be relevant to colorectal cancer screening. Participants were asked to verbalize thoughts, feelings, interpretations, and ideas that came to mind while examining or responding to 10 to 11 survey items. The results of cognitive response testing suggest negative reactions to items addressing the fatalism construct, concerns about appearing racist when responding to discrimination and mistrust items, and resistance to phrasing or terminology that conveys negative attitudes or frames of reference. When items were framed in a positive way, participants reported less frustration, confusion, and concern for how they would be perceived by others. The responses of older African Americans in this sample were consistent with research previously completed by Pasick et al.; participants questioned the relevance of items related to cultural constructs to health and cancer preventive behaviors. Recommendations for the assessment and use of cultural constructs and items assessing constructs are provided.
27486624	The aim of this study was to generate a theoretical model of underlying social processes that trigger stress in adolescent girls' everyday life. In-depth interviews regarding the experiences of stress at home, school and during leisure time were conducted with 14 17-year-old schoolgirls. Data were analysed by means of the grounded theory method. Stress was triggered in the interaction between responsibility and the way in which the girls were encountered. Triggered emotional reactions took the form of four dimensions of stress included ambivalence, frustration, despair and downheartedness. These reactions were dependent on whether the girls voluntary assumed responsibility for various situations or whether they were forced, or felt they were being forced, to assume responsibility in interaction with an encounter characterized by closeness or distance. These forms of stress reactions could appear in one dimension and subsequently shift to another. From the public health perspective, the generated stress model can be used in the planning and implementation of future actions to prevent stress and promote well-being related to stress in adolescent girls.
21448252	Experiential avoidance and distress intolerance play a central role in novel behavior therapies, yet they appear to overlap considerably the REBT concept of low frustration tolerance. Using baseline data from 100 adult cigarette smokers enrolled in a clinical trial of smoking cessation therapies, the present study evaluated the convergent validity of common questionnaire measures of experiential avoidance (Acceptance and Action Questionnaire; AAQ; Hayes et al. 2004, and Avoidance and Inflexibility Scale: AIS; Gifford et al. 2004) and behavioral measures of distress tolerance (computerized Mirror Tracing Persistence Task: MTPT-C: Strong et al. 2003; computerized Paced Auditory Serial Addition Task; PASAT-C; Lejuez et al. 2003). The distress tolerance measures correlated significantly (r = .29) with one another. However, the questionnaire measures of experiential avoidance did not correlate with each other, nor with the behavioral measures. Further research is needed on the validity of measuring experiential avoidance by self-report and of the overlap versus distinctiveness of seemingly similar constructs such as experiential avoidance, distress tolerance, and frustration tolerance.
21442941	A group of individuals with occupational diseases caused by chemical factors demonstrate higher incidence and severity of depression, frustration, rigidity, cognitive and sleep disorders, if compared to the group of individuals with occupational diseases caused by physical factors. In the occupational diseases group, encephalopathy is seen more frequently, individuals subjected to physical factors have prevailing encephalopathy of I and II grades, those subjected to chemical factors--of II-III and III grades, more severe encephalopathy in the group of chemical factors is seen among the individuals subjected to uranium compounds.
21438783	The current study examined whether the psychological stress of the still-face (SF) task (i.e. stress resulting from a parent's unresponsiveness) is a valid laboratory stress paradigm for evaluating infant cortisol reactivity. Given that factors external to the experimental paradigm, such as arriving at a new place, may cause an elevation in cortisol secretion; we tested the hypothesis that infants would show a cortisol response to the SF task but not to a normal FF task (control). Saliva was collected for cortisol measurement from 6-month-old infants (n = 31) randomly assigned to either a repeated SF task or to a continuous FF task. Parent-infant dyads were videotaped. Salivary cortisol concentration was measured at baseline, 20, and 30 min after the start of the procedure. Infant salivary cortisol concentrations showed a significant increase over time for the SF task but not for the FF task. The results provide new evidence that the repeated SF task provides a psychological challenge that is due to the SF condition rather than to some non-task related factor; these results provide internal validity for the paradigm. The study offers new insight into the role of parent-infant interactions in the activation of the infant stress response system.
21429518	To investigate the differential association of three modes (fussing, crying, unsoothable crying) and three properties (duration/day, frequency/day, maximum bout length) of infant distress with daily caregiver frustration.Replicated cross-sectional studies were completed in Vancouver, British Columbia (n = 1065) and Seattle, Washington (n = 1857). Infant fussing, crying, and unsoothable crying and caregiver frustration were measured daily for 4 days at 5 weeks of age by the Baby's Day Diary. Generalized estimating equation models were used to predict caregiver frustration from nine measurements of distress.	In Vancouver, measurements of distress significantly associated with caregiver frustration in decreasing order of magnitude were as follow: (1) maximum bout length of unsoothable crying; (2) duration/day of crying; and (3) frequency of unsoothable crying and duration/day of fussing. In Seattle, associated measurements of distress were: (1) maximum bout length of unsoothable crying; (2) maximum bout length and duration/day of crying, frequency of unsoothable crying, and duration/day of fussing; and (3) frequency/day of crying.	Daily caregiver frustration is associated differentially with different modes and properties of infant distress. Specifically, maximum bout length of unsoothable crying was most strongly related in both sites. Additionally, frequency/day of unsoothable crying and duration/day of crying and of fussing were significantly associated at both sites.	
21426613	To explore the experiences of healthcare assistants (HCAs) working in general practice (GP).HCAs increasingly play an important role in UK GP teams. The role is relatively new and little is known about how HCAs feel about their work in GP, and the challenges that they face.	Semi-structured interviews were undertaken with 14 HCAs from two Primary Care Trusts in the West Midlands, United Kingdom. Transcriptions were analysed using the framework analysis approach.	Overall, HCAs reported that they enjoyed their work, and particularly appreciated the patient contact and positive feedback gained. Attitudes to the role were affected by previous position, experience, and length of time working within the practice. The HCAs felt accepted and supported by GP team members and valued the support they were receiving. Key sources of frustration included the poor salary, the lack of initial clarity with regard to role definition, and the constraints of their scope of practice. Role boundaries between HCAs and practice nurses were experienced as well defined, and no perceptions of role ambiguity were reported. HCAs considered their work to be of relatively low status, with its main purpose being to ease the practice nurse's workload. Although many had the desire to train as nurses, few saw it as a realistic possibility.	Although HCAs appear to be satisfied overall, the elements of dissatisfaction relate to status, pay, and career progression, which may limit the retention of individuals in this role. Practices should consider the importance of recognising and valuing the work of HCAs and of providing protected time and resources for mentorship and career progression.	
21413935	The longitudinal relations of emotion regulation profiles to temperament and adjustment in a community sample of preadolescents (N=196, 8-11 years at Time 1) were investigated using person-oriented latent profile analysis (LPA). Temperament, emotion regulation, and adjustment were measured at 3 different time points, with each time point occurring 1 year apart. LPA identified 5 frustration and 4 anxiety regulation profiles based on children's physiological, behavioral, and self-reported reactions to emotion-eliciting tasks. The relation of effortful control to conduct problems was mediated by frustration regulation profiles, as was the relation of effortful control to depression. Anxiety regulation profiles did not mediate relations between temperament and adjustment.
21406018	Drawing on previous web-based diabetes management programs based on the Chronic Care Model, we expanded an intervention to include care management through mobile phones and a game console web browser.The pilot intervention enrolled eight diabetes patients from the University of Washington in Seattle into a collaborative care program: connecting them to a care provider specializing in diabetes, providing access to their full electronic medical record, allowing wireless glucose uploads and e-mail with providers, and connecting them to the program's web services through a game system. To evaluate the study, we conducted qualitative thematic analysis of semistructured interviews.	Participants expressed frustrations with using the cell phones and the game system in their everyday lives, but liked the wireless system for collaborating with a provider on uploaded glucoses and receiving automatic feedback on their blood sugar trends. A majority of participants also expressed that their participation in the trial increased their health awareness.	Mobile communication technologies showed promise within a web-based collaborative care program for type 2 diabetes. Future intervention design should focus on integrating easy-to-use applications within mobile technologies already familiar to patients and ensure the system allows for sufficient collaboration with a care provider.	
21402624	We aimed to compare affect and behavior of 3 groups of nonanemic 4-year-old children: children with iron-deficiency anemia (IDA) in infancy whose anemia was not corrected before 24 months (chronic IDA) (n = 27); children with IDA in infancy whose anemia was corrected before 24 months (corrected IDA) (n = 70); and children who were nonanemic in infancy and at 24 months (n = 64).Mother and child dyads were invited to a local clinic room. Children's social referencing, wariness, frustration-tolerance behavior, and affect were observed during a set of situations encountered in the laboratory, including free play, stranger approach, novel toy, and delay of gratification. The whole procedure was videotaped. The children's affective and behavioral displays were coded by using a time-sampling (5-second segments) code scheme. Iron status of children was determined on the basis of hemoglobin concentration measured with the cyanomethemoglobin method in blood samples obtained by fingerstick in infancy and at the ages of 24 months and 4 years.	Children who had chronic IDA in infancy displayed less positive affect, less frustration tolerance, more passive behavior, and more physical self-soothing in the stranger approach and delay of gratification. In contrast, the behavior and affect of children whose anemia was corrected before the age of 24 months were comparable to those of children who were nonanemic throughout infancy.	The results point to the potential benefits of preventing iron deficiency in infancy and treating it before it becomes chronic or severe.	
21400319	The roll-out of accessible and affordable antiretroviral (ARV) drugs for people living with HIV in low-income countries is drastically changing the nature of HIV-related healthcare. The Zimbabwean Ministry of Health has renewed efforts to make antiretroviral treatment (ART) for HIV free and publically available across the country. This paper describes the findings from a multi-method qualitative study including interviews and a focus group with healthcare workers (mostly nurses), totalling 25 participants, and field notes from over 100 hours of ethnographic observation in three rural Zimbabwean health centres. These health centres began providing free ARV drugs to HIV-positive people over one year prior to the research period. We examined sources of motivation and frustration among nurses administering ART in these resource-poor health centres. The findings suggest that healthcare workers administering ART in challenging circumstances are adept at drawing strength from the dramatic physical and emotional recoveries made possible by ART and from their personal memories of the suffering caused by HIV/AIDS among close friends or family. However, healthcare staff grappled with extreme resource shortages, which led to exhaustion and frustration. Surprisingly, only one year into ART provision, healthcare workers did not reference the professional challenges of their HIV work before ART became available, suggesting that medical breakthroughs such as ART rapidly come to be seen as a standard element of nursing. Our findings provide a basis for optimism that medical breakthroughs such as ART can reinvigorate healthcare workers in the short term. However, we caution that the daily challenges of nursing in poor environments, especially administering an ongoing and resource-intensive regime such as ART, must be addressed to enable nurses to continue delivering high-quality ART in sub-Saharan Africa.
21348176	The tensions between judicial and executive authorities regarding so-called Gypsies in fin de siècle Germany and Italy reveals an inherent contradiction between the universalist dictates of the modern Rechtsstaat and the requirements of building a national state free of perceived outsiders. The frustration of executive authorities with judicial authorities who insisted on protecting the universalist individual enshrined in law pushed executive authorities to utilize the 'state of exception' to achieve their vision of the national community. Rather than choosing to create illiberal laws that would expressly exclude Gypsies from the national body, and would resolve the tension with the judiciary, authorities in Germany and Italy instead chose to go around the law by treating Gypsies as an exception not subject to the law. The state of exception not only deprived those labelled as Gypsies of a method of resistance, since many were able to use unwilling courts to protect them from over-zealous executive authorities, but also created a group of stateless people, persecuted and lacking basic human rights.
21340285	This study aimed to understand severe maternal morbidity from the perspective of women who experienced it. The methodological precepts of qualitative research were adopted and the Collective Subject Discourse was the methodological framework chosen. A total of 16 women who experienced severe maternal morbidity were interviewed. Results were discussed based on four themes: describing the desire and plan for having a child; acknowledging the health problem and its influence on pregnancy and on the conceptus; overcoming the initial shock postpartum, and experiencing the risk situation: desires, frustration, and overcoming. This study will contribute to qualifying nursing care, specifically acknowledging the diversity and breadth of the needs presented by women in situations of severe morbidity during the pregnancy-puerperal cycle.
21314072	This article presents the findings of an analysis of 130 critical incidents reported by social workers in Israel. Almost all the incidents turned out to be upsetting events that caused the writers a great deal of pain, frustration, and self-doubt. Content analysis yielded four main categories of incidents or events: (1) client hostility and aggression toward the worker, (2) client behaviors that violated the unwritten rules of the profession or the workers' expectations, (3) inherent professional dilemmas, and (4) workers' personal issues. Although the events may not be typical of worker-client interactions, they tend to undermine the workers' professional confidence and color their entire work experience. Recommendations are made for training that better prepares social workers for the difficult situations they may encounter and for supervision that helps them to deal with such situations more effectively.
21305611	Swedish-style snus (SS) has recently garnered controversy for its proposed use as a smoking cessation aid and/or harm reduction tool. However, to date, little work has been done to evaluate the extent to which SS affects cigarette cravings and smoking behavior under double-blind controlled conditions.During four double-blind placebo-controlled randomized sessions, 15 smokers (8 male) administered SS, placebo (nicotine/tobacco-free) snus (PS), a nicotine-containing lozenge (NL), or a placebo lozenge (PL) for 30 min and assessed their effects using Visual Analogue Scales and the Brief Questionnaire of Smoking Urges. They could then self-administer their usual brand of cigarettes using a progressive ratio task over the next 60 min. Following the completion of their final session, 11 participants (6 male) ranked each of the products used in the study in terms of their preferences.	Relative to the other products, SS was associated with a decreased intention to smoke as well as a delayed onset of cigarette smoking in men but not women. However, SS administration was also associated with increased feelings of frustration and irritability relative to NL and SS was ranked as being the least preferred product used in the study.	Findings suggest that SS is effective in acutely suppressing craving and smoking in at least some smokers, but that its acceptability may be limited.	
21298583	In this article we use a culture-centered approach to understand people's experiences of treatment options for human immunodeficiency virus (HIV)-related peripheral neuropathy. We present from often unheard and marginalized voices the stories of how people live with this chronic illness and negotiate treatment options. Based on individual and group interviews, participants reported that biomedical pills were an important context for understanding decision making regarding neuropathy treatment. While most people spoke of the necessity of these drugs for their survival, they also expressed deep resentment and frustration with biomedically prescribed pills. Complaints about the pills worked to frame the holistic alternatives of acupuncture and massage therapy as better options for neuropathy and to establish a foundation for understanding how participants made particular health treatment decisions. Through strategically refusing certain drugs and choosing holistic treatments instead, participants asserted agency and control over their health decision making. By choosing holistic therapies, these clients were able to make choices about their neuropathy treatment in light of the many issues surrounding drug toxicity and treatment efficacy.
21290850	The present study (N = 193) examined use of emotional regulation strategies in physically and relationally aggressive preschool children (mean age: 55 months), compared to non-aggressive peers. To assess emotion regulation, we conducted a structured videotaped behavioral observation of a situation where frustration was elicited. Afterwards, regulation strategies were analyzed in seven categories. Physical and relational aggression was rated by preschool teachers. Cut-off scores were used to classify children as relationally or physically aggressive. Results show that physically aggressive children focused their attention on frustrating stimulus and used venting and cognitive verbalization more often than non-physically aggressive children. Relationally aggressive children used venting more often than non-relationally aggressive children. Findings suggest that aggressive children would benefit from training in emotion regulation.
21289340	Job dissatisfaction among nurses contributes to costly labor disputes, turnover, and risk to patients. Examining survey data from 95,499 nurses, we found much higher job dissatisfaction and burnout among nurses who were directly caring for patients in hospitals and nursing homes than among nurses working in other jobs or settings, such as the pharmaceutical industry. Strikingly, nurses are particularly dissatisfied with their health benefits, which highlights the need for a benefits review to make nurses' benefits more comparable to those of other white-collar employees. Patient satisfaction levels are lower in hospitals with more nurses who are dissatisfied or burned out-a finding that signals problems with quality of care. Improving nurses' working conditions may improve both nurses' and patients' satisfaction as well as the quality of care.
21276187	Improvements in clinical pain care have not matched advances in scientific knowledge, and innovations in medical education are needed. Several streams of evidence indicate that pain education needs to address both the affective and cognitive dimensions of pain. Our aim was to design and deliver a new course in pain establishing foundation-level knowledge while comprehensively addressing the emotional development needs in this area.One hundred eighteen first-year medical students at Johns Hopkins School of Medicine.	Performance was measured by multiple-choice tests of pain knowledge, attendance, reflective pain portfolios, and satisfaction measures.	Domains of competence in pain knowledge included central and peripheral pain signalling, pharmacological management of pain with standard analgesic medications, neuromodulating agents, and opioids; cancer pain, musculoskeletal pain, nociceptive, inflammatory, neuropathic, geriatric, and pediatric pain. Socio-emotional development (portfolio) work focused on increasing awareness of pain affect in self and others, and on enhancing the commitment to excellence in pain care. Reflections included observations on a brief pain experience (cold pressor test), the multidimensionality of pain, the role of empathy and compassion in medical care, the positive characteristics of pain-care role models, the complex feelings engendered by pain and addiction including frustration and disappointment, and aspirations and commitments in clinical medicine. The students completing feedback expressed high levels of interest in pain medicine as a result of the course.	We conclude that a 4-day pain course incorporating sessions with pain specialists, pain medicine knowledge, and design-built elements to strengthen emotional skills is an effective educational approach.	Innovations in medical education about pain are needed. Our aim was to design and deliver a new course for medical students addressing both the affective and cognitive dimensions of pain. Combining small-group sessions with pain specialists, active-learning approaches to pain knowledge, and design-built elements to strengthen emotional skills was highly effective.	
21263313	An earlier history of partial or continuous reinforcement produces differential behavioural effects during extinction in the runway, with an earlier partial reinforcement (PRF) leading to an increased resistance to extinction. This effect has been attributed to conditioned frustration or generalization-decrement processes. The actions of antianxiety drugs in this procedure are most easily interpreted as for reducing the emotional or aversive effects of nonreinforcement. In this study, C57Bl/6 mice were trained to asymptotic performance with food reinforcement on 50 or 100% of six trials in daily sessions. The anxiolytic benzodiazepine, chlordiazepoxide (15 mg/kg, intraperitoneally) or saline was administered before subsequent daily extinction sessions. Under saline, earlier PRF produced an increased resistance to extinction. Drug administration increased resistance to extinction, as measured by start, run and goal times, after either continuous or PRF. These findings are consistent with earlier findings of rats, but different from those obtained with chlordiazepoxide during extinction after operant training with either rats or mice. These findings can be interpreted in terms of frustration, anxiety or generalization-decrement theories of PRF.
21259052	This paper aims to report a possible warning sign for dangerous behavior in delusional psychotic patients. We demonstrate an association between aggressive or auto-aggressive ideation and "ego-dystonic" grandiose delusions, where the patient believes to possess unique qualities but finds them unbearable. The study is based on the sample of seven interviews with five psychotic in-patients at the Kfar Shaul Mental Health Center, Jerusalem, Israel. All patients experienced an acute psychotic episode, and committed acts of aggression or suicidality. The research method is narrative analysis of semi-structured interviews. Patients report ideas of grandiose self-identification with deities, Biblical figures or celebrities, yet report their reluctance to be in these high positions due to feelings of unworthiness, withdrawal, and social isolation. Resulting frustration arguably leads to aggressive and suicidal ideation or actions. Contrary to the established view, grandiose delusions are not free of association with (auto-)aggression. The patient's ego-dystonic attitude towards his/her delusional identity may serve as the warning sign for dangerous behavior and, as such, should be searched for and recognized by the mental health professionals.
21248420	This case study investigated an intervention that enabled an individual with Posttraumatic Stress Disorder (PTSD), Dissociative Identity Disorder (DID), and satanic ritual abuse to return to work after discharge from psychiatric inpatient treatment. The Occupational Questionnaire [88] revealed past difficulties in organization, awareness of time, communication, cooperation, frustration tolerance, competition, stress management, goal setting, and amnesia resulting in incomplete tasks and sporadic attendance at work. The Role Checklist [72] identified alters valuing work and employed in the past. The Modified Interest Checklist [70] identified running as an interest that 24 alters shared. Based on the initial evaluations, three times a week treadmill running was used as an intervention that built work skills (as measured by the Clerical Work Sample of the Valpar Component Work Sample Series [97]) necessary to sustain gainful employment upon discharge. After intervention, this individual improved in awareness of time, stress management, and goal setting abilities and was less amnestic as per the Occupational Questionnaire [88] and four additional alters expressed an interest in work according to the Modified Interest Checklist [70].
21232873	Appraisal theories developed in cognitive psychology are used here to attempt to better understand emotional experiences in animals. We investigated whether lambs are able to form expectations and whether their emotional responses are affected by situations discrepant from the expectations they may have formed. Forty-five female lambs were trained to obtain a small or a large amount of food reward by performing an operant task (introducing their muzzle into a hole). Then, half the lambs were shifted to the large or the small reward (i.e. positive or negative shift respectively), while the remaining half continued to get the same amount of reward. Thereafter, the lambs previously submitted to a reward change were shifted back to their initial amount of reward (i.e. successive shifts) while the lambs previously maintained on the same amount of reward were subjected to extinction (no reward, thus a negative shift). Behavior, cortisol levels and cardiac activity were analyzed, and the treatments were compared with ANOVAs for mixed models. When the amount of reward delivered was decreased, the lambs showed more locomotor activity and performed the operant task at a higher frequency but less efficiently, and there was a decrease in the parasympathetic influence on their cardiac activity. These responses were exacerbated when the negative shift followed a positive one. Similar responses were observed under extinction, and these responses were more pronounced when animals were trained with a large amount of reward before extinction. In response to a positive shift, we noticed a decrease in the frequency of the attempted operant task; this occurred only when the positive shift followed a negative one. Variations in plasma cortisol were not consistent with changes in the amount of reward. This study shows that lambs evaluate a reward according to their previous experience with that reward. They are able to form expectations, and a discrepancy from these expectations influences emotional responses, especially in the case of a negative shift. Given the appraisal criteria used by lambs and the matching emotions, we can assume that the emotional response to a negative shift expressed by lambs could reflect the despair caused by frustration.
21231817	Abstract Autism is a neurodevelopmental disorder characterized by impaired social interaction and restricted interests, compromised communication skills, and repetitive patterns of behavior. Both social and behavioral problems, which may include hyperactivity and quick frustration, may hinder the detection of other important pathologies such as orofacial pain. This is aggravated by the invasive nature of oral exploration, which may trigger violent and self-injurious responses, such as temper tantrums and/or head banging, which make the work of professionals extremely difficult during diagnoses, follow-up examinations, and dental treatments. In addition, mercury-containing amalgams used to treat dental caries (the most common form of acute orofacial pain) have been associated with higher rates of severe autism in children. The purpose of this review is to describe the current state of the art regarding the co-occurrence of orofacial pain and autism spectrum disorder, and how these conditions may interrelate clinically and neurobiologically.
21220393	Newborn screening for cystic fibrosis (CF) in Illinois uses an immunoreactive trypsinogen/DNA methodology; most false-positive results identify unaffected carriers.Parents whose child received a negative result from the sweat test after a positive newborn screening for CF were surveyed ≥ 6 weeks later by telephone. All parents received genetic counseling while waiting for the sweat-test results.	A total of 90 parents participated. Overall knowledge of CF was high (78%), but the ability to understand the CF screening results was mixed. Although 94% of the parents understood that their child did not have CF, only 79% (62 of 78) of participants whose child had a mutation knew their child was definitely a carrier, and only 1 of 12 parents whose child had no mutation understood that the child may be a carrier. Respondents stated that most relatives were not interested in genetic testing. Both parents had been tested in only 13 couples. Fewer than half (36 of 77 [47%]) of the untested couples expressed interest in genetic testing. Although most participants were satisfied with the process, parents expressed frustration because of the lack of prospective newborn screening discussions by prenatal and pediatric providers and lack of knowledge and sensitivity by those who initially notified them of the abnormal newborn screening results. Speaking to a genetic counselor when scheduling the sweat test decreased anxiety for many parents (53 of 73 [73%] were "very worried" at notification versus 18 of 73 [25%] after scheduling; P < .001).	Parental knowledge about CF is high, but confusion about the child's carrier status and the concept of residual risk persist despite genetic counseling. Relatives express low interest in carrier testing.	
21218361	Neurofibromatosis type 2 (Nf2) is an inherited autosomal dominant syndrome characterised by the development of nervous system tumours, ocular abnormalities and skin tumours. Symptoms of Nf2 can vary depending on the size and location of the tumour and include hearing loss, balance deficits and facial palsy. This study explored the physical, emotional and social impact of Nf2. Six patients were recruited through a neurofibromatosis clinic and underwent a semi-structured interview. Interviews were recorded and analysed using Framework analysis. Participants spoke of the negative impact of Nf2 on daily activities, including work. Social isolation resulted from the avoidance of social situations and was often a consequence of difficulties with communication due to loss of hearing. Patients expressed a range of negative emotional reactions in response to their diagnosis and the impact of the disease. Furthermore, the findings highlighted the important role of partners and family who were relied on for physical as well as emotional and psychological support. Patients also expressed frustration at the limited awareness of Nf2 among health professionals and a desire for improved access to information on Nf2 within their local community.
21208050	Most individuals with Alzheimer's disease are cared for at home by family members, particularly spouses. As language impairment progresses, communication between spouses becomes difficult and caregivers are likely to be unprepared for this challenge. The purpose of this study is to describe spouse caregivers' knowledge of communication in AD and to determine their learning needs regarding effective communication strategies. A measure of knowledge about declining language skills and appropriate communication strategies was developed and pilot tested. Participants included 16 spouses caring for a partner with AD at home. Care recipients were generally mildly impaired. Caregivers were aware of at least some of the decline in language but were less knowledgeable about communication strategies. They were experiencing numerous communication problems, but reported minimal difficulty in communicating. Nurses in acute and long-term care settings are challenged to assess spouses' knowledge and awareness about communication in AD and provide information about effective communication strategies to decrease misunderstandings and frustration, which often lead to behavior problems. Recommendations for further development of the AD Communication Knowledge Test are offered.
21206360	Gerardo is an 8-year-old Latino boy who saw his primary care pediatrician with a second asthma exacerbation this year. His frustration with his illness was immediately apparent when he said, "I hate having to go to the nurse's office to take my albuterol!" His mother expressed concern that her son frequently refused to take his prevention medication for asthma, montelukast, each morning. When questioned about compliance with his inhaled steroid, his mother hesitated and then admitted that she discontinued the controller medication because she is afraid to "poison his body with so many chemicals." She consistently gave her son the inhaled steroid for 12 months, until care by the allergy specialist was unexpectedly transferred to a Spanish-speaking allergist. She complained that the new doctor is "cold and acts like a veterinarian, not a pediatrician." Gerardo is a first generation Mexican-American who was born in the United States to Spanish-speaking parents. There is no family history of asthma, although his mother fears that she may have contributed to Gerardo's condition. She explained that during pregnancy, she worked cleaning houses where she was exposed to many toxic household cleaners. She has always worried that by inhaling these fumes during pregnancy, she induced her son's asthma. Gerardo presented with his first episode of reactive airway disease at 9 months of age. His mother vividly recalled his high temperature, rapid breathing, and their ambulance ride to the hospital. He was hospitalized for 3 days, and he has not been hospitalized since. Allergy testing revealed sensitivity to weed pollen only. Gerardo sleeps with a nonallergenic pillow and bed cover. Gerardo's mother explained that 3 days before his current exacerbation, he was playing at an amusement park with his friends on a hot day. Gerardo and his friends ran through a large fountain. His mother reported that he was soaked in water and stated, "He knows that he will get sick with asthma if he gets wet!" She recalled that 3 years ago at a friend's birthday party, Gerardo abstained from running through the sprinklers with the other children without instruction from his parents. Since that event, she has trusted Gerardo to care for his "weak lungs." She is frustrated now with his regression in self-care.
21205056	To study the 'social brain' in alcoholics by investigating social contract reasoning, theory of mind and emotional intelligence.A behavioral study comparing recently detoxified alcoholics with normal, healthy controls.	Emotional intelligence and decoding of emotional non-verbal cues have been shown to be impaired in alcoholics. This study explores whether these deficits extend to conditional reasoning about social contracts.	Twenty-five recently detoxified alcoholics (17 men and eight women) were compared with 25 normal controls (17 men and eight women) matched for sex, age and education level.	Wason selection task investigating conditional reasoning on three different rule types (social contract, precautionary and descriptive), revised Reading the Mind in the Eyes Test, Trait Emotional Intelligence Questionnaire (modified version) and additional control measures.	Conditional reasoning was impaired in alcoholics. Performance on descriptive rules was not above chance. Reasoning performance was markedly better on social contract and precautionary rules, but this performance was still significantly lower than in controls. Several emotional intelligence measures were lower in alcoholics compared to controls, but these were not correlated with reasoning performance.	Conditional reasoning, including reasoning about social contracts and emotional intelligence appear to be impaired in alcoholics. Impairment seems to be particularly severe on descriptive rules. Impairment in social contract reasoning might lead to misunderstandings and frustration in social interactions, and reasoning difficulties about precautionary rules might contribute to risky behaviors in this population.	
21193163	The aim of the study was to describe the experiences of a group of triage nurses with patient-related workplace violence during the previous month.Globally and within the Australian health industry, nurses have been reported to be the occupation at most risk of patient-related violence, with triage nurses identified as a high risk group for both verbal and physical violence.	The study took place in the Emergency Department of a tertiary referral and teaching hospital in regional New South Wales, Australia. Data were collected from August to September 2008, and a qualitative descriptive methodology was employed.	The participants all reported experiencing episodes of patient related violence that were perceived as inevitable and increasing in intensity and frequency. Themes included identification of precipitating factors such as long waiting times and alcohol and substance misuse. Organisational issues included lack of aggression minimisation training; lack of formal debriefing following episodes of violence and frustration at lengthy reporting processes.	In the context of the Emergency Department where patients present with a range of diagnoses and behaviours, it is unlikely that the issue of patient-related violence can be totally eliminated. However it can be prevented or managed more effectively on many occasions. Strategies to support staff and prevent and manage violence effectively should be a priority to provide a safe working environment and occupational health and safety for staff.	
21161770	As in many other parts of the world, young people in Papua New Guinea (PNG) are considered particularly vulnerable to HIV infection. Young Papua New Guineans' understanding of health and HIV form the basis of their interactions with HIV-prevention programmes, yet literature documenting their views is limited. Participatory research was conducted with 31 youth in two different settings in the Highlands of PNG to analyse their perceptions of factors influencing young people's health in a local context. The participants perceived social and structural factors to have a dominant influence on their health outcomes, in contrast to prevention programmes' focus on individuals. Youth perceived HIV to be less pressing than other everyday health concerns not currently addressed by national programmes, with their resultant frustration undermining the potential of existing HIV-prevention interventions. The young participants' experience of the social spaces developed through Photovoice, the research approach used, demonstrates the potential and limitations of participatory initiatives to support young people's actions to reduce their vulnerability to poor health outcomes. Findings point to the importance of youth-focused intervention programmes engaging influential adults in a community, and supporting "in-between" spaces where young people and community leaders can connect in order to affect the health-related contexts in which young people live.
21189333	Second-generation Holocaust survivors might not show direct symptoms of posttraumatic stress disorder or attachment disorganization, but are at risk for developing high levels of psychological distress. We present themes of difficult experiences of second-generation Holocaust survivors, arguing that some of these aversive experiences might have disorganizing qualities even though they do not qualify as traumatic. Based on in-depth interviews with 196 second-generation parents and their adolescent children, three themes of disorganizing experiences carried across generations were identified: focus on survival issues, lack of emotional resources, and coercion to please the parents and satisfy their needs. These themes reflect the frustration of three basic needs: competence, relatedness, and autonomy, and this frustration becomes disorganizing when it involves stability, potency, incomprehensibility, and helplessness. The findings shed light on the effect of trauma over the generations and, as such, equip therapists with a greater understanding of the mechanisms involved.
21185551	This study examined the effects of different emotion regulation strategies on the experience and expression of anger. Participants consisted of undergraduate students who endorsed at least a moderate level of state anger. As part of a laboratory experiment, they were instructed to reappraise (n = 24), suppress (n = 24), or accept (n = 25) their anger during a frustrating task. Reappraisal was more effective at reducing anger than attempts to suppress or accept it. Furthermore, participants in the reappraisal condition persisted significantly longer with the frustrating task than those who were instructed to suppress or accept their negative feelings. These findings suggest that reappraisal techniques are more effective than acceptance and suppression techniques for modulating the experience and expression of anger.
21177721	It is widely accepted that cancer is an intersubjective experience that impacts upon the psychological well-being of people with cancer and informal carers, as well as on couple relationships. This qualitative study examined the nature and consequences of cancer on the relationship between informal carers and the person with cancer, from the perspective of Australian cancer carers. Sixty-two carers (42 women and 20 men), across a range of cancer types, stages and relationship dyads took part in semi-structured interviews. Participants reported that cancer had precipitated a change in roles and in the dynamics of the relationship, including having to take on quasi-medical tasks and decisions, neglecting self and other relationships, changes to the emotions or personality of the person with cancer, changed patterns of communication, and changes to sexuality and intimacy. The impact of the changed relationship included sadness, anger and frustration, as well as feelings of love and being closer together, resulting in relationship enhancement. Women were more likely to report changes in the person with cancer and to mourn the previous relationship, while more men reported relationship enhancement.
21175121	Direct care staff struggle with the decision of when to physically intervene with patients. There is a widely held belief that they are expected to place themselves in danger of harm to prevent patients from hurting themselves or others. In this acute mental health care setting, an educational program was developed, using principles of adult and transformational learning, to dispel the idea that getting hurt is part of the job. The Staying Safe program strongly discourages staff from physically intervening alone and promotes staff getting enough help and having a plan. Staff are encouraged to interact with patients in helpful ways and to respond to patient requests in ways that do not increase frustration or evoke anger. There has been a positive response to the training program, evidenced by changes in the way staff think about their jobs and a reduction in the number of assaults and injuries to staff.
21174632	People with communication impairments may face barriers to civic participation, with resulting marginalisation of individuals who wish to be actively involved. The investigation aimed to explore the experience of civically engaged adults with acquired neurological communication difficulties.Six people with acquired neurological communication difficulties were interviewed. Discussion included the definition of active citizenship, their civic involvement, motivations, related barriers and facilitators. Qualitative analysis was undertaken, with data categorised, coded and examined for recurring themes.	All participants were active in disability-related organisations and four undertook wider civic roles. Motivations included activity being out with the home and wanting to effect change for themselves and the populations they represented. Disability group meetings were more positive experiences than broader community activities, which were associated with fatigue and frustration, commonly resulting from communication difficulties and unmet support needs. All participants identified a need for professional and public educational about disability and communication and made recommendations on content, methods and priority groups.	For these participants civic engagement had positive and negative dimensions. Speech and language therapists should promote reduction of the barriers that impede the active citizenship rights of people with communication support needs. Civic participation may be a relevant measure of outcome in communication impaired populations.	
21154085	Appalachians experience increased rates of cancer incidence and mortality and high-risk health behaviors. Additionally, Appalachians are often characterized by lower socioeconomic status, geographic isolation, and cultural beliefs such as fatalism. The purpose of this descriptive analysis is to identify cancer-related risk perceptions, beliefs, and physician avoidance behaviors among Appalachians as compared with non-Appalachians using data from the National Cancer Institute's 2008 Health Information National Trends Survey (HINTS), which contained a newly created "Appalachia" variable. Results suggest that compared with non-Appalachians, Appalachians have a significantly higher perceived risk of developing cancer in the future and are significantly more likely to associate cancer with death; believe individuals can tell they have cancer before a diagnosis; believe everything causes cancer; and admit to avoiding their physician even when they suspect they should plan a visit. Both Appalachians and non-Appalachians share similar mistaken beliefs about cancer prevention, screening, and curability, and frustration over the abundance of cancer prevention recommendations. In a geographic region recognized for cancer health disparities, development of tailored communication strategies and educational interventions designed to increase cancer knowledge may help to accurately explain cancer risk and incidence, dispel negative cancer beliefs, and promote a positive image of the doctor-patient relationship.
21165373	Fibromyalgia remains underdiagnosed and suboptimally treated even though it affects an estimated 3.3% of Canadians. The present study examines knowledge and attitudinal challenges affecting optimal care.A mixed-methods approach was employed. Discussion groups, semistructured interviews and a quantitative online survey (five-point scale) were conducted (June 2007 to January 2008). Participants included 189 general practitioners (GPs) and 139 specialists (anesthesiologists, neurologists, physiatrists, psychiatrists and rheumatologists) distributed across Canada. Participants included 18 patients to enrich the scope of the findings.	GPs reported insufficient knowledge and skill in diagnosing fibromyalgia, with not all believing it to be a diagnosable condition (mean 3.74/5). Twenty-three per cent of GPs and 12% of specialists characterized fibromyalgia patients as malingerers. They further reported a lack of knowledge and skill in treating fibromyalgia (mean 2.73/5), including the pain, sleep disorders and mood disorders related to the condition (mean 3.32/5). Specialists shared these challenges, although to a lesser degree - "We are not trained to treat distress and suffering" (Specialist). Attitudinal issues centred around frustration (mean 3.91⁄5) and negative profiling of fibromyalgia patients (mean 3.06/5 and 1.99/5).	Findings revealed the presence of GP attitudinal and confidence challenges in caring for fibromyalgia patients. As care of fibromyalgia patients moves to general practices, these fundamental competencies must be addressed to assure that all patients receive the quality of care necessary to manage their disease and to empower physicians to be more professionally effective. As stated by one patient, "Why are we being penalized for having this disability?"	
21141273	Animals in the wild are facing a wide variety of challenges and ever-changing environmental stimuli. For successful coping, animals use both innate behavioural programs and their cognitive skills. In contrast, zoo- and farm animals have to cope with restricted husbandry conditions, which offer only few opportunities to adequately satisfy their various needs. Consequences could be sensory and cognitive underchallenge that can cause boredom and frustration as well as behavioural disturbances. Initially intended for improvement of management and husbandry, different forms of operant behavioural training have been applied firstly in zoo- and later also in farm animals. It has been suggested that successful coping with appropriate cognitive challenges is a source of positive emotions and may lead to improved welfare. Under the term cognitive enrichment, new approaches have been developed to integrate cognitive challenges into the housing of zoo- and farm animals. The present article reviews actual research in the field. Previous results indicate that, beyond improvement of management and handling routines, such approaches can positively affect animal behaviour and welfare. The combination of explorative and appetitive behaviour with successful learning improves environmental predictability and controllability for the animals, activates reward-related brain systems and can directly affect emotional processes of appraisal. For practical implementation in farm animal husbandry, it sounds promising to link individual access to e.g. automated feeders or milking systems with previously conditioned stimuli and/or discriminatory learning tasks. First experimental approaches in pigs, dwarf goats and cattle are available and will be discussed in the present article.
21131103	The emergency department (ED) is the gateway to the hospital setting. Despite the intentions from the end-of-life care strategy in the UK to improve care provision, the ED has increasingly become the access site for end-of-life support. Little attention has been given to this aspect of the work of the ED, even as the quality of end-of-life care in hospitals has become the subject of increasing concerns. We explore end-of-life care in the ED and provide an understanding of how care is delivered to the dying, deceased and bereaved in the emergency setting.Observation was carried out in a large urban ED during 12 months. This was complemented by detailed interviews with emergency staff, patients diagnosed with a terminal condition, who had visited the ED in the previous 6 months, and their relatives. Data were analyzed thematically, following the normal conventions of ethnographic research.	Two distinct trajectories of end-of-life care were identified in the ED; the spectacular and the subtacular. Patients and family members experiencing end-of-life care in the ED have distinctly different care because of the nature of these 2 trajectories, frequently resulting in dissatisfaction for staff and distress and frustration for patients and their relatives.	The ED is priority driven, focused on resuscitation and the prolongation of life. As a result of the consuming nature of the spectacular death, a reluctance to build relationships with the dying, and a lack of educational support, the care needs of patients in the subtacular trajectory are somewhat neglected. These trajectories can be used to identify the shortfalls in end-of-life care in the ED and raise serious concerns for policy in regard to staffing, resources, and professional development.	
21130269	The purpose of this study was to determine whether children who stutter (CWS) and typically developing children (TDC) differ from each other on composite temperament factors or on individual temperament scales.Participants consisted of 116 age and gender-matched CWS and TDC (3.04-8.11). Temperament was assessed with a Dutch version of the Children's Behavior Questionnaire (CBQ-D; Van den Bergh and Ackx, 2003), a caregiver rating scale.	Results indicated significant differences between participant groups on the composite temperament factors of Negative Affectivity, and Effortful Control. Analysis of the individual temperament scales showed that CWS, compared to the TDC, scored significantly lower on the scales of 'Inhibitory Control' and 'Attentional Shifting' and higher on the scales of 'Anger/Frustration', 'Approach' and 'Motor Activation'. Stuttering severity and months of therapy were not associated with either of the temperament dimensions.	The present study provides data that support the hypothesis that CWS and TDC differ on both composite temperament factors and temperament scales. The findings were interpreted within existing frameworks of temperament development, as well as with regard to previous studies of temperament in CWS.	After reading this article, the reader will be able to: (1) describe the concept of temperament, including Rothbart's temperamental model, and its functional significance; (2) explain the CBQ-based (Children's Behavior Questionnaire) temperamental differences between CWS and CWNS; and (3) explain possible pathways for interaction between temperament and the development of stuttering.	
21123313	In recent years, increasing numbers of children have been diagnosed with bipolar disorder. In some cases, children with unstable mood clearly meet current diagnostic criteria for bipolar disorder, and in others, the diagnosis is unclear. Severe mood dysregulation is a syndrome defined to capture the symptomatology of children whose diagnostic status with respect to bipolar disorder is uncertain, that is, those who have severe, nonepisodic irritability and the hyperarousal symptoms characteristic of mania but who lack the well-demarcated periods of elevated or irritable mood characteristic of bipolar disorder. Levels of impairment are comparable between youths with bipolar disorder and those with severe mood dysregulation. An emerging literature compares children with severe mood dysregulation and those with bipolar disorder in longitudinal course, family history, and pathophysiology. Longitudinal data in both clinical and community samples indicate that nonepisodic irritability in youths is common and is associated with an elevated risk for anxiety and unipolar depressive disorders, but not bipolar disorder, in adulthood. Data also suggest that youths with severe mood dysregulation have lower familial rates of bipolar disorder than do those with bipolar disorder. While youths in both patient groups have deficits in face emotion labeling and experience more frustration than do normally developing children, the brain mechanisms mediating these pathophysiologic abnormalities appear to differ between the two patient groups. No specific treatment for severe mood dysregulation currently exists, but verification of its identity as a syndrome distinct from bipolar disorder by further research should include treatment trials.
21095600	The aims of this study were: 1) to describe how parents assess pain in their child with Down syndrome; and 2) to examine the relationship between pain assessment and decisions by parents to intervene to relieve pain in the child. Twelve parents of school-age children with Down syndrome (ages 6-12 years) were interviewed. Data analysis followed Spradley's Developmental Research Sequence (1979). This included domain analysis, taxonomic analysis, componential analysis, and theme development. Four themes emerged from the data analysis. Theme 1: Being sensitive to verbal and behavioral attributes of pain in the child. Parents reported that they assessed pain in their child with Down syndrome through the child's use of words to express pain, pointing or showing pain location, crying, changes in usual activities, and seeking closeness to the parent. Theme 2: Recognizing emotional and social responses to pain. Parents reported that emotional responses (e.g., anger, fear, frustration, acting out) were part of the pain expressions of their child with Down syndrome. Theme 3: Identifying differences in pain expressions between child and siblings. Parents used strategies to assess pain based on their beliefs that the child was less verbal, slower to complain, and less bothered by pain than siblings. Strategies included questioning the child to elicit self-reporting of pain and observing the child's behaviors. Theme 4: Making decisions to intervene. Parents reported that actions to relieve pain in their child with Down syndrome included more psychologic measures than physical measures, but otherwise no differences were noted in the actions taken for the child and the child's siblings.
21091136	Studies demonstrate that suicidal ideation (SI) is greater in persons with multiple sclerosis (MS) than in the general population. SI may offer some MS patients a mechanism for feeling in control of their lives, in the face of a daunting, unpredictable disease. In this study, we determined what specific mental constructs or perceptual themes occur for MS patients experiencing SI, while also examining the construct of 'control' as a central theme.Individual interviews (N = 16) were audiotaped, transcribed and qualitatively analysed by two independent raters to test for key themes in MS patients reporting SI.	In relation to SI, eight key themes were identified by both raters as having been expressed in interviews: perceived loss of control, increased family tension, loneliness, hopelessness and frustration, physical and psychological impact of MS, loss of perceived masculinity or femininity, regaining control and failure to achieve desired or expected role functioning. We created a model to explain the emergence of these themes as they contribute to SI among patients with MS. All participants indicated that perceived loss of control elicited thoughts of suicide.	Perceived loss of control appears to be a major disease related burden associated with SI in MS patients.	
21087302	This study examined the associations between employment frustration and both self-rated physical health (SRPH) and self-rated mental health (SRMH) among Asian American immigrants.A cross-sectional quantitative analysis was conducted utilizing data from 1,181 Asian immigrants participating in the National Latino and Asian American Study.	Employment frustration was measured by self-report of having difficulty finding the work one wants because of being of Asian descent. SRPH and SRMH were each assessed using a global one-item measure, with responses ranging from poor to excellent. Control variables included gender, age, ethnicity, education, occupation, income, whether immigrated for employment, years in the United States, English proficiency, and a general measure for everyday discrimination.	Ordered logistic regression showed that employment frustration was negatively associated with SRPH. This relationship, however, was no longer significant in multivariate models including English proficiency. The negative association between employment frustration and SRMH persisted even when including all control variables.	The findings suggest that Asian immigrants in the United States who experience employment frustration report lower levels of both physical and mental health. However, English proficiency may attenuate the relationship of employment frustration with physical health.	
21077003	Researchers have postulated that hope may be an important factor associated with burnout. Consistent with hope theory contentions, low-hope individuals may be susceptible to burnout because they are prone to experience goal blockage, frustration, and negative affect, all of which likely increase the risk of burnout. We examined the relationship between hope and athlete burnout among 178 competitive athletes (63 females and 115 males) aged 15-20 years. Hope was significantly and negatively correlated with all three burnout subscales: emotional/physical exhaustion, a reduced sense of accomplishment, and sport devaluation. Moreover, results of a multivariate analysis of variance showed that low-hope athletes scored significantly higher than medium- and high-hope athletes on all three burnout dimensions. Finally, results revealed that agency thinking was a significant predictor of all burnout dimensions. Frustration over unmet goals and a perceived lack of agency, a characteristic of low-hope athletes, might pose a risk factor in athlete burnout, whereas being able to maintain hope appears to be associated with health and well-being.
21076285	The aim of this study was to evaluate whether socioemotional stress affects the quality of cardiopulmonary resuscitation during advanced life support in a simulated manikin model.A randomized crossover trial with advanced life support performed in two different conditions, with and without exposure to socioemotional stress.	The study was conducted at the Stavanger Acute Medicine Foundation for Education and Research simulation center, Stavanger, Norway.	Paramedic teams, each consisting of two paramedics and one assistant, employed at Stavanger University Hospital, Stavanger, Norway.	A total of 19 paramedic teams performed advanced life support twice in a randomized fashion, one control condition without socioemotional stress and one experimental condition with exposure to socioemotional stress. The socioemotional stress consisted of an upset friend of the simulated patient who was a physician, spoke a foreign language, was unfamiliar with current Norwegian resuscitation guidelines, supplied irrelevant clinical information, and repeatedly made doubts about the paramedics' resuscitation efforts. Aural distractions were supplied by television and cell telephone.	The primary outcome was the quality of cardiopulmonary resuscitation: chest compression depth, chest compression rate, time without chest compressions (no-flow ratio), and ventilation rate after endotracheal intubation. As a secondary outcome, the socioemotional stress impact was evaluated through the paramedics' subjective workload, frustration, and feeling of realism. There were no significant differences in chest compression depth (39 vs. 38 mm, p = .214), compression rate (113 vs. 116 min⁻¹, p = .065), no-flow ratio (0.15 vs. 0.15, p = .618), or ventilation rate (8.2 vs. 7.7 min⁻¹, p = .120) between the two conditions. There was a significant increase in the subjective workload, frustration, and feeling of realism when the paramedics were exposed to socioemotional stress.	In this advanced life support manikin study, the presence of socioemotional stress increased the subjective workload, frustration, and feeling of realism, without affecting the quality of cardiopulmonary resuscitation.	
21062186	Disablement theory has been characterized as the sequence of events that occurs after an injury, but little research has been conducted to establish how disablement is experienced and described by physically active persons.To describe the disablement process in physically active persons with musculoskeletal injuries.	Concurrent, embedded mixed-methods study. For the qualitative portion, interviews were conducted to create descriptive disablement themes. For the quantitative portion, frequencies analysis was used to identify common terminology.	National Collegiate Athletic Association Division I collegiate and club sports, collegiate intramural program, large high school athletics program, and outpatient orthopaedic center.	Thirty-one physically active volunteers (15 males, 16 females; mean age  =  21.2 years; range, 14-53 years) with a current injury (18 lower extremity injuries, 13 upper extremity injuries) participated in individual interviews. Six physically active volunteers (3 males, 3 females; mean age  =  22.2 years; range, 16-28 years) participated in the group interview to assess trustworthiness.	We analyzed interviews through a constant-comparison method, and data were collected until saturation occurred. Common limitations were transformed into descriptive themes and were confirmed during the group interview. Disablement descriptors were identified with frequencies and fit to the themes.	A total of 15 overall descriptive themes emerged within the 4 disablement components, and descriptive terms were identified for each theme. Impairments were marked by 4 complaints: pain, decreased motion, decreased muscle function, and instability. Functional limitations were denoted by problems with skill performance, daily actions, maintaining positions, fitness, and changing directions. Disability consisted of problems with participation in desired activities. Lastly, problems in quality of life encompassed uncertainty and fear, stress and pressure, mood and frustration, overall energy, and altered relationships. A preliminary generic outcomes instrument was generated from the findings.	Our results will help clinicians understand how disablement is described by the physically active. The findings also have implications for how disablement outcomes are measured.	
21048803	Both patients and psychotherapists can experience strong emotional reactions towards each other in what are termed transference and countertransference within therapy. In the first part of this review, we discuss transference issues. Although not usually part of the obvious language of cognitive behavioral therapy (CBT), examination of the cognitions related to the therapist, is an integral part of CBT, especially in working with difficult patients. In the second part, we cover counter-transference issues. We describe schematic issues that give rise to therapist counter-transference and explain how this interacts in different types of patient therapist encounter. We also examine ways in which the therapist can use CT to help him/her modify the countertransference and, in the process, assist the patient.PUBMED data base was searched for articles using the key words "therapeutic relations", "transference", "countertransference", "cognitive behavioral therapy", "cognitive therapy", "schema therapy", "dialectical behavioral therapy". The search was repeated by changing the key word. No language or time constraints were applied. The lists of references of articles detected by this computer data base search were examined manually to find additional articles. We also used the original texts of A. T. Beck, J. Beck, M. Linehan, R. Leahy, J. Young and others. Basically this is a review with conclusions about how therapists can manage transference issues.	Transference. The therapist should pay attention to negative or positive reactions towards him/ her but should not deliberately provoke or ignore them. He/she should be vigilant for signs of strong negative emotions, such as a disappointment, anger, and frustration experienced in the therapeutic relationship by the patient. Similarly he/ she should be alert to exaggerated positive emotions such as love, excessive idealization, praise or attempts to divert the attention of therapy onto the therapist. These reactions open space for understanding the patient's past and actual relations outside the therapy. Countertransference. The therapist should be aware of countertransference schemas as they apply to him/her. He/she should monitor his/her own feelings that indicate countertransference. Further, the assistance of and discussion with supervisors and colleagues is useful in regard to countertransference even in experienced therapists. Countertransference can be used as an open window into the interpersonal relations of the patient.	Both the literature and our experience underscore the importance of careful and open examination of both transference and counter-transference issues in CBT and their necessary incorporation in the complete management of all patients undergoing CBT.	

20961034	This study aimed at learning about the feelings experienced by mothers while breastfeeding their premature babies in a rooming-in facility, by means of individual interviews with 33 mothers during the period of February to April 2006, at a maternity hospital in Natal/RN/Brazil. The main feelings referred by the mothers regarding their inability to breastfeed their premature babies immediately after delivery were: sorrow, guilt, disappointment, frustration, insecurity, and fear of touching, holding or harming the delicate babies while breastfeeding. However, the mother-child bond that was formed when the baby was discharged from the Neonatal Intensive Care Unit and taken to the rooming-in facility was reflected by feelings of fulfillment, pride, and satisfaction at experiencing the first breastfeeding.
20950195	Nurses in most clinical settings experience difficult 'nurse patient relationships' at various times. Attempts to describe and articulate how to manage such difficult relationships can be found, but often lay blame at the patient level and ultimately leave the nurse less confident to improve patient care. This study uses an action research approach in working with nurses in a generalist setting in developing an educational strategy that helped to improve their knowledge, skills and confidence in working within the 'difficult nurse patient relationship' paradigm. Through the experiential style learning methodology of scenario based learning and applying this via e-learning, an effective educational approach has been developed. Using a quasi-experimental design to evaluate the e-learning package, significant increases in knowledge, skill, confidence and reduced nurse stress as measured on the 'difficult patient stress scale' were shown. This approach allows nurses to reflect on their own behaviour and improve their ability to enhance patient care in difficult to manage nursing care situations.
20947084	Many countries are facing a serious situation of nursing shortage, and retention of nurses is a challenge.To examine whether reward frustration at work, as measured by the effort-reward imbalance model, predicts intention to leave the nursing profession, using data from the European longitudinal nurses' early exit study.	A prospective study with one-year follow-up.	6469 registered female nurses working in hospitals in seven European countries who did not have intention to leave the nursing profession at baseline were included in our analyses by multivariate Poisson regression.	8.24% nurses newly developed intention to leave during follow-up. High effort-reward imbalance at baseline predicted an elevated risk of intention to leave the profession (relative risk 1.33, 95% confidence interval 1.22-1.45), and reward frustration (poor salary and promotion prospects, lack of esteem) showed the strongest explanatory power. Findings were similar in a majority of the countries.	Results suggest that improving the psychosocial work environment, and specifically occupational rewards, may be helpful in retaining nurses and consequently reducing nursing shortage in Europe.	
20939735	the aim of this study was to explore the parental experiences of raising a child without a diagnosis.qualitative semistructured interviews were conducted with 14 parents recruited through a large Regional Genetics Centre in the United Kingdom. The interview guide was designed to examine issues such as when and why parents started searching for a diagnosis, whether they were still searching, and what psychosocial issues had arisen as a result of not having a diagnosis. Data were analyzed using the Grounded Theory method.	the parental experience can be viewed as a journey, which comprises of two distinct components: the inner, emotional experience, and the outer, sociological experience. Issues that comprise the emotional journey include the realization that there is a problem, the experience of testing, reasons for wanting a diagnosis, the emotional impact, and active coping mechanisms. Social issues include the experience with professionals, the various support networks accessed by parents, and issues such as education and housing. The issue of frustration was one that occurred throughout the journey.	although some of the experiences cited by parents are common to families raising a child with a diagnosed condition, lack of diagnosis adds a layer of complexity.	
20925472	Attention-deficit/hyperactivity disorder (ADHD) is a prevalent disorder in adult psychiatry, particularly in out-patient settings. There are no objective, laboratory-based tests that can establish this diagnosis. Present diagnostic criteria for ADHD are formulated primarily according to behavior in childhood, based on age inappropriate and impairing levels of hyperactivity, impulsivity and inattention. Other symptoms, such as mood instability and frustration intolerance, are not included in current criteria for ADHD, but are very prevalent in this patient group. ADHD is often comorbid with alcohol and substance abuse and other psychiatric disorders, in particular anxiety and personality disorders. Thus, the diagnostic assessment should both include a comprehensive clinical interview, rating scales for past and present symptoms and collateral information from multiple informants, as well as assessment of a broader spectrum of psychiatric and somatic conditions. As ADHD is associated with changes in brain function mediating different aspects of neuropsychological functions, assessment of those functions is important to understand the symptom patterns and to develop targeted treatment programs. Some topics for further research and for future developments of diagnostic criteria and tools are highlighted.
20921572	The brain-derived neurotrophic factor (BDNF) gene is a plausible candidate for early-emerging negative emotionality (NE), and evidence suggests that the effects of this gene may be especially salient in the context of familial risk for child maladjustment. We therefore examined whether the single-nucleotide polymorphism producing a valine-to-methionine substitution at codon 66 (val66met) of the BDNF gene was associated with childhood NE, in the context of parental depression and relationship discord. A sample of 413 three-year-old children was assessed for NE using standardized laboratory measures. The children's parents completed clinical interviews as well as a measure of marital satisfaction. Children with at least one BDNF methionine (met) allele exhibited elevated NE when a parent had a history of depressive disorder or when relationship discord was reported by a parent. In contrast, this allele was associated with especially low NE when parental depression was absent and when the parental relationship was not discordant. Our findings suggest that the BDNF met allele confers increased child sensitivity to both positive and negative familial influences.
20920084	The aims and objectives of this paper are to illuminate and discuss the experiences and perceptions of nursing students and supervising nurses regarding the students' learning of person- centred care of patients with Alzheimer's disease in a teaching nursing home. This information is then used to develop recommendations as to how student learning could be improved.The clinical experiences of nursing students are an important part of learning person-centred care. Caring for patients with Alzheimer's disease may cause frustration, sadness, fear and empathy. Person-centred care can be learned in clinical practice.	A qualitative study.	The study was performed in 2006 using field work with field notes and qualitative interviews with seven-fifth-semester nursing students and six supervising nurses.	This study determined the variation in the perceptions of nursing students and supervising nurses with regards to the students' expertise in caring for patients with Alzheimer's disease. The nursing students experienced limited learning regarding person-centred approaches in caring for patients with Alzheimer's disease. However, the supervising nurses perceived the teaching nursing home as a site representing multiple learning opportunities in this area.	Nursing students perceived limited learning outcomes because they did not observe or experience systematic person-centred approaches in caring for patients with Alzheimer's disease. It is important that measures of quality improvements in the care of patients with Alzheimer's disease are communicated and demonstrated for nursing students working in clinical practices in a teaching nursing home.	Introduction of person-centred approaches is vital regarding learning outcomes for nursing students caring for patients with Alzheimer's disease.	
20887577	Drug treatment programs for adolescents are now more widespread with some evidence of success. However, there has been little in-depth exploration of factors that may encourage or hinder program completion. This ethnographic study of an adolescent therapeutic community aimed to provide insights into the experience of the adolescent residents.Four months of participant observation at a program for drug-dependent adolescents in a metropolitan city in Australia. Twenty-one residents (15 boys and six girls) aged between 14 and 18 years participated, comprising all residents admitted during the study period.	Vocational Education and Art Therapy are activities that universally engaged residents whereas frustration was evident in Journaling-a core program activity. Group sessions were often used to set up or dismantle social cliques, although they were also useful to expose difficult inter-personal relationships. The risk of residents 'taking off' was heightened during breaks from program activities when strong emotions surfaced.	There needs to be a more central role for creative and vocational activities in adolescent programs and a variety of ways for them to document their journey. Group encounters need to be skillfully facilitated by staff to handle fluid inter-personal dynamics and residents need support outside of formal program time to minimise drop-out. The concept of a navigation-engagement continuum is discussed and the need to see treatment as a series of encounters that may be 'successful' despite 'non-completion'. This study gives adolescents a voice in program evaluation which may help improve retention.	
20859934	Anorexia nervosa (AN) is associated with difficulties in emotion regulation and this study aimed to examine emotion regulation experimentally in this group compared to healthy controls (HCs). Sixty-six women took part: 22 with AN and 44 HCs. Both groups completed the Rosenzweig Picture Frustration Study in which participants' responses to socially frustrating situations are scored regarding the direction of aggression/anger (outwardly/inwardly or neutralized) and type of aggression/anger (focused on the people or the obstacles in the situation, or solution-focused). Individuals with AN provided significantly fewer solution-focused responses and focused aggression on the people in the situation more often than HCs. There was also a trend for the AN group to neutralize aggression less compared to HCs. The findings support models of AN which suggest that difficulties with emotional processing, particularly around anger are associated with AN. Future work could explore these initial findings in a larger sample.
20857273	There is an increase in awareness in professionals that the Asperger syndrome (AS) in adulthood is associated with specific problems and burdens which may well differ from those in childhood and adolescence. The core symptoms of AS generally persist into adulthood, however in contrast to childhood and adolescence there is no specific support system for adults in Germany. Also the environment of the afflicted patient changes thus producing different challenges and problems. In addition a subgroup of patients with high functioning AS primarily presents in adulthood generally due to secondary psychosocial problems, depression or anxiety. Difficulties in social interaction, problems with modified daily routines and unforeseen situations cause severe frustration for the majority of the patients. While several therapy programs have been developed and implemented for children and adolescents, for adults there are none. Also there is a lack of comprehensive concepts addressing the specific needs of adult patients with AS. From an economic perspective this is particularly unfortunate since affected people often have good or excellent partial abilities and might be very valuable employees. In this article existing therapeutic concepts for AS are summarized and a newly designed group therapy program for adult patients with Asperger syndrome in Freiburg is introduced (Freiburg Asperger-spezifische Therapie für Erwachsene, FASTER) which specifically addresses the needs and problems of adult patients with AS.
20856192	Patients with severe and disabling pain and bodily distress which cannot be explained by underlying organic pathology are common in all levels of health care and are typically difficult to treat for physicians as well as for mental health specialists. Beside pain in different locations, not fully explained by specific somatic pathology, specific functional complaints such as dizziness, fatigue or vegetative disorders are common. A great proportion of patients with somatoform pain complain of comorbid depressive or anxiety disorder. Psychodynamic-interpersonal psychotherapy particularly emphasises interpersonal processes as well as disturbance of body awareness and self regulation already in childhood. Cognitive-behavioral models focus on the phenomenon of somatosensory amplification. The patients do have a strong believe in an underlying somatic illness, therefore seeking for further diagnostic and somatic therapy. This frequently leads to multiple but ineffective therapeutic attempts in the field of somatic medicine resulting in frustration of the patients and a difficult doctor-patient-relationship. General therapeutic recommendations include an active therapeutic approach with paying tribute for the patients' suffering and giving support to cope with the pain. A specific psychodynamic approach furthermore focuses on improvement of affect differentiation and the interaction of somatoform pain and interpersonal relationships.
20850619	The objective of this study is to retrospectively assess the surgical outcome and the quality of life (QOL) from the caregiver's perspective after total esophagogastric dissociation in neurologically impaired (NI) children with gastroesophageal reflux (GOR).Based on O'Neill questionnaire, a QOL questionnaire was designed, which was completed by the caregivers recording the child's well being and caregiver's satisfaction preprocedure, immediately (6 months), and long-term postprocedure (median, 21 months; range, 4-38). Statistical analysis was done using Kruskal-Wallis Test and Dunn's multiple comparisons test.	Twenty-three children underwent surgery between 2003 and 2008; 19 families participated. Ease of feeding improved significantly both immediately and long term. Statistically significant improvements were also seen in comfort and ability of the child to enjoy life, frequency of medical visits, vomiting, retching, and choking. Postoperatively, caring for the child became easier, and the caregiver's frustration in caring improved statistically, but the caregiver's overall QOL did not improve significantly.	Total esophagogastric dissociation has huge positive impact on the physical well being of the NI children experiencing GOR. The overall view of the procedure is one of success surpassing all expectations. Therefore, it should be considered alongside other antireflux procedures in NI children.	
20846966	Cognitive overload has been recognized as a significant cause of error in industries such as aviation and measuring mental workload has become a key method of improving safety. The aim of this study was to pilot the use of a new method of measuring mental workload in the operating theatre using a previously published methodology.The mental workload of the anaesthetists was assessed by measuring their response times to a wireless vibrotactile device and the NASA TLX subjective workload score during routine surgical procedures. Primary task workload was inferred from the phase of anaesthesia.	Significantly increased response time was associated with the induction phase of anaesthesia compared with maintenance/emergence, non-consultant grade, and during more complex cases. Increased response was also associated with self-reported mental load, physical load, and frustration. These findings are consistent with periods of increased mental workload and with the findings of other studies using similar techniques.	These findings confirm the importance of mental workload to the performance of anaesthetists and suggest that increased mental workload is likely to be a common problem in clinical practice. Although further studies are required, the method described may be useful for the measurement of the mental workload of anaesthetists.	
20829177	This study explored the experiences of NICU nurses in caring for infants with neonatal abstinence syndrome (NAS).A qualitative research approach was used with open-ended questions employing computer-assisted personal interviews.	Fourteen NICU nurses employed in a regional hospital provided responses.	The nurses reflected a personal struggle between a desire to employ their technical and critical nursing skills and the need to provide expected maternal care to NAS infants. Other themes included frustration and burnout, challenges to values about parenting, and increased awareness of drug use in the community and at home.	The results suggest that nurses underrate the skill required to care for infants with NAS. The level of knowledge, patience, and commitment to these newborns should be reframed to increase job satisfaction, and education should be offered to nurses about women struggling with addictions.	
20821836	This prospective study examined the impact of medication cabinets installed outside patient rooms on nursing and pharmacy workflow. Storing medications and supplies outside patient rooms decreased nursing visits to the automated medication dispensing system, and nurses also reported fewer episodes waiting to access the system when it was busy. Benefits of this study include the ability to demonstrate the impact of medication cabinets on the medication storage and delivery process, prior to housewide implementation.
20808076	The prevelance of cognitive impairment in older individuals is increasing in Taiwan. Most healthcare providers (HCPs) experience deep frustration while caring for residents of long-term care facilities who are cognitively impaired. Competence and preparedness of HCPs represent key factors in being able to successfully create and maintain a safe environment for elderly wards and are one of the main concerns of cognitive impairment care.The purpose of this study was to investigate the competence and preparedness of HCPs to manage the problem behaviors of cognitively impaired elders living in long-term care facilities.	This study utilized a correlational research design and included 221 participants that were recruited using a stratified random sampling process. Structured and semistructured questionaires on competence and preparedness of caring for cognitively impaired elders were used to collect data. Descriptive statistics and univariate and multivariate analyses were used to analyze the relationship between HCP demographic characteristics and their competence or preparedness in managing cognitive impairment care.	Ninety-five percent of participants were women. The top scoring item in the competence dimension was "preventing problem behaviors from occurring" (M +/- SD = 3.89 +/- 2.89), and the lowest scoring item was "reading related books and articles" (2.91 +/- 0.85). In the preparedness dimension, "modification of environment" (3.22 +/- 1.07) was the highest scoring item, and "resources referral skills" was the lowest scoring item (3.02 +/- 1.03). Results showed supervisors (F = 7.89, p = .001) and college graduates (F = 2.89, p = .047) to have higher levels of competency than other participants. Participant knowledge level in dealing with problem behaviors was significantly and positively correlated with frequency of continuing education participation (F = 28.73, p < .001).	Results point to the need for continuing education, practicum, counseling, staffing resources, and involvement of other professionals to increase HCP readiness and competence.	
20807864	Since its inception, strain theory has attempted to explore the dynamic evoked between the process of goal identification and the process of goal acquisition as this relates to subsequent criminal behavior. Over the years of its development, strain theorists have attempted to broaden the initial scope of this perspective. Robert Agnew with his general strain theory has sought to introduce a variety of other factors relative to the experience of strain and the capacity they represent concerning subsequent criminal activity. However, these recent developments have not addressed until recently, and only in somewhat limited ways, the theoretical and methodologic implications and limits of this theoretical approach. This article proposes that the way in which Agnew's formulation of general strain, particularly in its most recent conceptualization as story lines, fundamentally transforms the theoretical and methodological grounding of this approach but fails to offer a clearly articulated alternative theoretical perspective by which to conceptualize this "turn." Phenomenology provides such an alternative perspective and helps to greatly expand our understanding of the human experience of strain.
20732715	The present study examined infant negativity and maternal symptomatology by term status in a predominately low-income, rural sample of 132 infants (66 late-preterm) and their mothers. Late-preterm and term infants were group-matched by race, income, and maternal age. Maternal depression and anxiety symptoms were measured with the Brief Symptom Inventory 18 (BSI-18) when infants were 2 and 6 months of age. Also at 6 months, infant negativity was assessed by global observer ratings, maternal ratings, and microanalytic behavioral coding of fear and frustration. Results indicate that after controlling for infant age, late-preterm status predicted higher ratings of infant negativity by mothers, but not by global observers or microanalytic coding, despite a positive association in negativity across the three measures. Further, mothers of late-preterm infants reported more elevated and chronic co-morbid symptoms of depression and anxiety, which in turn, was related to concurrent maternal ratings of their infant's negativity. Mothers' response to late-preterm birth and partiality in the assessment of their infant's temperament is discussed.
20730394	The effects of tinnitus on quality of life (QOL) have never been extensively studied in Singapore. We describe the characteristics of tinnitus and its impact on QOL as measured by the Tinnitus Handicap Inventory (THI) in a series of ear, nose and throat clinic patients.A total of 327 patients who attended a tinnitus counselling clinic completed the THI questionnaire, a self-report measure with 25 items grouped into functional, emotional and catastrophic subscales.	The mean age of the 134 female and 193 male patients was 48.9 years. 36.7 percent of these patients had bilateral tinnitus and 64.6 percent had symptoms for less than one year. 270 patients had hearing loss, 74 percent of whom presented with bilateral high frequency hearing loss. Most patients (84.1 percent) perceived only one type of sound. The total THI score distribution was: 107 (33 percent) patients had THI less than 16, 100 (31 percent) had THI 18 to 36, 59 (18 percent) had THI 38 to 56, and 61 (19 percent) had THI more than 58. There were no differences in the overall THI and subscale scores between the patients' gender, those with or without hearing loss, and those with unilateral or bilateral tinnitus. However, significantly higher total THI and all subscale scores were found among patients who were hearing more than one type of tinnitus sound. The areas of concern that were commonly reported by the patients in this series were a lack of control over tinnitus, frustration and stress.	Tinnitus patients who hear multiple sounds tend to have a higher THI and subscale scores. The management of tinnitus should address common areas of concern, and may include counselling. The THI is a potential screening tool to determine if patients require counselling. A series of THI assessments can be used to chart the progress of treatment.	
20718925	Psychogenic and functional breathing disorders are common and affect mostly children and adolescents, resulting in considerable morbidity and contributing significantly to patient and physician cost and frustration. The most common non-organic clinical entities are psychogenic cough, throat clearing tic, sighing dyspnoea, hyperventilation syndrome, and vocal cord dysfunction. Combinations of organic respiratory diseases and psychogenic aspects can coincide. The mainstay of the diagnosis of psychogenic and functional breathing disorders is full and meticulously taken history. A list of possible questions is presented. Furthermore, the value of a thorough physical examination is often underestimated. If a diagnosis cannot be made clear enough by history taking and examination alone, some baseline instrumental diagnostics are meaningful. An interview with an experienced clinical psychologist and a visit at the physiotherapist may add further information in some cases. Criteria, which differentiate psychogenic or functional breathing symptoms from organic ones, include no nocturnal symptoms, mostly no typical trigger factors, symptoms may occur suddenly and even at rest, speaking is possible without problems and there are normal diagnostic results during episodes of symptoms. Intensive efforts should be made to diagnose psychogenic and functional symptoms, because this will reduce or eliminate harm, prevent stigmatization and fixation of symptoms and disease, allow an untroubled life (including sports), and prevent patients from undergoing unnecessary and potentially harmful therapies.
20695854	Anxieties associated with corticosteroid treatment and preference for 'safer natural therapy' are common in parents of children with atopic dermatitis. We used focus groups to explore the source of these attitudes.The study involved 16 parents. Parents expressed difficulties with living with and treating atopic dermatitis which were categorized into themes using qualitative data analysis software.	Themes identified include: emotional impact of atopic dermatitis; difficulty in accepting 'control' verses 'cure'; topical corticosteroid negative perceptions; anxiety and confusion with treatment; preference for 'natural' therapy; and attitude-changing positive experiences.	Our findings illustrate the emotional impact of atopic dermatitis and the frustration with the lack of potential cure. 'Corticosteroid phobia' was universal among parents in our cohort and is a fear generated by doctors, pharmacists, close acquaintances and information from the internet. Participants expressed high levels of parental guilt linked to a desire for an eradicable 'cause' for atopic dermatitis, despite intellectually understanding this is a genetically determined condition. Parents were willing to change attitudes with accurate information from perceived reliable sources, positive hospitalization experiences and a relationship with a trusted dermatologist. Parents' suggestions to improve confidence included the provision of readily available information and better access to doctor- and nurse-led paediatric dermatology services.	
20694454	Chronic urticaria (CU) is one of the most frequent diseases in the field of dermatology. Recent studies have shown a point prevalence between 0.5 and 1% in the total population with a predominance of females. In general, all age groups and all classes of the population can be affected. An incidence peak has been found in the third and fourth decades. According to the current guidelines, CU is characterized by the spontaneous occurrence of wheals and/or angioedema for more than 6 weeks. However, epidemiological studies have revealed that the majority of patients suffer for several months, or frequently years. Disease duration is likely to be longer in case of angioedema, a combination with physical urticaria, positivity in the autologous serum skin test (autoreactivity) and a high disease severity. Studies on the impairment of quality of life have been shown that many CU patients suffer as strong from their disease as patients with coronary artery disease. Apart from pure physical symptoms, patients experience restrictions in daily life activities and social life. In addition, sleep disturbances are common and CU patients frequently exhibit psychiatric comorbidities. To avoid frustration in care, it is important to perceive all different dimensions of CU that impact the patient's life and to take the patients and their disease seriously. The aim of therapy should be to obtain total symptom control.
20684140	Psoriasis is a common, frustrating problem for dermatologists and patients. Long-held notions about the need to use thick, greasy corticosteroid ointments for psoriasis contributed to frustration for many patients. Fortunately, the general approach to managing psoriasis is changing. The purpose of this article is to describe key components of psoriasis management with a focus on the changing paradigm for treating the disease. In addition to making the right diagnosis and prescribing the right treatment, key elements of psoriasis management include establishing a strong physician-patient relationship, educating patients about the disease and recognizing the importance of adherence to topical treatment. In light of the tendency toward poor adherence, use of a fast-acting agent in a vehicle that patients are willing to use is critically important for successful disease management.
20682403	Hip fracture, a significant health issue for older adults, is an acute event in which older adults can recover their prefracture functional abilities. The recovery phase is often difficult for older adults, and the role of informal caregivers is particularly important. The aim of this qualitative study was to explore informal caregivers' experiences with providing care to older adults over the first 6-month trajectory of hip fracture recovery and their support needs. Participants (N = 10) were interviewed twice at 0-2 and 5-6 months. Analyses of the verbatim transcripts revealed multiple shared themes. Some themes were consistent across phases, such as hip fracture as a turning point toward a frailer state, feeling tired, frustration with communication issues in health care delivery, and lack of information about caregiving-related activities. Certain themes were phase-specific. For instance, in the early phase, management of hospital bills and transitions between care settings were especially burdensome. The caregiving situation, however, was viewed as an opportunity to spend more time with their loved ones. Findings from this study revealed unmet support needs expressed by caregivers of older adult hip fracture patients. Ongoing research and clinical interventions are needed to establish effective methods to empower these caregivers.
20679970	The aim of this study was to highlight community nurses' experiences of ethical dilemmas in palliative care.There are many studies on palliative care but research on how community nurses experience ethical dilemmas in palliative home care is lacking. The ethical dilemmas to which these nurses are exposed seriously challenge their ethical competence.	Seven community nurses described their experiences of ethical dilemmas in palliative home care. The data was analysed by means of qualitative content analysis.	The core themes that emerged were: powerlessness, frustration, and concern in relation to ethical dilemmas in palliative care. The nurses were motivated and felt responsibility for their patients' end of life, and their relatives, and took their duties seriously. They wanted to satisfy all parties; the patient, the relatives and other palliative care professionals.	The study confirms the need for knowledge about how community nurses experience dilemmas in ethical decision-making. They have the freedom to act and the willingness to make decisions, but they lack competence and knowledge about how their colleagues' experience and deal with such issues.	
20658426	The purpose of this review is to examine forgiveness as a means to enhance coping with the emotional sequelae of two disorders, fibromyalgia and chronic fatigue. As with many chronic illnesses, fibromyalgia and chronic fatigue often result in a host of negative emotions including, anger, stress, fear, and depression. We contend that learning to become more forgiving may be a complementary treatment to cope with the ongoing stress, frustration, and negative emotions that result from these two conditions. Our review includes descriptive information on fibromyalgia and chronic fatigue, a brief review of the literature on anger and its influence on health, a review of the connections between forgiveness and well-being, and methods to enhance forgiveness in patients' lives. We conclude with a conceptual model that we hope will be useful to design and/or evaluate work on forgiveness in these patients.
20658394	This study was conducted on a population of seafarers serving in the Royal Fleet Auxiliary (RFA), the organisation providing support at sea to the Royal Navy. An investigation into work-related fatigue in RFA personnel onboard ships was carried out following changes to the regulations concerning maximum retirement age, to determine whether age was associated with recovery from work demands. A total of 322 personnel aged from 19 to 61 years were interviewed onboard seven RFA ships. The Need for Recovery scale was used to measure fatigue and work demands exposure was measured using the Baecke questionnaire and the NASA Task Load Index. It was found that older personnel did not have higher work-related fatigue than younger personnel. A measure of frustration at work was found to be most strongly related to work-related fatigue, even in seafarers who carried out physically demanding jobs. Work-related fatigue was found to accumulate over time in personnel who continued to be exposed to work demands onboard a ship. Finally, a relatively high level of work-related fatigue was found in the RFA sample as a whole, which may hold implications for management interventions. It was concluded that older personnel in the RFA can cope with the day-to-day demands of working life as well as younger personnel, possibly due to a 'survivor effect', whereby those personnel who do not cope as well with work demands leave and find a different job, leaving only those who successfully deal with the demands of working life at sea. STATEMENT OF RELEVANCE: In order to manage work demands in seafarers, it is important to identify the most fatiguing demands. Age is of interest because of the demographic ageing of the workforce. Age was not associated with a higher need for recovery. Psychological work demands had a greater effect on need for recovery than physical work demands.
20646948	Fatigue is a prominent symptom in many rheumatic diseases. Numerous factors contribute to cause fatigue, which can be a source of frustration for the patients and physicians, as the treatment often fails to produce the desired improvement. Diagnostic guidelines direct insufficient attention to the various semiological patterns of fatigue seen in rheumatic diseases. This update describes three main patterns of fatigue, depending on whether the source is physical or mental: muscle weakness in patients with neuromuscular disease; asthenia related to organic disease with excessive energy expenditure, deficient energy production (e.g., endocrine disorders), or inadequate recovery; and weariness due to the impact of stress and depression on quality of life. The prevalence of each pattern in various rheumatic diseases is discussed. This update underlines the practical benefits provided by a detailed semiological analysis of fatigue in patients with rheumatic disease and emphasizes the marked predominance of weariness due to stress and depression, on which the personality of the patient and inadequacy of social support systems may exert a major influence. Serotonin reuptake inhibitors (SSRIs) may be valuable in patients with fatigue not only because they improve the mental status, but also via their recently demonstrated anti-inflammatory effects.
20639736	Assessing subjective, patient-reported outcomes such as quality of life (QoL) is essential to health care research. This study aimed to assess the properties of a QoL measure relating to pain and discomfort: the WHOQOL-Pain.Chronic low back pain patients (n=133) completed the WHOQOL-Pain, SF-12, and short-form McGill Pain Questionnaire before treatment started and again 2-4 weeks later. Of these, 76 received a lumbar epidural steroid injection, and 57 were waiting to receive treatment.	Overall, there was no significant difference in effect of either epidural injections or no treatment on bringing about an improvement to QoL overtime. Moderate effect sizes were found for 5 facets including pain relief and uncertainty. Small effect sizes were found for 7 facets including vulnerability, fear and worry, anger and frustration. Larger effect sizes were found for those reporting the most improvement in pain. The waiting group reported no significant changes to QoL but small changes for uncertainty. Three of the four new facets were sensitive to change and test-retest reliability (stability) was confirmed in three.	Although this study was not designed to test treatment effectiveness, the WHOQOL-Pain enables patients to report changes to important aspects of QoL during many diverse interventions for relieving pain.	
20635176	This study emphasizes the importance of studying the emotional, motivational, and cognitive characteristics accompanying and the potential hemodynamic mechanisms underlying cardiovascular reactivity to and recovery from interpersonal conflict.The relation of dispositional hostility to cardiovascular reactivity during a frustrating anagram task and post-task recovery was investigated.	The sample was composed of 99 healthy participants (age, 18-30 years; 53% women; 51% Caucasian; 49% African American)-half randomly assigned to a harassment condition. High and low hostility groups were created by a median split specific to sex and race subgroup score distributions on the Cook-Medley Hostility Scale. It was hypothesized that hostility would interact with harassment such that harassed, high hostile individuals would display the greatest cardiovascular and emotional reactivity and slowest recovery of the four groups. Participants completed a 10-min baseline, a 6-min anagram task, and a 5-min recovery period with blood pressure, heart rate, pre-ejection period, stroke index, cardiac index, and total peripheral resistance index measured.	Harassed participants displayed significantly greater cardiovascular responses and lower positive affect to the task and slower systolic blood pressure (SBP) recovery than did nonharassed participants. The high hostile group, irrespective of harassment, showed blunted cardiovascular responses during the task and delayed SBP recovery than the low hostile group.	Although the predicted interaction between hostility and harassment was not supported in the context of cardiovascular responses, such an interaction was observed in the context of blame attributions, whereby harassed hostile participants were found to blame others for their task performance than the other subgroups.	
20630008	Chronic pelvic pain (CPP) is a common and complex disease whose cause is often clinically inexplicable, with diagnosis and treatment being more difficult. From a clinical viewpoint, CPP is defined as non-cyclic, non-menstrual pain lasting at least 6 months and sufficiently severe to interfere with habitual activities and requiring clinical or surgical treatment. Thus, CPP is a syndrome resulting from a complex interaction of the nervous, musculoskeletal and endocrine systems and also influenced by psychological and sociocultural factors. CPP is influenced by emotional aspects with an impact on quality of life, and involving high costs for health services. Its aetiology is not always clear and a cure or significant improvement of symptoms is not always obtained with the treatments employed, with constant frustration of the professionals involved. It can be seen that its treatment is often unsatisfactory, simply providing temporary relief of symptoms.In the present study, we reviewed the bibliography regarding pelvic pain, with emphasis on emotional aspects and on the importance of a multidimensional approach to the care for these patients.	New investigations are needed to clarify these relations and interventions in a more effective manner. Interdisciplinary care can minimize the impact of the disease, helping the patients to cope with symptoms and improving their quality of life.	
20611039	Paul is an 8-year-old boy with a long-standing history of encopresis and enuresis. Potty training was initiated when he was 2(1/2) years old. At this time, his mother was absent from the home for 6 weeks when she cared for her ill father in a different city. The process of teaching Paul to use the bathroom was described as "inconsistent" due to multiple caretakers.Paul never successfully mastered bowel and bladder control. He continues to wet and soil his clothes on a daily basis at home and school. According to his parents, he does not accept responsibility and comments about his soiling such as, "I didn't do it; someone else must have put it there." One of Paul's teachers commented that she could tell at the beginning of the school day whether he would maintain bowel and bladder control. If he was "agitated and talkative" in the early morning, he would often soil that day.He had a pediatric gastroenterological evaluation at the age of 5 years when he was having daily episodes of stool soiling. Physical examination revealed normal anal tone, normal placement of the anus, and moderate stool in the rectal vault. An abdominal radiograph revealed moderate stool throughout the colon. He was treated with Miralax and instructed to sit on the toilet twice daily. Paul did not respond to these interventions and was diagnosed with "overflow incontinence secondary to stool withholding." When he was taking Miralax, he had a normal barium enema radiograph. He was admitted to the hospital for a clean out with a polyethylene glycol/electrolyte solution. Although abdominal radiographs demonstrated absence of colonic stool for the following 5 months, he continued to soil his clothing. Play therapy and biofeedback did not change the chronic soiling and wetting pattern. An evaluation at the Continence Clinic resulted in a rigorous program including stooling after each meal, wearing a vibrating watch reminding him to void every 2 hours, drinking 60 ounces of water per day, tracking elimination patterns on a calendar, and a daily laxative (polyethylene glycol). A neuropsychological evaluation revealed a superior aptitude associated with unresolved early childhood issues of self-control, self-care, and frustration tolerance. Family therapy was initiated. However, daily fecal soiling and wetting persisted.Paul was born full-term without prenatal or perinatal complications. He was breast fed for 1 year and described as an easy baby. He achieved motor, social, and language milestone on time. Paul had difficulty with separation and aggression in preschool (e.g., biting). In school, teachers report inattention, fidgetiness, and difficulty following directions. He has been obese since age 3 years; his current body mass index is 29.
20607411	This psychobiographical essay aims to shift Boisen scholarship from a focus on his disputed psychiatric diagnosis to a more inclusive investigation of the disparate aspects of his personality. I conclude that Boisen's central personality trait was a brand of loquacity that lacked substance--specifically the substance of his deepest secrets. This caused a kind of chronic frustration in his relations with others and, I argue, led to his chronic, psychotic state of being. Additionally, I argue that Boisen's psychosis and religious practice worked together to sustain his psychological regression.
20607307	This study aimed to analyze the impact of winter weather conditions on young children's behavior and affective states by examining a group of 61 children attending day-care centers in Florence (Italy). Participants were 33 males, 28 females and their 11 teachers. The mean age of the children at the beginning of the observation period was 24.1 months. The day-care teachers observed the children's behavioral and emotional states during the morning before their sleeping time and filled in a questionnaire for each baby five times over a winter period of 3 weeks. Air temperature, relative humidity, air pressure and solar radiation data were collected every 15 min from a weather station located in the city center of Florence. At the same time, air temperature and relative humidity data were collected in the classroom and in the garden of each day-care center. We used multilevel linear models to evaluate the extent to which children's emotional and behavioral states could be predicted by weather conditions, controlling for child characteristics (gender and age). The data showed that relative humidity and solar radiation were the main predictors of the children's emotional and behavioral states. The outdoor humidity had a significant positive effect on frustration, sadness and aggression; solar radiation had a significant negative effect only on sadness, suggesting that a sunny winter day makes children more cheerful. The results are discussed in term of implications for parents and teachers to improve children's ecological environment.
20599207	Speech-language pathologists (SLPs) are advised to consider the distress of preschoolers and parents along with the social consequences of the child's stuttering when deciding whether to begin or delay treatment. Seventy-seven parents completed a survey that yielded quantitative and qualitative data that reflected their perceptions of the impact of stuttering on their children and themselves. Sixty-nine (89.6%) parents reported between 1 and 13 types of negative impact (modal=2). The most frequently reported reactions of children were frustration associated with their stuttering, withdrawal, reduced or changed verbal output, making comments about their inability to talk, and avoidances. The most frequently reported peer reaction was teasing (27.3%). Seventy parents (90.9%) reported that they were affected by their child's stuttering. Their most frequently reported reactions were worry/anxiety/concern, uncertainty about what to do, frustration, upset (parent term), self-blame (fear that they had caused the stuttering), taking time to listen, waiting for the child to finish talking, modifying their own speech, and asking the child to modify speech. Findings support calls for SLPs to consider the distress of preschool children and their parents and the social consequences of the children's stuttering when making the decision to begin or delay treatment.Readers will be able to describe parents' perceptions of the impact of stuttering on their children and themselves. In particular, readers will learn about (1) parents' perceptions of young children's awareness and reactions to their stuttering, (2) parents' perceptions of the social consequences of stuttering for young children; and (2) the emotional effect of stuttering on parents.	
20594400	This article is an author response to Harenski and Kiehl's (2010) commentary on Blair (2010).
20593538	To describe structural barriers to mental health specialists and consequences of these barriers to care for patients with dementia and neuropsychological symptoms and their primary care physicians (PCPs).Cross-sectional qualitative interview study of PCPs.	Physicians' offices, primarily managed care.	Forty PCPs in Northern California.	Open-ended interviews lasted 30-60 minutes. The interview guide covered clinician background, practice setting, clinical care of a particular patient, and general approach to managing patients with Alzheimer disease or related dementias.Interviews were transcribed and themes reflecting referrals identified.	Ninety-three percentage of the PCPs described problematic access to and communication with mental health specialists (in particular psychiatrists and neuropsychologists) as impediments to effective care for dementia patients. Thematic analysis identified structural barriers to mental health referrals ranging from problems with managed care and reimbursement policies to lack of trained providers and poor geographic distribution of specialists. Structural barriers compromised care for patients with dementia because the barriers limited PCP treatment options, and resources, impacted office staff and time with other patients, impeded and delayed care, and fostered poor communication and lack of coordinated care. Negative consequences for PCPs included increased frustration,conflict, and burnout.	PCPs viewed problems created by onerous referral systems, such as mental health carve outs, as particularly burdensome for elderly patients with comorbid dementia and neuropsychiatric problems. These problems were cited by PCPs across different types of practice settings. PCPs managed treatment of neurobehavioral symptoms as best they could despite lack of specialist support.	
20585422	To explore pharmacy students' experiences with and perceptions of aggressive incidents in pharmacy practice.Data were taken from a survey completed by second-year pharmacy (P2) students and analyzed using a retrospective, cross-sectional design. Survey items were adapted using the following scales: Perception of Aggression Survey (POAS), List of Aggressive Incidents experienced by mental health staff, and List of Emotions experienced by nurses.	The majority of respondents did not identify aggression as normal, instead perceiving it as a violent reaction and functional. The 3 most frequent aggressive incidents experienced were: verbal abuse to face (40%); verbal abuse on the phone (39%); and refusal to cooperate with instructions (34%). The 3 most frequent emotions reported were: frustration (70%), empathy (65%), and no pride in their profession (70% rarely-never).	Pharmacy students reported experiencing aggressive incidents with patients in person and on the phone, and with patients not following instructions. Preparing future pharmacists in techniques to address and resolve patients' aggression must become a priority for pharmacy academia and further research in this area is needed.	
20581218	The purpose of this article was to understand the experience of speech impairment (speech sound disorders) in everyday life as described by children with speech impairment and their communication partners.Interviews were undertaken with 13 preschool children with speech impairment (mild to severe) and 21 significant others (family members and teachers).	A phenomenological analysis of the interview transcripts revealed 2 global themes regarding the experience of living with speech impairment for these children and their families. The first theme encompassed the problems experienced by participants, namely (a) the child's inability to "speak properly," (b) the communication partner's failure to "listen properly," and (c) frustration caused by the speaking and listening problems. The second theme described the solutions participants used to overcome the problems. Solutions included (a) strategies to improve the child's speech accuracy (e.g., home practice, speech-language pathology) and (b) strategies to improve the listener's understanding (e.g., using gestures, repetition). Both short- and long-term solutions were identified.	Successful communication is dependent on the skills of speakers and listeners. Intervention with children who experience speech impairment needs to reflect this reciprocity by supporting both the speaker and the listener and by addressing the frustration they experience.	
20580048	Advance directive (AD) use is uncommon in surgical patients, yet the exact reasons for this are unknown. Our aim was to identify and describe beliefs held by surgeons regarding ADs. A qualitative exploration of physicians' opinions of ADs for surgical patients was designed. This methodology is preferred to quantitative techniques, which are subject to bias when an issue's underlying themes are unknown.A purposive sample of physicians, primarily surgeons performing high-risk operations, was interviewed using a semi-structured questionnaire. Representation from several subspecialties established maximum transferability. Data collection continued until theoretical saturation was achieved. Transcribed audiotapes were first coded independently and then collaboratively using a coding scheme developed through grounded theory and deductive approaches. Modeling identified themes and trends to ensure faithful data representation.	Three significant themes emerged, illustrating the conflicting attitudes surgeons harbor with respect to ADs. Surgeons described a general benefit of ADs in providing a framework for discussion ("It [AD] is a useful framework to begin discussion in the end of life issues for the patient."), but they also exhibited frustration with the disconnect between reality and written ADs ("What they [patients] really mean and what the words say are totally different.") and felt conflicted between the battle for surgical cure and the treatment limitations that occur with ADs in practice ("[ADs] may tie a surgeon's hands that might influence my judgment in performing the operation.").	Surgeons describe conflicting feelings about ADs for high-risk surgical patients. These beliefs and attitudes may be an underlying factor for the limited use of ADs by surgical patients. Methods for improving effective use of ADs in surgical practice must address these attitudes.	
20576177	This investigation examined transactional relations across contextual strain, parenting quality, and child adjustment in 209 mothers and children at 24, 42, and 72 months of age. Independent ratings of mothers' stressful life events, social support, and relationship quality provided an objective measure of maternal contextual strain. Observers evaluated parenting quality during parent-child interactions at each time point. Child regulatory functioning during laboratory tasks at 24 and 42 months was evaluated by independent observers based on both behavioral (e.g., noncompliance, distractibility) and emotional (e.g., frustration, anger) indices. At 72 months, teachers reported on children's externalizing behaviors, and children completed objective measures of academic achievement. Nested path analyses were used to evaluate increasingly complex models of influence, including transactional relations between child and parent, effects from contextual strain to parenting and child adaptation, and reciprocal effects from child and parent behavior to contextual strain. Over and above stability within each domain and cross-sectional cross-domain covariation, significant paths emerged from maternal contextual strain to subsequent child adjustment. Bidirectional relations between parenting and child adjustment were especially prominent among boys. These findings counter unidirectional models of parent-mediated contextual effects by highlighting the direct influences of contextual strain and parent-child transactions on early childhood behavioral and academic adjustment, respectively.
20573133	We examined mothers' ratings of children's affective and behavioral aspects of approach tendencies and links with overt aggressive behavior problems while considering the genetic etiology of these processes. Approach/positive anticipation (AP), frustration/anger (FA), and overt aggression in 4-9-year-olds were assessed using mothers' reports in a diverse national sample (n=992) and a sample of same-sex twins (n=195 pairs). AP and FA were positively correlated with each other and with overt aggression (r from .2 to .5), and these associations were very similar for boys and girls. AP and FA provided overlapping as well as independent statistical prediction of aggression. AP statistical prediction of aggression was substantially mediated by FA, an effect that was accounted for by underlying genetic and nonshared environmental influences.
20564682	The authors describe and illustrate means of engaging depressed African American adolescents in treatment. Twenty-eight youth participated in focus groups or individual interviews. Using grounded theory and transcript based analysis, they derived 5 themes describing African American adolescents' experience of depression and suggested mechanisms for improving African American youth treatment engagement. Practitioners can educate African American youth about depression as a medical disorder, build trust, and apply innovative approaches to recognizing differential manifestations of depression in African American youth.
20562755	This paper describes a patient who is suffering from PTSD with elements of hypochondria, panic attacks and episodes of depression in comorbidity with kidney stones. Kidney stones provoked egzacerbation of psychiatric symptoms. Kidney stones and frustration about them have taken part of provoking factor, the last drop, which led to regression of otherwise precarious, but compensated patient's mental functioning which resulted in development of psychiatric symptoms.
20555259	Empathic and informative interactions with health professionals are important for the well-being of people with cancer. However, there is a dearth of research examining the construction and experience of interactions with health professionals from the perspective of informal cancer carers.The aim of this study was to explore how cancer carers subjectively position their experiences of interactions with health professionals, in particular, their construction of experiences as positive or negative, and the perceived consequences of such interactions. Positioning theory is used to examine how the sociomedical construction of health professionals shapes carers' experiences of interactions with them.	Semistructured interviews were carried out with 53 informal cancer carers across a range of cancer types and stages, analyzed using thematic decomposition.	Carers positioned positive interactions as those involving health professionals who were warm and genuine, accessible and approachable, and who made carers feel accepted and comfortable. In the case of allied health professionals, the provision of a space for carers' cathartic release was also constructed positively. Negative interactions were positioned as those involving poor communication and a lack of empathy, poor or absent information provision, and absence of guidance about additional support.	Positive experiences with health professionals were positioned by carers as leading to feelings of empowerment, value, and recognition, and negative interactions as leading to distress, anger, frustration, and feelings of isolation.	It is important for health professionals to be supportive of carers' needs, to communicate in an empathic manner, to be approachable and accessible, and to recognize carers needs and concerns.	
20545815	Building on prior cross-sectional work, this longitudinal study evaluated the proposition that maternal and paternal overreactive and authoritative parenting mediates the effect of child personality characteristics on externalizing behavior. Data from the Flemish Study on Parenting, Personality, and Problem Behavior were used in a moderated mediation analysis (N=434). Teachers rated children's Big Five characteristics, fathers and mothers rated their parenting, and 3 years later, children rated their externalizing behavior. Mediational analysis revealed both direct and indirect effects. Higher levels of Extraversion and lower levels of Benevolence were related directly to higher levels of child externalizing behavior. Higher levels of paternal authoritative parenting and lower levels of maternal overreactivity were related to lower scores on externalizing behavior. In addition, the relation between Benevolence, Emotional Stability, and externalizing behavior was partially mediated by parental overreactivity. Conscientiousness had an indirect effect on externalizing behavior through paternal authoritative parenting. Relations were not moderated by child gender. This study is of theoretical interest because the results demonstrate that parenting is a mediating mechanism that accounts for associations between personality and externalizing behavior.
20544380	Gender-based violence rooted in norms, socialization practices, structural factors, and policies that underlie men's abusive practices against married women in India is exacerbated by alcohol. The intersection of domestic violence, childhood exposure to alcohol and frustration, which contribute to drinking and its consequences including forced sex is explored through analysis of data obtained from 486 married men living with their wives in a low-income area of Greater Mumbai. SEM shows pathways linking work-related stress, greater exposure to alcohol as a child, being a heavy drinker, and having more sexual partners (a proxy for HIV risk). In-depth ethnographic interviews with 44 married women in the study communities reveal the consequences of alcohol on women's lives showing how married women associate alcohol use and violence with different patterns of drinking. The study suggests ways alcohol use leads from physical and verbal abuse to emotional and sexual violence in marriage. Implications for gendered multi-level interventions addressing violence and HIV risk are explored.

20529785	Peripheral neuropathies are a common side effect of certain types of chemotherapy drugs, including taxanes, platinum-based drugs, vinca alkaloids, and thalidomide. Neuropathies may last for months or years following treatment and can impact functional performance and quality of life. The purpose of this study was to explore the effects of chemotherapy-induced peripheral neuropathy (CIPN) and neuropathic pain on the lives of patients with cancer. Participants were recruited from an urban outpatient medical oncology clinic in West Central Florida. Semistructured, private interviews with 14 participants were conducted and transcripts were reviewed for symptoms and effects. Participants often had difficulty describing neuropathic symptoms but reported simultaneous pain or discomfort and loss of sensation in the upper and lower extremities. Injuries secondary to numbness, muscle weakness, and loss of balance were reported. Neuropathic symptoms interfered with many aspects of daily life and participants voiced feelings of frustration, depression, and loss of purpose as a result of having to give up enjoyable activities. The results of this study emphasize the importance of ongoing assessment and communication with patients about their experiences with peripheral neuropathies. Knowledge of what patients with CIPN experience will guide nurses in suggesting interventions to promote safety and help alleviate symptoms.
20517229	The purpose of this study was to analyze the subjective mechanisms of symptomogenesis (semantogenesis) of disturbed body perception in psychosis. Three groups of psychiatric patients (58 with schizophrenic spectrum disorders, 15 with affective disorders and 32 with organic disorders) with pathological body sensations (sensopathies) and 64 controls with somatic disorders accompanied by pain were studied clinically and with the Component Language Analysis. Based on the clinical and linguistic analysis of utterances of patients, we propose an evolutionary model that describes the development of sensopathies as a continuum of frustration arising from a so-called protopathic shift, the further formation and differentiation of which is provided by subjective (linguistic, first of all) factors of symptomogenesis, which we understand as sematogenesis (the sense formation). The component analysis has shown that the lexical structure of patient's utterances is formed on a basis of a small number of classifying conceptions according to which 7 lexical-semantic groups (LSG) have been discriminated. These groups form, in their turn, two thematic lines: hyperpathical (pain, burning, pressure) and parapathical (volume, density, form, movement).
20509794	This paper describes a case of a hospice patient that a hospice and palliative care team struggled to palliate. We review a case of a 63-year-old man with anal squamous cell carcinoma who was transferred from an inpatient hospice unit to an intensive care setting in an ill-fated attempt to alleviate his pain and suffering. This paper also describes the frustration and desperation on the part of his medical and interdisciplinary team to provide him adequate relief. In retrospect, there were likely many system factors that may have contributed to this patient's ongoing suffering, including restrictions on the use of certain medications by location (i.e., hospice unit versus intensive care setting) as well as medication and ordering misunderstandings. Opiate neurotoxicity, existential and spiritual angst, and social isolation also contributed substantially to this patient's suffering. Furthermore, we describe not only the importance of exhausting all medical resources to relieve patients' pain and suffering, but also of learning to sit with patients in their suffering.
20500288	The aim of the study was to investigate what expressions nurses use when documenting patient-focused nursing care in electronic patient records.Much effort has been made in the development of nursing documentation. Many studies have found inadequate reporting, focused more on tasks and treatment than on the patient's voice. Electronic patient record-systems have been introduced, bringing new challenges because of unfamiliarity with computers. Electronic patient records have caused dissatisfaction and frustration, however, some studies show improvement in documentation given enough time and effort. Electronic patient record documentation is an integral part of patient-focused care and thus needs to be investigated.	The study is based on the grounded theory approach, as developed by Strauss and Corbin.	Forty electronic patient records were analysed, considering whether nurses' written expressions reflected a patient-focused approach. An inductive qualitative method was used, involving constant comparative analysis, up to axial coding.	Three categories emerged from the data: Patient's voice: the patient has expressed his/her thoughts, which are written by the nurse, Nurse's view: the nurse recounts the patient's own thoughts, state or situation and mutual view in patient-nurse relationship: the documentation describes the patient-nurse relationship.	This study found that the nursing documentation was patient-focused, to some extent. This is significant because nursing documentation represents much more than simply a record of the continuity of care. Many topics for further studies were presented, e.g., the timing of documentation and the differences between the mode of nursing and the documentation.	The presented findings may be helpful in the development of nursing documentation in electronic patient records and in nursing practice generally. Highlighting the patient's voice could become an effective tool in nursing and its documentation, saving time and getting clear information for improving the patient's care.	
20493913	The present study examined whether mindfulness-based strategies can effectively reduce food cravings in an overweight and obese adult population. Individuals participating in a dietary group treatment for overweight received an additional 7-week manual based training that aimed to promote regulation of cravings by means of acceptance. The control group did not receive this additional training program. The results showed that participants in the experimental group reported significantly lower cravings for food after the intervention compared to the control group. The findings are discussed in terms of possible mechanisms like prevention of goal frustration, disengagement of obsessive thinking and reduction of automatic relations between urge and reaction.
20471321	Although heart disease is the single most common cause of death knowledge about palliative care for this group of patients is deficient.The aim of this study was to describe physicians' experiences of palliative care for heart failure patients.	Fifteen physicians at a medical geriatrics clinic were interviewed. The interviews were analysed using thematic content analysis.	The results show that the physicians are confronted with patients with an unpredictable disease trajectory, including patients with severe symptoms, uncertainty about anticipating the course of dying and encountering close relative's anxiety and frustration. The physicians face difficult situations regarding whether to continue or withdraw care and medical treatment which means deciding concerning 'active' medical treatment, cardio pulmonary resuscitation and an implantable cardioverter-defibrillator (ICD). The physicians acknowledge the necessity for better structured follow-ups and cooperation with outpatient settings. They recognize that there is a lack of follow-ups and continuity of care and treatment at the hospital, involving their passing on or retaining responsibility for the patients' medical care.	From the physicians' view clarification of who is principally responsible for the patient's medical care, being involved throughout the disease trajectory and cooperating more closely with palliative care services are necessary to further improve the way in which care is delivered to patients dying of heart failure.	
20464410	Aging is a natural consequence of a society developing process. Although many adults retain good hearing as they aging, hearing loss related with age-presbycusis which can vary in severity from mild to substantial is common among elderly persons. There are a number of pathophysiological processes underlying age-related changes in the auditory system as well as in the central nervous systems. Many studies have been dedicated to the illustration of risk factors accumulating presbycusis such as heritability, environment factors, medical conditions, free radical (reactive oxygen species, ROS) and damage of mitochondrial DNA. Left untreated, presbycusis can not only lead sufferers to reduced quality of life, isolation, dependence and frustration, but also affect the healthy people around. These can be partly corrected using hearing aids, but it is not enough, more and more strategies of treatment based on the findings associating with presbycusis should be added rather than using single hearing aids. We review here the pathophysiology; heritability, susceptibility genes and other risk factors including environmental, medical, especially free radical (ROS) and damage of mitochondrial DNA; and some strategies of treatment, as well as promising rehabilitations associating with presbycusis.
20464261	To understand how Estratégia Saúde da Família (Family Health Strategy) nurses experience the overlapping of duties and building of technical autonomy.This was a qualitative study performed with 22 nurses, in the city of Recife, Northeastern Brazil, between August 2005 and November 2006. Based on management evaluation (geographic access; conflicts in the team, between team and district and between team and community; and public violence in the area), four teams were selected in each of the six health districts. Semi-structured interviews were conducted. The main themes in the interview guide were about work expectations and relevance, its organization and process, and feelings towards these practices. The results were interpreted under the perspective of burnout.	The nurses' opinion on the excessive number of families, insufficient organizational support and pressures from user demands that had not been met was recurrent. Overlapping of health care and management caused work overload, creating anxiety, impotence, frustration and the feeling of being treated unfairly when tasks were divided among team members. The clinical dimension of practice led to a feeling of insecurity of a technical and ethical nature, in addition to the satisfaction for the power and prestige achieved by the professional category. Specialized medical training represented an obstacle to autonomy and responsibility becoming interdependent. Stress, dissatisfaction, becoming physically and mentally ill, recognition of the relevance of work and importance of one's performance, and low work involvement were reported.	In view of the lack of expectation of changes in the short term, the overlapping of low professional satisfaction and work overload causes negative attitudes, indicating the importance of health promotion to increase the possibility of influencing and changing work conditions.	
20464255	To analyze experiences of heterosexual Mexican people living with HIV (PLWHA) related to the exercise of their sexual and reproductive rights.Qualitative study based on 40 in-depth interviews with PLWHA in four Mexican States.	Lack of support and counseling limits the exercise of sexual and reproductive rights by PLWHA, especially women. Principal limitations include feelings of frustration and confusion, fear of re-infection, scanty information, lack of power to negotiate condom use, social stigma and discrimination, and limited access to services and adequate technologies.	To increase awareness and exercise of rights by PLWHA it is necessary to: improve sexual education; promote processes of cultural change to combat gender inequality and stigma and discrimination; and provide timely and scientific information about HIV prevention.	
20444771	The purpose of this study was to illuminate the ethically difficult situations experienced by care providers working in a nursing home. Individual interviews using a narrative approach were conducted. A phenomenological-hermeneutic method developed for researching life experience was applied in the analysis. The findings showed that care providers experience ethical challenges in their everyday work. The informants in this study found the balance between the ideal, autonomy and dignity to be a daily problem. They defined the culture they work in as not supportive. They also thought they were not being seen and heard in situations where they disagree with the basic values of the organization. The results are discussed in terms of Habermas's understanding of modern society. Care settings for elderly people obviously present ethical challenges, particularly in the case of those suffering from dementia. The care provider participants in this study expressed frustration and feelings of powerlessness. It is possible to understand their experiences in terms of Habermas's theory of modern society and the concept of the system's colonization of the life world.
20442271	This article explores the experience of offenders while under probation supervision and analyses the "pains of probation" in connection to rehabilitation aspirations. The article has two main parts. In the first part of the article, the experiences of probationers are examined using thematic analysis, and eight different pains of probation are identified. In the second part of the article, these pains of probation are examined from two different perspectives: human rights and the Good Lives Model. The conclusion is that these two perspectives support each other and can help reduce the frustrations and deprivations experienced by individuals on probation. By implementing these two perspectives, probation services may overcome the obstacles toward desistance and earn more legitimacy in the eyes of probation recipients.
20433598	We present four case illustrations highlighting the complex interplay of therapists' and clients' spirituality in therapy. Complexity, in these cases, results from (a) degrees of similarity and difference, both real and perceived, between clients' and therapists' spiritual beliefs and practices; (b) degrees of spiritual disclosure; (c) characteristics of the therapeutic relationship; and (d) geographic and cultural influences. Practicing therapists and therapist training programs can benefit from addressing how therapist and client spirituality intersect and influence therapy, how both similarity and difference present obstacles and opportunities, and how ambiguity and assumptions can contribute to misunderstandings. We believe that both the therapist's and the client's spiritualities are key influences in therapy that can contribute to the frustration, and the growth, of clients and therapists alike.
20426796	Variability in behaviour displayed by children with fragile X syndrome (FXS) may be partially attributable to environmental factors such as maternal responsivity. The purpose of this study was to explore variables associated with maternal behaviour during a task designed to elicit frustration in their children with FXS.Forty-six mother-child dyads, in which the child had full-mutation FXS, were observed in their homes during a task designed to elicit frustration in the child. Each child was given a wrong set of keys and asked to open a box to retrieve a desired toy. Mothers were provided with the correct set of keys and instructed to intervene when they perceived their child was getting too frustrated. Child-expressed frustration and requests for help and maternal behaviours (comforting, negative control, and encouraging/directing) were observed and coded. Maternal variables (e.g. depression, stress, education levels), child variables (e.g. autistic behaviours, age, medication use) and child behaviours (frustration, requests for help) were explored as predictors of maternal behaviour.	Almost all mothers intervened to help their children and most used encouraging/directing behaviours, whereas very few used comforting or negative control. Child age and child behaviours during the frustrating event were significant predictors of encouraging/directing behaviours in the mothers. Children whose mothers reported higher depressive symptomology used fewer requests for help, and mothers of children with more autistic behaviours used more negative control.	The results of this study suggest that child age and immediate behaviours are more strongly related to maternal responsivity than maternal traits such as depression and stress.	
20424032	We show how being "jilted"-that is, being thwarted from obtaining a desired outcome-can concurrently increase desire to obtain the outcome, but reduce its actual attractiveness. Thus, people can come to both want something more and like it less. Two experiments illustrate such disjunctions following jilting experiences. In Experiment 1, participants who failed to win a prize were willing to pay more for it than those who won it, but were also more likely to trade it away when they ultimately obtained it. In Experiment 2, failure to obtain an expected reward led to increased choice, but also negatively biased evaluation, of an item that was merely similar to that reward. Such disjunctions were exhibited particularly by individuals low in intensity of felt affect, a finding supporting an emotional basis for relative harmonization of wanting and liking. These results demonstrate how dissociable psychological subsystems for wanting and liking can be driven in opposing directions.
20424026	We examined the role of working memory in observed reactive parenting in a sample of 216 mothers and their same-sex twin children. The mothers and their children were observed completing two frustrating cooperation tasks during a visit to the home. The mothers worked one-on-one with each child separately. Mothers completed the Vocabulary (verbal), Block Design (spatial), and Digit Span (working memory) subtests of the Wechsler Adult Intelligence Scale-Third Edition. We used a within-family quasi-experimental design to estimate the magnitude of the association between sibling differences in observed challenging behaviors (i.e., opposition and distractibility) and the difference in the mother's negativity toward each child. As hypothesized, reactive negativity was evident only among mothers with poorer working memory. Verbal and spatial ability did not show this moderating effect. The effect was replicated in a post hoc secondary data analysis of a sample of adoptive mothers and sibling children. Results implicate working memory in the etiology of harsh reactive parenting.
20423635	In the present study, we designed a model of self-regulated inquiry that connects theory to practice for teachers to deepen their understanding of the core beliefs, commitment, and the experiences shaping their professional identity. The rationale of this model was grounded in motivational and identity theories related to self-regulation, self-efficacy, and goal setting. We posed three questions to 342 participants enrolled in graduate courses in educational psychology. These questions formed part of an interview process used as a dialogic retrospection to elicit teachers' voices. The results were summarized in meaningful written narratives, which were analyzed for generative themes. The researchers identified several themes that related to findings from the literature, confirming that (a) teacher identity is a complex construct, related to teachers' experiences of success and frustration, age, and cultural context; (b) the dialogic retrospection served as a mediator to clarify what influenced their teacher identity, and (c) the self-regulated inquiry model helped teachers to assess the development of their professional growth from a motivational perspective. Implications for teacher education and research to expand the notion of teacher identity are discussed.
20423549	Many problem behaviors in youth have been attributed to maladaptive self-regulation in response to frustration. Frontolimbic networks that promote flexible as well as over- and undercontrolled regulation could provide evidence linking cortical mechanisms of self-regulation to the development of internalizing or externalizing symptomology. Specifically, ineffective dorsally mediated inhibitory control may be associated with rule-breaking and substance use behaviors, whereas overengagement of ventral limbic systems responsible for self-monitoring of errors may increase risk of developing anxious and depressed symptomology. In this study, a sample of 9- to 13-year-old children were presented with an emotional go/no-go task. Event-related potentials were used to identify differences in cortical mechanisms related to inhibitory control (indexed with the stimulus-locked medial frontal negativity) and self-monitoring (indexed with the error-related negativity). These measurements were then related to externalizing and internalizing behaviors. As predicted, externalizing problems were associated with smaller medial frontal negativity amplitudes, which indicate undercontrolled self-regulation and poor dorsal mediation of actions. Internalizing symptoms were related to larger error-related negativity amplitudes, demonstrating overregulation and overengagement of ventral limbic systems. These findings suggest that the use of event-related potential methodology with paradigms that elicit cognition-emotion can provide insight into the neural mechanisms of regulatory deficits that result in problem behaviors in youth.
20419576	Lahey and Waldman (2003, 2005) proposed a model in which three dispositions-sympathetic response to others; negative emotional response to threat, frustration, and loss; and positive response to novelty and risk-transact with the environment to influence risk for conduct disorder (CD). To test this model, the Child and Adolescent Dispositions Scale (CADS) was developed to measure these dispositions using parent ratings of the child. Here we report psychometric evaluations of a parallel youth self-report version (CADS-Y). Exploratory factor analysis of CADS-Y items among 832 9- to 17-year-olds yielded a 3-factor structure that was consistent with the model and invariant across sex and informants. In 1,582 pairs of 9- to 17-year-old twins, confirmatory factor analyses supported the CADS-Y 3-factor model. Each CADS-Y dimension was associated with CD and related personality dimensions as predicted.
20410021	To prospectively validate the Parent and Adolescent Medication Barriers Scales (PMBS and AMBS) for assessing perceived barriers to medication adherence in adolescent transplant recipients by examining the relations of perceived barriers to medication adherence and clinical outcomes at 18-month follow-up.Of the 82 adolescent recipients enrolled in the initial cohort, 66 families participated in the follow-up. Relations among barriers, adherence, and clinical outcomes were examined.	Reported barriers demonstrated temporal stability over an extended span of time. Adolescent-perceived barriers of Disease Frustration/Adolescent Issues and parent-perceived barriers of Regimen Adaptation/Cognitive Issues were associated with poorer adherence to medication taking at follow-up. Interestingly, medical complications and mortality were significantly associated with both parent and adolescent-perceived ingestion issues barriers.	Barriers to adherence are essential to address in an effort to ameliorate adherence difficulties and potentially reduce the incidence of medical complications.	
20405198	This research examined whether variations in salivary measures of the hypothalamic-pituitary-adrenal axis (cortisol) and autonomic nervous system (alpha amylase [sAA]) contribute to individual differences in the association between peer victimization and aggression. Children (N = 132; M age = 9.46 years, SD = 0.33) completed a measure of peer victimization, teachers rated children's aggression, and children's saliva was collected prior to, and following, participation in a laboratory-based peer-oriented social challenge task. Children rated their level of frustration at the end of the task. Results revealed that victimization interacted with cortisol and sAA measured in anticipation of the task to predict aggression; the victimization x cortisol contribution to aggression was partly mediated by children's self-reported frustration level. Victimization also was associated with heightened frustration in girls with high task-related sAA reactivity. Task-related sAA reactivity was associated with heightened aggression, but only for girls. These findings suggest that associations between peer victimization and aggression are moderated by variation in the activity of the major components of the psychobiology of stress; results are discussed in relation to theoretical models of individual differences in biological sensitivity to context.
20402422	Work-family conflict and job burnout are both issues for 272 correctional staff (response rate of 68%). The two major forms of work-family conflict are work-on-family conflict and family-on-work conflict. Multivariate analysis of survey data from 272 correctional staff at a state prison indicated work-on-family conflict had a significant positive relation with job burnout, while family-on-work conflict did not.

20379778	Clinical leaders and other practicing psychiatrists face a great deal of pressure and frustration in their professional lives. Organizational, supervisory, practice and interpersonal challenges are great. The potential for burnout is high, perhaps higher than for those in other medical disciplines. With these concerns in mind, a facilitated meeting of a large group of clinical directors working in New York State's Office of Mental Health was focused on a discussion of the role of the clinical director. The meeting employed an approach that can be termed "mindfulness". Clinical directors described their current roles, what they would like their roles to be, impediments to achieving the roles they wished to have and approaches that could be taken (mainly by themselves) to enhance their role success and satisfaction. The paper describes this process and its outcome.
20373727	Academic writing can fill pre- and postregistration students with fear and dread. Students often construct written work around re-worded passages from their sources. This results in poor quality work, low marks and frustration. The aim of this article is to inform students embarking on courses in higher education about what academic writing is and equally importantly what it is not.
20362215	The Joint Commission mandates that hospitals seeking accreditation have a process to define and address disruptive behavior. Leaders at Maimonides Medical Center, Brooklyn, New York, took the initiative to create a code of mutual respect that not only requires respectful behavior, but also encourages sensitivity and awareness to the causes of frustration that often lead to inappropriate behavior. Steps to implementing the code included selecting code advocates, setting up a system for mediating disputes, tracking and addressing operational system issues, providing training for personnel, developing a formal accountability process, and measuring the results.
20345695	OBJECTIVES Improving nurses' competence in resolving clinical ethical issues must start with ethics education in training and clinical practice. However, many students complain that they cannot apply classroom learning to actual clinical scenarios. This study explored ethical issues and dilemmas, and their impact experienced by student nurses in clinical practice. METHODS Focus groups were conducted with 44 first-year student nurses from a 2-year college course in northern Taiwan. Interviews were tape-recorded and verbatim transcripts were analysed using content analysis. RESULTS Students expressed and discussed their views in eight focus groups. Analysis of interviews revealed five themes: frustration at inability to help some patients; oppression caused by lower status; lack of honesty and ethical courage; powerlessness, and self-encouragement in adversity. CONCLUSIONS Taiwanese nurse ethics training was only recently introduced and the curriculum has not addressed the clinical reality in Taiwan. This reality includes limitations arising from the medical hierarchy and the socio-cultural role of families in medical decision making, which may inhibit ethical judgements and decision making. In clinical dilemmas, the most common problems faced by Taiwanese nursing students involved not knowing how to handle some situations, inability to abide by principles, and a lack of appropriate role models. Hence, we suggest that nursing ethics education should: (i) integrate scenarios involving ethical dilemmas into daily routines; (ii) give students opportunities to discuss their feelings about their experiences; (iii) allow teachers and students to talk about scenarios with ethical implications, and (iv) provide students with opportunities to reflect on clinical scenarios in order to clarify their values and learn how to respect the value of life.
20331671	To further the understanding of the effects of early experiences, 9-month-old infants were observed during a frustration task. The analytical sample was composed of 348 linked triads of participants (adoptive parents, adopted child, and birth parent[s]) from a prospective adoption study. It was hypothesized that genetic risk for externalizing problems and affect dysregulation in the adoptive parents would independently and interactively predict a known precursor to externalizing problems: heightened infant attention to frustrating events. Results supported the moderation hypotheses involving adoptive mother affect dysregulation: Infants at genetic risk showed heightened attention to frustrating events only when the adoptive mother had higher levels of anxious and depressive symptoms. The Genotype x Environment interaction pattern held when substance use during pregnancy was considered.
20308843	To estimate the effect of anal incontinence on postpartum quality of life (QOL).We conducted a longitudinal follow-up study of women reporting anal incontinence on a statewide postpartum survey to estimate the effect of anal incontinence on QOL up to 2 years postpartum. Quality of life was assessed every 6 months for 2 years based on the Uebersax incontinence impact questionnaire. The effect of severe anal incontinence on QOL was determined by multivariate logistic regression.	A total of 1,050 women reported persistent anal incontinence and returned at least two completed QOL surveys during the 2-year study period. Among women with anal incontinence, 51% reported frustration caused by anal incontinence, 26% reported that anal incontinence affected their emotional health, 18.5% reported anal incontinence affected their child-caring abilities, and 16.2% reported a negative effect on social activities. One in three women with anal incontinence reported severe symptoms. Compared with women with mild anal incontinence, women with severe anal incontinence were four to seven times as likely to report that anal incontinence affected emotional health and the ability to perform daily activities. However, only 10% of women sought medical help for anal incontinence at 6 months, 13.5% at 1 year, and 16.7% at 2 years.	Even 2 years after delivery, more than a quarter of women who experience a new onset of anal incontinence after childbirth report persistently negative QOL. Despite this, few women discuss anal incontinence with their medical providers.	III.	
20300852	At the Kennedy Centre for Phenylketonuria, Denmark, large neutral amino acids (LNAAs) are being used to treat adult and adolescent patients who are nonadherent to dietary treatment for phenylketonuria (PKU). At the start of treatment, a patient must undergo dietary analysis and regular blood sampling to measure plasma amino acid (AA) concentrations. The aim of this analysis and treatment is that the patient receives 25-30% of the daily protein requirement from LNAA supplementation and the remaining 70-75% from natural, low-phenylalanine proteins (although some patients have difficulties in maintaining this level of protein intake). Patients are therefore able to follow a more "normal" diet than those adhering to a PKU diet with AA supplementation (in which only 20% of the daily protein requirement is provided from the diet and 80% from AA supplementation). LNAAs have also been used to treat older patients with untreated/late-diagnosed PKU who show profound intellectual, psychological, and behavioral impairments. Treatment with LNAAs has been shown to improve measures of concentration and awareness of external stimuli in some of these patients and thus enhance their socialization, emotionality, frustration tolerance, and mood. 
20230513	This paper explores the experiences of parents of asthmatic children in the period leading up to their child receiving a formal medical diagnosis. To what extent did the parents face difficulties in obtaining this diagnosis? How did they describe their encounters with the healthcare professionals? In particular, did parents portray themselves as passive and dominated or active and participating during the prediagnosis phase? In-depth interviews with individuals and participants in a focus group exposed the prediagnosis phase as a distinct and memorable phase of the disease, often recalled as a period of frustration and uncertainty. Results show that instead of accepting the authority of the professional, parents eventually acquire knowledge elsewhere about the diagnosis and the healthcare system, and act according to that knowledge. As a fundamental uncertainty appears involved in the diagnostic process, parents dealing with this uncertainty use a number of strategies to gain control of the process of alleviating their child's disease. The paper discusses the status of the information that the researcher obtained from parents. Lay narratives cannot be treated as simple reports of an external reality. As the parental role is rooted in normative conceptions about what constitutes 'responsible parenthood', information given to the observer may therefore be influenced by the informants' concern with their appearance as moral persons or adequate parents. Although a research strategy based on one-sided interviews has limitations, using parents as a source of information offers a rare glimpse into the realities of patient-physician encounters.
20222769	This qualitative study explored the experiences of children participating in modified constraint-induced movement therapy (CIMT) within a circus-themed day camp.Individual semi-structured interviews were performed with 32 children (15 girls, 17 boys; mean age 10.1 years) to gain insights into their experience of CIMT. Interviews were audio recorded, transcribed verbatim and independently read by two authors to identify common themes.	Three themes emerged from the data: children's experience of wearing the glove employed in the modified CIMT, their reactions to the camp format and the gains they made during the camp.	The results highlighted the need to achieve a balance between the frustration of participating in modified CIMT and what was seen as motivators to sustain involvement. Findings are interpreted in the context of self-determination theory and remind clinicians to ensure interventions consider autonomy, competence and relatedness.	
20215950	To describe the lived experience of nurse-midwives.A qualitative study using a phenomenological approach. Semistructured in-depth interviews were conducted with a purposive sample of 10 seasoned nurse-midwives. Two data-generating questions guided the study: "How would you describe the circumstances involving your decision to become a nurse-midwife?" and "What is the experience of being a nurse-midwife like for you?" Interviews were audio-recorded and transcribed verbatim. Data saturation was achieved, and analysis procedures were adapted from Colaizzi.	Seven themes emerged from the data: (1) The path to midwifery: Decisions and plans; (2) Midwifery education: Rigor and enlightenment; (3) Being "with woman": Positive presence and therapeutic alliance; (4) Midwifery as a vocation: A call to serve; (5) A juggling act: Balancing career and family life; (6) Professional struggles: Stress and frustration; and (7) Professional triumphs: Joys and satisfactions.	Insight into the experience of nurse-midwives provides a framework for additional research in this arena. Listening to the voices of midwives provides vital information about women's healthcare providers who do so much to add to the comprehensive care of women.	
20207927	Many patients with diabetes have poorly controlled blood glucose, lipid, or blood pressure levels, increasing their risk for cardiovascular disease (CVD) and other complications. Relatively little is known about what physicians perceive to be barriers to good CVD risk factor control or their own role in helping patients achieve good control.We interviewed 34 primary care physicians in 4 states to assess their perceptions of patients' barriers to CVD risk factor control. Interviews were coded and analyzed for emergent themes.	Physicians attributed barriers primarily to patients (socioeconomic issues, competing medical conditions, and lack of motivation) or to health system barriers (cost of care or lack of a multidisciplinary team). Physicians also expressed high levels of frustration with their efforts to address barriers.	Physicians felt that barriers to CVD risk factor control often were beyond their abilities to address. Training physicians or other members of the primary health care team to address patients' personal barriers and health system barriers to good control could help alleviate high frustration levels, improve relationships with patients, and improve the treatment of diabetes. Supporting such efforts with adequate reimbursement should be a focus of health care reform.	
20189914	To explore oncology nurses' perceptions and experiences with patient involvement in chemotherapy error prevention.Qualitative descriptive study.	In- and outpatient oncology units of a community hospital in Switzerland.	11 actively practicing oncology nurses working in an ambulatory infusion unit or on wards.	Oncology nurses participated in two focus groups on two occasions. Participants discussed their personal experiences with patients intervening to intercept errors, attitudes toward patient involvement in error prevention, and changes in relationships with patients. A content-analysis framework was applied to the transcripts and analytical categories were generated.	Perceptions about patient involvement in error prevention.	Participants shared affirmative attitudes and overwhelmingly reported positive experiences with engaging patients in safety behaviors, although engaging patients was described as a challenge. Nurses intuitively chose among a set of strategies and patterns of language to engage patients and switch between participative and authoritative models of education. Patient involvement in error prevention was perceived to be compatible with trustful relationships. Efforts to get patients involved have the potential for frustration if preventable errors reach patients. Considerable differences exist among organizational barriers encountered by nurses.	Nurses acknowledged the diverse needs of patients and deliberately used different strategies to involve patients in safety. Patient participation in safety is perceived as a complex learning process that requires cultural change.	Oncology nurses perceive patient education in safety as a core element of their professional role and are receptive to advancing their expertise in this area.	
20182933	The present investigation examined the incremental predictive validity of mindfulness skills, as measured by the Kentucky Inventory of Mindfulness Skills (KIMS), in relation to multiple facets of emotional dysregulation, as indexed by the Difficulties in Emotion Regulation Scale (DERS), above and beyond variance explained by negative affectivity, anxiety sensitivity, and distress tolerance. Participants were a nonclinical community sample of 193 young adults (106 women, 87 men; M(age) = 23.91 years). The KIMS Accepting without Judgment subscale was incrementally negatively predictive of all facets of emotional dysregulation, as measured by the DERS. Furthermore, KIMS Acting with Awareness was incrementally negatively related to difficulties engaging in goal-directed behavior. Additionally, both observing and describing mindfulness skills were incrementally negatively related to lack of emotional awareness, and describing skills also were incrementally negatively related to lack of emotional clarity. Findings are discussed in relation to advancing scientific understanding of emotional dysregulation from a mindfulness skills-based framework.
20174446	This study examined the association between the security of attachment and processes influencing the development of emotion regulation in young children. A sample of 73 4 1/2-year-olds and their mothers were observed in an emotion regulation probe involving mild frustration for children, and mothers and children were later independently interviewed about how the child had felt. Fewer than half the mothers agreed with children's self-reports in the emotion they attributed to children (a lower rate than the concordance of observer ratings with children's self-reports), and higher mother-child concordance was associated with secure attachment and mother's beliefs about the importance of attending to and accepting their own emotions. Mother-child conversations about recent events evoking children's negative emotion were also analyzed. Children were less likely to avoid conversing about negative feelings when they were in secure attachments and when mothers were more validating of the child's perspective. Children's greater understanding of negative emotions was also significantly associated with higher mother-child concordance and less child conversational avoidance. Taken together, these findings underscore the multiple influences of attachment on emotion regulation and the importance of children's emotion understanding to these processes.
20170429	This study presents emergent findings from a qualitative study of caregivers' well-being that illuminates why caregivers of children with autism are often found to be more stressed by their caregiving than caregivers of children with other disabilities. Nine mothers with diverse backgrounds whose sons had autism spectrum disorders participated. Data were gathered through intensive interviewing and analyzed using a deductive interpretive approach. Mothers characterized their caregiving as vigilance rather than burden. Yet, this vigilance was highly fatiguing. Mothers intensely attended to their children's activities. This intense focus promoted participation in self-care, leisure, and social activities, and prevented frustration and behavioral meltdowns. Mothers also performed "forensic analyses" to understand the root cause of participation problems. This parenting was intensive because mothers oversaw the children's activities at all times even during periods when mothers of typical children could take breaks. The children's continuing participation problems included limited self-care skills, difficulties in problem solving in novel situations, and lack of leisure skills. This intense vigilance may be a key factor in maternal health issues, such as anxiety and depression. While these problems fall within the scope of occupational therapy's expertise, it appears that many of these issues were not addressed by the current service-delivery models, leaving families to continue to struggle and the children to lack the skills for independent living as adults.

20152023	Prospective associations have been found between high use of information and communication technology (ICT) and reported mental symptoms among young adult university students, but the causal mechanisms are unclear. Our aim was to explore possible explanations for associations between high ICT use and symptoms of depression, sleep disorders, and stress among young adults in order to propose a model of possible pathways to mental health effects that can be tested epidemiologically.We conducted a qualitative interview study with 16 women and 16 men (21-28 years), recruited from a cohort of university students on the basis of reporting high computer (n = 28) or mobile phone (n = 20) use at baseline and reporting mental symptoms at the one-year follow-up. Semi-structured interviews were performed, with open-ended questions about possible connections between the use of computers and mobile phones, and stress, depression, and sleep disturbances. The interview data were analyzed with qualitative content analysis and summarized in a model.	Central factors appearing to explain high quantitative ICT use were personal dependency, and demands for achievement and availability originating from the domains of work, study, social life, and individual aspirations. Consequences included mental overload, neglect of other activities and personal needs, time pressure, role conflicts, guilt feelings, social isolation, physical symptoms, worry about electromagnetic radiation, and economic problems. Qualitative aspects (destructive communication and information) were also reported, with consequences including vulnerability, misunderstandings, altered values, and feelings of inadequacy. User problems were a source of frustration. Altered ICT use as an effect of mental symptoms was reported, as well as possible positive effects of ICT on mental health.	The concepts and ideas of the young adults with high ICT use and mental symptoms generated a model of possible paths for associations between ICT exposure and mental symptoms. Demands for achievement and availability as well as personal dependency were major causes of high ICT exposure but also direct sources of stress and mental symptoms. The proposed model shows that factors in different domains may have an impact and should be considered in epidemiological and intervention studies.	
20148797	The aim of the present study was to determine the mediating role of affiliation with cannabis-using peers in the pathways from various dimensions of temperament to life-time cannabis use, and to determine if these associations also contributed to the development of regular cannabis use.Objectives were studied using data from 1300 participants of the Tracking Adolescents' Individual Lives Survey (TRAILS), a large, general population study of Dutch adolescents. We used parent-reports on the Early Adolescent Temperament Questionnaire to assess the dimensions of high-intensity pleasure, shyness, fearfulness, frustration and effortful control at age 10-12 years. By means of self-reports, life-time and regular cannabis use were determined at age 15-18 years, and proportion of substance-using peers was determined at ages 12-15 and 15-18 years. Models were adjusted for age, sex, intelligence and parental cannabis use.	High-intensity pleasure [odds ratio (OR) = 1.09, 95% confidence interval (CI) = 1.05-1.13] and effortful control (OR = 0.92, 95% CI = 0.89-0.96) affected the risk for life-time cannabis use through their influence on affiliation with cannabis-using peers. Shyness affected this risk independently from peer cannabis use. Only the pathway from effortful control was associated additionally with the development of regular cannabis use (OR = 0.93, 95% CI = 0.89-0.98).	Peer cannabis use and, to a lesser extent, certain temperamental characteristics affect an adolescent's risk of cannabis use, and should be considered in prevention programmes. We recommend future research to focus upon factors that potentially modify the association between temperament, affiliation with cannabis-using peers and cannabis use.	
20142746	Optimal care for patients with cancer involves the provision of effective physical and psychological care. Nurses are key providers of this care; however, the effectiveness of care is dependent on the nurses' training, skills, attitudes, and beliefs.The study reported in this article explored cancer nurses' perceptions of their ability to provide psychosocial care to adults with cancer and their subsequent evaluation of the effectiveness of the care provided. This study was the first part of a larger project that evaluated the effectiveness of Proctor's model of clinical supervision in an acute care oncology environment.	An exploratory qualitative design was used for this study. One focus group interview was conducted with 10 randomly selected registered nurses working within the oncology units at a major Melbourne tertiary referral hospital. Analytic themes were developed from the coded data using content analysis.	The 4 analytic themes to emerge from the data were frustration, difficult to look after yourself, inadequate communication processes, and anger.	The findings from this study indicate that, although informal mechanisms of support are available for oncology nurses, most of these services are not accessed.	Leaders in cancer care hospital settings need to urgently develop and implement a model of support for their oncology nurses who are attempting to provide psychosocial support to oncology patients.	
20133405	To investigate how bereaved families felt about the explanation received before and after forensic autopsies, the authors conducted a cross-sectional survey of the bereaved families whose next of kin underwent a forensic autopsy at the two Departments of Forensic Medicine and a few bereaved families of crime victims. Of 403 questionnaires sent, 126 families responded. Among 81.5% of the respondents who received an explanation from policemen before the autopsy, 78.8% felt that the quality of the explanation was poor or improper. In Japan, the law has restricted disclosure of information from a forensic autopsy. Despite legal restrictions, 82% wanted to hear from the person who conducted the autopsy. However, police explained the results of autopsy to 65.2% of respondents. Among the families whose frustration and anger increased after autopsy, 86.4% had not been satisfied with the explanation before the autopsy. Additionally, 57.7% had not been informed on the autopsy findings at the time of the questionnaire when more than 2 years had passed after the autopsy. These results reminded us of the importance of an explanation before and shortly after a forensic autopsy for a better understanding and acceptance by bereaved families.
20132368	The purpose of this study was to explore the impact of recurrent bacterial vaginosis (BV) and its treatment on quality of life (QOL), acceptance of current treatment options, and psychosocial issues related to lifestyle practices associated with BV.Qualitative and quantitative data were obtained from 23 African American women with recurrent BV. Participants completed a short survey, developed by the researchers based on a prior study which examined factors associated with recurrent BV, and a one-on-one interview assessing the impact of BV, current treatment modalities, and lifestyle practices related to recurrent BV.	Emerging themes suggest that recurrent BV is associated with psychosocial issues that are currently not addressed in a typical office visit. Reported feelings of shame and embarrassment often cause women to engage in hypervigilant routines of hygiene that negatively impact their professional, personal, and intimate relationships, significantly affecting their QOL.	Without proper education, advice, and support, BV is perpetuated by lifestyle practices leading to recurrent infection and associated symptoms. With proper guidance, it is expected that women with recurrent BV will see an improvement in their QOL, with fewer complications from BV infection, and healthy relationships with intimate partners, family, and friends.	
20128518	This literature review explored the experiences of workers with on-the-job injuries, and the effect of psychosocial factors on their abilities to return to work. Four common themes were discovered frustration, depression, discrimination, and obstacles in understanding how the workers compensation system works and in obtaining care. The literature review suggested that interventions such as rehabilitation programs and psychosocial interventions help injured workers return to work. Nursing implications, including early, comprehensive, and fair interventions, are discussed. Intervening in this manner contributes to holistic nursing care of injured workers.
20120135	Neurologists and general practitioners frequently encounter patients with inexplicable, unintentionally produced somatic complaints otherwise known as somatoform disorders.A literature search was performed including MEDLINE, as well as local and intemrnational journals using the following keywords/ phrases and crossreferencing: somatoform disorder, somatization, medically unexplained physical symptoms.	Illness with excessive somatic preoccupation is difficult to diagnose or categorize reliably due to rigid diagnostic criteria that often overlap with several psychiatric disorders.	Management of patients with dysfunctional somatoform disorders is complex and challenging, particularly when initiated in a neurology outpatient or inpatient setting. The acronym CARE-MD represents a comprehensive treatment regimen that can be used to decrease physician and patient frustration, dramatically minimise health care over utilization, and improve overall well-being for patients with somatoform disorders.	
20117184	Groups of common carp (Cyprinus carpio) were trained for 33 days to discriminate between two acoustic signals differing in frequency and temporal pattern. One signal (positive stimulus) was reinforced by food, while the other (negative stimulus) was not rewarded. When exposed to 3 positive and 3 negative stimuli per day (training Paradigm 1) the fish responded similarly to the two signals. When daily negative stimuli outnumbered positive stimuli (3 positive and 33 negative, training Paradigm 2) the fish responded similarly to the two signals for the first 2 weeks and then began to discriminate between them. Discriminatory response was statistically significant from Day 21 of training. After 33 days, training was switched from Paradigm 2 to Paradigm 1 and the fish maintained their discriminatory capability. The results are interpreted in terms of anticipatory frustration and risk management.
20113964	Cross-border reproductive care, also called reproductive tourism, refers to the travelling of citizens from their country of residence to another country in order to receive fertility treatment through assisted reproductive technology. Several reasons account for cross-border reproductive care: (i) a certain kind of treatment is forbidden by law in the couple's own country or is inaccessible to the couple because of their demographic or social characteristics; (ii) foreign centres report higher success rates compared with those of the centres in the country of residence; (iii) a specific treatment may be locally unavailable because of a lack of expertise or because the treatment is considered experimental or insufficiently safe; and (iv) limited access to the treatment in the couple's home country because of long waiting lists, excessive distance from a centre or high costs. Although cross-border reproductive care can be viewed as a safety valve, the phenomenon is often associated with a high risk of health dangers, frustration and disparities. Solutions to these problematic effects need to be considered in the light of the fact that cross-border reproductive care is a growing phenomenon.
20110712	Dually diagnosed clients are described as one of the most challenging treatment populations, often leading to staff frustration, helplessness and negative attitudes. As yet it is unclear whether dual diagnosis (DD)-specific competency and therapeutic optimism among staff are related to client outcomes.The study used a 3-month follow-up design involving 124 DD clients starting treatment at 6 UK addiction services. Practitioners (n = 46) treating these clients were assessed regarding their DD specialisation levels. Cox regression analyses were performed to examine predictors of clients' 3-month retention rates.	Staff reported a median of 7 years work experience with DD clients, and 80% had received co-morbidity-specific training. Practitioners provided high average ratings on both the DD competency and the therapeutic optimism scale. Nevertheless, 78% of the sample indicated additional support needs in dealing with this client group. Higher levels of DD competencies among staff predicted better client retention.	The increased provision of support packages for practitioners is vital for improving competency levels in dealing with DD clients, which in turn may lead to improved client outcomes.	
20101940	The objective of this study was to describe the experience of caring for individuals at the end of life by five nurses working in curative care units. Semi-structured interviews were conducted to gain a better understanding of the meaning nurses give to this experience. The analysis of results, based on Giorgi's phenomenological method (1997), highlighted a central meaning: it is a human experience fraught with paradoxes where the bedside nurse feels both privileged to be accompanying these individuals at the end of their lives and torn between the medical priority given to curative care and the lesser priority given to palliative care. This study offers relevant options for nurse managers wanting to improve these nurses' work environment and the quality of care for individuals at the end of life.
20088922	Developmental goals of adolescence include attaining confidence in independent decision making and a positive image of the self, others and surrounding world. A diagnosis of cancer during adolescence has the potential to impact on successful achievement of these goals. This study examined the 'adolescent cancer experience' from the perspective of young people. In-depth semi-structured interviews were conducted with 10 young people (16-22 years old) who had been diagnosed with cancer during adolescence. Thematic analysis of interview transcripts revealed two latent themes: loss of control and benefit finding. Adolescents reported that feelings of loss of control resulted in a sense of frustration, feelings of inadequacy and anger, and non-compliance with treatment. Perceived benefits of cancer experiences included improved personal attributes, strengthened relationships and material gains. These themes have not previously been well described in this population. The findings underline the need for effective communication, ongoing psychological support and service flexibility when providing care for adolescents with cancer.
20082163	Recent research has shown that satisfaction with weight loss is predictive of weight loss maintenance, yet empirical evidence for how people derive satisfaction with weight loss is quite limited.To determine whether satisfaction with weight change systematically covaries with various weight-loss-related outcomes and experiences (e.g., improvement in physical appearance, amount of frustration experienced), which outcomes and experiences are the strongest longitudinal correlates of satisfaction, and whether the longitudinal covariations are due to between-person differences and/or within-person changes.	We analyzed longitudinal data obtained from overweight or obese individuals enrolled in a weight-loss program who were followed for 18 months using random coefficient models.	In univariate analyses controlling for the amount of weight people lost, nine of ten outcomes and experiences independently covaried with people's satisfaction, and the models accounted for 21-38% of the within-person variance in satisfaction. In a multivariate analysis, four outcomes and experiences remained as significant longitudinal covariates of satisfaction. In both sets of analyses, there were more significant relations due to within-person changes than to between-person differences.	The results suggest that people's weight loss satisfaction systematically covaries with ongoing changes in weight-loss-related outcomes and experiences. The findings help elucidate how people derive satisfaction with weight loss.	
20081165	Tip-of-the-tongue states (TOTs) are judgments of the likelihood of imminent retrieval for items currently not recalled. In the present study, the relation of emotion to the experience of TOTs is explored. Emotion-inducing questions (e.g., "What is the term for ritual suicide in Japan?") were embedded among neutral questions (e.g., "What is the capital of Denmark?"). Participants attempted to recall the answers and, if unsuccessful, were asked if they were in a TOT and given a recognition test. For unrecalled items, there were significantly more TOTs for the emotional items than for the neutral items, even though the recognition performance was identical. There were more TOTs for questions that followed emotional questions than TOTs for questions that followed neutral questions, suggesting the emotional arousal lasts beyond the specific question. These findings suggest that emotional cues increase the likelihood of TOTs. These data are consistent with a metacognitive view of TOTs.
20077577	Research suggests that rheumatoid arthritis (RA) can have a negative psychosocial impact on partners, as well as patients. However, until now there has been very little in-depth qualitative research in this area. The aim of this study was to explore the experiences of partners of people with RA.Semi-structured interviews were conducted with a heterogeneous sample of eight partners of people with RA (six men, two women, age range 48-73 years). Transcripts were analysed thematically.	Five overarching themes emerged: psychological burden in partners was substantial, as they experienced frustration and distress at watching their partner suffer and tried to protect their spouse from emotional and physical distress. 'It's a restricted life': partners reported having to cut back on previously enjoyable shared activities and had difficulty making future plans. Adjusting lives: partners had to make considerable adjustments to many aspects of their lives, and had adopted practical and psychological ways to cope. 'It's a joint approach': many partners discussed adopting a joint approach to managing the RA. Met and unmet support needs varied considerably, and many partners felt that a joint approach to treatment taken by health professionals is needed, which involves and recognizes their role.	Partners of people with RA are vital to the patients' disease management, but the data show that many carry a substantial psychosocial burden. Healthcare professionals should be aware of this, so that couples coping with RA can be better supported.	
20076874	Generally, medico-legal conflicts which occur in surgical and medical practice are a source of worry for both the medical profession and the society as a whole, because on one hand, they could cause high emotional stress for doctors, and on the other hand, patients could be rejected. Once consolidated, defensive medicine increases treatment costs and the doctor-patient relationship could transform into a tragedy. There are many causes for this, including non-treatment factors, such as an unsupported and disorganized health system, lack of participation from society and the doctor in improving this system, the training machine which launches a large number of young unprepared doctors to practice in this noble profession, along with a lack of continuing training, as there are few public or private institutions providing preparation, or further medical training. The related treatment factors are generally, a deficient doctor-patient relationship, poor work condition, power abuse by the doctor, a lack of clear agreement, and poor medical record keeping. These conflicts cannot be solved by simple creating legislation, or by denying the existence of medical error, which occurs at higher frequency than the actual conflicts. It is very important to improve the doctor-patient relationship because an effective fraternal relationship reduces the chance of a judicial demand. The doctor still needs to fully understand his/her conduct obligations and mainly to avoid power abuse. Doctors must also professionally link themselves with politicians who fight for the individual's rights against the system. Society must also understand that health is not just an issue exclusive for doctors, and people must fight to improve living conditions. Society must seriously show its frustration with the increasing disparity between scientific possibilities and actual wellbeing. The training machine needs immediate profound changes to produce professionals with the highest qualifications equipped for the needs of our population.
20070597	The professional role of nurses and mental health workers in social psychiatry is being re-defined towards a recovery, client-focused perspective. Approximately 0.7 percent of the adult population in Sweden suffers from severe mental illness leading to a need for community services. The primary aims of the Mental Health Reform in 1995 in Sweden were to improve the quality of life for people with severe, long-term mental illness and, through normalization and integration, enhancing their opportunities to communicate with and participate in society. This study examines nurses' and mental health workers' views and experiences of being care providers in a municipal psychiatric group dwelling context when caring for clients suffering from severe mental illness. Three focus group interviews were made and thematic content analysis was conducted. Four themes were formulated: 'Being a general human factotum not unlike the role of parents', 'Having a complex and ambiguous view of clients', 'Working in a mainly 'strangled' situation', and 'Feeling overwhelming frustration'. The staff, for instance, experienced a heavy workload that highly involved themselves as persons and restricted organization. The individual relational aspects of the nursing role, the risk of instrumentalizing the staff due to an organizational economical teleopathy (meaning a pathological desire to react goals), and the high societal demands on accomplishing the Mental Health Reform goals are discussed. To redefine the professional role of nurses and mental health workers in the community, in Sweden known as municipality, they need support in the form of continuously education, supervision, and dialogue with politicians as well as the public in general.
20049092	Among all types of sexual disturbance in men, disturbances of sexual function are the most important in clinical practice. These are classified by the segment of the sexual reaction cycle in which they arise (appetence, arousal, orgasm, and resolution). Partial functional impairment must be distinguished from dysfunction causing significant suffering and requiring treatment.The authors' clinical experience is supplemented with a selective review of the literature on sexual dysfunction, its association with underlying diseases, and its impact on sexual and relational satisfaction.	The sexual history (including the partner's sexual history, as far as this can be obtained) is of prime importance in the diagnostic evaluation of sexual disturbances. This evaluation must take the multidimensionality and multiple functions of human sexuality into account. Chronic frustration of the fundamental psychosocial needs for acceptance, closeness, and security is a very important factor that has been neglected until now by the prevailing conceptions of the etiology and pathogenesis of sexual disturbances. Their treatment involves a combination of elements from sexual medicine and psychotherapy, along with somatic medical and pharmacotherapeutic intervention, if needed. The goal of syndyastic sex therapy, a further development of the previous therapies, is to fulfill these fundamental needs and thereby to improve the patient's sexual function and deepen his satisfaction with the relationship in its entirety.	It is essential to understand the different types of sexual disturbance in their biopsychosocial context as well as the significance of sexuality for the individual, and for the couple, with respect to reproduction, sexual pleasure, and bonding. Sexual disturbances are common, and patients therefore expect their physicians to be proficient in sexual medicine. The coverage of this subject in both undergraduate and postgraduate medical education in Germany needs to be improved.	
27529932	The development of a biopsychosocial model of disease acquires a great practical value for modern phthisiology, which presupposes an in-depth study of the psychological and social constituents of disease as important factors of therapy optimization and an increase in the efficiency of the rehabilitative measures being implemented. The problem of psychological causes and factors associated with the occurrence of a tuberculous process in children and adolescents has been inadequately developed in phthisiology. A psychodiagnostic study was conducted in 90 patients from Moscow pediatric tuberculosis facilities. The children and adolescents with respiratory tuberculosis were ascertained to have the personality characteristics distinct them from their somatically healthy coevals: tenderness, responsibility, honesty, diligence, deliberate observance of generally accepted moral rules and regulations, inclination to moralize, anxiety, irritability, infantilism, low frustration tolerance, dependence, sensitivity, and a need for support. The revealed psychological features enhance the pathogenicity of stressors, lead to the tension of adaptive mechanisms and may contribute to the development of the disease. Psychocorrective measures aimed at expanding the behavioral range and molding self-regulation skills in these patients should be developed within the complex rehabilitation system for children and adolescents with respiratory tuberculosis, which will aid in enhancing the efficiency of their psychoemotional adaptation and preventing the recurrences of the underlying disease.
21434378	Irritable bowel syndrome is one of the most frequent diseases of the digestive system. Psychodiagnostic investigation of patients with IBS testifies to presence of asthenic frustration. In article results of preparation Ladasten use are presented in therapy of patients with irritable bowel syndrome.
20037920	Irritability is prevalent and impairing in pediatric bipolar disorder (BD) but has been minimally studied using neuroimaging techniques. We used magnetoencephalography (MEG) to study theta band oscillations in the anterior cingulate cortex (ACC) during frustration in BD youth. ACC theta power is associated with attention to emotional stimuli, and the ACC may mediate responses to frustrating stimuli.We used the affective Posner task, an attention paradigm that uses rigged feedback to induce frustration, to compare 20 medicated BD youth (14.9+/-2.0 years; 45% male) and 20 healthy controls (14.7+/-1.7 years; 45% male). MEG measured neuronal activity after negative and positive feedback; we also compared groups on reaction time, response accuracy, and self-reported affect. Patients met strict DSM-IV BD criteria and were euthymic. Controls had no psychiatric history.	BD youth reported more negative affective responses than controls. After negative feedback, BD subjects, relative to controls, displayed greater theta power in the right ACC and bilateral parietal lobe. After positive feedback, BD subjects displayed lower theta power in the left ACC than did controls. Correlations between MEG, behavior, and affect were nonsignificant.	In this first MEG study of BD youth, BD youth displayed patterns of theta oscillations in the ACC and parietal lobe in response to frustration-inducing negative feedback that differed from healthy controls. These data suggest that BD youth may display heightened processing of negative feedback and exaggerated self-monitoring after frustrating emotional stimuli. Future studies are needed with unmedicated bipolar youth, and comparison ADHD and anxiety groups.	
20016496	There is increasing evidence that partners have a major role in treatment-seeking behavior for men with ED. This study investigated the motivations of 100 females for seeking medical treatment for their partner's ED. Semi-structured interviews focused on reasons for seeking treatment from the female's perspective. The themes that emerged from the data centered on the importance of sex in the relationship, with closeness and intimacy frequently being seen as more important than sex. The second major theme related to hopes that females had in relation to the medication, particularly in relation to increasing their partner's confidence and reducing his sexual frustration. Enhancement of the relationship as well as improving the female's own feelings of self-doubt and sexual frustration were also mentioned. The results of this study show the multi-faceted nature of the motivations that females express in terms of seeking help for their partner's ED.
20011758	The aim of the present qualitative study was to analyse patients' attitudes towards oral health and experiences of periodontal treatment.Patients who were referred to a specialist clinic in periodontics were subjected to open-ended interviews before (Abrahamsson et al, 2008), as well as after, the phase of cause-related periodontal therapy. An interview guide was used with themes of interest. The time interval between the interviews was about 6 months. Because the study focused on psychosocial interactions, the qualitative method used for the analysis was Grounded Theory (Glaser and Strauss, 1967). Data collection and analysis were simultaneous processes that focus on psychosocial processes, existing problems and how these problems were dealt with. The interviews were tape-recorded and transcribed verbatim, and consequently analysed in a hierarchical coding process until saturation was met (n = 16).	In the analysis, a core category was identified: 'Understanding the seriousness of the disease condition'. This core concept was related to four additional categories and dimensions: 'The need to be treated respectfully', 'To gain insight', 'Frustration about the financial cost for treatment' and 'Feelings of control over the situation'. Taken together, the core category and its related subcategories described a psychosocial process that was related to periodontal treatment.	The results elucidated the patients' vulnerability and the importance of patient communication in the treatment for chronic periodontitis in order for the patient to feel in control of the situation.	
19999938	The nursing shortage presents a challenge for both nursing education programs and clinical agencies to identify creative options for increasing the supply of nurse educators, especially those who can teach vital clinical skills to future nurses. Some clinicians have voiced that they would enjoy having opportunities to share their clinical expertise through teaching, but they lack preparation for this new role. Through written narratives of nurses enrolled in a Clinical Nurse Educator Academy, this study explored the research question: How can narratives of clinicians participating in a Clinical Nurse Educator Academy enhance understanding of the unique perspectives of these individuals as they prepare for roles as clinical nurse educators? Data consisted of 135 reflective narratives from 45 participants and were analyzed using van Manen's approach to human science research. One overarching pattern, "The Phenomenon of Learning to Teach:" and three themes,"Buckle Your Seatbelt," "Embracing the Novice," and "Mentoring in the Dark," emerged from the data. Implications for faculty and further research are offered.

19950254	The purpose of this paper is to analyze the social organization of caring as gendered work as it relates to meal preparation and consumption activities surrounding older adult cancer patients and their caregivers.Qualitative methods consisting of in-depth, semi-structured, face-to-face interviews with 30 older cancer patients (17 women and 13 men aged 68-90) and their caregivers were conducted separately. Participants were diagnosed with pancreatic, colon, breast, lymphoma, skin, and head and neck cancer.	Major findings were that both patients and caregivers experienced distress surrounding food preparation and mealtime activities, and these varied according to the gender of both patients and caregivers and the relationship that existed between patients and caregivers. Of particular note, female patients experienced distress over not being able to fully participate in meal planning and cooking activities that were central to their self-identity. Related to this, male spouses experienced frustration over not being able to engage in cooking activities that met their wives' expectations. Female caregivers expressed tremendous discontent that the one they were caring for did not eat like they 'should'.	Matters related to the organization of meals and food consumption activities may be a source of significant distress for patients and caregivers. Further research and greater attention from health care providers are warranted to evaluate the extent of such distress.	
19929161	Alcohol and drug dependency is a widespread health and social issue encountered by registered nurses in contemporary practice. A study aiming to describe the experiences of registered nurses working in an alcohol and drug unit in South East Queensland was implemented. Data were analysed via Giorgi's phenomenological method and an unexpected but significant finding highlighted the frustration felt by registered nurses regarding experiences of stigma they identified in their daily work encounters. Secondary analysis confirmed the phenomenon of stigma with three themes: (1) inappropriate judgement; (2) advocacy; and (3) education. Resultantly, findings concluded registered nurses' working in this field need to become advocates for their clients, ensuring professional conduct is upheld at all times. This paper recommends that stigma could be addressed by incorporating alcohol and other drug dependency subjects and clinical placements into the curriculum of the Bachelor of Nursing degrees, and in-services for all practising registered nurses.
19928539	It has been reported that school-aged children with high functioning pervasive developmental disorder (HFPDD) have numerous difficulties in their school class. We used three psychological tests to investigate whether there is a relationship between intelligence and cognitive, behavioral development in children with HFPDD. The three tests used were an intelligence test (WIPPSI, WISC-lll), the P-F (Picture Frustration) study, and behavioral assessment by their parents. In the P-F study, 60% of 23 children with HFPDD showed a GCR% (Group Conformity Rating) above or below the standard. There was no relationship between GCR% and IQ. In the behavioral assessment by their parents, over 50% of 40 children with HFPDD showed maladaptive behaviors. The high VIQ group showed more maladaptive behaviors than the low VIQ group. These findings suggest that school-aged children with H-FPDD need educational treatment for social deficits and maladaptive behaviors.
19922399	From population-based surveys, chronic pelvic pain (CPP) in women is a common condition with a spectrum of associated disability and distress. Those seen by gynaecologists in a referral setting often have substantial impairment of function and mood disturbance. Because in most cases, the aetiology of CPP cannot be explained and the range of effective interventions remains limited, treatment of CPP might easily result in a sense of frustration not only for the patient but also for the gynaecologist. To avoid this situation in clinical practice, a structured assessment of women suffering from CPP using a cognitive behavioural model, is suggested. This type of assessment provides information about the impact of CPP on a particular patient's daily life. It also facilitates referral for pain management. Future studies are needed to show further evidence of benefit of this approach for women with CPP.
19893340	Increased migration into Spain requires the development of preventive strategies that help both immigrants and the host society to deal with the associated risk factors and thus avoid the emergence of psychopathology.To determine the level of psychopathology in Latin-American immigrants who reside in Barcelona and its relationship to the coping strategies used to mitigate the effects of the stress linked to migration.	The sample comprised 210 Latin-American immigrants over the age of 18. Sampling was based on consecutive cases, and participants were contacted through an NGO.	Employment is the stressor that most affects immigrants. Psychopathological symptoms are common among the immigrant population, and there is a relationship between the use of avoidance coping strategies and greater symptomatology. The longer immigrants have been in the host country, the less they make use of approach strategies.	The migratory process produces high levels of stress that are linked to psychopathology. Being subjected to a prolonged stressor has a destabilizing effect on both mental and physical health and can lead to a deterioration in social relationships due to more intense feelings of anger and frustration. Coping strategies appear to be more widely used among immigrants than in the indigenous population, and this may indicate the high levels of stress to which the former are subject and the attempts they make to deal with it. The limitations of the study include the source of data collection and the fact that most of the instruments used have not been validated in the participants' countries of origin.	
19889914	Amidst the wealth of literature on the topic of moral distress in nursing, a single citation is ubiquitous, Andrew Jameton's 1984 book Nursing practice. The definition Jameton formulated reads '... moral distress arises when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action'. Unfortunately, it appears that, despite the frequent use of Jameton's definition of moral distress, the definition itself remains uncritically examined. It seems as if the context of how moral distress arises (i.e. anger, frustration etc.) has been co-opted as its definition. This current work suggests that the current definition is not moral distress as defined by Jameton, but rather, in large part, nursing's discomfort with moral subjectivity in end-of-life decision making. A critical examination of how the Catholic tradition's normative ethical framework accounts for moral subjectivity in end-of-life decision making serves to aid nursing's discomfort and as a starting point to recontextualize moral distress.
19887344	To explore the role of supportive-expressive group therapy (SEGT) in facilitating the development and quality of healthcare relationships in patients with ovarian cancer.Qualitative, grounded theory, and comparative approach.	Tertiary care cancer center.	6 patients with advanced ovarian cancer and 3 healthcare professionals.	Patients participated in semistructured interviews that examined the nature of their healthcare relationships, diagnoses, and SEGT experience. The primary gynecologic oncologist and two nurses responsible for the care of the patients also were interviewed. Analysis of this qualitative study employed a grounded theory technique.	Patients' and healthcare professionals' perceptions of healthcare relationships.	Patients' negative diagnostic experiences were found to influence the quality of relationships with healthcare providers. However, the process appears to benefit from patient participation in SEGT. Patients perceived that SEGT helped facilitate communication between patients and professionals. Patients also indicated that SEGT led them to participate more actively in the treatment process. Professionals viewed patient participation in SEGT as a positive outlet for emotional expression, a source of psychological healing, and a tool that facilitated communication, collaboration, and understanding of medical treatment.	Participation in SEGT can advance communication and collaboration in medical care and provide opportunity and resources for psychological healing.	SEGT provides a vehicle to enhance the quality of life of patients with ovarian cancer by breaking down the common feeling of isolation, addressing women's frustration and resentment regarding delayed diagnosis, and enhancing relationships with healthcare providers to promote collaborative care in this patient population.	
19883286	Speech-language pathologists (SLPs) working in early childhood intervention are expected to have knowledge and skills across a number of areas and to engage in evidence-based practice. We explored the knowledge and perceptions of SLPs working with young children within Australian early childhood settings about augmentative and alternative communication (AAC), evidence-based practice, and barriers to such practice. Fourteen clinicians participated in group or individual interviews. Thematic analysis of the transcripts of these discussions revealed that they had a broad view of AAC and its benefits. Their reported assessment and intervention approaches reflected best practice as documented in the literature. The exception was in the implementation of family-centred practice. Although the participants involved families in their children's intervention, many appeared to use a directive approach. There was also evidence of struggling with families' negative attitudes about the use of AAC. A major barrier for these clinicians in implementing AAC and best practice was limited time in light of the many demands and expectations. Despite some frustration, these participants were passionate about their work and belief in the benefits of AAC for young children with varied communication difficulties. The results suggest that many expectations placed on clinicians within early childhood intervention settings may fail to take into account the everyday demands on their time, in a context of varied resources and support.
19877061	Health-care providers have only begun to understand the medical aspects of Niemann-Pick disease type B (NPDB), a relatively rare disease. Even less information is known about the psychological effects of living with NPDB. Patients with NPDB and their families face numerous psychological stressors including extensive medical testing, uncertainty of diagnosis, living and coping with a chronic illness, and grief and bereavement surrounding this progressively debilitating, and, ultimately, fatal disease. We used a qualitative case study approach to explore the human experiences of NPDB patients and families. To assess psychosocial adjustment, all participants were administered a semi-structured, qualitative interview, as well as quantitative measures. Five major findings emerged: (1) limited physical activity, social isolation, and peer rejection were identified as significant stressors; (2) stressors had a specific impact during the age span of 10-16 years; (3) parents and adult patients expressed frustration regarding the lack of available information and treatment; (4) patients described close family relationships as a way of coping with illness; and (5) adult patients identified early medical experiences as having a considerable psychological impact. The results of this investigation highlight and expand awareness of the psychological and social needs of NPDB patients and families. This study calls for a collaborative, multidisciplinary effort in the treatment of these patients and their families.
19851595	This report describes the reasons of the suicidal behavior in adolescents, taking in this anthropologic analysis, the impact in the familiar and social context. The study was conducted during the period of March to August, 2005 using a qualitative approach and ethnography as methods. The participants of this study were 12 teenagers, assisted in an emergency hospital in Fortaleza, Ceará State, Brazil, for suicide attempt using any kind of mechanisms. As shown in the experiment's result, the main reason of the attempts was a broken heart, this as a reason of dating someone and others love relationship established between two persons. Not only broken heart was mentioned, there were also cases of problems with family bonds, the affection and the lack of attention to the individual adolescent. In this context, the inability of the health professional was very clear. Under the presented circumstances, the professional must come up with a new praxis approach. The suicide is a real fact present at the teenagers' life and it is necessary to redirect the Brazilian Unified Health System s philosophy and operational principles of the way health professionals cope with this demanding the society to embrace the politics that cares for the human being life and wellness.
19844079	This study examined some health and psychosocial problems associated with mourning among 72 elderly Ijaw widows. The respondents complained of fever, gastrointestinal disorders and a range of psychosocial problems such as disinheritance, suspicion, frustration, hopelessness and degrading inhuman treatment. Community women/in-laws increased the extent to which elderly widows accepted traditional mourning rites. Care from nurses, good psychosocial support, health and conventional education enhanced the widows' health status and ability to cope with mourning rites. Elderly widows in polygamous marriages experienced better psychosocial support than those in monogamous marriages. Implications for nursing and psychological practices have been highlighted in this study.
19840049	A sensitivity to the intentions behind human action is a crucial developmental achievement in infants. Is this intention reading ability a unique and relatively recent product of human evolution and culture, or does this capacity instead have roots in our non-human primate ancestors? Recent work by Call and colleagues (2004) lends credence to the latter hypothesis, providing evidence that chimpanzees are also sensitive to human intentions. Specifically, chimpanzees remained in a testing area longer and exhibited fewer frustration behaviors when an experimenter behaved as if he intended to give food but was unable to do so, than when the experimenter behaved as if he had no intention of giving food. The present research builds on and extends this paradigm, providing some of the first evidence of intention reading in a more distant primate relative, the capuchin monkey (Cebus apella). Like chimpanzees, capuchin monkeys distinguish between different goal-directed acts, vacating an enclosure sooner when an experimenter acts unwilling to give food than when she acts unable to give food. Additionally, we found that this pattern is specific to animate action, and does not obtain when the same actions are performed by inanimate rods instead of human hands (for a similar logic, see Woodward, 1998). Taken together with the previous evidence, the present research suggests that our own intention reading is not a wholly unique aspect of the human species, but rather is shared broadly across the primate order.
19835601	Drug formularies have been created by third party payers to control prescription drug usage and manage costs. Physicians try to provide the best care for their patients. This research examines family physicians' attitudes regarding prescription reimbursement criteria, prescribing and advocacy for patients experiencing reimbursement barriers.Focus groups were used to collect qualitative data on family physicians' prescribing decisions related to drug reimbursement guidelines. Forty-eight family physicians from four Ontario cities participated. Ethics approval for this study was received from the Hamilton Health Sciences/Faculty of Health Sciences Research Ethics Board at McMaster University. Four clinical scenarios were used to situate and initiate focus group discussions about prescribing decisions. Open-ended questions were used to probe physicians' experiences and attitudes and responses were audio recorded. NVivo software was used to assist in data analysis.	Most physicians reported that drug reimbursement guidelines complicated their prescribing process and can require lengthy interpretation and advocacy for patients who require medication that is subject to reimbursement restrictions.	Physicians do not generally see their role as being cost-containment monitors and observed that cumbersome reimbursement guidelines influence medication choice beyond the clinical needs of the patient, and produce unequal access to medication. They observed that frustration, discouragement, fatigue, and lack of appreciation can often contribute to family physicians' failure to advocate more for patients. Physicians argue cumbersome reimbursement regulations contribute to lower quality care and misuse of physicians' time increasing overall health care costs by adding unnecessary visits to family physicians, specialists, and emergency rooms.	
19831160	Inadequate nutrient intake is common in cancer patients and is associated with poor outcomes. Social factors may contribute to inadequate nutrient intake, although they have not been studied. The purpose of this study was to investigate social factors that may contribute to undereating in older adults with cancer. Participants included 30 patients, 17 women and 13 men, aged 70-99 years, who were diagnosed with pancreatic, colon, breast, lymphoma, skin, and head and neck cancers. Both participants and caregivers interpreted weight loss as a positive health outcome of cancer. Furthermore, some patients who had lost weight worked to keep the weight off by going on special diets. Patients and caregivers imbued certain foods with health-promoting qualities without corroborating scientific evidence. Cancer- and treatment-related alterations in self-identity due to changes in their bodies, in taste, and in the manner in which they must eat caused cancer patients to experience frustration and embarrassment, which led to reduced nutritional intake. Despite their compromised nutritional status, patients did not discuss food and eating habits with their physicians. Behaviors and attitudes of patients and caregivers may lead to negative changes in eating behaviors beyond the cancer itself or its treatment or sequelae. Many of these behaviors are potentially modifiable with appropriate education, communication, and intervention.
19825115	To outline the experiences of family caregivers in Brisbane, Australia who have placed a relative with dementia into long-term care.Whilst the aged care literature in Australia highlights the rising numbers of people with dementia admitted to long-term care, empirical research exploring family and staff relationships and their influence on quality of care remains limited. International research demonstrates that the transition to long-term care is stressful for families and the person with dementia, often resulting in ongoing family and staff conflict.	The study utilised a descriptive qualitative design.	A purposive sample of 10 participants from a large study that tested an education intervention took part in the qualitative phase of this mixed method, sequential design study. Semi-structured interviews and confirmatory thematic analysis were used to identify family caregiver experiences following placement of their relative in long-term care.	The findings emphasise the increasing isolation and burden of care felt by families prior to admission, which often is perpetuated during long-term care placement and may present as dissatisfaction with care.	Improving staff-family relationships has the potential to reduce conflict and to improve the long-term care environment, relieve the pressure of work overload, decrease staff frustration and reduce negative reactions to family caregivers.	The findings highlight the crucial need for long-term care facilities to support families, as well as the person with dementia, through the transition to the care environment. The resulting improved family relationships with staff, based on negotiation and increasing knowledge of dementia care, can then provide potential to develop more specialised evidence-based dementia care and service delivery.	
19824973	Mental health treatments that are effective and accessible to the general population are in high demand. Cognitive behavioural therapy (CBT) has been shown to be effective and is popular but such treatments are difficult to access especially within primary care, causing delay, frustration and suffering. One approach to meeting demand would be through the use of self-help CBT materials that aim to address common mental health problems such as depression. The aim of this review is to discover whether self-help CBT materials are effective in the treatment of depression and how mental health nurses within primary care can use their skills to provide access and low-level support. Studies critiqued within this literature review indicate that self-help CBT is effective for the treatment of depression. However, there is a lack of evidence that specifically considers self-help CBT for the treatment of depression in primary care. This review addresses the question of how much nurse client contact is needed to provide adequate support for the facilitation of self-help CBT in depression with primary care patients and recommends the use of a service delivery model. However, more research needs to be carried out on the application of self-help CBT for depression in primary care.
19820278	Patients with type 2 diabetes, approximately 85% of whom are overweight or obese, often have an increased incidence of cardiovascular disease (CVD) risk factors such as hypertension and dyslipidemia. Both type 2 diabetes and obesity are independent risk factors for CVD. Unfortunately, many therapies aimed at maintaining and improving glucose control are associated with weight gain. Among the older antidiabetes agents, most, including the insulin secretagogues and sensitizers, can lead to weight gain, except for metformin, which is weight-neutral. Among the newer agents, the dipeptidyl peptidase-4 inhibitors generally are weight-neutral in addition to lowering glucose, while the glucagon-like peptide-1 receptor agonists lead to weight reduction. Patients with type 2 diabetes are at an increased risk for both diabetes- and CV-related outcomes, and weight reduction is an important component of diabetes management. Weight gain in patients with type 2 diabetes can contribute to patient frustration and may negatively impact their compliance to therapeutic regimens. The selection of antidiabetes agents that not only improve glucose control but reduce or have a neutral effect on weight with beneficial effects on lipids are ideal options for managing patients with type 2 diabetes.
19807959	When confronted with chronic fatigue syndrome (CFS), general practitioners (GPs) need to deal with diverse complaints. This may introduce a sense of powerlessness and frustration in the GP, which could possibly undermine the doctor-patient relationship.Our aim was to list the perspectives of patients with CFS regarding the medical encounter.	This was a questionnaire study of systematically selected patients presenting to a tertiary clinic specialising in CFS. A questionnaire was presented to every third patient attending the clinic. Statistical computations were performed using the SPSS statistical package.	One hundred and seventy-seven patients completed the questionnaire. A diagnosis of CFS was made by a GP in 8% of the cases. In 31% of the cases the GP had experience with general CFS complaints, and 35% of the GPs showed experience in CFS. Only 23% reported sufficient knowledge to treat the condition. According to the patients surveyed, 35% felt that their GP had experience in dealing with CFS.	The heterogeneity of CFS and the controversy surrounding this condition seemed to overwhelm GPs and strain the medical encounter. Patients with CFS seemed unsatisfied with the interaction with their doctor. Moreover, the results show that CFS is not addressed well by the medical community, and the failure to diagnose leads to a lack of empathetic care, with consequential loss of the capacity of the doctor to act as a healer.	
19807945	This article is a commentary on 'Psychopathy, frustration, and reactive aggression: The role of ventromedial prefrontal cortex' (Blair, 2010).
19796128	To assess the sexual activity of women with male partners in Japan.An original web-based questionnaire was conducted. A total of 2593 women in five age groups (20s, 30s, 40s, 50s, and 60s or older) were randomly invited to participate. Of the 1077 (41.5%) respondents, data for 883 women with partners were evaluated. Age and 15 items related to sexual activity and social background were analyzed. Women who stated that they neither had sexual activity with a partner nor had frustration with a partner's erectile dysfunction (ED) were defined as low sexuality (LS) subjects. Some subjects in the LS group were psychologically serious cases who did not feel the importance of a sexual relationship with their partner. These subjects were selected and defined as high-risk LS (HLS) subjects.	Of the participants, 36.6% (n = 323) stated that they did not have sexual activity with their partner, and 30.7% (n = 271) and 21.7% (n = 192) were categorized as LS and HLS subjects, respectively. The percentage of HLS subjects increased significantly with age: 2.0%, 5.6%, 18.6%, 36.1% and 41.8% in the 20s, 30s, 40s, 50s, and 60s or older age groups, respectively. Age and unemployment status were independent predictors of HLS behavior.	A high proportion of Japanese middle-aged women with a male partner have low sexual activity.	
19794369	Involuntary emotional expression disorder (IEED) is syndrome characterized with relatively stereotypical episodes of uncontrollable crying and/or laughing. Additionally, this syndrome can include irritability, anger and frustration. This syndrome is common among a number of neurologic diseases like patients with a stroke or traumatic brain injury (TBI), patients with amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), as well as dementias such as Alzheimer's disease (AD), and motor disorders such as Parkinson's disease (PD). IEED is very common but misdiagnosed and consequently undertreated. Prevalence of IEED in AD is between 15-39%. Recent controlled clinical studies suggest that dextromethorphan (DM) and quinidine (Q) is an effective treatment for IEED. United States Food and Drug Administration (FDA) has accepted for filing and review its New Drug Application (NDA) for Zenvia (dextromethorphan hydrobromide and quinidine sulfate capsules) for the treatment of IEED. In Republic of Croatia current treatment involves antidepressants (tricyclic and selective serotonin reuptake inhibitors), antipsychotic agents, anxiolytics, antidementives and mood stabilizers. New promising treatment can reduce the frequency of episodes and improve the quality of life of patients and their families and caregivers.
19782898	The purpose of this qualitative study was to explore chronic sorrow as a relapse trigger among female victims of child abuse seeking treatment for substance abuse relapse. A purposive convenience sample of 12 women was interviewed using qualitative description to provide insight into their perceptions of relapse triggers. In addition to chronic sorrow, three common themes were interwoven in the narrative stories of these women: mothering loss, blocking feelings, and relapse triggers. Feelings described as relapse triggers included loneliness, sadness, anger, and frustration. The information gleaned from these women can be incorporated into the treatment of women and children in an effort to better prepare them for these recurrent feelings and triggers that could result in substance abuse and relapse.
19781873	Stress and burnout, the human side of the health service and the quality of care, are touchy subjects experienced on an everyday basis. Caregivers in the health systems are constantly called upon to handle feelings and "strong emotions", both their own and those of others: rage, impatience, frustration, helplessness, fear and so on. Frustration and conflicts between oneself and others are a frequent event, and may undermine the professional skills of each health professional. This article summarises problems, skills and situations where caregivers, patients, family face the difficulty to communicate. The aim is to provide an overview in this area and to suggest possible tools to overcome the daily difficulties.
19770218	Loneliness is a universal phenomenon that influences one's health and health perception. GPs are confronted with lonely people quite often. Yet, what GPs think of this phenomenon and how they deal with emotions lonely patients evoke is not known.We aimed to explore GPs' experiences with lonely patients. We wanted to gain insight in GPs' feelings regarding consultations with lonely patients and potential resulting behaviour from these feelings.	We performed a qualitative study based on semi-structured interviews. We interviewed 20 Dutch GPs. Transcripts were analysed according to a grounded theory-like method in order to bring to surface key concepts and relations between them.	GPs considered loneliness as something subjective, a feeling. They found it relevant to know whether their patients were lonely. However, they had difficulty defining their task and experienced a lack of therapeutic options. Beside feelings of pity and interest, lonely patients could evoke feelings of frustration and powerlessness. These feelings were more pronounced when patients were chronically lonely and could cause GPs to spend less time on these patients or refer them more often. GPs did not constructively use their own emotions during consultation.	When confronted with lonely patients, a helpful distinction could be made between transitory and chronic loneliness. Chronically lonely patients are more likely to evoke negative feelings and behaviour in their GPs. GPs should try to recognize these emotions and make sure they do not harmfully influence consultation.	
19759436	Transferring knowledge and evidence from the pain psychology literature to all types of practitioners is one small but important step towards reducing the economic and personal cost of injuries. Through early identification of at-risk clients, it may be possible to prevent chronic pain from developing. Pain is a perception which is affected by physical, psychological and social factors, yet many health care professionals are only beginning to consider the relative contributions of each of these elements. It is essential that clinicians understanding of how a client's pain coping strategies impact progress and functional outcomes. For clients endorsing maladaptive methods of coping, one step is to refer the client to a psychologist; however, understanding of key underlying principles can also inform any type of treatment. All care providers involved with the client should discourage maladaptive strategies where appropriate and encouraging adaptive ones. Of equal importance is knowing whether or not the client is ready to adapt to change. Clinician knowledge of coping strategies and readiness may also help reduce the likelihood of clients withdrawing from treatment in frustration. The end result will hopefully be less disability and improved functioning of clients experiencing chronic pain.
19754237	PARENTS OF SERIOUSLY ILL CHILDREN FACE difficult decisions when standard therapies are limited or ineffective. In their search for information, they may turn to websites created by other parents facing similar experiences. We conducted a qualitative content analysis of 21 websites created by families with children affected by cancer or genetic disease, two serious conditions with a range of treatment and clinical trial options. Our research questions address how parent authors portray serious pediatric illness, available options, parties to decision making, and sources of influence. In addition, we examine what these sites reveal about family vulnerability to various risks, particularly the risk of misunderstanding the distinction between standard treatment and research and the risk of overestimating the likely benefits of research participation, as well as whether vulnerability varies by type of condition. Our results demonstrate typically favorable views on research, but with inadequate distinctions between research and treatment and a complex set of trade-offs in consideration of research risks and potential benefits. While portraits of vulnerability emerge for both parents and children, so do portraits of strength and resilience. As a result, parents describe frustration with both under- and overprotection from research participation. Our discussion of these findings clarifies the potential for parent-authored websites to inform and influence families considering research and treatment options for their seriously ill children.
19751961	Recent research suggests that emotional dysfunction in psychiatric disorders can be reflected in autonomic abnormalities. The present study examines sympathetic and parasympathetic autonomic nervous system activity in individuals with Borderline Personality Disorder (BPD) before, during, and following a social stressor task. Data were obtained from an analogue sample of participants screening positive for BPD (n=12) and healthy controls (n=28). In general, BPD participants exhibited increased sympathetic activity (indexed by Cardiac Sympathetic Index, CSI; Toichi et al., 1997) and decreased parasympathetic activity (indexed by Respiratory Sinus Arrhythmia, RSA) compared to controls. During the stressful task, BPD and control participants exhibited different trajectories of sympathetic activation: estimates of sympathetic activity increased for BPD participants and decreased for controls. Furthermore, BPD participants reported the task (but not baseline or recovery phases) to be more frustrating than controls. Findings are interpreted in the context of Polyvagal theory.
19707083	The experiences of 9 fathers of premature infants in the technological environment of the neonatal intensive care unit were examined using interpretive methods. Fathers were interviewed 6 to 8 times each. Findings revealed emotional costs for fathers as technology often took precedence. Fathers' feelings of frustration, fear, and alienation were hidden from nurses, as fathers were silent and silenced. Fathers perceived a power dynamic between themselves and nurses, which may be due, in part, to a complex interplay between the technological imperative and gender dynamics. Two exemplars illustrated how fathers forged emotional connections with their babies despite the technological imperative.
19706198	With increasing rates of chronic disease associated with lifestyle behavioural risk factors, there is urgent need for intervention strategies in primary health care. Currently there is a gap in the knowledge of factors that influence the delivery of preventive strategies by General Practitioners (GPs) around interventions for smoking, nutrition, alcohol consumption and physical activity (SNAP). This qualitative study explores the delivery of lifestyle behavioural risk factor screening and management by GPs within a 45-49 year old health check consultation. The aims of this research are to identify the influences affecting GPs' choosing to screen and choosing to manage SNAP lifestyle risk factors, as well as identify influences on screening and management when multiple SNAP factors exist.A total of 29 audio-taped interviews were conducted with 15 GPs and one practice nurse over two stages. Transcripts from the interviews were thematically analysed, and a model of influencing factors on preventive care behaviour was developed using the Theory of Planned Behaviour as a structural framework.	GPs felt that assessing smoking status was straightforward, however some found assessing alcohol intake only possible during a formal health check. Diet and physical activity were often inferred from appearance, only being assessed if the patient was overweight. The frequency and thoroughness of assessment were influenced by the GPs' personal interests and perceived congruence with their role, the level of risk to the patient, the capacity of the practice and availability of time. All GPs considered advising and educating patients part of their professional responsibility. However their attempts to motivate patients were influenced by perceptions of their own effectiveness, with smoking causing the most frustration. Active follow-up and referral of patients appeared to depend on the GPs' orientation to preventive care, the patient's motivation, and cost and accessibility of services to patients.	General practitioner attitudes, normative influences from both patients and the profession, and perceived external control factors (time, cost, availability and practice capacity) all influence management of behavioural risk factors. Provider education, community awareness raising, support and capacity building may improve the uptake of lifestyle modification interventions.	
19700229	to explore and describe Chinese midwives' experience of providing one-to-one continuity of care to labouring women.a qualitative study using a phenomenological approach. Data were collected using open-ended, tape-recorded interviews. The analysis of the transcribed texts included searching for themes sorted into clusters for a final expression of the essential structure of the phenomenon.	Obstetrics and gynaecology hospital of Fudan University, Shanghai, China.	12 midwives, providing one-to-one continuity of care to labouring women.	two main categories were identified: (1) midwives' feelings on providing continuity of care, and (2) impact of on-call system on midwives providing continuity of care. Key themes emerged from each main category: (1) 'playing important roles in labour care', 'gaining a sense of self-achievement', 'falling into exhaustion and frustration' and 'coping with caring work'; and (2) 'on-call syndrome', 'affecting personal lives' and 'managing on-call shift'. The midwives experienced mixed feelings of being with women and expressed their adaptation to being on-call, which was the essence of this study. They played important roles in caring for women, gained a sense of self-achievement and developed suitable coping strategies. However, they also indicated the impact of the on-call system upon them in the process of providing continuity of care.	midwives have gained both positive and negative experiences when providing continuity of care to labouring women. The positive aspects may facilitate other professional midwives working in a similar role, whereas the negative aspects may inform them of learning to live with this situation, and may also have implications for managers to develop new approaches to the organisation and provision of continuity of care to support midwives' practice, and to fully utilise 'flexibility' under an on-call system.	
19695878	Mechanical ventilator withdrawal can amount up to 40% of total ventilator time. Being on a mechanical ventilator is associated with risk of anxiety, post-traumatic stress syndrome, nosocomial pneumonia and premature mortality.The purpose of the present study was to describe different conceptions of nurses' facilitating decision-making strategies regarding weaning patients from mechanical ventilations cared for in intensive care unit (ICU).	Semi-structured interviews were analysed within the phenomenographic framework. Twenty ICU nurses were interviewed.	The findings revealed three main categories of nurses' facilitating decision-making strategies: "The intuitive and interpretative strategy" featured nurses' pre-understandings. "The instrumental strategy" involved analysis and assessment of technological and physiological parameters. "The cooperative strategy" was characterised by interpersonal relationships in the work situation. Absence of a common strategy and lack of understanding of others' strategies were a source of frustration. The main goals were to end mechanical ventilator support, create a sense of security, and avoid further complications.	Although these findings need to be confirmed by further studies we suggest that nurses' variable use of individual strategies more likely complicate an efficient and safe weaning process of the patients from mechanical ventilation.	
19656224	To investigate both concurrent and prospective relationships between daily frustration, cognitive coping and coping efficacy on the one hand and daily headache occurrence on the other.Eighty-nine adolescents aged 13-21 completed an online daily diary for 3 weeks. Data were analyzed using multilevel modeling.	Daily frustration of goal pursuits was significantly related to both same day and next day headache occurrence. Coping efficacy beliefs were significantly related to lower next day headache occurrence (no same day relationship was found). None of the cognitive coping strategies used in response to daily frustration were related to headache occurrence on the same or next day.	Daily frustration to goal pursuit is suggested to be an important stressor contributing to concurrent and prospective headache occurrence. Furthermore, the extent to which adolescents believe in their ability to cope also appears to influence experience of subsequent headache. Further prospective studies are necessary to confirm these findings and to further unravel the possibly reciprocal relations between these factors. These findings offer useful insights into the dynamic interplay between daily stressful experiences and headache in youths.	
19654579	Limited research has investigated the specific needs of patients with advanced incurable cancer. The aim of this study was to describe the prevalence of perceived needs among this population.Medical specialists from two regions in New South Wales, Australia, identified patients with advanced, incurable cancer, who were estimated to have a life expectancy of <2 years and were not receiving formal palliative care. Of the 418 eligible patients, 246 (59%) consented to participate. Consenting patients completed the Needs Assessment for Advanced Cancer Patients questionnaire, which has demonstrable validity and reliability. Patients' perceived needs were assessed across the seven domains of the questionnaire: psychological, daily living, medical communication and information, symptom related, social, spiritual and financial needs.	Patients identified the greatest areas of need in relation to psychological and medical communication/information domains. Patients' specific needs were highest in dealing with a lack of energy and tiredness, coping with fears about the cancer spreading, and coping with frustration at not being able to do the things they used to do.	This study indicates that patients with advanced, incurable cancer have high levels of unmet needs, especially in relation to the areas of psychological and medical communication/information needs. The data have the potential to guide the development of interventions aimed at meeting the current unmet needs of patients with advanced, incurable cancer.	
19653775	Although functional links between emotion and action are implied in emotion regulation research, there is limited evidence that specific adaptive actions for coping with a challenge are more probable when certain negative emotions are expressed. The current study examined this question among 3- and 4-year-olds (N = 113; M age = 47.84 months, SD = 6.19). Emotion expressions and actions were observed during 2 challenging tasks: children waited for a gift while the mother worked, and children worked alone to retrieve a prize from a locked box with the wrong key. Angry and happy expressions, compared with sad expressions, were associated with more actions. These actions varied with the nature of the task, reflecting appreciation of situational appropriateness. In addition, when waiting with the mother, happiness was associated with the broadest range of actions, whereas when working alone on the locked box, anger was associated with the broadest range of actions. Results are discussed in terms of the adaptive function of negative emotions and in terms of functional and dimensional models of emotion. Findings have implications for the development of emotion regulation and social-emotional competence.
19653534	The purpose of this study was to explore and describe the experiences of informal caregivers in home-based care in the Odi Sub-District area in the Province of the North West. A qualitative, exploratory and descriptive study was followed to collect data from the selected population. The study population consisted of informal caregivers who conduct home visitations in the Odi Sub-District area. Participants were purposively selected. Data were collected from the participants by means of focus group interviews, which were guided by the group moderator. The experiences of informal caregivers were shared through the participants' responses to a central research question. Tesch's qualitative method of data analysis was used to analyse the data. The experiences of informal caregivers were related to emotions, social circumstances and support. The participants placed emphasis on emotions of love and caring, fulfilment, frustration, exploitation, anger and helplessness, fear, rejection, shame and denial. Social circumstances regarding finance, antagonism and stigma were also emphasised. The participants raised the issue of the necessity of the support of the family, community and clinic during home-based care. It was recommended that this support group should assist families in dealing with fear, stigma and discrimination. Furthermore, it was recommended that the government should provide the services for developing and empowering informal caregivers in home-based care.
19637725	Stress is an important disorder that affects the health of world-wide people. Recent evidence indicates that the level of stress is related to specific personality profiles. In particular, medical residents are exposed to high stress levels.To determine the relationship between personality profiles and stress levels in medical residents.	A prospective, transversal, correlational and descriptive study was assembled with 61 medical residents. Two psychological tests were used: 16 Personality Factor Questionnaire and Nowack's stress profile; followed by a psychological interview.	50% of medical residents showed medium to high levels. Correlation analyses indicate that stress is associated with specific personality profiles, such as: C- (low emotional stability; r = -0.337; P = 0.008), H- (shyness; r = -0.313; P = 0.014), O+ (self-guiltiness; r = 0.298; P = 0.02) and Q4+ (recklessness; r = 0.474, P = 0.001). Factors H and Q4 were related to high levels of stress.	A half of medical residents showed important stress levels. The personality profile C- H- O+ Q4+ describes people with low tolerance to frustration, high concern to be accepted by others, which is associated to inferiority complex and high levels of nervous tension that may affect their professional performance.	
19635341	To provide an insight into individual physiotherapists' experiences of Continuing Professional Development (CPD), and to gain an understanding of the challenges of undertaking CPD in a geographically dispersed primary healthcare setting.A qualitative phenomenological methodology using a one-to-one semi-structured interview technique to achieve an in-depth exploration of this complex area of study. Data analysis was conducted by data transcription, immersion, coding and generation of themes using a pragmatic five-step process.	Eleven participants were identified from a study population of physiotherapists working in two local primary care trusts following the principle of maximum variation sampling.	Four main themes emerged: CPD processes; motivation for undertaking CPD; enabling CPD; and outcomes of CPD. Participants felt that CPD should include a range of activities and learning behaviours. However, there was a preference for active learning styles and formal course-based learning. Engagement in reflective practice and portfolio keeping was generally poor, with participants identifying lack of skills in these areas. Factors motivating CPD engagement included a strong sense of professional obligation and wishing to provide the best possible service to patients. There was frustration over the impact of external issues including political and organisational change on CPD, and anxiety over forthcoming regulatory changes affecting physiotherapy. The study also identified issues around CPD planning and needs identification. There was evidence of change in individuals' practice and internal perceptions as outcomes of CPD, although issues around the application and maintenance of change were identified.	There is evidence that CPD has an effect on clinical practice in this small group of physiotherapists working in community National Health Service settings. Significantly, undertaking CPD improves confidence as well as competence, enabling individuals to form effective therapeutic relationships with patients and other members of their teams.	
19634265	Today's complex world of nursing practice challenges nurse educators to develop teaching methods that promote critical thinking skills and foster quick problem solving in the novice nurse. Traditional pedagogies previously used in the classroom and clinical setting are no longer adequate to prepare nursing students for entry into practice. In addition, educators have expressed frustration when encouraging students to apply newly learned theoretical content to direct the care of assigned patients in the clinical setting. This article presents algorithms as an innovative teaching strategy to guide novice student nurses in the interpretation and decision making related to vital sign assessment in an acute care setting.
19630351	Chronic disability syndrome is one of the stumbling blocks of primary care. The medical health organizations, as well as the patients, sense significant frustration being helpless in tagging the various symptoms under a nomenclatural diagnosis, in order to suggest a proper treatment approach. Major attention should be focused upon the diagnostic procedure not to miss a solvable and treatable cause. NevertheLess, as the comorbidity index demonstrates high probability indicators for sick role induced malfunctioning, so should the primary care physician intervene. A medical confrontation along with patient's family support might be inevitable just to maintain a reasonable vague chance for cure and functional recovery.
19618707	Between-participant research has shown that high negative affectivity predicts greater activity limitations and vice versa. This study examined both between- and within-participant associations of negative and positive affectivity with activity levels using ecological momentary assessment.Participants were 25 people who had undergone joint replacement surgery 12 months previously. Participants made multiple reports of their activity and positive and negative affectivity over a single day using a computerized diary. Activity was also objectively recorded using an activity monitor. The following day, participants made a self-report of their activity over the measurement day and general positive and negative affectivity levels were recorded.	Higher self-reported walking time over the whole measurement day was associated with higher general positive affectivity but not negative affectivity. However, using ecological momentary assessment, higher diary reports of negative affectivity predicted increased activity levels while positive affectivity neither predicted nor was predicted by activity.	These findings demonstrate the importance of within-participant methodology in detecting subtle and immediate effects of individuals' mood on behavior that may differ from findings investigating between-participant effects over longer time periods.	
19593713	This research was conducted to examine the consequences of forewarning drivers about impending congestion on aggressive driving behavior. Some have argued that aggressive driving stems from frustration experienced on the roadway (often due to congestion), and that by warning drivers about congestion, frustration, and consequently aggressive driving, can be reduced.The study employed an experimental design, where participants (whose dispositional driver anger was measured using the Driver Anger Scale) were instructed to operate an instrumented vehicle along a prescribed route containing construction. Participants were randomly assigned either to receive a warning about the construction or to receive no warning about the congestion. Measures of aggressive driving behavior were extracted from video (shot from a camera hidden behind the vehicle's license plate) and from an ongoing accelerometer.	A total of 49 participants completed the study. Analyses of combined measure of aggressive driving behavior data revealed a statistically significant main effect for dispositional driver anger (with participants scoring higher on the scale actually driving more aggressively), as well as interactions between driver anger and forewarning. Accordingly, forewarning about potential congestion reduced aggressive driving behavior for participants high in dispositional anger but increased aggressive behavior for participants who were low on dispositional anger.	Some of the results-particularly the increase in aggressive driving among participants low in dispositional driver anger who were warning about congestion-were unexpected. The interaction effect suggests that the strategy providing warnings about upcoming congestion will not necessarily reduce frustration among all drivers.	
19586175	The purpose of the study was to examine the relations of effortful control (EC), impulsivity, and negative emotionality to at least borderline clinical levels of symptoms and change in maladjustment over four years. Children's (N = 214; 77% European American; M age = 73 months) externalizing and internalizing symptoms were rated by parents and teachers at 3 times, 2 years apart (T1, T2, and T3) and were related to children's adult-rated EC, impulsivity, and emotion. In addition, the authors found patterns of change in maladjustment were related to these variables at T3 while controlling for the T1 predictor. Externalizing problems (pure or co-occurring with internalizing problems) were associated with low EC, high impulsivity, and negative emotionality, especially anger, and patterns of change also related to these variables. Internalizing problems were associated with low impulsivity and sadness and somewhat with high anger. Low attentional EC was related to internalizing problems only in regard to change in maladjustment. Change in impulsivity was associated with change in internalizing primarily when controlling for change in externalizing problems.
19566693	This study aimed to investigate the attitudes of Australian psychiatric triage and crisis clinicians toward those with a diagnosis of personality disorder.The design of the study was exploratory descriptive research. The study employed a survey method using Bowers and Allan's (2006) Attitude to Personality Disorder Questionnaire, which was designed to identify global attitudes toward those with a diagnosis of personality disorder.	The findings of this study indicate that psychiatric crisis and triage clinicians hold negative attitudes toward those with a diagnosis of personality disorder.	Education and clinical supervision is required to address negative clinician attitudes.	
19556552	The purpose of this study was to explore individual, educational, and system barriers that limit low-income diabetes patients' ability to achieve optimal diabetes self-management.Economically disadvantaged patients with diabetes who used the Diabetes Clinic of Grady Health System in Atlanta, Georgia, participated in 3 focus group discussions.	The discussions were held with mostly African Americans (n = 35) to explore barriers to achieving optimal diabetes self-management. Most participants were not married, approximately one-third had less than high school level reading skills, and 40% were not currently working. In terms of individual barriers, the emotional toll from the diagnosis of and lifestyle changes to treat diabetes was a recurrent theme, and included stress, frustration, social isolation, interpersonal conflicts, depression, and fear. Denial was often mentioned as the key factor that inhibited adherence to a healthy mode of living. The educational barriers were failure to recognize the risks and consequences of an asymptomatic condition. Many participants did not understand A1C. Finally, several system barriers were identified. The participants identified needed services, including follow-up and refresher courses, support group discussions, nutrition and medication education, availability of different education modalities, and expanded clinic hours.	The focus group discussions identified both barriers to diabetes management and opportunities for improving care for underserved patients with diabetes. The results are useful to improve the delivery of care and to develop quantitative studies to explore particular areas of interest. Based on these results, the current system needs to provide more support and education to patients with diabetes.	

19536599	Intracorporeal suturing is one of the most difficult laparoscopic tasks. The purpose of this study was to assess the impact of robotic assistance on novice suturing performance, safety, and workload in the operating room.Medical students (n = 34), without prior laparoscopic suturing experience, were enrolled in an Institutional Review Board-approved, randomized protocol. After viewing an instructional video, subjects were tested in intracorporeal suturing on two identical, live, porcine Nissen fundoplication models; they placed three gastro-gastric sutures using conventional laparoscopic instruments in one model and using robotic assistance (da Vinci) in the other, in random order. Each knot was objectively scored based on time, accuracy, and security. Injuries to surrounding structures were recorded. Workload was assessed using the validated National Aeronautics and Space Administration (NASA) task load index (TLX) questionnaire, which measures the subjects' self-reported performance, effort, frustration, and mental, physical, and temporal demands of the task. Analysis was by paired t-test; p < 0.05 was considered significant.	Compared with laparoscopy, robotic assistance enabled subjects to suture faster (595 +/- 22 s versus 459 +/- 137 s, respectively; p < 0.001), achieve higher overall scores (0 +/- 1 versus 95 +/- 128, respectively; p < 0.001), and commit fewer errors per knot (1.15 +/- 1.35 versus 0.05 +/- 0.26, respectively; p < 0.001). Subjects' overall score did not improve between the first and third attempt for laparoscopic suturing (0 +/- 0 versus 0 +/- 0; p = NS) but improved significantly for robotic suturing (49 +/- 100 versus 141 +/- 152; p < 0.001). Moreover, subjects indicated on the NASA-TLX scale that the task was more difficult to perform with laparoscopic instruments compared with robotic assistance (99 +/- 15 versus 57 +/- 23; p < 0.001).	Compared with standard laparoscopy, robotic assistance significantly improved intracorporeal suturing performance and safety of novices in the operating room while decreasing their workload. Moreover, the robot significantly shortened the learning curve of this difficult task. Further study is needed to assess the value of robotic assistance for experienced surgeons, and validated robotic training curricula need to be developed.	
19526411	Socioeconomic status is a strong correlate of health status. Low literacy is associated with barriers to health information and anxiety about disease.Using 2003 Health Information National Trends Survey data, the relationship between self-reported health status and proxy measures of literacy (Hispanic ethnicity, education, and media variables), cancer anxiety, and cancer information seeking were assessed.	Low literacy, measured by proxy variables, was associated with a greater likelihood of reporting fair-poor health status. Reporting excellent-good health status was less likely for people reporting frustration finding cancer information (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.52-0.89), worry about cancer (OR 0.56, 95% CI 0.35-0.89), and increased chance of getting cancer (OR 3.5, 95% CI 0.24-0.51).	Proxy variables for literacy suggest a possible contribution to health status disparities.	
19525718	TG is a 32-month-old girl with a rare lysosomal storage disease. The diagnosis was confirmed at 8 months of age; she underwent bone marrow transplant at 14 months. TG's father remained at home with her siblings whereas her mother lived at the transplant hospital with TG for 1 year. Significant respiratory infections led to dependency on a tracheotomy and ventilator. She was transferred to the current hospital 10 months ago for respiratory rehabilitation, which has been complicated by pulmonary hemorrhages. On examination, TG was in a wheelchair with truncal support and leg splints. She is a small child with coarse facial features, generalized hypotonia, and significant joint restriction. She exhibited intermittent repetitive arm movements. A tracheotomy was in place, and she did not vocalize. Variable levels of alertness were observed although she rarely signaled to others for social engagement or to express her needs. Eye contact was limited and she responded inconsistently to her name. TG's mother states that her daughter interacts well with her and uses a number of signs for communication. The rehabilitation staff reported limited progress and recommends withdrawal of services. TG's mother expressed frustration with her daughter's poor developmental improvement and believes she needs more intensive therapy, not less. Staff members are now frustrated with TG's mother's level of involvement with her daughter's care. Although TG's mother spends full weekdays at her daughter's bedside, she is often working on her computer managing her business. TG's father works full time and visits on the weekends, when her mother returns home. TG's mother has expressed frustration with her daughter's level of improvement; she believes TG needs more intensive therapy that the hospital is not providing. She informed the staff that other children with this type of storage disease may have delays, but are often higher functioning. TG's mother made the point to the staff that the family's reason for pursuing a bone marrow transplant was to attempt to correct the enzyme deficiency and improve her daughter's outcome.
19522180	Valuable insights about emotional well-being can be learned from studying older adults who have wrestled with differentiating and regulating their emotions while they navigate through the many joys and traumas of a lifetime. Our objective was to document the underlying reasons for older adults' (n = 353, ages 72 -99) emotional experiences. Using a phenomenological approach, we identified participants' reported reasons (i.e., antecedents) for a broad variety of positive and negative emotions, classifying them into thematic categories through a content analysis. The array of thematic categories that emerged for some emotions was more differentiated than for others. For example, 14 antecedent categories were required to account for the emotion of happiness; whereas, only 4 categories were needed to capture all antecedents for anger. Our analysis provided a rich description of what older adults report as the causes of their emotions, showing that later life is characterized as a time when the loss of love ones elicits sadness, self-limitations elicit frustration, and others' transgressions elicit anger. Yet, our data show that old age can be portrayed even more so as a time when a variety of positive emotions are elicited by social factors (interactions and relationships), achievements, and personal attributes. Finally, in an analysis of the most common antecedents for pride (accomplishments) and anger (other's transgression), we suggest that pride over accomplishments is most likely elicited by internal attributions to skill and effort; whereas, anger over others' transgressions is most likely elicited by controllable attributions to the transgressor's inconsiderate or offensive behavior. Overall, this shows the utility of applying Weiner's attributional framework (Weiner, 1985) to an analysis of emotion antecedents in late life.
19505357	The aim of this study was to explore how participants experience working with clients they describe as self-deceptive, as well as the participants' reflections on the experience and their understandings of self-deception.Data were collected in two stages. In the first stage, participants were asked to provide a written description of a specific incident or of a set of sessions in which it seemed to the therapist that the client was deceiving him/herself. The second stage consisted of a semi-structured interview, designed to follow-up the written description in greater detail.	Four participants took part in the study. The data were analysed using interpretative phenomenological analysis.	Three superordinate themes were identified in the analysis: therapists' self experiences; engaging with the client; and therapists' experiences and perceptions of the client.	The concept of self-deception offered participants a perspective for describing and understanding clients who present a range of 'difficult' attitudes and behaviours, such as evasion and denial of the 'truth' of their predicament as understood by the therapist, conflicting, and contradictory attitudes to the process of self change, avoiding taking responsibility for themselves, lack of self-understanding, withholding from engagement in therapy, and from relationship with the therapist. The findings also bring to light therapists' experiences of discomfort, frustration and anger, and feelings of incompetence when working with clients they described as self-deceptive. The construct of client's self-deception constitutes one possible interpretation but other interpretative possibilities are considered.	
19505043	In this study, by an immunocytochemistry it is established that development of the depression after an inescapable stress in the learned helplessness model in rats is associated with stable induction of the transcription factor NGFI-A in the dorsal hippocampus (CA1 field) and in the paraventricular hypothalamic magnocellular nucleus (PVNm), as well as with rapid and transient stress-induced expression of NGFI-A in the dentate gyrus and, supported on high level till 5 days, in the neocortex. Hypoxic preconditioning using mild repetitive hypobaric hypoxia (360 Torr for 2 hrs each of 3 days) prevented development of the depressive state in rats, and considerably changed the dynamics of the NGFI-A immunoreactivity in the hippocampus: the stable increase of an expression in the dentate gyrus and only transitory and delayed (for 5 day) in the CA1 field was detected. In the neocortex (Layer II) the stress influence was levelled with preconditioning by preventing the prolongation of the first wave of expression NGFI-A untill 5 days, and in PVNm, on the contrary, was stimulated the second (delayed) wave of an expression of this transcription factor. The pattern of NGFI-A expression in the hippocampus, neocortex and hypothalamus of preconditioned rats revealed an obvious pathological response to aversive stress, which results in development of depressive frustration rather than the adaptation. Stress-induced modifications of early gene product NGFI-A expression in the brain caused by hypoxic preconditioning, possibly, play important role in tolerance to hard psychoemotional stresses and may be an important part of antidepressive mechanisms.
19492269	Hurricane Ike played havoc with students and residents at The University of Texas Medical Branch at Galveston. Their education was disrupted, they lost many of their possessions, and some were forced to train elsewhere.
19491355	We examined characteristics, responses, and psychological well-being of care partners who support and assist older adults recently diagnosed with mild cognitive impairment (MCI).Based on a sample of 106 care partners of community residents diagnosed with MCI at memory clinics, we conducted face-to-face interviews including scales and open-ended questions. Measures tapped elements of the caregiver stress process model advanced by Pearlin and associates (1990, Caregiving and the stress process: An overview of concepts and their measures. The Gerontologist, 30, 583-594), including background characteristics, knowledge and attitude resources, stressors, strains, and protective conditions. The outcome was psychological well-being as indexed by depressive symptoms.	Care partners' depressive symptoms were higher in the context of poorer health, lower perceived importance of religion, less knowledge about dementia, being more bothered by the older adult's MCI symptoms, having a lower sense of environmental mastery, more perceived burden, more frequent use of coping strategies, and more social support. Narratives revealed multiple dimensions of stress, strain, and frustration, regardless of the level of depressive symptoms.	Assisting a relative with MCI presents new and complex challenges, even though it is an early caregiving role. Care partners likely would benefit from strategies aimed at reducing self-blame, enhancing coping skills, sustaining their sense of mastery, managing their health, seeking and accepting respite, and communicating effectively with the person with MCI and significant others.	
19490279	The purpose of this analysis was to compare social support offered by two telehealth nursing interventions for mothers of children with serious mental illnesses.A randomized, controlled, quantitative investigation is underway to test two support interventions, using the telephone (TSS) or Internet (WEB). Qualitative description was used to analyze data generated during telehealth interventions.	The behaviors and attitudes of children were challenging for the mothers to manage. Mothers' emotional reactions included fear, frustration, concern, and guilt. They sought to be advocates for their children. The nurses provided emotional, informational, and appraisal support. TSS mothers were passive recipients, while WEB mothers had to choose to participate.	Mothers in both interventions shared similar concerns and sought support related to their child's problems.	
19489819	Up till now, no study satisfactorily addressed the effect of social mobility on antagonistic attitudes toward ethnic minorities. In this contribution, we investigate the effect of educational and class intergenerational mobility on ethnic stereotypes, ethnic threat, and opposition to ethnic intermarriage by using diagonal mobility models. We test several hypotheses derived from ethnic competition theory and socialization theory with data from the Social and Cultural Developments in The Netherlands surveys (SOCON, waves 1995, 2000, and 2005) and The Netherlands Kinship and Panel Study (NKPS, wave 2002). We find that the relative influence of social origin and social destination depends on the specific origin and destination combination. If one moves to a more tolerant social destination position, the influence of the social origin position is negligible. If on the other hand, one is socially mobile to a less tolerant social position, the impact of the origin on antagonistic attitudes is substantial and may even exceed the impact of the destination category. This confirms our hypothesis that adaptation to more tolerant norms is easier than adaptation to less tolerant norms. We find only meagre evidence for the hypothesis that downward mobility leads to frustration and consequently to more antagonistic attitudes.
19485274	Following previous articles on possible etiologies and context of diagnosing borderline personality, this article discusses treatment for such cases, utilizing a case study of a woman diagnosed as borderline, who received ambulatory psychotherapy and psychiatric hospitalization. In the past, this patient experienced sexual abuse by members of her family. Notwithstanding her praiseworthy efforts to conduct a normal life, her past haunted her, both mentally and realistically. 'Borderline' can be envisioned not only as an intrapsychic struggle of aggressive impulses of a destructive quality. It can also be understood as acting out frustration that emanates from lack of empathy from the relevant milieu, and as an unremitting coping with present-life revival of the past traumata. We conclude that an empathic understanding of such considerations is crucial for the success of treatment of borderline personality.
19482444	While temperamental characteristics have been related to the onset of cannabis use, it is not clear at what point(s) along the trajectory from early onset of tobacco use (EOT) to early onset of cannabis use (EOC) these characteristics exert their impact. This study examined if (1) temperamental characteristics predispose to EOT that on its turn predisposes to EOC, and (2) temperament moderates the importance of EOT on the progression to EOC.Data from 1848 (83%) participants in the TRacking Adolescents' Individual Lives Survey (TRAILS), a prospective population study of Dutch adolescents, were analyzed. We used parent-reports on the Early Adolescent Temperament Questionnaire to assess the dimensions of high-intensity pleasure, frustration, effortful control, shyness and fearfulness at age 10-12. EOT and EOC were defined as use at least once before the ages of 12 and 13 years, respectively, assessed by means of self-reports. We performed mediation and moderation analyses in Mplus.	High levels of high-intensity pleasure predisposed to entrance in the trajectory from EOT to EOC. Once tobacco use had been initiated at early age, low levels of shyness and high levels of high-intensity pleasure increased the risk of progression to EOC.	Besides a common liability for EOT and EOC based on temperament, the risk of transition from tobacco to cannabis use is modified by temperamental characteristics. Differences in interplay with other risk factors may explain the impact of temperament on distinct points along the substance use trajectory.	
19481610	The idea that pain can lead to feelings of frustration, worry, anxiety and depression seems obvious, particularly if it is of a chronic nature. However, there is also evidence for the reverse causal relationship in which negative mood and emotion can lead to pain or exacerbate it. Here, we review findings from studies on the modulation of pain by experimentally induced mood changes and clinical mood disorders. We discuss possible neural mechanisms underlying this modulatory influence focusing on the periaqueductal grey (PAG), amygdala, anterior cingulate cortex (ACC) and anterior insula as key players in both, pain and affective processing.
19450019	Dogs (Canis familiaris) trained to receive a preferred food (dry beef liver) from an experimenter learned to maintain a longer gaze on the experimenter than dogs receiving a less preferred food (dog pellets). Dogs downshifted from dry liver to pellets rejected food more frequently than nonshifted controls. Gaze duration also decreased in downshifted dogs below the level of a group always reinforced with pellets. In addition, downshifted dogs tended to move away from the experimenter, adopting a lying down posture. This phenomenon, called successive negative contrast, has been described in analogous experiments with a variety of mammalian species, but has failed to occur in similar experiments with nonmammalian vertebrates. Unlike similar previous observations, the present data were obtained in an environment involving interspecific communication.
19449983	The personality trait of neuroticism refers to relatively stable tendencies to respond with negative emotions to threat, frustration, or loss. Individuals in the population vary markedly on this trait, ranging from frequent and intense emotional reactions to minor challenges to little emotional reaction even in the face of significant difficulties. Although not widely appreciated, there is growing evidence that neuroticism is a psychological trait of profound public health significance. Neuroticism is a robust correlate and predictor of many different mental and physical disorders, comorbidity among them, and the frequency of mental and general health service use. Indeed, neuroticism apparently is a predictor of the quality and longevity of our lives. Achieving a full understanding of the nature and origins of neuroticism, and the mechanisms through which neuroticism is linked to mental and physical disorders, should be a top priority for research. Knowing why neuroticism predicts such a wide variety of seemingly diverse outcomes should lead to improved understanding of commonalities among those outcomes and improved strategies for preventing them.
19413452	The authors tested the hypothesis that activity inhibition (AI), a measure of the frequency of the word "not" in written material, marks a propensity to engage functions of the right hemisphere (RH) and disengage functions of the left hemisphere (LH), particularly during stress. Study 1 and Study 2 showed that high AI predicts faster detection of stimuli presented to the RH, relative to the LH. Study 2 provided evidence that the AI-laterality effect is specific to perceptual, but not motor, laterality and that it is particularly strong in individuals with low mood, but absent in individuals in a positive mood state. Study 3 showed that negative affective stimuli prime the AI-laterality effect more strongly than positive affective stimuli. Findings from Study 4 suggest that situationally induced frustration (losing a contest), in conjunction with high AI, leads to increased attentional laterality. The present findings substantially bolster the construct validity of AI and contribute to a better understanding of earlier findings linking AI to physiological stress responses, immune system functioning, alcohol abuse, and nonverbal behavior.
19410263	The purpose of this study was to examine individual differences in the activation and regulation of the hypothalamic-pituitary-adrenal (HPA) axis in prepubertal children after exposure to two different stress modalities and to evaluate the utility of an individual differences approach to the examination of HPA axis functioning. After a 30-min controlled baseline period, 73 7-year-olds (40 boys and 33 girls) were randomly assigned to a validity check condition or one of two experimental tasks designed to elicit fear or frustration. This was followed by a 60-min controlled regulation phase. A total of 17 saliva samples were collected, including 12 poststress samples at 5-min intervals. There was a significant stress modality effect, with children exposed to the fear condition reaching peak cortisol levels at 25min poststress and those exposed to the frustration condition reaching peak levels at 45min poststress. There was no difference in peak cortisol levels between the stress modalities. Individual variability across conditions was significant, with participants reaching peak levels as early as 10min poststress and as late as 60min poststress. Our data suggest that analysis of individual curves prior to making group-level comparisons may improve the explanatory power of HPA axis behavior models.
19408453	To evaluate the impact of Computerized Provider Order Entry (CPOE) on workplace stress and overall job performance, as perceived by medical students, housestaff, attending physicians and nurses, after CPOE implementation at Penn State-Milton S. Hershey Medical Center, an academic tertiary care facility, in 2005. Using an online survey, the authors studied attitudes towards CPOE among 862 health care professionals. The main outcome measures were job performance and perceived stress levels. Statistical analyses were conducted using the Statistical Analytical Software (SAS Inc, Carey, NC). A total of413 respondents completed the entire survey (47.9 % response rate). Respondents in the younger age group were more familiar with the system, used it more frequently, and were more satisfied with it. Interns and residents were the most satisfied groups with the system, while attending physicians expressed the least satisfaction. Attending physicians and fellows found the system least user friendly compared with other groups, and also tended to express more stress and frustration with the system. Participants with previous CPOE experience were more familiar with the system, would use the system more frequently and were more likely to perceive the system as user friendly. User satisfaction with CPOE increases by familiarity and frequent use of the system. Improvement in system characteristics and avoidance of confusing terminology and inconsistent display of data is expected to enhance user satisfaction. Training in the use of CPOE should start early, ideally integrated into medical and nursing school curricula and form a continuous, long-term and user-specific process. This is expected to increase familiarity with the system, reducing stress and leading to improved user satisfaction and to subsequent enhanced safety and efficiency.
19391380	Focus groups were used to examine the social, cultural and spiritual dimensions of biotechnology through an analysis of five selected community groups (total n = 68): scientists, Buddhists, business people, mothers with young children and the environmentally active. Participants from all groups were united in their perspective on three of the value spheres explored: health and welfare of family/society; maintaining/preserving the environment; and ethical considerations (e.g. welfare of animals, sanctity of life). However, values regarding science and business differentiated scientists and business people from the remaining community segments. Business people were more likely to adhere to "productionism," resulting in a greater acceptance of biotechnology, since business people did not hold the same resentment toward the business sphere held by other community segments. Scientists were far more accepting of the norms and values inherent in the sphere of science, believing science to be more predictable and controllable than general public perceptions. The disparity in worldviews for this value sphere meant scientists and laypeople did not communicate at the same level, in spite of having the same concerns for health and the environment. This resulted in feelings of frustration and powerlessness on the part of the layperson and the scientist.

19379230	Since the publication of Heinz Kohut's last book in 1984, "self psychology" has become much more diverse in its perspectives and even fragmented in its applications. Perhaps due in large part to Kohut's own inconsistencies and lack of clarity on certain major points of theory and technique, self psychology currently lacks a clear definition and has become increasingly marginalized in the larger psychoanalytic community, even as some concepts have been absorbed into more general psychoanalytic usage. Major theoretical and clinical concepts in self psychology remain foggy in their definition and in their clinical application. This article will outline an essential paradigm for a psychoanalytic self psychology, given the author's background in social science, and its connection to particular psychoanalytic values. Focal changes in post-Kohutian self psychology that conflict with these views are briefly reviewed; changes that I saw at odds with not only the basic orientation of self psychology but also with psychoanalysis itself. Changes in the selfobject concept and in how the role of early trauma is understood in the context of Kohut's concept of optimal frustration are discussed. A clinical illustration demonstrates my concern that the introduction of the relational perspective in self psychology appears to interfere with psychoanalytic goals per se; that heavy reliance on present reality and "optimal gratification" is at the expense of access to the unconscious and interferes with achievement of specific analytic goals regarding the acquisition of maturity in the narcissistic realm. These conclusions relocate self psychology within the fabric of psychoanalysis and its emphasis on the self as internal.
19363008	The aim of this study was to translate the evidence-based Resources for Enhancing Alzheimer's Caregiver Health (REACH) II intervention for use in 4 Area Agencies on Aging (AAAs). A secondary aim was to examine possible moderators of treatment outcome.We used a quasi-experimental pre-post treatment design with no control group. A partnership was formed between the Alabama Department of Senior Services and the University of Alabama. The partnership trimmed the REACH II intervention used in the clinical trial for feasible use in a social service agency. The condensed REACH intervention, termed REACH OUT, was delivered to 272 dementia caregivers during 4 home visits and 3 phone calls for a period of 4 months. The assessment examined pre-post treatment effects on a number of outcomes, including care recipient risk, mood, memory, and behavior problems; caregiver stress and emotional well-being; caregiver health; and program satisfaction. All aspects of the program except for training, periodic consultation, and data analysis were controlled by the AAA staff.	Analyses were conducted on the 236 dyads that completed at least 3 of the 4 planned sessions. Significant positive pre-post effects were found on caregiver subjective burden, social support, caregiver frustration, depression, caregiver health, care recipient behavior problems and mood, and 2 of 4 care recipient risk behaviors. Site of intervention and certain participant characteristics (e.g., caregiver relationship) moderated several pre-post differences. A caregiver survey and interventionist focus group reported high acceptability of the program	This project suggests that the REACH II intervention can be modified for feasible and effective use in AAAs. The next step is to integrate the intervention into usual service delivery to achieve sustainability.	
19360521	There have been very few reports on sexual conflicts involving elderly married couples. Irrespective of their age, most married people expect to have sex. This is the reason behind the frustration of sexually energetic people with spouses who dislike having sex. In this qualitative study on a small sample of elderly married Korean people, men were found to be sexually frustrated while their wives reported marital dissatisfaction. The men persistently asked for sex with the belief that consistency of active sexual expression is important in keeping their masculinity. Although they eventually have sex with their wives, the men were found to remain sexually frustrated for over several days because of their wives' initial disregard of their sexual advances. This disregard was mainly due to the husbands' involvement in extramarital sexual affairs.
19342713	The purposes of this study were to discover the structure of the lived experience of waiting and to generate new knowledge about health and quality of life. The participants in this study were 11 persons who were on a waiting list for a lung transplant. The Parse research method was used to answer the research question: What is the structure of the lived experience of waiting? The central finding of this study was: The lived experience of waiting is arduous constraint arising with anticipating the cherished in fortifying engagements. This finding illustrates waiting as an immensely difficult and agonizing experience of persistently expecting a prized opportunity, finding strength in being with other persons, and engaging in diverse activities. The findings are discussed in relation to nursing knowledge and as to how they inform future research and humanbecoming patient-centered nursing practices.
20854501	Job satisfaction has been shown to affect levels of staff retention and productivity, but few studies have been conducted on the work of occupational therapy managers and their job satisfaction. This study explores the roles and responsibilities of occupational therapy managers who are clinician-managers or manager-administrators, and sources of their work satisfaction.A collective case study involved telephone interviews with 16 occupational therapy managers. Semistructured interview questions were based on an earlier discussion with a separate group of occupational therapy managers. Interview transcripts were analysed for emerging themes.	There were no clear differences in the roles and responsibilities of the two types of managers (manager-administrators and clinician-managers); however, manager-administrators tended to be responsible for larger numbers of staff. Managers reported that taking a clinical caseload is often at their own discretion. A common challenge for managers is the balancing of priorities as a clinician and a manager. Managing people was a common source of joy and sometimes a source of frustration. Mediating between staff and senior management and the need for budget control and efficiencies was an important aspect of managers' work, as was their autonomy to make decisions.	Occupational therapy managers assume responsibilities consistent with clinician managers across disciplines. The main sources of work satisfaction related to people management particularly when staff were working effectively as a team and there was respect from senior management. Further research will confirm whether there are no obvious differences between clinician-manager and manager-administrators, and whether there are clear differences in work-related frustration across sectors.	
19321035	Psychopathy is a developmental disorder marked by emotional hyporesponsiveness and an increased risk for instrumental and reactive aggression. The increased risk for reactive aggression is the focus of the current paper. It will be argued that the increased risk for reactive aggression does not relate to an increased sensitivity to threatening stimuli since psychopathy is associated with a reduced sensitivity to threat. Instead, it is argued that the increased risk for reactive aggression relates to an increased risk for frustration; i.e., the emotional state following the performance of an action in the expectation of a particular reward and not receiving this reward. Two impairments seen in psychopathy would increase the risk for frustration and consequent potential reactive aggression; impairments in stimulus-reinforcement learning and reversal learning. It is argued that both are known consequences of impairment in ventromedial prefrontal cortex, one of the regions principally implicated in psychopathy.
19321021	Existing measures of stress either focus on burnout or frustration and fatigue factors, often referred to as job strain. The objectives of this study were to: establish a reliable measure of distress that is sensitive enough to identify job strain at lower levels of distress and risk of burnout at higher levels of distress; and document levels of distress among the major medical specialties and across varying patterns of clinical practice.A stratified cross-sectional survey of physicians in Canada was conducted in 2004. Among the eligible population, 2810 physicians (56.7%) responded. Response bias was negligible. Responding physicians completed a 13-item measure of distress. Confirmatory factor analysis was used to establish the measure. Scheffe tests were used to document differences in the levels of distress among specializations and by clinical practice profile.	Factor analysis revealed reliable dimensions of: fatigue (alpha = 0.75) and reaction (alpha = 0.73). The distress measure was reliable (alpha = 0.82). Emergency physicians (n = 4.51), surgeons (n = 4.35), and general practitioners (n = 4.33) reported the highest levels of distress, while administrative physicians (n = 3.30), community health (n = 3.35), and clinical specialists (n = 3.46) reported the lowest levels of distress. Physicians with clinical and administrative responsibilities reported the highest levels of distress (n = 4.40), compared with purely clinical physicians (n = 3.94) and clinician-academics (n = 3.98).	Some specializations are associated with more distress than others. Administrative duties appear to add to distress for all physicians. Counterintuitively, adding academic as well as administrative responsibilities appears to add less distress than adding administrative duties alone. Academic duties are viewed as advancing medicine.	
19285935	To investigate the impact of conducting structured antenatal psychosocial assessments (SAPSA) on midwives' emotional wellbeing. The SAPSA includes screening and assessment tools for domestic violence, childhood trauma, drug and alcohol use, depression, and vulnerability factors.Registered midwives who had conducted the SAPSA with women during the first hospital booking visit at two hospitals in NSW. Data was collected by means of focus group interviews.	Four sub-themes were identified that directly impacted upon the midwives' emotional wellbeing: cumulative complex disclosures, frustration and stress, lack of support for midwives and unhealthy coping strategies.	There was a cumulative emotional effect with some midwives utilising unhealthy strategies to cope with feelings of frustration, inadequacy and vicarious trauma. Establishment of structured referral pathways for women and supportive systems for midwives is essential prior to implementing the SAPSA.	
19284679	For many years now there has been a growing frustration with the statistics of head and neck cancer. Despite the many advances in diagnosis and therapy, there has been little change in the prognosis for most cancers of the head and neck in the last 50 years, so what is the point of yet another journal? Well, it is not all bad news.
19282824	Despite the growing epidemic of extreme obesity in the United States, weight management is not adequately addressed in primary care. This study assessed family physicians' practices and attitudes regarding care of extremely obese patients and factors associated with them. A cross-sectional, self-administered survey was mailed to 500 family physicians in New Jersey (NJ) during March-May 2008. Measures included knowledge, weight management approaches, attitudes toward managing obesity, challenges with examinations, availability of supplies, and strategies to improve care. Response rate was 53% (N = 255). Bariatric surgery and weight loss medications were infrequently recommended, particularly in physicians with higher volume of extremely obese patients (odds ratio (OR) 0.38; 95% confidence interval (CI) 0.23, 0.62 and OR 0.51; 95% CI 0.31, 0.85 for surgery and medications, respectively). Higher knowledge was associated with increased frequency of recommendations of weight loss medications (P < 0.0001) and bariatric surgery (P < 0.0001). There was a high prevalence of negative attitudes, particularly in younger physicians and those with lower patient volume. Increased knowledge of weight-loss diets was associated with less dislike in discussing weight loss (P < 0.0001), less frustration (P = 0.0001), less belief that treatment is often ineffective (P < 0.0001), and less pessimism about patient success (P = 0.0002). Many providers encountered challenges performing examinations on extremely obese patients. More education of primary care physicians, particularly on bariatric surgery, specific examination techniques, and availability of community resources for obese persons is needed. Further research is needed to determine if interventions to increase knowledge of physicians will lead to less negative attitudes toward weight loss and extremely obese patients.
19271828	This study examined the possible risk-buffering and risk-enhancing role of family characteristics on the association between temperament and early adolescent externalizing and internalizing problems, adjusted for familial vulnerability for psychopathology and early childhood problem behavior. Furthermore, it explored whether these effects were specific or conditional for either internalizing or externalizing problems or more generic for psychopathology. Data on temperament (frustration and fearfulness) and family characteristics (overprotection, rejection, emotional warmth, and socioeconomic status) came from a large longitudinal Dutch population sample of early adolescents (n = 2,149; M age = 13.55 years; 51.2% girls). Hypotheses on the direction and the specificity of the effects were derived from a goal-framing approach. The findings indicate that family characteristics can either buffer or enhance the temperamental risk in the development of psychopathology. Analyses on the direction of these effects resulted in a descriptive classification of domain-specific, conditional, and generic factors that promote or protect the development of psychopathology. Implications of the results are discussed, and directions for future research are given.
19271660	The purpose of this pilot study was to evaluate the Readiness to Manage Arthritis Questionnaire (RMAQ), a new multibehavior measure of readiness for change in arthritis management. Data were obtained from 46 patients with chronic inflammatory arthritis admitted for intensive treatment. Test-retest reliability, correlations with clinical variables and theoretically related constructs, and responsiveness to change were assessed. Test-retest reliability indicated reasonable stability, with intraclass correlation coefficients ranging from 0.30 to 0.75. A significant association was observed between psychological well-being and readiness status. Clinical variables of disease duration, disease severity, pain, and function were not related to readiness status. Correlations between stages-of-change scores and self-efficacy for managing arthritis symptoms were mostly nonsignificant, with the exception of modest agreement between readiness to engage in physical activity and exercise self-efficacy (0.43). Significant changes were observed in mean RMAQ scores from initial assessment to 12 weeks posttreatment for the behaviors of using joint protection, dealing with frustration, learning about arthritis, engaging in physical activity, and stress management. Findings from this pilot study suggest that the RMAQ has adequate psychometric properties in patients with chronic inflammatory arthritis and can be used to assess an individual's readiness to adopt important arthritis self-management behaviors.
19255028	Infant crying is an important precipitant for shaken-infant syndrome. OBJECTIVE. To determine if parent education materials (The Period of PURPLE Crying [PURPLE]) change maternal knowledge and behavior relevant to infant shaking.This study was a randomized, controlled trial conducted in prenatal classes, maternity wards, and pediatric practices. There were 1374 mothers of newborns randomly assigned to the PURPLE intervention and 1364 mothers to the control group. Primary outcomes were measured by telephone 2 months after delivery. These included 2 knowledge scales about crying and the dangers of shaking; 3 scales about behavioral responses to crying generally and to unsoothable crying, and caregiver self-talk in response to unsoothable crying; and 3 questions concerning the behaviors of sharing of information with others about crying, walking away if frustrated, and the dangers of shaking.	The mean infant crying knowledge score was greater in the intervention group (69.5) compared with controls (63.3). Mean shaking knowledge was greater for intervention subjects (84.8) compared with controls (83.5). For reported maternal behavioral responses to crying generally, responses to unsoothable crying, and for self-talk responses, mean scores for intervention mothers were similar to those for controls. For the behaviors of information sharing, more intervention mothers reported sharing information about walking away if frustrated and the dangers of shaking, but there was little difference in sharing information about infant crying. Intervention mothers also reported increased infant distress.	Use of the PURPLE education materials seem to lead to higher scores in knowledge about early infant crying and the dangers of shaking, and in sharing of information behaviors considered to be important for the prevention of shaking.	
19254617	To describe the experience of living with arthritis while recovering from stroke.Qualitative, phenomenological study. During the first three months post-stroke, 14 one-on-one semi-structured interviews were conducted. Analysis was guided by the modified van Kaam method.	General community.	Three men and two women with self-reported pre-existing knee arthritis who were recovering from a first stroke.	Not applicable.	Not applicable.	"Holding me back" was central to the experience of living with knee arthritis while recovering from stroke, due to pain, mobility limitations, frustration, and additional coping demands. Experiencing arthritic pain occurred during daily physical activity. As a result, arthritis interfered with participants' ability to fully engage in stroke rehabilitation. The resulting mobility limitations due to arthritis were frustrating experiences that required additional coping strategies by all participants.	From the perspective of the participants, the slowed recovery from stroke due to arthritis illustrated the need to consider the influence of knee arthritis on stroke recovery during inpatient rehabilitation and after discharge. Stroke rehabilitation interventions that emphasize weight-bearing exercise may not be tolerated by those with arthritis. Alternate pharmacological treatments and physical rehabilitation should be considered for people with pre-existing knee arthritis post-stroke.	
19248448	To assess the response of health professionals working in a Kenyan hospital emergency department to patients who had experienced intimate partner violence and the obstacles they encountered.In-depth interviews were conducted with 11 health professionals. Transcribed interviews were analysed using QSR NVivo 7 software to reveal themes and sub-themes.	Health professionals managed victims of intimate partner violence symptomatically without following any predetermined guidelines and protocols. Participants were hindered in their attempts to screen and offer subsequent help to victims by other health professionals, victims of partner violence and the police.	Effective management by health professionals of intimate partner violence in Kenya was hindered by factors such as a lack of knowledge, training and resources. Better training is needed in assessment, screening, intervention and referral.	
19245422	The phenomenon of abused women with mental illness is often unrecognised by staff working within welfare services. This may be explained by staff members' attitudes, insecurity or lack of awareness. Today, there are shortcomings in the knowledge of staff members' experiences and interpretations of abuse against women suffering from mental illness. The aim of this qualitative study was to describe how staff members experience and understand their work with abused women suffering from mental illness. Thematic interviews were conducted with 13 staff members from various welfare services. Data were subject to content analysis. The findings showed that working with abused women was experienced as ambiguous and painful and made the staff act pragmatically. Feelings of ambiguity were mainly related to the lack of theoretical frameworks for interpreting why women with mental illness are exposed to abuse. Painful experiences involved intertwined feelings of distress, frustration, worthlessness, ambivalence and powerlessness. These were all feelings that emerged in the direct encounters with the abused women. In response to the abused women's comprehensive needs, staff members acted pragmatically, implying networking without any sanction from the leaders of the organisation, compliance with routines and taking action in here-and-now situations. By acting pragmatically, staff members could achieve concrete results through their interventions. It is concluded that staff members, working with abused women with mental illness, are in a vulnerable situation and in need of formally accepted and implemented support and legitimacy as well as theoretical knowledge regarding causes and consequences of abuse in this particular group of women.
19243459	This paper reports on a study exploring the experiences and attitudes of generic mental health nurses towards care of women with severe mental illness during the perinatal period.Severe mental disorder in the perinatal period is a global public health concern. However, there are concerns that mental health nurses other than dedicated perinatal mental health teams may lack knowledge, skills and experience in caring for such disorders, because of their low prevalence.	Sixteen generic Registered Mental Nurses working in public adult mental health services participated in three focus groups during 2007.	Participants did not perceive any difference between symptoms during perinatal and non-perinatal periods. There were mixed attitudes towards caring for women with severe mental illness in the perinatal period. Fear and anxiety was expressed by the nurses when caring or feeling responsible for the babies of clients. Lack of communication between professional groups and decreased clinical decision-making following the introduction of the Edinburgh Post Natal Depression Scale caused frustration. Confidence was displayed when working with known and trusted colleagues.	Generic mental health nurses would benefit from more education on perinatal mental health and there may be a need for them to be supported by specialist perinatal mental health practitioners.	
19239665	To describe public nursing home Enrolled Nurses' and Nurses Aides' view of their work and their perceptions of themselves in their professional role while they were receiving a serious of role awareness sessions focusing on empowerment for nine months.According to several studies, it is typical that women may experience problems and injustices at work. The main focus of the intervention was to help enrolled nurses' and nurses aides' in developing their self-image and professional role.	This study was descriptive and qualitative in design.	The present study comprises semi-structured interviews conducted with enrolled nurses and nurses aides (n = 14) from public nursing homes at start of the intervention and again nine months following the intervention. The text from the interviews was analysed using latent content analysis.	The main findings primarily show an improved professional role for the caregivers, as described in the following themes: the move from passivity to activity, the move from complaining to understanding, the move from expectations to frustration and the move from being silent to speaking loud.	For caregivers working with older people within public nursing home care, it seems to be a good form of clinical supervision to implement a serious of role awareness sessions in order to improve their professional role.	The findings showed that an intervention providing opportunities with focus on empowerment improved the enrolled nurses' and nurses aides' professional role in working with older people. This can be useful information for managers and educators and they may want to adapt it when working in a public nursing home.	
19239516	The high HIV/AIDS-related mortality among young adults is devastating countries in sub-Saharan Africa. The implementing capacity of the health systems is the main limiting factor of antiretroviral treatment (ART) scaling-up;(1) this capacity depends mainly on the health workforce. Tackling the issue of human resources for health is thus of paramount importance to achieve universal access to ART and for the survival of health systems in time of AIDS. To support such a process, the World Health Organization stresses the importance of task shifting(2) from medical doctors to nurses and from nurses to community health workers. Such task shifting is not easy to achieve but undoubtedly needed.This paper raises issues about the involvement of new actors(3) without precise redefinitions of roles and task-shifting procedures. We take the example of a 'Centre de Prévention et de Dépistage Volontaire du VIH/sida'(4) in one major town of the Far-North province of Cameroon (Central Africa).	The study was qualitative. Observations were carried out in the service and in-depth interviews conducted with health workers and actors of Cameroon's National AIDS Control Committee. These interviews were recorded and transcribed. The material was analysed using keywords. KEY RESULT: The involvement of new actors in a context of human resources for health shortage and health system crisis creates confusion and role conflicts, which lead to frustration. It favours the appearance of chinks within which these new actors slip and 'find their way' in the system; it finally raises problems related to their legitimacy and position within the existing hierarchy. KEY POLICY MESSAGE: It is necessary, when involving new staff members (particularly when they do not belong to internationally recognized health professionals such as nurses, doctors and pharmacists), to redefine roles and build precise task-shifting procedures so that everyone may still have a place in the whole system and feel useful.	
19236404	This study examined the additive and interactive effects of temperament and harsh and indulgent parenting on Chinese children's proactive and reactive aggression. Participants were 401 children (M age = 9.29 years, 203 girls) and their parents who were recruited from 2 elementary schools in Shanghai, People's Republic of China. The results showed that children's sensation seeking was associated with proactive aggression, whereas anger/frustration was associated with reactive aggression. Both subtypes of aggression were negatively related to children's effortful control but positively related to harsh parenting. Significant Temperament x Temperament and Parenting x Temperament interactions were also found. The findings point to similarities and differences between proactive and reactive aggression in relation to children's temperament and harsh and indulgent parenting in the Chinese context.
19224875	In this article, we describe how young adults who are transitioning off treatment for childhood cancer and beginning early survivorship are living in what might be described as a paradox of reality. These survivors' dual reality is their experience of intense frustration with their current state of functioning, and an overwhelming relief that therapy is over and that they survived. They have feelings of fear, trepidation, and anxiety for what experiences lay ahead, but have hope for the future. Finally, they acknowledge the growth they achieved through the experience of cancer treatment, as well as the many missed opportunities to experience normalcy while undergoing therapy. Young adults who are in early cancer survivorship exist in a reality in which they are living disease free, but perceive themselves as having a long road to travel to be healed.
19218301	To investigate and summarize participant experience of exercise programmes for non-specific chronic low back pain and the effects of these experiences on exercise participation and engagement.Three groups of six adults (>18 years) who speak, read and understand English and who had participated in an exercise programme for non-specific chronic low back pain.	Qualitative research methods were used and three focus groups were conducted by an experienced facilitator. Each group was guided with a set of pre-determined questions and participants were encouraged to give personal opinions. Transcribed data were read independently by two researchers and analysed thematically according to Grounded Theory.	Preference for partnership in care emerged as a significant theme from all focus group transcripts. The following subthemes emerged: (1) engagement with the health care process; (2) 'listen to me; I know my own body'; (3) 'tell me: explain it to me'. People with non-specific chronic low back pain want an active role in their rehabilitation. They expressed anger and frustration at not being listened to, not being provided with adequate explanations and education and not being given credit for knowing their own bodies. Tension existed between patients' wanting a genuine voice in the partnership and them wanting a care-provider to give explicit diagnosis and best management instruction.	A gap exists between care-seeker experiences of, and preferences for, exercise programmes for back pain. Care-seekers consider that care-providers should adopt a willingness to listen and consider care-seeker's experiences when designing exercise programmes.	
19212868	This study examined racial discrimination and blood pressure (BP) in 211 Black Americans. Racial discrimination is a chronic stressor for many Black Americans and hypertension prevalence is high in this population. Secondary analyses of data from the study, "Everyday Life for Black American Adults," were conducted to examine relationships among perceived racial discrimination, emotional and behavioral responses to racism, and BP. Although racial discrimination was not correlated with BP, sadness and frustration were significantly but negatively correlated with BP. Speaking out and prayer were frequent behavioral responses to racism. Findings should sensitize healthcare providers to the effects of racial discrimination on the health of Black Americans.

19191938	This paper is a report of a study exploring the impact of neuropathic pain on family, social and working relationships among patients at a pain clinic serving a large urban area.Neuropathic pain is a particularly distressing type of chronic pain which is extremely difficult to manage successfully. It produces a range of unpleasant symptoms and adversely affects patients' quality of life, but little is known about its personal impact.	A descriptive and exploratory approach was used and 10 participants participated in three focus groups in 2005. Because of the low response rate of 20% from the initial sample, a second sample of 16 patients was invited to participate. However, only one person responded and therefore it was not possible to convene an additional group.	The unpleasant and bizarre nature of neuropathic pain underpinned much of its impact in terms of respondents' difficulties in maintaining a range of relationships. For closer relationships, key difficulties centred on the reduction in quality and/or number of personal relationships. For more distant relationships and those with professionals, frustration at the invisibility of their pain and their own failure to communicate symptoms and its consequences were central.	More extensive work is needed to improve our understanding of how neuropathic pain is experienced, how it affects close and more distant kinds of relationships, and how healthcare professionals might best support people with persistent neuropathic pain to maintain personal and social relationships, and to communicate their pain effectively.	
19184138	Brosnan and de Waal (Nature 425:297-299, 2003) reported that if a witness monkey saw a model monkey receive a high-value food, the witness was more inclined to reject a previously acceptable, but low-value food. Later work demonstrated that this alleged inequity aversion might be due to frustration induced by switching subjects from their role as models receiving a high-value food to the role of witnesses receiving a low-value food. In the present study, pairs of female capuchins exchanged a token for either a high- or a low-value food without switching their model-witness roles. Witnesses could exchange a token for a low-value food after an adjacent model had exchanged a token for the same food (Equity Condition) or for a high-value food (Inequity Condition). Failure- and latency-to-exchange measures showed that witnesses were unaffected by the food type offered to models (no inequity aversion). Moreover, models were unaffected by their history of food type offered (no frustration). These results join earlier work suggesting that alleged inequity effects depend on frustration-induction procedures. Furthermore, inequity effects sometimes fail to emerge because frustration induction in nonhuman primates is labile.
19176863	The purpose of this research was to uncover the structure of the lived experience of living with changing expectations from the perspectives of women with high-risk pregnancies. The researchers' nursing theoretical perspective is the humanbecoming theory and the Parse research method was used. For the participants, living with changing expectations is foreboding disquietude arising with arduous restrictions, while envisioning the yearned-for with mitigating nurturing engagements. Findings enhance the theory of humanbecoming as well as enhance understanding of the experience of living with changing expectations. Recommendations for future research and practice are discussed.

19139245	The subjective psychological experience of people with moderate to severe dementia living in residential care is insufficiently understood. In the present study we aimed to explore the subjective experience of life with dementia in residential care from the perspective of the person with dementia, and to understand the psychological impact of being in this situation.This was an exploratory qualitative study. Eighty individuals with dementia who were living in residential care homes engaged in unstructured conversations with a researcher. We subjected the transcripts of the resultant 304 conversations to interpretative phenomenological analysis in order to develop a thematic account.	The experience of living with dementia in residential care was fundamentally one of experiencing difficult and distressing emotions relating to loss, isolation, uncertainty, fear, and a sense of worthlessness. Participants generally tried to cope by accepting and making the best of things and affirming their past sense of self and identity, but some also expressed frustration and anger.	Participants were able to describe aspects of their situation and their emotional response to it, grounded in a strong retained sense of self and identity. The participants' experience emphasizes the importance of improving the living situation of elders with dementia in residential care settings.	

19127529	To explore rheumatoid arthritis (RA) patients' experience of access to anti-tumour necrosis factor (anti-TNF) therapy in the UK, and of switching therapies after an initial failure.Patients were asked about their experience of accessing, receiving and discontinuing anti-TNF therapy in face-to-face indepth interviews, within the context of the larger study about treatment outcomes. Seventeen individuals with a diagnosis of RA and experience of receiving anti-TNF therapy were interviewed in one hospital trust in England.	Different emotions (Theme 1) surrounded the process of accessing anti-TNF therapy: hope, desperation, apprehension, anxiety and frustration. Experience of receiving anti-TNF therapy (Theme 2) included not only positive transformation, but also fear of failure and discontinuation. The subsequent value that patients placed on anti-TNF therapy (Theme 3) included having a right to receive therapy and being lucky. These three themes were underpinned by the core category of 'willing to try anything'. Those switching therapies reported increased caution over the possibility of recurring side effects, but some suggestion of benefit. There was a perception that access to anti-TNF therapy was restricted by cost, rather than being recommended for those in clinical need.	Anti-TNF therapies may have a sudden and dramatic impact on RA patients' lives that contrast with other available medications. However, the stress of the patient's journey through the need to 'qualify' for anti-TNF therapy, and the fear of failing or discontinuation of therapy, should not be underestimated by clinicians.	
19120951	The Reporter-Interpreter-Manager-Educator (RIME) evaluation framework is intuitive and reliable. Our preceptors' frustration with using summative tools for formative feedback and the hypothesis that the RIME vocabulary might improve students' and preceptors' experiences with feedback prompted us to develop and pilot a RIME-based feedback tool.The tool was based on the RIME vocabulary, which has previously been used for evaluation. As interpersonal skills and professionalism are difficult areas in which to give feedback, we added these as explicit categories. We piloted the tool in a longitudinal, 5-month, multi-specialty clerkship. Preceptors completed pre- and post-introductory workshop surveys. Students completed post-workshop and post-clerkship surveys.	Preceptors (n = 14) and students (n = 8) preferred RIME-based feedback to 'usual feedback' (previously given using end-of-clerkship evaluation forms). After the initial workshop, preceptors expected that giving feedback, including critical feedback, would be easier. After the 5-month clerkship, students reported receiving more feedback than in previous clerkships and rated feedback given using this tool more highly (P = 0.002; effect size 1.2). Students also felt it helped them understand specifically how to improve their performance (P = 0.003; effect size 1.2).	In this pilot study, preceptors and students preferred feedback with a specific RIME-based tool. Students felt such feedback was more useful and helped them identify specifically how to improve. Whether this method can improve student performance through improved feedback remains an area for further research.	
19119033	The aim of this study was to investigate the relationships between goal frustration, coping and well-being in the context of adolescent headache. Firstly, we investigated whether adolescents with weekly, monthly or no headache complaints differed with regard to the importance assigned to their personal goals, experience of goal frustration, coping with goal frustration and well-being. Secondly, the extent to which goal and coping factors contributed to well-being and whether this relationship differed according to the frequency of headache complaints was examined. For this purpose, 1202 adolescents aged 12-18 completed self-report questionnaires in schools. Adolescents were divided into three groups based on their experience of headache: no headache reported (38%); monthly headache (40%); weekly headache (18%). Results show that these groups did not differ with respect to the importance they attach to goals. They did, however, differ according to experience of goal frustration, use of strategies to cope with goal frustration and well-being, although effect sizes were small. After controlling for individual and headache characteristics, frustration of self acceptance and health goals, and the use of self blame, rumination and other blame were consistently related to lower well-being. Moreover, interactions with headache group indicated that for adolescents with weekly headache, greater frustration of school and self acceptance goals and a lower importance assigned to health goals was more detrimental to well-being than for those with no headache complaints. We conclude that frustration to goal pursuit and strategies for coping with this frustration are important factors in adolescent well-being and may offer important targets for intervention.
19117824	Many individuals with body dysmorphic disorder (BDD) seek non-psychiatric treatment. BDD occurs in about 5% of patients who seek cosmetic surgery, and rhinoplasty is the most frequently sought treatment. A correlation exists between individuals' self-esteem and demand for cosmetic surgery.To investigate whether those subjects with BDD traits requesting cosmetic rhinoplasty differ from those without BDD traits in self-esteem, personality and quality of life.	This study included 54 patients applying to the 1st ENT Division of Turin University. Assessment of the patients before cosmetic rhinoplasty includes: nasal obstruction symptom evaluation, health-related quality of life, Rosenberg self-esteem scale, body dysmorphic disorder questionnaire (BDDQ) and temperament and character inventory (TCI). Based on their responses to BDDQ questions 1, 3 and 4, patients were subdivided into subgroups and then compared.	No difference emerged in the objective data. Lower self-esteem, higher harm avoidance (HA) and lower self-directedness (SD) are found in subjects who are worried about how they look, in those with interference in their social life due to this worry and in those who spend more than 3h per day thinking about the way they look. Novelty seeking (NS) is significantly higher in subjects who think about their looks for up to 3h than in those who spend less than 1h.	Different subgroups of patients are identified. The first group includes pessimistic, shy, insecure subjects; people with fragile and immature personality and poor self-esteem; individuals concerned about the way they look and those who spend more time thinking about it. The second group includes more confident subjects with stronger personality and greater self-esteem. A third, less differentiated group, includes more impulsive (high NS) subjects who spend an intermediate amount of time thinking about the way they look. Patients should be carefully screened and assessed before cosmetic surgery interventions to avoid frustration to both, clinicians and patients.	
20301930	The aim of this paper was to present the incidence and causes of smoking among those currently unemployed, and to show changes, if any, resulting from their continued joblessness. The analysis was based on the results of 1,068 surveys taken in 2007 among the unemployed registered with the District Employment Office in Poznan. It was found that cigarette smoking among the unemployed remains high and is associated with the respondents' gender, educational background, economic status and duration of unemployment. Severity of smoking increased more often for those unemployed on a short-term basis, with a number of smoked cigarettes per day more likely to decrease for those in medium- and long-term unemployment. Respondents quoted two equivalent reasons for smoking: wanting to have a cigarette and frustration.
19112583	When experiencing aggression from group members, chimpanzees commonly produce screams. These agonistic screams are graded signals and vary acoustically as a function of the severity of aggression the caller is facing. We conducted a series of field playback experiments with a community of wild chimpanzees in the Budongo Forest, Uganda, to determine whether individuals could meaningfully distinguish between screams given in different agonistic contexts. We compared six subjects' responses to screams given in response to severe and mild aggression. Subjects consistently discriminated between the two scream types. To address the possibility that the response differences were driven directly by the screams' peripheral acoustic features, rather than any attached social meaning, we also tested the subjects' responses to tantrum screams. These screams are given by individuals that experienced social frustration, but no physical threat, yet acoustically they are very similar to screams of victims of severe aggression. We found chimpanzees looked longer at severe victim screams than either mild victim screams or tantrum screams. Our results indicate that chimpanzees attend to the informational content of screams and are able to distinguish between different scream variants, which form part of a graded continuum.
19111371	This study investigates students' expectations and apprehensions before starting writing their Bachelor thesis and their experiences after completion. The questionnaire, which consisted of open questions, was given to 171 students at the beginning of the thesis course; of these, 107 replied; at the end of the course a total of 150 students answered and returned the questionnaire. The answers were analysed according to content analysis. Seven themes describing expectations and apprehensions; and four themes describing experience after completion of the thesis emerged. The results show that students' experiences can be divided into two different groups. One group saw the thesis project as being an important preparation for future professional activities, and one group, consisting of only a few students, described the production of a thesis as being a nightmare. Nevertheless, all the students considered that their experience of learning and the insights gained, together with the learning skills acquired through writing would be of great value in their coming professional life, and that they had become aware of alternative ways of thinking. All the students were proud of the work they had completed, and some saw it as a form of recognition or a "craftsman's diploma".
19103687	This study elucidates the nursing of undernourished patients as experienced by eight registered clinical nurses and five nursing assistants by using content analysis. The participants' narratives describe the inner perspective of caring for undernourished patients, known in Sweden as 'the thin ones'. Categories identified were: frustration in nursing, joy in nursing and that undernourishment is taboo. The taboo was narrated as feelings of guilt and shame. Frustration in nursing could be seen as feeling stressed, exposed, lonely, powerless, helpless, and being torn between demands and needs. Joy in nursing was experienced when creating a trusting relationship, promoting pleasure in the meal situation and working with respect for each individual's life-style and context of life. Understanding staff members' views is important when implementing guidelines as well as in the teaching situation in order to identify where staff stand with regard to knowledge and attitudes.
19103402	The purpose of this study was to describe the ways that parents and 11- to 15-year-old teens communicate and the recurrent themes and patterns of behavior that were revealed during brief interactions about issues related to diabetes management.A secondary qualitative analysis of data, based on a template for analysis developed from the literature, was completed on audiotaped interactions of 28 adolescents and their parents.	Themes identified were frustration, fear, normalizing, trusting, and discounting. Trusting the adolescent to manage diabetes was difficult for the parents and was associated with frustration, fear, and discounting communication.	Results support the need for clinicians to work with families to facilitate trust and positive parent-adolescent communication about diabetes management.	
19089681	The aim of the present study was to investigate possible independent and combined effects of inhibitory control, delay aversion, and RT variability in relation to symptoms of hyperactivity/impulsivity and inattention. A community-based sample of school children (N = 111) completed neuropsychological tasks designed to measure inhibitory control, delay aversion, and RT variability. Behavioral symptoms were measured through parental and teacher ratings of the DSM-IV criteria for ADHD and ODD. The results showed that inhibitory control and RT variability were primarily related to symptoms of inattention rather than hyperactivity/impulsivity. Further, out of the three neuropsychological factors studied, only inhibitory control contributed uniquely to the variance of ADHD symptoms. However, significant interaction effects of delay aversion and RT variability on symptoms of both hyperactivity/impulsivity and inattention were found. This study shows the importance of searching for possible combined effects of neuropsychological factors to learn more about the different pathways that lead to ADHD symptoms in children.
19086668	Black, Hispanic, and White mothers (N = 739) and adolescents (N = 806) completed a Parent Success Indicator to assess maternal behavior related to Communication, Use of Time, Teaching, Frustration, Satisfaction, and Information Needs. Comparisons between each ethnic group and a previously established national parenting standard revealed that both generations from each group judged the overall performance of mothers to be favorable. Teaching received the highest rating followed by Satisfaction. Mothers indicated that a need to have more Information about a particular adolescent was their greatest learning challenge, while adolescents reported that their mothers were prone to Frustration. While each group demonstrated favorable and unfavorable variations from a national standard, Hispanic generational differences indicated the least congruence by ethnicity.
19071998	Structural equation models are commonly used to analyze 2-mode data sets, in which a set of objects is measured on a set of variables. The underlying structure within the object mode is evaluated using latent variables, which are measured by indicators coming from the variable mode. Additionally, when the objects are measured under different conditions, 3-mode data arise, and with this, the simultaneous study of the correlational structure of 2 modes may be of interest. In this article the authors present a model with a simultaneous latent structure for 2 of the 3 modes of such a data set. They present an empirical illustration of the method using a 3-mode data set (person by situation by response) exploring the structure of anger and irritation across different interpersonal situations as well as across persons.
19060608	Care for cancer patients has changed significantly over the past 10 years and in turn, the pressure on family caregivers of these patients is increasing. The trend toward community-based medical facilities, shorter hospital stays, and growing survivorship rates all contribute to the growing burden on family caregivers. To best address the needs of caregivers, the psychosocial oncology community must seek a deeper understanding of caregiver burden and develop strategies to manage the stress that is a result of this burden. Toward this goal, The Wellness Community in partnership with the National Coalition for Cancer Survivorship conducted and reported on a national survey of over 500 caregivers to look at the psychosocial impact of the disease on caregivers. The findings from this survey as well as data from The Wellness Community's online support group research were used to outline recommendations to better meet caregivers and patients.
19057988	Chronic pain has a considerable impact on patient-reported outcomes such as quality of life (QoL). To assess QoL in people with chronic pain, a pain and discomfort module (PDM) was developed for use with the WHOQOL-100 and its psychometric properties assessed. Sixteen items covered four facets on pain relief; anger and frustration; vulnerability, fear and worry; and uncertainty. Chronic low back pain patients (n = 133) (age 56; pain duration 85 months; 65% female) completed the WHOQOL-100 and PDM, McGill Pain Questionnaire, and SF-12. The PDM showed good internal consistency reliability (alpha = .88) (alphas .66-.81). Except for anger, all facets associated most strongly with their 'parent' domain. Pain and poorer QoL were strongly associated, supporting construct validity. The SF-12 physical health component associated strongly with pain relief, and the mental health score with other facets, indicating good concurrent validity. Discriminant validity tests showed that PDM scores distinguished between ill and well patients, and between those reporting different health statuses. The PDM has fair to good psychometric properties indicating its value as a patient-reported outcome measure for clinical trials.
19057886	We used a large sample of singleton children to estimate the effects of socioeconomic status (SES), race/ethnicity, gender, additional socio-demographics, gestational and birth factors, and parenting on children's risk for learning-related behavior problems at 24 months of age. We investigated to what extent these factors increased a child's risk of displaying inattention, a lack of task persistence, disinterest, non-cooperation, or frustration as he or she completed a series of cognitive and physical tasks with a non-caregiver. Results indicated that boys are about twice as likely as girls to display learning-related behavior problems. Children from lower SES households are about twice as likely as those from high SES households to display such behavior problems, which is largely attributable to the effects of having a mother with a low educational level. Statistically controlling for these factors, we found consistently significant patterns of elevated learning-related behavior problems for some Asian and Native American children. Results for African-American children were mixed. Hispanic children did not have consistently elevated risks of problem behaviors. Only small portions of these effects are explained by variation in the children's gestational or birth characteristics. A significant portion, but still less than half of the socio-demographic effects are attributable to measured features of the children's parenting. This study helps provide population-based estimates of children's risk for learning-related behavior problems while at an age when early interventions are most effective.
19039091	There is scientific evidence, but limited, that physicians experience sickness certification tasks as problematic. More knowledge is needed about physicians' own opinions on this matter.To further describe the experiences of physicians regarding their task of sickness certification.	Qualitative analyses of 622 written responses to an open-ended question on physicians' own opinions about sickness certification given in a comprehensive questionnaire that comprised 83 close-ended items about this matter. The questionnaire was sent to 7665 physicians in Sweden and the response rate was 71%.	The physicians stated that they found it difficult to provide sickness certificates and expressed frustration over an altered concept of disease, problems in assessing work capacity, lack of time, labour market issues, limited resources for care and rehabilitation, and lack of management and support in their work. They also felt that their authority has diminished and that it was hard to combine the two roles of being patients' advocate and a medical expert. Consequently, they felt distressed and suggested that several types of changes be made, including transfer of sickness certification tasks to specialized physicians, multi-professional teams, or specialized clinics, and introduction of specific guidelines for certification.	Physicians state several types of problems related to sickness certification tasks and many lack support in handling these problems. Such support needs to be improved, and scientifically studied.	
19025230	The current study tests a prediction of the behavioral activation system (BAS) dysregulation theory of bipolar disorder, namely that following high levels of reward or frustration, individuals with bipolar disorder will take longer than will healthy controls to recover to baseline levels of BAS activity. Eighty individuals (40 with bipolar I disorder, currently euthymic; 40 with no history of affective disorder) completed a daily diary over a 28 day period. No differences were found between the 2 groups in terms of the relation among levels of reward or frustration experienced, magnitude of initial response, or time taken to recover. However, examination of the relation between number of previous episodes and time to recover revealed that history of mania was associated with prolonged activation following reward, whereas history of both mania and depression were associated with prolonged recovery following frustration. The findings do not support an association between lifetime diagnosis of bipolar disorder and slow recovery of BAS activity. Nevertheless, they offer tentative support for an association between number of previous episodes and slow recovery of BAS activity.
19012345	We studied the experiences of children identified by family screening who were found to be a mutation carrier for a genetic cardiovascular disease (Long QT Syndrome (LQTS), Hypertrophic Cardiomyopathy (HCM), Familial Hypercholesterolemia (FH)). We addressed the (a) manner in which they perceive their carrier status, (b) impact on their daily lives, and (c) strategy used to cope with these consequences. Children (aged 8-18) who tested positive for LQTS (n=11), HCM (n=6) or FH (n=16), and their parents participated in semi-structured audiotaped interviews. Interview topics included illness perception, use of medication, lifestyle modifications, worries, and coping. Each interview was coded by two researchers. The qualitative analysis was guided by Leventhal's model of self-regulation. The children were overall quite articulate about the disease they were tested for, including its mode of inheritance. They expressed positive future health perceptions, but feelings of controllability varied. Adherence and side-effects were significant themes with regard to medication-use. Refraining from activities and maintaining a non-fat diet were themes concerning lifestyle modifications. Some children spontaneously reported worries about the possibility of dying and frustration about being different from peers. Children coped with these worries by expressing faith in the effectiveness of medication, trying to be similar to peers or, in contrast, emphasizing their "being different." Children generally appeared effective in the way they coped with their carrier status and its implications. Nevertheless, dealing with the daily implications of their condition remains difficult in some situations, warranting continued availability of psychosocial support.
19012098	The objectives of the present pilot study were to: (1) examine the prevalence of body image distress in overweight and obese women with polycystic ovary syndrome (PCOS); (2) assess the effects of a low-cost intervention in the form of a self-directed brisk walking program on body image distress; and (3) assess the level of participation, the feasibility of a larger study and the sample size required.This was an observational study whereby volunteers acted as their own control. Thirty-five women with PCOS (mean age 29.26 +/- 7.57 years) with body mass index (BMI) > 25 kg/m(2) volunteered for the study. Twenty-three returned six months later for reassessment. Of these, 12 completed the exercise program (completers) and 11 did not (non-completers). Pre and post assessments comprised the exercise tolerance test, the Body Dysmorphic Disorder Examination - Self-Report (BDDE-SR), a questionnaire on self-perceived hirsutism and dietary and activity records.	Distress with body size was highly prevalent for the overall sample. However, completers had significantly higher BDDE-SR scores at baseline compared with non-completers (p < 0.005). Pre and post assessments showed a significant reduction in body image distress only for completers (p < 0.01) despite no significant change in BMI.	A self-directed walking program is a low-cost intervention that can have psychological benefits for overweight women with PCOS. Specific recommendations for a randomized study are put forward.	
19011490	Meeting mothers' personal breast-feeding goals depends on a number of factors, including the timely resolution of any problems she encounters. Nurses are often the first providers who interact with the mother during the perinatal period and are positioned to guide mothers through the prevention and solving of breast-feeding problems. Although many problems may be "common," failure to remedy conditions that cause pain, frustration, and anxiety can lead to premature weaning and avoidance of breast-feeding subsequent children. This article describes strategies and interventions to alleviate common problems that breast-feeding mothers frequently encounter.

19011174	Irritable bowel syndrome (IBS) is a common condition associated with no certain organic cause, though diet and stress are widely implicated. The condition is frustrating for both sufferers and doctors, and there are problems in diagnosing and treating the condition. Eliciting explanatory models (EMs) is a useful tool for understanding how individuals relate to their illnesses and their expectations for treatment, particularly for illnesses with uncertain aetiology like IBS.To understand the EMs, experiences and expectations for management of patients with IBS.	Qualitative, semi-structured interviews were conducted with 51 primary care patients (31 in the UK, 20 in The Netherlands) meeting the Rome II diagnostic criteria for IBS.	Although IBS often had a significant dampening effect on daily life, IBS patients made great efforts not to allow the condition to take over their lives. Triggers of symptoms were more important to patients than understanding the underlying aetiology of IBS. Diet and stress were both recognized as important triggers, but views about which foods were problematic and the extent to which stress was modifiable were inconsistent. Diagnosis and treatment were often a confusing and frustrating process, and patients often expected more diagnostic tests than they were offered before receiving a diagnosis of IBS. However, the often poor outcome of medical interventions does not, in general, appear to have a negative impact on the patient-doctor relationship.	Clinicians should be aware of the extensive impact of IBS on sufferers' daily life and the frustration that results from repeatedly trying treatments with little effect. Clearly explaining the guidelines for diagnosing IBS and the range of treatment options may help patients to make sense of the diagnostic and treatment processes. The personal EM should be addressed during the consultation with the IBS patient, ensuring that any successive medical interventions match with the patients' disease perception.	

19006959	Professional nurses working in rural primary health-care settings are experiencing burnout due to serious shortages of personnel. This is exacerbated by the brain drain of nurses leaving the country. Rural settings are resource constrained in terms of personnel and equipment. This results in dissatisfaction among nurses due to the unbearable working conditions which result in stress and frustration. A qualitative, explorative, descriptive study was conducted to explore and describe the experiences of nurses working in a rural primary health-care setting in the greater Letaba sub-district in Limpopo Province. Purposive sampling was used to identify the participants. Data was collected in the form of in-depth interviews. The study revealed that nurses working in primary health-care settings were experiencing emotional and physical strain as a result of the shortage of human resources. It was recommended that policies that meet the health-care needs of rural communities be developed, and that strategies to retain professional nurses in primary health-care settings be formulated.

18953460	Eating behaviour depends partly on food preference, which may be determined by different types of emotions. Among the emotions generated by food, disgust and pleasure are common and can lead to increased and reduced food consumption. We tested the hypothesis that (1) elderly men and women felt different emotions towards food, and (2) low energy intake is related to negative emotions towards food. In February 2004, a convenience sample of elderly participants was recruited locally by telephone. Food intake of 52 elderly people, aged 63-80 years, was monitored throughout each day for one week and made it possible to assign the elderly people to two groups (low and high energy intake from food consumption data). One month later, each of them assessed their likes or dislikes towards 30 food pictures (vegetables, cheeses, fruits, starchy foods, sweets, meat, fish, offal and eggs) using 19 emotional words (eight words with a positive valence: 'to like', 'thrilled', 'satisfaction', 'surprise', 'serene', 'amused', 'pride', 'interest', and 11 other words with a negative valence: 'disgust', 'indifference', 'guilt', 'uneasiness', 'nostalgia', 'impatience', 'doubt', 'frustration', 'embarrassment', 'disappointment' and 'lassitude'. The emotional intensities experienced with the different pictures were analysed by ANOVA for each group (men and women, small and big eaters). There were differences in likes and dislikes between men and women. Both guilty and liking scores towards food were generally higher in women than in men. Small eaters felt more doubt, unease, disappointment and indifference towards food than big eaters. In conclusion, the report of low food intake was related to more negative emotions towards foods that might be associated with the willingness to restrict food intake or to undernutrition.
18942563	Life-long lymphedema is a common complication of cancer therapy. In this Canadian study, we adopted a phenomenological methodology to explore the experience of patients with cancer-related lymphedema, and their spouses. We conducted audio taped semistructured interviews with 11 patients and eight spouses, who were recruited through a university hospital-based lymphedema clinic and through local lymphedema therapists. We developed an analytical framework from the data themselves, and tentative hypotheses and thematic categories that represented shared case features. Participants expressed frustration because of lack of financial support from government and insurance companies, inadequate knowledge and perceived lack of interest on the part of physicians, and lack of awareness in society in general. This study suggests further investigation of the funding of lymphedema treatments, and of the effect of lymphedema on work, intimacy, and leisure activities. Our research findings will inform educational initiatives and cancer rehabilitation programs.
18936293	As the number of specialty pediatric oncology units increases, many units are hiring increasing numbers of newly graduated registered nurses. Intense specialty training and an emotionally demanding work environment place new nurses at risk for job frustration and early job resignation. The purpose of this study is to investigate experiences of pediatric oncology nurses during their first year of hire using a phenomenological approach. Participants were 6 nurses employed on an inpatient pediatric oncology unit in a tertiary care center located in the Intermountain West. A purposive sampling approach was used. Data were collected via semistructured interviews, which were analyzed for specific statements and themes providing description and meaning to nurses' experiences. Eleven themes in the categories of professional role development, a unique practice, and personal reflection were identified. Practice implications include supporting new nurses beyond the acquisition of skills and knowledge and including opportunities for personal reflection as part of the orientation experience. Successful role development is essential to ensure the retention of new pediatric oncology nurses as well as their future achievements within the subspecialty.
18929587	Delay-related motivational processes are impaired in children with Attention Deficit/Hyperactivity Disorder (ADHD). Here we explore the impact of ADHD on the performance of three putative indices of Delay Aversion (DAv): (i) the choice for immediate over delayed reward; (ii) slower reaction times following delay; and (iii) increased delay-related frustration-to see whether these tap into a common DAv construct that differentiates ADHD cases from controls and shows evidence of familiality.Seventy seven male and female individuals (age range 6-17) with a research diagnosis combined type ADHD, 65 of their siblings unaffected by ADHD and 50 non-ADHD controls completed three delay tasks.	As predicted the size of the correlation between tasks was small but a common latent component was apparent. Children with ADHD differed from controls on all tasks (d=.4-.7) and on an overall DAv index (d=.9): The battery as a whole demonstrated moderate sensitivity and specificity. In general, deficits were equally marked in childhood and adolescence and were independent of comorbid ODD. IQ moderated the effect on the MIDA. Scores on the DAv factor co-segregated within ADHD families.	There is value in exploring the broader DAv phenotype in ADHD. The results illustrate the power of multivariate approaches to endophenotypes. By highlighting the significant, but limited, role of DAv in ADHD these results are consistent with recent accounts that emphasize neuropsychological heterogeneity.	
18925946	To develop the content for two new patient reported outcome (PRO) measures to: a) assess the severity of symptoms; and b) the impact of facial skin oiliness on emotional wellbeing using qualitative data from face to face, and internet focus groups in Germany and the US.Using input from initial treatment satisfaction focus groups (n = 42), a review of relevant literature and expert clinicians (n = 3), a discussion guide was developed to guide qualitative inquiry using Internet focus groups (IFGs). IFGs were conducted with German (n = 26) and US (n = 28) sufferers of oily skin. Questionnaire items were generated using coded transcript data from the focus groups. Cognitive debriefing was conducted online with 42 participants and face to face with an additional five participants to assess the comprehension of the items.	There were equal numbers of male and female participants; mean age was 35.4 (SD 9.3) years. On average, participants had had oily skin for 15.2 years, and 74% (n = 40) reported having mild-moderate acne. Participants reported using visual, tactile and sensory (feel without touching their face) methods to evaluate the severity of facial oiliness. Oily facial skin had both an emotional and social impact, and was associated with feelings of unattractiveness, self-consciousness, embarrassment, irritation and frustration. Items were generated for a measure of oily skin severity (Oily Skin Self-Assessment Scale) and a measure of the impact of oily skin on emotional well-being (Oily Skin Impact Scale). Cognitive debriefing resulted in minor changes to the draft items and confirmed their face and content validity.	The research provides insight into the experience of having oily skin and illustrates significant difficulties associated with the condition. Item content was developed for early versions of two PRO measures of the symptoms and emotional impact of oily facial skin. The psychometric validation of these measures reported elsewhere.	
18855325	What are the explaining factors for the wave of riots in France in November 2005? In providing some answers, this article begins by examining the practical usefulness of the French republican model of integration for social cohesion, highlighting the way its negation of other criteria, such as ethnicity, race, or religion, limit this national conception of citizenship and emphasizing these excluded factors as one of the main causes of frustration and resentment among migrant groups in France.The author compares these riots to the student movements in spring 2006 and shows some similarities as well as important differences between the explaining structural factors of these two youth-based social upheavals. One of the contributing distinctions is the experience of ethnic and racial discrimination as an important source of deep resentment. The author avoids reducing the riots simply to a clash between ethnic groups with specific ethnic interests or a class revolt. Instead, he stresses the relationship between specific social structural factors and spatial effects as the element that created the context for the riots by transforming inequalities into visible and indefensible discrimination. Several factors show that spatial aspects (in the form of segregation) are important alongside the ethnic/racial ones in explaining the riots.
18855169	Based on in-depth interviews with 65 older nursing home residents, this study examined the residents' own understanding and perceptions of depressive symptoms, causes of their depression, their self-reported coping strategies, and their preferences for acceptable depression interventions. About half (n = 32) of all interviewees stated that they were either feeling depressed or experiencing negative affects. The major themes related to the causes of their depression were loss of independence, freedom and continuity with their past life; feelings of social isolation and loneliness; lack of privacy and frustration at the inconvenience of having a roommate and sharing a bathroom; loss of autonomy due to the institutional regimen and regulations; ambivalence toward cognitively impaired residents; ever-present death and grief; staff turnover and shortage; and stale programming and lack of meaningful in-house activities. Self-reported coping mechanisms included religion and stoicism, a sense of reality, positive attitude and family support. In regard to depression treatment, the interviewees appeared to prefer nursing home programs that reduce their isolation over group or individual psychotherapy.
18853347	Leaders in this community mental health system approached the problem of job frustration, morale issues, and turnover concerns of their Community Mental Health Nurses (CMHNs) by designing a qualitative study using Participant Action Research (PAR) methodology based on the philosophy of Habermas. Six focus groups were conducted to address the nurses' concerns. The themes of Valuing Autonomy, Struggling for an Identity and Collective Voice, and Seeking Role Recognition best explained the participants' concerns. The study concluded with an action plan, the implementation of the plan, and a discussion of the plan's final outcomes.
18850342	To examine aggression in adolescent males with and without traumatic brain injury (TBI).Quasi-experimental, matched-participants design.	Thirty-nine adolescents were examined, including a TBI group (n = 11) and a matched, uninjured comparison group (n = 28). Participants with TBI were injured an average of 8.3 years (SD = 4.2 years) prior. Participants and parents completed the Youth Self Report (YSR) and the Child Behavior Checklist (CBCL), both measures of global psychopathology. In addition, the theoretically-driven Reactive and Proactive Aggression Questionnaire (RPQ) and the Form of Aggression Scale (FAS) were completed.	When compared using the YSR and CBCL, no group differences were detected. In contrast, using the self-report RPQ, participants with TBI reported more reactive and proactive aggression than non-injured peers. Using the FAS, participants with TBI reported engaging in aggression out of frustration and not to dominate or acquire objects.	Aggressive behaviours are a long-term outcome after paediatric TBI. Measures of global psychopathology do not permit detailed examination of specific behaviour problems such as aggression, which may provide inaccurate data from which to derive incidence rates. In contrast, theoretically-driven measures can provide greater insight into post-TBI aggression with important treatment implications.	
18848849	EEG coherence and EEG power response were recorded as 63 participants engaged in one of three experimental conditions: 'personal rumination', 'nominal rumination', and 'baseline counting'. The rumination conditions were separated by a neutral (counting) task to eliminate neural carry-over effects. For personal rumination, participants spent 2 min ruminating about something in their life about which they were in two minds (i.e., in a state of personal conflict). For nominal rumination, they were presented with a conflict scenario (concerning buying a car) and instructed to ruminate about that for 2 min. The baseline counting task simply involved counting forwards from 1 at a speed comfortable to the individual. Participants completed various questionnaires to measure mood and also traits of personality (including trait anxiety). EEG data were analysed in the following wavebands: 4-6 Hz, 6-8 Hz, 8-10 Hz, 10-12 Hz, 12-20 Hz and 20-30 Hz. Results revealed that the scalp-wide EEG theta (4-6 Hz and 6-8 Hz) coherence associated with personal rumination was significantly greater than that associated with nominal rumination and baseline counting. Similarly, the scalp-wide 6-8 Hz and parietal-occipital 4-6 Hz power associated with personal rumination were significantly greater than power associated with the nominal rumination and power for baseline counting. For alpha, the 10-12 Hz scalp-wide EEG coherence associated with personal rumination was significantly greater than that associated with baseline counting. Otherwise, the scalp-wide 10-12 Hz power related to both nominal rumination and personal rumination were significantly greater than in response to baseline counting. For 20-30 Hz scalp-wide EEG power, data in response to the nominal rumination condition were significantly increased compared to data associated with the baseline counting condition. In terms of questionnaire data, tense arousal, anger/frustration, hedonic tone and energetic arousal were all influenced by rumination. This was largely in line with expectation. Also, mood state was influenced by neuroticism and state anxiety. Our EEG results are consistent with Gray and McNaughton's [Gray, J.A., McNaughton, N., 2000. The neuropsychology of Anxiety: An Anquiry into the Functions of the Septo-Hippocampal System. 2nd ed. Oxford University Press, Oxford.] account of recursive processing between the septo-hippocampal system and neocortex during goal-conflict resolution inherent in rumination. Evidence of posterior cingulate involvement in this processing was also discussed. Recommendations for future research, aimed at further evaluating the role of the SHS and the posterior cingulated, were outlined. Effects found in alpha were linked to increased vigilance whilst effects in beta were linked to cognitive and emotional aspects of the task. We conclude that these data provide new information of the neural processes associated with the psychological state of anxious rumination and, thus, hold implications for understanding normal and pathological anxiety.
18840211	To describe Soldiers' (e.g., U.S. Army personnel) perspectives of the effect of musculoskeletal injuries.Data were collected in the summer of 2003 using a prospective survey design. The survey was mailed to active duty Soldiers on modified work plans because of musculoskeletal injuries. These Soldiers were assigned to one Army installation in the US.	Responses to the survey questions were analyzed using descriptive statistics. The numerous handwritten comments were evaluated qualitatively.	Injuries most often involved the back and knees (18% each). At least 47% of the injuries were work related. Injuries interfered with Soldiers' abilities to perform military tasks such as road marching (80%) and organized physical training (69%). Although many respondents indicated they were not experiencing pain, at least some Soldiers reported mild pain for each of 19 anatomic locations. Severe pain was reported most often for the lower back (21%). In their written comments, Soldiers expressed a sense of frustration with their injuries, the healthcare system and providers, and their unit leaders.	Healthcare personnel are challenged to better manage Soldiers with musculoskeletal injuries and expedite their return to full duty. Unit leaders are challenged to create work environments that focus on injury prevention and allow injured Soldiers time to heal.	The Soldiers in this study were often engaged in physically challenging work or sports activities when injured. Because people outside the Army engage in similar activities (e.g., construction workers, endurance athletes), the findings from this study might be applicable to nonmilitary communities. Additionally, with the number of Reserve and National Guard Soldiers currently on active duty, civilian nurses might be caring for Soldiers with musculoskeletal injuries.	
18838172	The goals of the study were to compare anger expressions in individuals with eating disorders and healthy controls, and to explore the relation among eating disorder symptoms, comorbid psychopathology, personality traits, and impulsive behaviours. Participants comprised 135 eating disorder patients consecutively admitted to our unit and 103 healthy controls. Assessment measures included the Eating Disorders Inventory 2 (EDI-2), Bulimic Investigatory Test Edinburgh (BITE), Symptom Checklist-Revised (SCL-90-R), Social Avoidance Distress Scale (SAD), Temperament and Character Inventory-Revised (TCI-R), State-Trait Anger Expression Inventory 2 (STAXI-2), and other clinical and psychopathological indices. In the control group also the General Health Questionnaire-28 (GHQ-28) was also used. Women with eating disorders obtained significantly higher mean scores than controls on all STAXI-2 scales except for Anger Control. When various purging methods were assessed independently, the frequency of laxative use was associated with anger suppression. Eating disorder symptoms and specific personality traits were positively associated with different forms of anger expression. Finally, patients with higher scores on anger suppression were more likely to report self-harming behaviors. Eating disorder patients may have inadequate anger expression and deficits in coping with anger and frustration. Furthermore, different purging methods may be related to different facets of anger.
18837630	Gender differences in job stress were investigated, collecting both qualitative (stressful incidents at work) and quantitative (rating scales of commonly experienced job stressors and strains) data from a sample of university employees. Content analyses of the qualitative data revealed 5 major job stressors, 5 major psychological strains, and 4 major physical strains experienced by both genders. When comparisons are made between men and women on their job stress experiences, a potential confounder is occupation, for which the authors controlled. While the authors controlled for occupation, women reported more overall psychological strains (as indicated by the qualitative data) and depression (as indicated by the quantitative data) than did men. Conversely, while the authors controlled for gender, faculty reported more anger and less frustration (as indicated by the qualitative data) and less turnover intentions (as indicated by the quantitative data) than did support staff. In this study, both qualitative and quantitative data indicated interaction effects between gender and occupation in predicting job stressors and strains. Finally, there was a stronger relation between interpersonal conflicts and negative emotions/job satisfaction were stronger for faculty than for staff.
18826530	Disruptive behavior, including aggression, defiance, and temper tantrums, typically peaks in early toddlerhood and decreases by school entry; however, some children do not show this normative decline. The current study examined disruptive behavior in 318 boys and girls at 2, 4, and 5 years of age and frustration reactivity, physiological regulation, and maternal behavior in the laboratory at 2 years of age. A latent profile analysis resulted in 4 longitudinal profiles of disruptive behavior, which were differentiated by interactions between reactivity, regulation, and maternal behavior. A high profile was associated with high reactivity combined with high maternal control or low regulation combined with low maternal control. Results are discussed from a developmental psychopathology perspective.
18822371	The purpose of this study was to examine the role of prenatal cocaine exposure and associated risk factors on infant reactivity and regulation at 7 months of infant age. Participants consisted of 167 mother-infant dyads participating in an ongoing longitudinal study of prenatal cocaine exposure, who completed the arm restraint procedure at the 7-month assessment (87 cocaine exposed, 80 non-cocaine exposed). We hypothesized that cocaine exposed infants would display higher arousal or reactivity and lower regulation during a procedure designed to arouse anger/frustration. Results indicated that cocaine exposed infants were more reactive to increases in the level of stress from trial 1 to trial 2 but exhibited no change in the number of regulatory strategies as stress increased, unlike the control group infants. Infant birth weight moderated the association between cocaine exposure and infant regulation. Among cocaine exposed infants, those with lower birth weight displayed higher reactivity compared to those with higher birth weight. Contrary to expectations, there were no indirect effects between cocaine exposure and infant reactivity/regulation via environmental risk, parenting, or birth weight. Results are supportive of a teratological model of prenatal cocaine exposure for infant reactivity/regulation in infancy.
18821528	Attachment security has been identified as an important buffer of distress in patients with cancer and other medical illnesses but current measures have not been adapted for this population who may be older, in long-term stable relationships, and suffering from considerable disease burden. This study reports on (1) the psychometric properties of a modified 36-item Experiences in Close Relationships scale (ECR), adapted for this population; and (2) the validity of a brief 16-item version of our modified scale.A modified ECR (ECR-M36) was constructed by rephrasing relevant items to refer more generally to people with whom one feels close, instead of specifically in relation to one's romantic partner(s). Patients with metastatic gastrointestinal (GI) and lung cancer completed the ECR-M36 and other scales tapping self-esteem, social support, and depressive symptoms on two occasions within a period of 4-6 months. Based on factor analyses of the ECR-M36, 16 items were selected to form a brief measure (ECR-M16).	Factor analyses of both ECR forms revealed a higher-order factor structure in which four first-order factors (Worrying about Relationships, Frustration about Unavailability, Discomfort with Closeness, Turning Away from Others) loaded onto two second-order factors tapping Attachment Anxiety and Avoidance. Both ECR forms were reliable and valid.	The ECR-M36 and ECR-M16 are good measures of attachment orientations for use with medically ill, older populations.	
18821107	Persistent calls for school-based education about stuttering necessitate a better understanding of peer attitudes toward children who stutter and a means to measure outcomes of such educational interventions. Langevin and Hagler in 2004 developed the Peer Attitudes Toward Children who Stutter scale (PATCS) to address these needs and gave preliminary evidence of reliability and construct validity.To examine further the psychometric properties of PATCS and to examine the negativity of attitudes.	PATCS was administered to 760 Canadian children in grades 3-6. Measures included reliability, a confirmatory factor analysis (CFA), a known groups analysis, convergent validity with the Pro-Victim Scale of Rigby and Slee, and the negativity of attitudes.	PATCS appears to tap a second-order general attitude factor and three first-order factors representing the constructs of Positive Social Distance (PSD), Social Pressure (SP), and Verbal Interaction (VI). In the known groups analysis, participants who had contact with someone who stutters had higher scores (more positive attitudes) than those who had not, and girls had higher scores than boys. PATCS correlated moderately (0.43, p<0.01) with the Pro-Victim scale. Finally, one-fifth (21.7%) of participants had scores that were somewhat to very negative.	Results provide evidence of the validity and reliability of PATCS and confirm the need for school-based education about stuttering. The PSD and SP factors suggest that education include discussions about (1) similarities and differences among children who do and do not stutter in order to increase acceptance, and (2) making personal choices and handling peer pressure in thinking about children who stutter. The VI factor suggests that open discussion about stuttering may alleviate frustration experienced by listeners and provide the opportunity to give strategies for responding appropriately. Results also suggest that education involve contact with a person who stutters.	
18810603	Hypersexuality in Alzheimer's disease (AD) has been rarely investigated. Hypersexual behaviours should be classified as a sexual obsession and included in the "obsessive-compulsive disorder-like" spectrum. Hypersexuality has no proven treatment, although reports have described reductions of this behaviour using antiandrogen treatment, H2-receptor antagonists and antipsychotic drugs. Serotonin reuptake blockers seem to be effective in the treatment of sexual obsessions or compulsions and less on paraphilic disturbances. We present the case of a 54-year-old male patient with Alzheimer's disease with compulsive sexual behaviour as reported by his wife. A 18-FDG PET scan evidenced prevalent hypometabolism of the right hemisphere, congruent with neuropsychological evaluation. Donepezil, 10 mg per day, produced cognitive improvement but no effects on sexual behaviour. Therapy with SSRI was subsequently started (citalopram): after 60 days, the patient showed improvement in both the compulsive pursuit of sex acts and the level of frustration when refused.
18805753	Various recent surveys in Taiwan show physicians' decreasing satisfaction and increasing frustration with their working environment. Their major complaints are stress, long hours, salary, management's disrespect, and lack of trust from patients and society. To move towards restoration of social trust, this paper proposes incorporating the concept of "doctor as mediator in the changing relationship with patients" into the medical curriculum, as will be described in detail. This paper argues that structured community service for medical students facilitates self-learning, and will not only motivate them to develop good clinical and communication skills, but will also lead them to realize that the essence of medicine must be social trust. These effects have been seen after several years of an experimental curriculum involving more than 800 students. A program using methodology for community empowerment has been realized in a two-stage curriculum design. Students' self-assessment of achievements in these courses included further improvement in communication skills, courage to express own position, appropriate planning in advance, management of human resources, ability to deal with limited space and time, and experience of a profoundly moving learning process. In conclusion, community-based curriculum designs that facilitate self-learning for medical students should be the key element of reformed humanities education in Taiwan medical schools. Moreover, medical humanities continues to be a key element contributing to ongoing intellectual movements in Taiwan for building civil society and rooting democracy in the community.
18805678	Depressive disorder is associated with problems of coping with life's difficulties, including episodes of frustration and disappointment, operationally defined as an unexpected reinforcer omission or a reduction of reinforcer magnitude. In a novel model aimed at detecting potential antidepressants, rats were trained in the operant task under progressive ratio schedule of reinforcement with the break point (BP, the value of the last completed response ratio) as a behavioral endpoint. In the main experiment, a 32% sucrose solution was initially used as the reinforcer. Once the stable responding was achieved, for the following 5 days animals were treated once daily with the experimental drugs, and were offered a 4% sucrose solution instead. In vehicle-treated controls, the reduction of sucrose concentration resulted in a decrease in responding from a BP of about 40 (totaling 166 responses) to a BP of about 9 (totaling 22 responses). Chlordiazepoxide (4 and 8 mg/kg), fluoxetine (3 mg/kg), citalopram (6 mg/kg) and cocaine (2.5 and 5 mg/kg) markedly inhibited this response decrement, while fluoxetine (6 mg/kg) augmented it. Neither desipramine (1-6 mg/kg) nor morphine (1-5 mg/kg) affected responding under the reduced sucrose concentration condition. In the control experiment, the rats have never been offered 32% sucrose solution but their responding was always maintained by 4% sucrose. Under these unchanged conditions, only cocaine (5 mg/kg) affected (increased) responding. The present results suggest that the antidepressants selectively inhibiting serotonin reuptake and a benzodiazepine anxiolytic but not psychostimulant cocaine may specifically protect animals from the effects of a reinforcer downshift.

18786080	Renal diets are arguably the most restrictive for any patient group, and many of the restrictions contradict current recommendations for healthy eating. OBJECTIVES. This study aims to explore the knowledge and beliefs of chronic kidney disease (CKD) patients about the role of diet in their disease presentation and management.Focus groups (FG) with nephrology and dialysis patients informed the development of a questionnaire. Patient experiences and knowledge of diet-disease links and their education needs were explored.	Renal diets were not always perceived as compatible with other dietary advice, and often difficult to integrate with family and social occasions. Eighty percent respondents said they would like to receive dietary advice as soon as they know they have renal damage. Renal dietitians were identified as the most reliable and trustworthy source of dietary information, followed by renal specialist doctors.	Early dietetic intervention would be welcomed by patients, with group work and 'expert patient' assistance offering one means of delivering this service in a patient-centred way.	
18777608	The primary objective of this study was to identify veterans affairs (VA) primary care clinicians' attitudes regarding chronic pain treatment. A secondary objective was to explore relationships between clinician and practice characteristics and an objective measure of opioid prescribing rates.Cross-sectional study of clinician survey and pharmacy data.	Forty-five VA clinicians from five primary care clinics of one VA medical center.	Survey of pain-related attitudes and behaviors, satisfaction with treatment resources, and job satisfaction; percentage of patients in clinicians' panels prescribed opioids (PCPO).	Seventy-one percent of clinicians felt moderately or strongly confident in their ability to treat chronic pain, and 77% moderately or strongly agreed that skilled pain management is a high priority. However, 73% moderately or strongly agreed that patients with chronic pain are a major source of frustration and 38% reported moderate or greater dissatisfaction with their ability to provide optimal pain treatment. Fifty-two percent moderately or strongly agreed that their management is influenced by previous experiences with patients addicted to drugs. The mean PCPO was 16.5% (SD = 6.7). In bivariate comparisons, clinician panel size, job and resource satisfaction, and professional training were associated with opioid prescribing rates.	High clinician confidence and interest in treating chronic pain concurrent with low satisfaction with ability to provide optimal treatment suggests a need for more system support. VA primary care clinicians are frequently influenced by fears of contributing to dependence or addiction. The relationships among panel size, job satisfaction, and opioid prescribing rates merit additional investigation.	
18760476	Utilizing the conceptual framework of the Social Information Processing (SIP) model (Milner, 1993, 2000), associations between cognitive risk factors and child physical abuse risk and maladaptive discipline style and practices were examined in an at-risk population.Seventy-three mothers of 5-12-year-old children, who were identified by their therapist as having an externalizing behavior problem, responded to self-report measures pertaining to cognitive risk factors (empathic perspective taking, frustration tolerance, developmental expectations, parenting locus of control), abuse risk, and discipline style and practices. The Child Behavior Checklist (CBCL) provided a confirmation of the child's externalizing behaviors independent of the therapist's assessment.	The results of this study suggest several cognitive risk factors significantly predict risk of parental aggression toward children. A parent's ability to empathize and take the perspective of their child, parental locus of control, and parental level of frustration tolerance were significant predictors of abuse potential (accounting for 63% of the variance) and inappropriate discipline practices (accounting for 55% of the variance).	Findings of the present study provide support for processes theorized in the SIP model. Specifically, results underscore the potential role of parents' frustration tolerance, developmental expectations, locus of control, and empathy as predictive of abuse potential and disciplinary style in an at-risk sample.	
18760154	To explore the long-term experience of mood changes in community-dwelling stroke survivors at 1, 3, and 5 years after stroke.A qualitative study using a modified grounded theory approach. The primary data collection method was semi-structured interviewing.	Community-dwelling stroke survivors in metropolitan Newcastle, NSW, Australia.	Twelve community-dwelling stroke survivors (6 men, 6 women; age range 43-92y; 4 participants from each cohort) discharged from a tertiary referral hospital.	Not applicable.	Qualitative outcomes were participants' perceptions using in-depth, semi-structured interviews with participants from 3 community-based cohorts of stroke survivors at 1, 3, and 5 years poststroke.	Four main categories of mood change were described by participants including feelings of frustration, reduced self-efficacy, dependency, and loss. Factors that modulated these mood changes included the presence or absence of insight, hope for the future, faith, and support. A modified grounded theory approach was used for data analysis using a process of constant comparison.	Mood changes continued well beyond discharge and in some cases commenced after discharge in this sample of stroke survivors. Use of qualitative methodology extends our understanding of the extent and nature of low mood after stroke. There is a need for enhanced services to monitor and address low mood.	
18723742	Detection and treatment of undiagnosed refractive error (RE), with its attendant functional consequences, is a priority of VISION 2020, the global initiative against avoidable visual disability. The authors investigated the frequency of visual impairment due to undiagnosed RE and its associations with vision-related quality of life (VRQOL), general health and social circumstances in a contemporary and nationally representative population of British working-age adults.9271 members of the 1958 British birth cohort had visual acuity and VRQOL assessed at 44/45 years. The authors compared those with undiagnosed RE with those with diagnosed RE, defining undiagnosed RE as >or=0.2 logMAR units/2 lines acuity improvement in both eyes with pinhole in individuals without current or prior optical treatment or ophthalmic history.	144/9271 (1.6%) individuals had undiagnosed and 3513/9271 (37.9%) diagnosed RE. 18% (24/144) of those with undiagnosed RE were classifiable as visually impaired. Individuals with undiagnosed RE were more likely to have a manual (vs non-manual) occupation and to be separated, divorced or widowed, and less likely to be in social or professional organisations. There is also some evidence that they are more likely to express concern, embarrassment and frustration about their eyesight and worry about coping with life.	A significant proportion of working age adults in Britain appear to have undiagnosed but visually significant RE. Improvements in existing opportunities for detecting RE in adults could benefit these individuals during their working lives and avoid the serious adverse consequences associated with vision impairment in later life.	
18707620	The aim of this paper was to discuss how words for symptoms relate to experience and to find out how seriously ill patients two years after diagnosis and treatment articulated suffering. Nine patients who have had a cancer tumour of the central nervous system were interviewed in their homes and the findings were interpreted in a hermeneutic process. Bodily, obstructive, emotive and metaphorical expressions of symptoms appeared. The transformed life situation involved inability to perform everyday tasks and a feeling of frustration of needs and desires. The words for symptoms conveyed individual embodied experience connected to a discourse of shared meanings. The relationship between individuality and culture means that words for symptoms are created and understood in a process between patient and listener, between discourse, culture and history.
18705734	To systematically review the research regarding communication between nurses and patients with complex communication needs (CCN). The research was reviewed with respect to the following themes: (a) the importance of communication; (b) the barriers to effective communication; (c) the supports needed for effective communication; and (d) recommendations for improving the effectiveness of communication between nurses and patients with CCN. Augmentative and alternative communication (AAC) strategies that can be used by nurses to facilitate more effective communication with patients with CCN are discussed.Effective nurse-patient communication is critical to efficient care provision. Difficulties in communication between nurses and patients arise when patients are unable to speak. This problem is further complicated because nurses typically receive little or no training in how to use AAC to communicate with patients with CCN.	Systematic review.	This paper reviewed the published research focusing on the perspectives of nurses, patients with CCN and their caregivers regarding the challenges to effective communication between nurses and patients with CCN. Further, specific strategies (i.e., using AAC) that nurses can use to improve and facilitate communication with patients with CCN are provided.	Communication between nurses and patients is critical to providing and receiving quality care. Nurses and patients have reported concern and frustration when communication is not adequate. Using AAC strategies will help nurses and patients better communicate with each other when speech is not an option.	Communication with all patients is very important to the provision of quality nursing care. Communication cannot always be achieved using the speech modality. Nurses need to have tools and skills that will allow them to communicate with all of their patients whether or not they can speak.	
18696227	The purpose of this study was to examine the association between hypothalamic-pituitary-adrenal axis (HPA-axis) reactivity and proactive and reactive aggression in pre-pubertal children. After a 30-min controlled base line period, 73 7-year-old children (40 males and 33 females) were randomly assigned to one of two experimental tasks designed to elicit fear (N = 33) or frustration (N = 32), or a validity check condition (N = 8). This was followed by a 60-min controlled regulation phase. A total of 17 saliva samples for cortisol analysis were collected including 12 post-stress samples at 5-min intervals. Reactive and proactive aggression levels were assessed via the teacher-completed Aggression Behavior Teacher Checklist (Dodge and Coie, J Pers Soc Psychol, 53(6), 1146-1158, 1987). Reactive aggression significantly predicted total and peak post-stress cortisol regardless of stress modality. Proactive aggression was not a predictor of any cortisol index. Examination of pure reactive, proactive, combined, or non-aggressive children indicated that reactive aggressive children had higher cortisol reactivity than proactive and non-aggressive children. Our data suggest that while an overactive HPA-axis response to stress is associated with reactive aggression, stress induced HPA-axis variability does not seem to be related to proactive aggression.
18690125	Graduate nurses experience role conflict and stress as they begin practice in work environments of high complexity, nurse shortages, and expectations to become competent rapidly. The authors report outcomes from a study that evaluated qualitative responses to the Casey-Fink Graduate Nurse Experience Survey administered to graduate nurse residents in the University HealthSystem Consortium/American Association of Colleges of Nursing postbaccalaureate nurse residency program at 12 academic hospital sites. Qualitative analysis provided sufficient evidence to convert specific open-ended questions on the Casey-Fink Graduate Nurse Experience Survey instrument to a quantitative format for ease of administration and analysis.
18678735	Forty-six seriously delinquent, incarcerated boys received individual and group therapy for 32 months. The study examined how art therapy addressed the boys' psychological needs via analysis of the boys' self-selected art productions. In descending order of frequency, the eight most frequent need themes were identity issues; need for security and tranquility; need for freedom, adventure, and fun; need for ideal parental relationships; need for affiliation and affection; erotic and sexual needs; expression of depression, childhood trauma, and other psychological problems; and religious or spiritual needs. The boys' perceptions of what was most helpful about art therapy in descending order were stress relief and relaxation, reduction of boredom, pride and self-confidence, positive recognition, working through frustration, enjoyment and fun, improvement of ability to concentrate, and the way they were treated. Three brief case histories and a description of the art therapy procedures are given. Possible implications for cognitive restructuring are discussed.
18674412	Different studies have demonstrated that there are significant changes in the health and habits/life-style of university students, and it seems that Medical students also reveal a significant vulnerability to the adoption of health risk behaviours. The present study aims to (1) characterize the main sources of academic stress of the Medical School students of the University of Porto as well as the intensity with which they are experienced, (2) investigate the variations in academic stress and psychosocial variables, due to gender, year of course and displacement from home and (3) contribute, for the first time, to the understanding of stress and life-style of medical students in Portugal. The empirical study included a sample of 251 students from all 6 years of the course (160 females and 91 males), evaluated by the following instruments: (1) The Inventory of Sources of Academic Stress in Medical Education (ISASME), and the Portuguese versions of (2) the Brief Personal Survey (BPS), (3) the General Health Questionnaire 12 (GHQ-12), and (4) the Interpersonal Behaviour Survey-Brief (ICIBrief). In terms of overall levels of stress (GHQ-12), a prevalence of 58.2% of clinically significant stress symptoms was found, with the students from the basic cycle and those who are living away from home, presenting higher levels of stress. In terms of life-style, 47% of the students revealed health risk behaviours, with eating habits, physical exercise, alcohol and drug consumption, and body image being the main problem areas. Gender and year of course seem to have a significant influence on the variables studied, being the female students those who present higher levels of academic stress, stress responses (pressure/overload, physical distress, anxiety, anger/frustration, inefficiency, depression and loss of control), and low levels of coping confidence; the students of the basic cycle reveal higher levels of stress in managing their life-style (academic stress), general stress symptoms and stress responses. This study calls attention for the need of preventive intervention with medical students in order to prevent negative consequences of stress and improve their life-style by promoting individual and social resources.
18665893	Desired and feared possible future selves are important motivators of behavior and provide a temporal context for self-evaluation. Yet little research has examined why people desire some possible selves and fear others. In two studies, we tested the reflection of identity motives for self-esteem, efficacy, meaning, continuity, belonging, and distinctiveness in people's desired and feared possible future selves and in their possible future identity structures. As predicted, participants desired especially those possible futures in which motives for self-esteem, efficacy, meaning, and continuity would be satisfied, and they feared especially those in which the same four motives and, marginally, the motive for distinctiveness would be frustrated. Analyses supported an indirect path from belonging via self-esteem to desire and fear. Desired and feared possible future selves reflect potential satisfaction and frustration of these identity motives.
18652726	This qualitative study investigated the repeated use of the emergency department (ED) by men with a history of suicidal behaviour and substance abuse to understand the needs and barriers to care for this high-risk group. Identification of common themes from interviews with patients and health care workers can serve as a basis for improved ED-based interventions.Using semistructured interviews, patients, ED staff and family physicians were asked about needs of the aformentioned group. Twenty-five patients were interviewed and completed questionnaires regarding their substance use, aggression, parasuicidal behaviour, alexithymia and childhood trauma. In addition, 27 staff members were interviewed. Interviews were tape-recorded, transcribed and qualitatively analyzed using an iterative coding process.	Of the 25 patients, 23 (96%) had a mood or anxiety disorder and 18 (75%) had borderline personality disorder. One-half of the patients scored high and another quarter scored moderate on alexithymia testing. The ED was viewed as a last resort despite seeking help. Frustration was felt by both patients and staff regarding difficult communication, especially during an acute crisis.	The ED plays an important role in the provision of care for men with recurrent suicidal behaviour and substance abuse. Some of the diagnoses and problems faced by these patients are beyond the purview of the ED; however, staff can identify mutual goals for crisis interventions, allow for frequent communication and seek to de-escalate situations through the validation of the stress patients are experiencing.	
18640539	In the health sector anywhere in the world, nurses make up one of the groups that are most exposed to violence such as sexual harassment, verbal abuse, and physical abuse. This descriptive study investigated the experience of verbal abuse among 339 hospital nurses in Turkey. Findings indicate that the most frequent and most severe forms of verbal abuse reported were judging and criticizing, accusing and blaming, and abusive anger; the most common emotional reactions were anger, followed by shame, humiliation, and frustration; and most nurses used engaging in negative activities to cope with verbal abuse. The results of the study suggest that hospitals must adopt zero-tolerance policies for professional verbal abuse.
18600154	Although the use of laptops in the classroom is not a new idea, very few colleges of nursing require students to purchase and use them in the classroom. The authors report on a survey of faculty experiences and concerns related to the required use of laptops in the classroom.
18599113	The purpose of this qualitative analysis is to identify problems general internists and pediatricians encountered when ordering and receiving influenza vaccine during the 2005-2006 influenza season.A U.S. national network of general internists and pediatricians was surveyed via the internet in November 2005. A content analysis was conducted of responses to an open-ended invitation to comment on problems encountered ordering and receiving influenza vaccine.	Survey response rates were 51% (156/308) for general internists and 64% (180/283) for pediatricians. A total of 53 general internists and 102 pediatricians provided comments. Four general themes emerged: barriers to obtaining influenza vaccine, the impact of shortages and delays on practices, issues contributing to the problems practices experienced, and physicians' overall perceptions of influenza vaccine delivery in the U.S. Within these themes, notable domains included the perceived lack of communication between distributors and practices and physicians' frustration with vaccine availability at non-medical facilities.	Our findings indicate that physicians perceived a number of problems with the influenza vaccine distribution/supply system and have concerns about their ability to vaccinate their patients. These findings are useful in directing further quantitative assessments about the extent and nature of perceived problems with vaccine supply and distribution.	
18592952	The study investigated the relationship between body mass index and self-concept among adolescent black female university students. The study used a mixed research design (quantitative and qualitative methods). Media images of handsome faces and beautiful bodies are used to sell almost everything, from clothes and cosmetic to luncheon, meats, and so on. These images reinforce the western cultural stereotype that women should be thin and shapely to be attractive. Thus, as some girls go through puberty they may become dissatisfied with their weight, and to a lesser extent, with their shape, thus, developing low self-concept or imae of themselves. It is in this context that the study was conceptualised. First year female students from three different Schools and Faculties at the University of Limpopo, Turfloop Campus, South Africa, participated in the study. Using the availability and convenient sampling method, 75 students were selected for this study. For the quantitative aspect of the study, the Rosenberg Self-esteem Measure was used to measure self-esteem. For the qualitative part, a topic guide was used for the focus group discussions. Analysis of Variance (ANOVA) and the Pearson's Product Moment Correlation were used to analyse the quantitative data, while the phenomenological principle of open coding used for the thematic analysis. Results showed that there is a relationship between body mass and self-concept and that overweight participants tend to have a low self-esteem. Low self-esteem was perceived to be aggravated by a number of factors, like the attitude of the media and the society. Participants who are overweight also indicated that they are limited in certain activities of daily living (e.g., sports) as a result of their body mass. They expressed mixed feelings and frustration when it comes to such activities. The above results did not differ from those reported from western cultures. Support groups, life-skills programmes and psychotherapy should be made available and attainable for overweight female adolescent students.
18581585	This study compared the mental symptoms, especially symptoms of posttraumatic stress disorder (PTSD), of women who escaped prostitution, helping activists at shelters, and matched control subjects.We assessed 113 female ex-prostitutes who had been living at a shelter, 81 helping activists, and 65 control subjects using self-reporting questionnaires on demographic data, symptoms related to trauma and PTSD, stress-related reactions, and other mental health factors.	Female ex-prostitutes had significantly higher stress response, somatization, depression, fatigue, frustration, sleep, smoking and alcohol problems, and more frequent and serious PTSD symptoms than the other 2 groups. Helping activists also had significantly higher tension, sleep and smoking problems, and more frequent and serious PTSD symptoms than control subjects.	These findings show that engagement in prostitution may increase the risks of exposure to violence, which may psychologically traumatize not only the prostitutes themselves but also the people who help them, and that the effects of the trauma last for a long time. Future research is needed to develop a method to assess specific factors that may contribute to vicarious trauma of prostitution, and protect field workers of prostitute victims from vicarious trauma.	
18578757	This paper explores the role of the mentor in contemporary nursing practice in the UK. It presents findings from a recent study which investigated the impact of a locality-based nursing education initiative on students, practice mentors and academic staff and draws on another study, conducted in the same setting and two Australian sites, to examine the perceptions of nursing students and mentors.Within nursing, mentorship is integral to students' clinical placement experiences and has attracted increasing interest among researchers. Despite a plethora of studies focussing on mentoring and its nature and application within the practice setting, limited attention has been paid to the extent to which guidelines provided by regulatory bodies for nursing inform and influence the practice of mentoring in contemporary health-care settings.	The study used a two-phased design with data on mentorship being focussed on the second phase.	Data were collected using an online survey questionnaire of pre-qualifying students and a postal questionnaire for practice mentors.	The findings highlight the importance of mentorship for prequalifying students and emphasise the need to provide mentors with adequate preparation and support. They confirm previous research, but also highlight improvements in bridging the gap between rhetoric and reality for mentorship. Results are further strengthened when compared with those of the second study.	Findings provide new evidence of a narrowing of the gap between the theory and practice of mentoring and for the continuing implementation of national standards to clarify the roles and responsibilities of the mentor. They also suggest the benefits of developing such standards in countries with similar systems of support for nursing students.	Mentorship is pivotal to students' clinical experiences and is instrumental in preparing them for their role as confident and competent practitioners.	
18572998	Goal orientation was hypothesized to moderate the relationship between quantitative workload and frustration. Based on data from 460 graduate students, two forms of goal orientation moderated this relationship. Specifically, it was found that workload was positively related to frustration for people with high levels of avoiding goal orientation, but not for those with low levels of avoiding goal orientation. In addition, it was found that the positive effect of workload on frustration was weaker for people with high levels of mastery goal orientation than for those with low levels of mastery goal orientation. Both theoretical and practical implications of the current findings are discussed.
18569223	Cooperation between rider and horse is of major importance in equitation. A balanced team of horse and rider improves (sport) performances and welfare aspects by decreasing stress, frustration, risks of injuries, and accidents. Important features affecting the cooperation are the physical skills, knowledge, and personality of the rider on one hand and the temperament, experience, and physical abilities of the horse on the other. A study with 16 riders and 16 warm-blood riding horses tested the effect of personality of riders and temperament of horses on cooperation between riders and horses. More emotionally reactive horses showed more evasive behavior during riding. Riders preferred to ride those horses who were assessed by the riders as being attentive to the rider's aid. The frequency of evasive behaviors during riding--as assessed by riders, in contrast to the assessments made by an external judge--influenced the cooperation between rider and horse. On average, a rider's personality did not affect the cooperation between rider and horse; however, it is suggested that a rider's personality does affect the cooperation with more emotionally reactive horses.
18567225	A process is proposed that helps a person adapt to a social environment. During sleep, this process executes a set of dreams with social content that schemas tentatively incorporate by self-modifying. Due to vast interconnectivity that exists amongst social schemas, such modifications may introduce accidental, maladaptive conflicts. Consequently, a second set of dreams is executed in the form of test scenarios in order to evaluate the schema modifications effected by the first set of dreams. The process would monitor emotions generated during these latter dream tests. If prior, tentative modifications alleviate anxiety, frustration, sadness, or in other ways appear emotionally adaptive, they would be selected for retention. Those modifications that compare negatively to existing, unchanged schemas would be abandoned or further modified and tested. The correspondences of these hypotheses to the sleep cycle, previous dream studies, and functional neurological processes are discussed.
18561003	Culture is an essential variable of diagnosis and treatment. A cultural perspective draws attention to the social context within which symptoms arise, are given meaning, and are managed. Ethno-cultural work on illness narratives suggests that most people can provide culturally-based explanations for their symptoms. While these explanations are inconsistent with biomedical theory, they relieve patient distress by allowing the patient to create meaning for symptoms. Exploring the characteristics, context, and antecedents of the symptoms enables the patient to convey them to the clinician who may have a divergent explanation of sickness. This case study uses the Outline for Cultural Formulation of the DSM-IV created for clinicians to elicit a narrative account of the illness experience from the patient. Our study examines how the patient, a Laotian used social indignation ("Kwam khem keuang") as an explanatory model for his ailment. He was diagnosed with post-traumatic stress disorder after having undergone a traumatic amputation. In the process of explaining his illness through a cultural idiom, the patient was able to reveal both personal and collective meaning of repressed anger and frustration, expressing them in a context that was acceptable to him. This cultural idiom allowed the patient to reflect upon the structure of the health care system and the specific context in which symptoms and their possible origins are recounted and explored. It also clarified to the treating clinicians some categories of experience and causal explanations that did not fit easily with western biomedical and psychiatric understanding. The case study illustrates how a cultural approach to illness from the patient's perspective offers a reflexive stance on the clinician-patient interaction that allows for better patient care.
18537496	This study evaluated the association between Internet addiction and frustration intolerance, the gender difference of frustration intolerance, and the gender differences of the association between Internet addiction and frustration intolerance. Participants were 2,114 students (1,204 male and 910 female) who were recruited to complete the Chen Internet Addiction Scale and Frustration Discomfort scale. Females had higher scores on the subscale of entitlement and emotional intolerance and the total scale of the frustration intolerance. There was a significant gender difference on the association between Internet addiction and frustration intolerance. The association was higher in male adolescents. Regression analysis revealed male adolescents with Internet addiction had higher intolerance to frustration of entitlement and emotional discomfort, and female adolescents with it had higher intolerance to emotional discomfort and lower tolerance to frustration of achievement. Frustration intolerance should be evaluated for adolescents with Internet addiction, especially for males. Rational emotive behavior therapy focusing on different irrational beliefs should be provided to male and female adolescents with Internet addiction.
18524094	This paper explores the impact of trauma on the later development of a 6-year-old boy. The trauma disturbed his development and psychic functioning in almost every area, including his attainment of object constancy, capacity to regulate affects and tolerate frustration, his sense of self and self-protective functioning, as well as his capacity to symbolize. Three phases can be distinguished in his analysis based on his capacity to deal with memories of his traumatic past: initially attempting to forget but expressing them through persistent increased arousal and re-enactment behavior followed by recalling and re-enacting salient incidences, and finally, remembering and playing through early memories in displacement. Each phase was characterized by an increasing level of affect regulation, symbolic play, and capacity to tolerate and think about the unbearable. The paper explores the different ways in which chronic trauma and the salient traumatic event, experienced in infancy are repeated, recalled, and expressed verbally and through behavior.
18521838	Brosnan and de Waal [Nature 425:297-299, 2003] reported that capuchin monkeys responded negatively to unequal reward distributions between themselves and another individual when comparing their own rewards with that of their partner. It was suggested that social emotions provided the underlying motivation for such behavior and that this inequity aversion is specific to the social domain. However, alternative hypotheses such as the "frustration effect" or the "food expectation hypothesis" may provide more parsimonious explanations for Brosnan and de Waal's [Nature 425:297-299] results, while others have argued that these findings are not congruent with the Fehr-Schmidt inequity aversion model cited by the authors. The claim that inequity aversion behavior is specific to the social domain has also been questioned, as primates also develop expectations about rewards in the absence of partners, and react negatively when those expectations are violated. In this study, a modified Dictator game was used to investigate whether capuchins would exhibit either disadvantageous inequity aversion behavior or reference-dependent expectancy violation in social and nonsocial conditions, respectively. When given the choice between an equitable and an inequitable outcome, the subjects showed disadvantageous inequity aversion behavior, choosing the equitable outcome significantly more in the social condition. In the nonsocial condition, however, subjects did not show negative expectancy violation resulting from the formation of reference-dependent expectations, choosing the equitable outcome at chance levels. These results suggest that capuchins attend to differential payoffs and that they are averse to inequity, which is disadvantageous to themselves.
18515436	Nursing advocacy for patients is considered to be an essential component of nursing practice. This phenomenological qualitative pilot study explored registered nurses' lived experience of nursing advocacy with patients using a sample of three medical-surgical registered nurses. The guiding research questions were: (1) how do registered nurses practicing in the medical-surgical specialty area describe their experiences with nursing advocacy for their patients; and (2) what reflections on educational preparation for their professional roles do registered nurses identify as related to their practices of nursing advocacy with their patients? Data analysis procedures were based on Moustakas' data analysis method, and Lincoln and Guba's criteria were applied for rigor. The emergent themes were: speaking out and speaking for patients; being compelled to act on unmet needs of patients; fulfillment and frustration; the patient is changed; primarily learned on the job; and confidence gained through practice. The findings increase the body of knowledge surrounding nursing advocacy as practiced by nurses.
18507717	Large, well-designed observational or clinical efficacy and safety randomized clinical trials are required to identify the prevalence of premature ejaculation (PE) and its associated risk factors, to characterize the dimensions of PE and the basis for treatment-seeking behaviour, and to achieve regulatory approval of new drug treatments.The objective of this article was to make recommendations for the criteria for defining and selecting the study population.	Contemporary published data on clinical trial design and the epidemiology, definitions, dimensions, and psychological impact of PE.	Contemporary data on the epidemiology, definitions, dimensions, and psychological impact of PE were reviewed, critiqued using the principles of evidence-based medicine, and incorporated into a series of evidence-based recommendations for standardization of patient selection for clinical trials in PE.	Data from PE observational, interventional, and treatment preference studies are only reliable, interpretable, and capable of being generalized to patients with PE when study populations are defined by the constructs of an ejaculatory latency time of less than about 1 minute on all or nearly all occasions, the inability to delay ejaculation, and the presence of negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy.	These constructs can be incorporated into a multidimensional evidence-based definition of PE and/or single-item questions or multi-item diagnostic questionnaires. The International Society of Sexual Medicine definition of PE reflects the contemporary understanding of PE, represents the state-of-the-art multidimensional definition of PE, and is recommended as the basis of diagnosis of PE for all PE clinical trials.	
18507706	A theoretical framework is presented to explain individual differences in situation-specific emotional experience in terms of three different sources of variance: (a) individual differences in how one appraises one's circumstances, (b) individual differences in how appraisals are related to the experience of emotion, and (c) individual differences independent from situation and appraisal. The relative contribution and nature of these sources was examined empirically for the experience of anger based on data from two directed imagery studies (total N=1,192). Consistent results across the two studies demonstrated that variability in anger experience primarily stems from variability in how a situation is appraised and to a smaller extent from individual differences in the relations between the appraisals and anger and individual differences independent of appraisal. The findings further identified frustration as the central appraisal involved in anger. Implications for emotion theories and anger management programs are discussed.
18498422	To develop a contemporary, evidence-based definition of premature ejaculation (PE).There are several definitions of PE; the most commonly quoted, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders - 4th Edition - Text Revision, and other definitions of PE, are all authority-based rather than evidence-based, and have no support from controlled clinical and/or epidemiological studies. Thus in August 2007, the International Society for Sexual Medicine (ISSM) appointed several international experts in PE to an Ad Hoc Committee for the Definition of PE. The committee met in Amsterdam in October 2007 to evaluate the strengths and weaknesses of current definitions of PE, to critically assess the evidence in support of the constructs of ejaculatory latency, ejaculatory control, sexual satisfaction and personal/interpersonal distress, and to propose a new evidence-based definition of PE.	The Committee unanimously agreed that the constructs which are necessary to define PE are rapidity of ejaculation, perceived self-efficacy, and control and negative personal consequences from PE. The Committee proposed that lifelong PE be defined as a male sexual dysfunction characterized by ejaculation which always or nearly always occurs before or within about one minute of vaginal penetration, and the inability to delay ejaculation on all or nearly all vaginal penetrations, and negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy. This definition is limited to men with lifelong PE who engage in vaginal intercourse. The panel concluded that there are insufficient published objective data to propose an evidence-based definition of acquired PE.	The ISSM definition of lifelong PE represents the first evidence-based definition of PE. This definition will hopefully lead to the development of new tools and patient-reported outcome measures for diagnosing and assessing the efficacy of treatment interventions, and encourage ongoing research into the true prevalence of this disorder, and the efficacy of new pharmacological and psychological treatments.	
18496098	If individuals with mental illness become violent, mothers are most often victims, yet there is little available research addressing how, when, and from whom mothers seek help for themselves or their children when they become victims of this form of familial violence.To describe how mothers understood violence their adult children with mental illness exhibited toward them and to articulate the process mothers used to get assistance and access mental health treatment when this violence occurred.	: Grounded theory methods were used to explore and analyze mothers' experiences of violence perpetrated by their adult children with mental illness. Eight mothers of adult children who are violent with a diagnosed Diagnostic and Statistical Manual of Mental Disorders Axis I disorder participated in one to two open-ended interviews. Mothers were of diverse ethnic backgrounds.	Getting immediate assistance involved a period of living on high alert, during which mothers waited in frustration for their children to meet criteria for involuntary hospitalization. This was a chaotic and fearful period. Fear and uncertainty eventually outweighed mothers' abilities to manage their children's behavior, at which time they called the police or psychiatric evaluation teams who served as gatekeepers to mental health treatment. Mothers accepted the consequences of being responsible for their children's involuntary hospitalization or of being left home with their children if the gatekeepers did not initiate involuntary hospitalization.	Mothers can identify signs of decompensation in their children who are ill and recognize their need for hospitalization. They cannot, however, always access mental health treatment due to their children's refusal or failure to meet legal criteria for involuntary hospitalization. Mothers' inability to intervene early sometimes results in their own violent victimization.	
18494100	The aim of this paper is to thoroughly examine the involvement and experiences of nurses in the care of mentally competent, adult patients requesting euthanasia (i.e. administration of lethal drugs by someone other than the person concerned with the explicit intention of ending a patient's life, at the latter's explicit request) by means of a literature review.A keyword search was used to identify relevant journal articles and books published between 1990 and 2007. Manual searches of review article bibliographies were also conducted as well as searches of archives and collections of key journals.	The electronic databases Medline, Cinahl, PsycINFO, The Cochrane Library, Social Sciences Citation Index, and Invert were searched using a combination of keywords and carefully constructed inclusion criteria.	Forty-two publications of empirical research were identified and included in the present study after critical appraisal. The included publications represented 35 separated studies (20 quantitative, 11 qualitative and 4 mixed-method publications) and 28 different research samples.	Analysis of these studies revealed that nurses across diverse geographic and clinical settings play a major role in caring for and showing a personal interest in patients requesting euthanasia. The nurses' feelings about euthanasia and their involvement are extremely complex. Descriptions of personal conflict, moral uncertainty, frustration, fear, secrecy,and guilt appear to reflect a complex array of personal and professional values as well as social, religious, and legal rules.	Nurses can make a significant contribution to the quality of care by assisting and counseling patients and their families, physicians, and their nursing colleagues in a professional manner, even in countries where euthanasia is not legal. However, research on nurses' involvement in euthanasia has methodological and terminological problems,leading to our recommendation for more carefully designed qualitative studies that explore in-depth the experiences of nurses in caring for patients requesting euthanasia.	
18491834	Communication is vitally important in relationships and a hearing loss can have a profound impact on a person's desire to interact with others. Embarrassment and frustration can cause a person to withdraw and avoid social situations leading to isolation and depression. Persons who recognize they have a hearing problem, seek treatment, and have benefited from available therapies are able to have better relationships with friends and family, feel better about themselves, have improved mental health, and feel greater security and independence. It is in the best interest of the patient that the nurse actively assess for any kind of hearing difficulty and provide appropriate education and referral.
18489409	The relations of parenting and temperament (effortful control and anger/frustration) to children's externalizing problems were examined in a 3.8-year longitudinal study of 425 native Chinese children (6-9 years) from Beijing. Children's experience of negative life events and coping efficacy were examined as mediators in the parenting- and temperament-externalizing relations. Parents reported on their own parenting. Parents and teachers rated temperament. Children reported on negative life events and coping efficacy. Parents, teachers, children, or peers rated children's externalizing problems. Authoritative and authoritarian parenting and anger/frustration uniquely predicted externalizing problems. The relation between authoritarian parenting and externalizing was mediated by children's coping efficacy and negative school events. The results suggest there is some cross-cultural universality in the developmental pathways for externalizing problems.
18482125	The aim of this paper is to shed light on how nurses describe situations that reflect achievement and provide confirmation that they have done good work.Nurses' recognition of good work does not seem to have been the object of direct investigation, but is indirectly reflected in studies focusing on nurses' perceptions on work environments and the multifaceted nature of nursing. However, acknowledging high-quality performance in professional nurses can facilitate nurses in maintaining and strengthening the goals and values of the profession. This in turn can help nurses shoulder the multifaceted responsibilities they have to patients and next of kin.	This paper is part of the Professional Learning in a Changing Society project, Institute of Educational Research, University of Oslo, funded by the Research Council of Norway. The project involves four professional groups. This paper, however, focuses on a group of 10 nurses, nine of whom work in hospitals and one in an outpatient clinic. A qualitative approach was chosen to gain insight into how nurses, as well as the other professional groups in the project, engage in processes of knowledge production and quality assurance work.	Data presented in this paper derive from semi-structured in-depth interviews conducted during spring 2005 and focuses on the recognition of good work.	The following themes were identified as essential in confirming that one did good work: securing fundamental needs of patients and next of kin; managing the flow of responsibilities; positive feedback. CONCLUSIONS. Good work seems to be related to specific situations and a sense of achievement by the respondents.	Recognition of good work is not only rewarding and enjoyable; it may also serve as a source of consciousness raising for professional and ethical guidelines in the work place.	
18478458	The International Affective Picture System (IAPS) uses a series of emotional, normative and internationally accessible pictorial stimuli and is considered to be the most reliable and valid system in the experimental study of emotions. The IAPS has been used in research on mental disorders such as schizophrenia, major depression, anxiety or psychopathic personality traits. Furthermore, it is frequently used as independent variable in neuroimaging studies. Some of the approaches to borderline personality disorder consider that the fundamental psychopathological element in these subjects is affective dysregulation, from which the principal symptoms such as intolerance to frustration, reactivity or dysphoria are derived. This review paper has aimed to gather and analyze the information on the study of emotional regulation and the use of the IAPS in the different mental disorders.A review is made of the different data bases of the studies published in the general population and in the clinical populations as well as of the internal characteristics of the test.	In agreement with the results described in the studies reviewed, the IAPS seems capable of defining specific responses to stimuli in different mental disorders, including mood disorders and schizophrenia.	In conclusion, the use of the IAPS in the study of borderline personality disorder could be of interest for the understanding and treatment of borderline personality disorder in which emotional dysregulation is a principal factor.	
18476477	In Heinz Kohut's (1977, 1984) theory of the psychology of the self, good parenting provides a child with optimal frustration and just the right amount of loving empathic concern. In the present study, the authors examined the relations of perceived parental empathy and love inconsistency with measures of narcissism, self-esteem, and depression. In a sample of university undergraduates (N=232; 78 men, 153 women, and 1 nonresponder), perceived parental empathy predicted more adaptive self-functioning, whereas parental love inconsistency was related to psychological maladjustment. These results support the theoretical assumption that perceived parental empathy is associated with healthy self-development.
18469294	Brain death is a medical, legal and cultural category constructed to fill an important need created by evolving medical technologies and practices. However, managing life and death via organ transplants and brain death criteria is not without controversy; there remains much confusion and ambivalence in both lay and medical populations regarding both organ donation and the diagnostic category of brain death. By way of a case study of cranial trauma taken from a larger study of bereaved parents, this article discusses how, from a parent's perspective, brain death and organ donation are neither morally nor medically straightforward concepts. The case study presented in this article demonstrates the necessity for more research and clinical training in communication issues regarding brain death and end-of-life care with families in critical care situations.
18468282	Functional analysis has been demonstrated to be an effective method to identify environmental variables that maintain problem behavior. However, there are cases when conducting functional analyses of severe problem behavior may be contraindicated. The current study applied functional analysis procedures to a class of behavior that preceded severe problem behavior (precursor behavior) and evaluated treatments based on the outcomes of the functional analyses of precursor behavior. Responding for all participants was differentiated during the functional analyses, and individualized treatments eliminated precursor behavior. These results suggest that functional analysis of precursor behavior may offer an alternative, indirect method to assess the operant function of severe problem behavior.
18467475	The psychiatric clerkship is a stressful experience that influences attitudes toward patients with psychiatric illnesses and influences recruitment into the field. This study focused on medical students' encounters with patients they found troubling or difficult, and whether specific themes regarding their emotional responses could be identified.Third-year medical students rotating through the psychiatry clerkship participated in a problem patient conference for which they were required to submit a form detailing a troubling encounter that occurred with a patient in the prior week. During the conferences, students discussed these encounters and their responses to them. The encounters were later reviewed and grouped into a set of four themes. Comparisons were made between male and female students, and response to patients at the start and finish of the clerkship.	For both male and female students the most common reaction of a problematic encounter was frustration/helplessness, followed by having a strong negative reaction, then identification with patients evoking a disturbing response, and finally feelings of intimidation and fear. There were no gender differences for any of the four categories. The proportion of encounters classified as intimidating/frightening significantly declined from the first half to the second half of the rotation.	The problem patient conference is an effective tool to elicit candid concerns regarding the care of psychiatric patients and is an opportunity to empathically address struggles specific to the psychiatric clerkship.	
18466262	The medical literature contains several definitions of premature ejaculation (PE). The most commonly quoted definition, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revision, and other definitions of PE are all authority based rather than evidence based, and have no support from controlled clinical and/or epidemiological studies.The aim of this article is to develop a contemporary, evidence-based definition of PE.	In August 2007, the International Society for Sexual Medicine (ISSM) appointed several international experts in PE to an Ad Hoc Committee for the Definition of Premature Ejaculation. The committee met in Amsterdam in October 2007 to evaluate the strengths and weaknesses of current definitions of PE, to critique the evidence in support of the constructs of ejaculatory latency, ejaculatory control, sexual satisfaction, and personal/interpersonal distress, and to propose a new evidence-based definition of PE.	The committee unanimously agreed that the constructs that are necessary to define PE are rapidity of ejaculation, perceived self-efficacy and control, and negative personal consequences from PE. The committee proposed that lifelong PE be defined as ". . . a male sexual dysfunction characterized by ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration, and the inability to delay ejaculation on all or nearly all vaginal penetrations, and negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy." This definition is limited to men with lifelong PE who engage in vaginal intercourse. The panel concluded that there are insufficient published objective data to propose an evidence-based definition of acquired PE.	The ISSM definition of lifelong PE represents the first evidence-based definition of PE. This definition will hopefully lead to the development of new tools and Patient Reported Outcome measures for diagnosing and assessing the efficacy of treatment interventions and encourage ongoing research into the true prevalence of this disorder and the efficacy of new pharmacological and psychological treatments.	
18450389	There is a controversy about the mechanisms involved in the interspecific communicative behaviour in domestic dogs. The main question is whether this behaviour is a result of instrumental learning or higher cognitive skills are required. The present investigations were undertaken to study the effect of learning processes upon the gaze towards the human's face as a communicative response. To such purpose, in Study 1, gaze response was subjected to three types of reinforcement schedules: differential reinforcement, reinforcer omission, and extinction in a situation of "asking for food". Results showed a significant increase in gaze duration in the differential reinforcement phase and a significant decrease in both the omission and extinction phases. These changes were quite rapid, since they occurred only after three training trials in each phase. Furthermore, extinction resulted in animal behaviour changes, such as an increase in the distance from the experimenter, the back position and lying behaviour. This is the first systematic evaluation of the behavioural changes caused by reward withdrawal (frustration) in dogs. In Study 2, the gaze response was studied in a situation where dogs walked along with their owners/trainers. These results show that learning plays an important role in this communicative response. The possible implications of these results for service dogs are discussed.
18450143	Care for a dependent elderly individual with a chronic disease can be a threat and cause stress. Success in dealing with this situation will depend on coping strategies, defined as processes used in order to control the demands of the individual-environment relationship. In this study the goal was to detect coping strategies used by caregivers for the elderly. A qualitative study was carried out through the analysis of coping discourse and theoretical reference. The sample was comprised of 16 individuals. It was observed that the coping strategies most used by caregivers were centered on emotion, and that caregiving tasks imply many changes in the life of caregivers, who perform them with no aid, with work overload, loss of liberty, and frustration. The greatest stress is related to the lack of help from family members and of shared responsibilities. Stimulating the involvement of the family, educating and giving basic orientation, which may reduce the difficulties of caregiving, could improve these individuals' well-being.
18448726	To evaluate one ethics rounds model by describing nurses' and doctors' experiences of the rounds.Philosopher-ethicist-led interprofessional team ethics rounds concerning dialysis patient care problems were applied at three Swedish hospitals. The philosophers were instructed to promote mutual understanding and stimulate ethical reflection, without giving any recommendations or solutions. Interviews with seven doctors and 11 nurses were conducted regarding their experiences from the rounds, which were then analysed using content analysis.	The goal of the rounds was partly fulfilled. Participants described both positive and negative experiences. Good rounds included stimulation to broadened thinking, a sense of connecting, strengthened confidence to act, insight into moral responsibility and emotional relief. Negative experiences were associated with a sense of unconcern and alienation, as well as frustration with the lack of solutions and a sense of resignation that change is not possible. The findings suggest that the ethics rounds above all met the need of a forum for crossing over professional boundaries. The philosophers seemed to play an important role in structuring and stimulating reasoned arguments. The nurses' expectation that solutions to the ethical problems would be sought despite explicit instructions to the contrary was conspicuous.	When assisting healthcare professionals to learn a way through ethical problems in patient care, a balance should be found between ethical analyses, conflict resolution and problem solving. A model based on the findings is presented.	
18427866	The present study evaluated whether different patterns of temperament may predict a different threshold of acceptability of obsessive-compulsive (OC) symptoms in adolescents. OC symptomatology was detected with the Leyton Obsessional Inventory-Child Version (LOI-CV) and temperament was assessed using the tridimensional personality questionnaire in 2,775 high-school students. According to the LOI-CV scores, the adolescents were classified as high interference (interfering, ego-dystonic symptoms) (HI), supernormal (noninterfering, ego-syntonic symptoms) (Sn) and controls (C) HI were 119 (4.3%), Sn 85 (3.1%) and C 2,571 (92.6%). The best predictor of belonging to HI or Sn groups was the temperament configuration of high Harm Avoidance (HA) and high Persistence (P). The feature that mainly distinguishes the two symptomatic groups were Novelty Seeking (NS) levels. Our data suggest that people characterized by pessimistic worry in anticipation of future problems, passive avoidant behaviour, rapid fatigability (high HA) and irresoluteness, ambitiousness, perseverance, perfectionism, enduring feelings of frustration (high P) might develop OC symptoms. Whether OC symptoms become ego-syntonic or ego-dystonic seems to mainly depend on NS levels: low NS might protect people (with the prevention of "exploratory and active behaviours" that may elicit loss of control on symptoms) from the development of interfering OC symptoms.
18427073	Disruptive behavior can have a significant impact on care delivery, which can adversely affect patient safety and quality outcomes of care. Disruptive behavior occurs across all disciplines but is of particular concern when it involves physicians and nurses who have primary responsibility for patient care. There is a higher frequency of disruptive behavior in neurologists compared to most other nonsurgical specialties. Disruptive behavior causes stress, anxiety, frustration, and anger, which can impede communication and collaboration, which can result in avoidable medical errors, adverse events, and other compromises in quality care. Health care organizations need to be aware of the significance of disruptive behaviors and develop appropriate policies, standards, and procedures to effectively deal with this serious issue and reinforce appropriate standards of behavior. Having a better understanding of what contributes to, incites, or provokes disruptive behaviors will help organizations provide appropriate educational and training programs that can lessen the likelihood of occurrence and improve the overall effectiveness of communication among the health care team.
18423086	Temperament, effortful control, and problem behaviors at 4.5 years were assessed in 72 children classified as exuberant, inhibited, and low reactive as 2-year-olds. Exuberant toddlers were more positive, socially responsive to novel persons, less shy, and rated as having more problem behaviors, including externalizing and internalizing behaviors, than other children as preschoolers. Two forms of effortful control, the ability to delay a response and the ability to produce a subdominant response, were associated with fewer externalizing behaviors, whereas expressing more negative affect (relative to positive/neutral affect) when disappointed was related to more internalizing behaviors. Interaction effects implicated high levels of unregulated emotion during disappointment as a risk factor for problem behaviors in exuberant children.
18420762	This study used Smith and Lazarus's appraisal model to explore nurses' emotional reactions to self-identified distressing work situations. Key situations reported typically involved time or interpersonal pressure, coping with errors at work, difficulties with patients, and managerial conflict. The strongest emotions experienced were anger and frustration. Anxiety and sadness were less endorsed. Most nurses felt able to cope emotionally and problem-solve solutions to the problems they faced. The findings were generally supportive of Smith and Lazarus's theory, with the exception of the emotion of sadness. The implications of the results are discussed.
18402422	Nursing education institutions are facing a challenge of realigning its functioning according to the changes that are taking place within the country. The intention of the government post apartheid was to correct the imbalances which were brought about by the apartheid government and the following regulations and policies influenced the change in nursing education, that is, Reconstruction and Development Programme (RDP), White Paper on Higher Education (WPHE), and the National Qualification Framework (NQF) (South Africa, 1995:6). In 1996 the government introduced the first democratic constitution of the Republic of South Africa (RSA) according toAct 108 of 1996. In the light of those increasing changes in nursing education, led by political change, the experiences of nurse educators is a critical issue facing nursing campuses. The purpose of this study was two-fold; namely: to explore and describe the experiences of nurse educators with regard to the rationalisation of nursing education and to use information obtained to describe guidelines for the effective rationalisation of a nursing college in the Limpopo Province. A qualitative, exploratory, descriptive and contextual research design was used. Qualitative interviews were conducted with nurse educators who worked in nursing colleges before and after 1994. Measures to ensure trustworthiness were applied and ethical issues were adhered to throughout the research process. Data was analysed following Tesch's method (Creswell 1994:154-155). The research established that nurse educators experienced dissatisfaction in several areas relating to the rationalization of nursing education. Support was also expected from bureaucracy at higher level. This study developed guidelines to policy makers and nurse educators to ensure effective rationalisation process.
18399952	Adults' level of Eriksonian generativity in midlife has been shown to predict variations in parenting, but there has been less research on its relation to inter generational processes in the three-generational family. As part of a larger study, a sample of 35 Canadian mothers and fathers described a particular, salient child-rearing problem with grandparents when their first-born children were 8 years old. Descriptions were rated for severity of the problem, anger/irritation, optimism about solution, and forgiveness of the grandparent's behavior. Generativity data were collected by a standard questionnaire (the Loyola Generativity Scale of McAdams; McAdams & de St. Aubin, 1992). Results showed few gender differences, though mothers tended to be angrier than fathers with the grandparents. More mature parents were more forgiving than younger parents and saw problems as less serious, as predicted. Finally, parent level of generativity predicted maternal and paternal forgiveness of grandparent behaviors, as well as paternal, but not maternal, optimism about problem outcomes. Parental generativity may thus serve to encourage greater forgiveness and optimism among the generations of the family.
18399386	Home care services have characteristics that are distinctive from other health care settings. Thus, they require different management systems to those traditionally used in institutional settings. Typical management models often require adaptation for home care services in areas such as staffing, education and support. This includes performance appraisal, where traditional models may be inappropriate when clinicians work alone, with little supervision. This article describes an experience of adapting a performance appraisal tool, in order to be more relevant for staff working in home-based care. The project arose from staff frustration with the expectation of management that a tool developed for institutional settings would be appropriate for the home setting. This frustration gave the impetus for developing a successful appraisal system, and because of staff involvement, the model was wholeheartedly embraced. The process of development is discussed, and the model explained, with commentary about its implementation in a home care service.
18392146	We undertook a qualitative e-mail survey of federally-funded principal investigators of their views of the US human subjects protection system, intended to identify the range of investigator attitudes. This was an exploratory study with a 14% response rate. Twenty-eight principal investigators responded; their comments were analyzed to show underlying themes, which are here presented along with supporting quotations.There was consensus that it is important to protect human subjects from research abuse, but disagreement over how well the IRB system is functioning. Some researchers felt that the system is effective and serves its purpose well. Of those who support the system, some endorse its methods, purpose, and daily functioning, as they experience it, without reservation. Others, while expressing some frustration, feel that the purpose is important and their local IRB does its best to make a difficult system work well.Those investigators who were more harshly critical commented on multiple flaws in the system, including (1) consent forms that are inappropriate and incomprehensible, (2) an emphasis on minutiae, and (3) concern with protecting the institution more than research subjects. Respondents told us that the IRB system is a particular burden for research in neurology, emergency medical conditions, repositories, and social sciences in general; a more comprehensive study might identify other problematic areas. Significant concern was expressed about the cost, inefficiency, and irrationality of IRB review. The IRB system works well for some researchers, but our results indicate that other investigators feel the costs outweigh the benefits.
18385007	To promote monthly interpersonal skill communication role-play and coaching for front-office staff.For 15 min a month, during staff meetings, healthcare staff such as receptionists and medical assistants should participate in communication skill coaching. Participants should discuss a recurring communication challenge (e.g., patients irritated by repeated requests for health histories), role-play options for communication, and receive feedback.	Interpersonal communication skills such as acknowledging the concerns of others are acquired slowly. Repeated practice and supportive feedback increase the likelihood that these skills will be valued and mastered.	Research shows communication skills develop when they are modeled and role-played frequently and are less likely to develop with occasional interventions.	Health care professionals should devote time to role-playing interaction with patients for brief intervals at least monthly. Staff should give one another feedback on the best options for managing challenging communication situations.	
18377108	This article analyzes the topic of leadership from an evolutionary perspective and proposes three conclusions that are not part of mainstream theory. First, leading and following are strategies that evolved for solving social coordination problems in ancestral environments, including in particular the problems of group movement, intragroup peacekeeping, and intergroup competition. Second, the relationship between leaders and followers is inherently ambivalent because of the potential for exploitation of followers by leaders. Third, modern organizational structures are sometimes inconsistent with aspects of our evolved leadership psychology, which might explain the alienation and frustration of many citizens and employees. The authors draw several implications of this evolutionary analysis for leadership theory, research, and practice.
18375218	There are few validated instruments measuring parental beliefs about parent-child feeding relations and child compliance during meals.To test the validity of the Feeding Demands Questionnaire, a parent-report instrument designed to measure parents' beliefs about how their child should eat.	Participants were 85 mothers of 3- to 7-year-old same-sex twin pairs or sibling pairs, and their children. Mothers completed the eight-item Feeding Demands Questionnaire and the Child Feeding Questionnaire, plus measures of depression and fear of fat.	Psychometric evaluations of the Feeding Demands Questionnaire included principal components analysis, Cronbach's alpha for internal consistency, tests for convergent and discriminant validities, and Flesh-Kincaid for readability.	The Feeding Demands Questionnaire had three underlying factors: anger/frustration, food amount demandingness, and food type demandingness, for which subscales were computed. The Feeding Demands Questionnaire showed acceptable internal consistency (alpha ranging from .70 to .86) and was written at the 4.8th grade level. Mothers reporting greater anger/frustration during feeding were more likely to pressure their children to eat, while those reporting greater demands about the type of foods their children eat were more likely to monitor child fat intake. Mothers reporting greater demands about the amount of food their children eat were more likely to restrict eating, pressure children to eat, and monitor their fat intake.	The Feeding Demands Questionnaire appears valid for assessing maternal beliefs that children should comply with rules for eating and frustration during feeding. Different demand beliefs can underlie different feeding practices.	
18351500	In a cross-sectional study, the effects of disease duration of type 2 diabetes mellitus (DM) were examined along with parent history of DM on disease-related outcome variables. Specifically, the moderating role of parent history of DM on outcome variables was examined. Participants were 53 male veterans with DM. Chart reviews and self-reports were examined. Results showed that in those with a positive parent history of DM, hopelessness increased with diabetes duration. In the negative parent history group, glycemic control worsened with disease duration. These findings suggest parent history of DM should be considered in designing interventions to facilitate coping with type 2 diabetes.
18335488	We examined indices of vagal tone and two dimensions of temperament as predictors of emotion regulation (ER) strategies among children (n = 54, ages 4-7) of mothers with a history of depression and control mothers. Children's (adaptive and maladaptive) ER strategies were observed during a delay of gratification (frustration) task in one protocol. In a separate and independent protocol, vagal tone was assessed during rest (baseline), during emotional challenge (reactivity) and post-challenge (recovery) and mothers rated their children's temperament (effortful control, negative affectivity). Lower vagal recovery and higher negative affectivity were associated with maladaptive ER responses to frustration. However, vagal tone and temperament were not associated with adaptive ER responses and maternal depression status did not affect the results. Overall, the findings are consistent with models of vagal tone and temperament as markers of individual differences in ER.
18330693	The present study was aimed at determining the family factors related to juvenile delinquency and identifying the effect of family violence, family functioning, parental partner dynamics, and adolescents' personality on delinquent behavior among Korean adolescents. A cross-sectional study was performed using an anonymous, self-reporting questionnaire. The subjects for this study consisted of 1,943 Korean adolescents, including 1,236 students and 707 juvenile delinquents, using a proportional stratified random sampling method. Compared to student adolescents, delinquent adolescents perceived their parents as having a higher level of dysfunctional parental partner dynamics, poorer family functioning, and a higher level of family violence. Furthermore, delinquent adolescents were more likely to report a greater incidence of antisocial personality tendencies, a higher level of psychosomatic symptoms and frustration, and higher frequencies of delinquent behavior compared to student adolescents. Antisocial personality tendency and gender had the largest significant total effects on delinquent behavior, followed by family violence, psychosomatic symptoms, family functioning, parental partner dynamics and need frustration. On the other hand, family functioning and parental partner dynamics had the largest indirect effect on delinquent behavior. Gender, antisocial personality tendency, and family violence, in that order, had the largest direct effects on delinquent behavior. In conclusion, it is apparent from the results of the present study that delinquent Korean adolescents perceived and experienced significantly more family dysfunction, family violence, and poor parental partner dynamics than did non-delinquents.
18316912	Dementia adversely affects patients' receptive and expressive communication abilities, making it more difficult for nurses to assess their needs and provide necessary care. Communication Difficulties: Assessment and Interventions in Hospitalized Older Adults with Dementia outlines questions nurses can use to assess the nature and severity of language deficits, which vary greatly from patient to patient and over the course of the disease. Best-practice techniques for tailoring communication to each patient's abilities are also discussed. For a free online video demonstrating the use of these approaches, go to: (http://links.lww.com/A236).
18311326	This study compared the responses of on-site, remote-site, and traditional classroom students on measures of student/teacher interaction, course structure, physical learning environment, and overall course enjoyment/satisfaction. The sample population consisted of students taking undergraduate courses in medical terminology at two western colleges. The survey instrument was derived from Thomerson's questionnaire, which included closed- and open-ended questions assessing perceptions of students toward their courses. Controlling for grade expectations, results revealed no significant differences among the on-site, remote-site, and traditional classroom students in any of the four cluster domains. However, a nonsignificant (and continuing) trend suggested that students preferred the traditional classroom environment. When results were controlled for age, significant differences emerged between traditional and nontraditional students on measures of student/teacher interaction, physical learning environment, and overall enjoyment/satisfaction, as nontraditional students exhibited higher scores. Students' responses to open-ended questions indicated they enjoyed the convenience of online instruction, but reported finding frustration with technology itself.
18295151	In this article the authors reflect on the role of executive function (EF) deficits and delay aversion (DAv) in the diagnosis of attention deficit hyperactivity disorder (ADHD). The authors, empirical review shows clearly that EF deficits and DAv are implicated in ADHD, although neither is necessary for ADHD nor specific to it. The constructs are somewhat dissociable from one another so that each may represent a distinctive feature associated with an ADHD subsample. The authors argue that neither EF deficits nor DAv add much value to the diagnosis of ADHD as it is currently conceptualized, but may be crucial in helping to partition heterogeneity in the condition, leading to the refinement of ADHD nosology.
18291501	A remote control, which can be used to manipulate the scanner functions remotely from within the sterile field, is designed to save time during IOUS. This study was designed to evaluate whether the time saved by using a remote control should be a decisive factor in buying a special system.During 50 intracranial operations, the temporary arrest of the operative procedure caused by the use of ultrasound was measured. In 25 arbitrarily chosen operations, the remote control was draped and used (group 1); in the other group (group 2), it was not used. In addition, we analyzed the use of vascular duplex sonography in 12 of the operations with remote control (group 1a) and 14 of the operations without remote control (group 2a).	The average time spent for ultrasound use including draping was 390 seconds in group 1, compared to 388 seconds in group 2 (without remote control). During examinations including duplex sonography, the average time spent for IOUS including draping was 464 seconds for group 1a and 466 seconds for group 2a.	Based on results, the neurosurgeon does not save much time by using a remote control. The time used for draping the additional remote control is equal to the length of time that is saved. However, the surgeon's frustration in attempting to instruct a layperson to operate the ultrasound keyboard and its impact on the operative procedure cannot be measured.	

18275935	Compulsive hoarding, the acquisition of and failure to discard large numbers of possessions, is associated with substantial health risk, impairment in functioning, and economic burden. Despite clear indications that hoarding has a detrimental effect on people living with or near someone with a hoarding problem, no empirical research has examined these harmful effects. The aim of the present study was to examine the burden of hoarding on family members. Six hundred sixty-five family informants who reported having a family member or friend with hoarding behaviors completed an internet-based survey. Living with an individual who hoards during childhood was associated with elevated reports of childhood distress and family strain. Family members reported high levels of patient rejection attitudes, suggesting high levels of family frustration and hostility. Rejecting attitudes were predicted by severity of hoarding symptoms, the individual's perceived lack of insight into the behavior, and having lived in a cluttered environment during childhood. These results suggest that compulsive hoarding adversely impacts not only the hoarding individual, but also those living with them.
18266106	Recent calls for psychiatric services to focus upon psychosocial recovery for people with severe mental illness has led to a renewed interest in recovery communities. Hence, Community Connections (Washington DC) set up a Women's Empowerment Center as an intentional recovery community. The aim of this paper is to qualitatively chronicle the development of this center to assess emerging challenges. Focus groups and participant observation were conducted regularly over a 16-month period. Analysis suggested three emerging challenges (i) concern regarding unmet practical and physical needs (ii) the struggle to establish internal rules and corrective mechanisms (iii) frustration regarding differential participation.
18264026	Firstly, to identify groups of inmates according to personality. Secondly, to differentiate types of personality through coping strategies, psychopathology, criminal records and social factors.A cross-sectional design was used to study psychosocial, correctional, personality and clinical characteristics in inmates. The group was composed of 106 male inmates. The measures used to evaluate personality, clinical and psychosocial variables were a standard protocol and three self-report questionnaires: the Millon Clinical Multiaxial Inventory-II, the Minnesota Multiphasic Personality Inventory-2 and the Coping Responses Inventory-Adult Form. A cluster analysis, ANOVA and Kruskall-Wallis test were conducted.	Four clusters were identified. The secondary type was characterized by an impulsive, suspicious, hostile personality, by anxiety, a low tolerance of frustration, and by the use of cognitive avoidance coping. The controlled-healthy type showed a less pathological and more self-controlled personality. The primarytype was similar to secondary, but with lower tendency to impulsivity. The inhibited-affected type was shown to have an avoidant personality, greater tendency to symptomatology and also to use acceptance-resignation and emotional discharge coping.	The four groups of young inmates identified showed profiles with different degrees of psychopathological risk and also different coping profiles.	
18257793	The Communication Aids Project (CAP) was a 4-year initiative by the UK Department for Education and Skills to provide communication equipment for students who were unable to speak in order to facilitate their access to education. Each child was given three goals or targets which were then evaluated after 6 months of provision of the communication aid.We evaluated the targets of 60 children, between the ages of 3 and 18 years. Six months after receipt of equipment, the targets were mailed to the initial referrer who was requested to record whether the child had achieved, partially achieved or not achieved each target. Evidence and explanations of these outcomes were also requested. Data were analysed using descriptive statistics, and the explanations were grouped into common themes using a keyword analysis.	Sixty-three per cent of targets were not achieved and 36% were achieved. We investigated any possible associations to attempt to explain some of the possible reasons for the children's non-achievement of targets. Targets were grouped into operational, linguistic, social and academic, but there were no differences between the successes because of target type. Age may be an influence on success, but neither school placement or type of communication aid influenced success. The explanations for non-achievement highlighted the misunderstanding or interpreting of the underlying skills of the communication aid user as a potential cause.	The CAP raised the profile of children with Augmentative and Alternative Communication needs within education. However, only one-third of the targets of children using the equipment were achieved. The reasons for this include inappropriate provision of equipment, demands of the equipment, lack of appropriate support and targets. The major consequence, however, is the need for detailed assessment and provision appropriate to the individual needs of each child. There is a need for research into the best methods of providing communication aids and the support needed for successful communication.	
18252939	It was hypothesized that male perpetrators of domestic violence in the early stages of a 1-year process of cognitive restructuring therapy would manifest on the Rosenzweig Picture-Frustration Study higher levels of extra-aggressiveness than in later stages of the therapy process. A sample of male batterers in the process of treatment took the Rosenzweig instrument. The resulting responses were rated by trained scorers. Chi-square calculations revealed that batterers in the first quarter of treatment manifested Rosenzweig responses indicative of extra-aggressiveness, whereas in the fourth quarter, batterers manifested Rosenzweig responses indicative of im-aggression. The data are discussed relative to implications for domestic violence treatment and the use of the Rosenzweig instrument as an index of treatment progress.
18251387	Dealing with children who have disruptive behavior disorders can evoke feelings of frustration and anger in their therapists. D.W. Winnicott discussed the complexities in the treatment of enraging patients in his article "Hate in the Countertransference" (1949). In the following paper, I will depict the relationship between limit setting, projective identification dynamics, and enraging behavior in the treatment of a provocative latency-aged boy. I will argue that poor limit setting caused by powerful projective identification dynamics were central to the pathology of the boy and his family. These dynamics partially repeated in the boy's treatment--an outcome of which Winnicott had warned. The repetition contributed to the boy becoming physically out of control in my office and led to a disruption in his treatment. The establishment of solid limits by addressing projective identification forces was necessary for the improvement in the disruptive behavior of the child.
25160047	This article reports the development of a pain and discomfort module (PDM) designed to assess the full impact of quality of life (QoL) relating to chronic pain, which could be used with the generic World Health Organisation Quality of Life Assessment (WHOQOL). First, cognitive interviewing was completed with nine participants with chronic pain, for 108 items representing 10 pain-specific facets of QoL. Sixty-eight QoL items and 16 importance questions on pain were relevant, comprehensive, comprehensible and acceptable to users, and were confirmed to assess their purported concepts. Secondly, these items were pilot tested using a cross-sectional survey of 216 people with chronic pain, to investigate the preliminary psychometric properties of the PDM, and reduce its items statistically. All new facets were important to those with chronic pain. Sixteen items within four facets of pain relief, anger and frustration, vulnerability/fear/worry, and uncertainty were retained, and demonstrated acceptable to good internal consistency reliability (α = 0.77-0.85). The PDM is a self-administered, multidimensional subjective assessment of pain-related QoL, with potential to evaluate pain-relieving interventions, identify sufferer's needs, and for survey use. 
18226758	As health care costs rise, nurses are increasingly delegating tasks to unlicensed assistive personnel (UAP). The purpose of this phenomenologic study was to describe delegation from the perspective of the acute care nurse. We analyzed interviews with staff nurses, and a description of the meaning of delegation was developed using Donabedian's structure, process, outcome model to organize the findings. The process of delegation centered on communication and on nurse-UAP relationship and was shaped by the structural themes. The outcomes of delegation included nursing and patient outcomes. An enhanced content on communication and interpersonal relations is needed in nursing education.
18225829	Previous studies have indicated that situational context impacts the rapport experience (e.g., F. J. Bernieri, J. S. Gillis, J. M. Davis, & J. E. Grahe, 1996; N. M. Puccinelli, L. Tickle-Degnen, & R. Rosenthal, 2003). The authors designed the present study to further document the behavioral and experiential predictors of dyadic rapport and to evaluate dyadic rapport experiences when contributions were required from both interactants. Participants (N = 60) were paired into dyads and instructed to complete children's puzzles. However, the dyadic members were restricted in how they could accomplish this task: Only one interactant was allowed to work on the puzzle and had to do so blindfolded, while the second interactant gave instructions. Results suggested that less attribution of responsibility to the worker and the instructor's experience of enjoyment and frustration were indicative of higher rapport. Other characteristics of dyads reporting higher dyadic rapport included difficulty completing the task and more communicative behavior. The results provide important information for the understanding of the dyadic experience of rapport.
18215542	Previous research suggests that compared to mobile phone use, eating and drinking while driving is more common and is seen as lower risk by drivers. Nevertheless, snacking at the wheel can affect vehicle control to a similar extent as using a hands-free phone, and is actually a causal factor in more crashes. So far, though, there has not been a controlled empirical study of this problem. In an effort to fill this gap in the literature, we used the Brunel University Driving Simulator to test participants on a typical urban scenario. At designated points on the drive, which coincided with instructions to eat or drink, a critical incident was simulated by programming a pedestrian to walk in front of the car. Whilst the driving performance variables measured were relatively unaffected by eating and drinking, perceived driver workload was significantly higher and there were more crashes in the critical incident when compared to driving normally. Despite some methodological limitations of the study, when taken together with previous research, the evidence suggests that the physical demands of eating and drinking while driving can increase the risk of a crash.
18211727	The degree to which infant attention behaviors, together with infant reactivity to frustrating events, predict aggressive behavior at 2.5 years, and the moderating effect of maternal behavior were tested with 64 low-risk mothers and infants. Mothers rated infant negative reactivity at 5 months and aggressive behavior and maternal trait anger at 2.5 years; infant and maternal behaviors were observed at 6 months. Based on hierarchical multiple regressions, infant attention to frustrating events at 6 months positively predicted aggressive behavior, whereas looking away from frustrating events was associated with less aggressive behavior for girls only. High reactivity to limits predicted aggressive behavior only when mothers encouraged infant attention to the frustrating event, suggesting that maternal behavior amplifies developmental pathways associated with infant temperament.
18204005	A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems.To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features.	Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study).	At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait.	Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.	
18179534	The aim of this study is to clarify the process of identification with diabetes as a dimension of autonomy as described by people with type 2 diabetes.People with type 2 diabetes view autonomy as competency in shaping one's life. This concept of autonomy has seven dimensions, which emerged as categories in prior research. Dynamic processes shape these dimensions of autonomy. One of the dimensions of autonomy is identification.	This study has a qualitative descriptive and exploratory design and an inductive approach as described in grounded theory. Data were collected by means of in-depth interviews. The sample consisted of 15 people with type 2 diabetes mellitus in a nurse-led, shared-care setting in the Netherlands.	The phases of identification are comprehending, struggling, evaluating and mastering. Each phase has its own characteristics. Identifying with the diabetes is a non-linear, cyclical and continuous process because people with diabetes have to deal with changing conditions.	The dynamics of identification is directed to a process of identifying with diabetes and its care requirement. Recognizing identification as an element of autonomy enables nurses to adopt a more patient-oriented view of autonomy.	Nursing that fosters the process of identification promotes autonomy. This implies that a person with diabetes should be able to identify with the nurse's interventions. Hence it is vital that nurses build supportive partnerships when providing care for such a patient.	
18173298	Although often described as temperamentally "easy" and sociable, children with Down syndrome also exhibit behavior problems. Affective development is important for social and behavioral competence. We examined negative affective expressions and a range of emotion regulation/coping strategies during a frustrating task in a sample of children with Down syndrome, nonspecific mental retardation, and typical development. Results revealed that children with Down syndrome displayed significantly more frustration and more orienting to the experimenter without asking for help. Typical children used more goal-directed strategies, including assistance-seeking and cognitive self-soothing. Findings suggest that children with Down syndrome may use a limited repertoire of strategies for coping with frustration. Suggestions for future intervention studies are provided.
18160859	Watson's Theory of Caring and Caritas proposes that caring and love potentiate healing. Creating a profile of the characteristics of a "Caritas nurse" has implications for integrating caring and love into patient care, and measuring the impact of caring on patient and operational outcomes.This psychometric study examined the profile of nurses effective in caring. The Caring Factor Survey and the Healthcare Environment Survey were selected to measure caring and work environment conditions as reported by the patient and by the nurse, respectively.	The results of this study revealed that nurses of all ages who received high scores in caring were most frustrated with the work environment, were most experienced, worked only the hours scheduled, were most affected by the relationship with the patient, derived the most enjoyment from the relationship with their coworkers, and provided continuity of care most consistently.	Findings from this study indicate that further inquiry into the profile of nurses effective in caring and evaluation of the presence of caring and love on patient outcomes is warranted.	
18157994	Fibromyalgia syndrome (FMS) is a condition of chronic widespread pain that is difficult to control and is associated with strains in physician-patient interaction. Shared decision making (SDM) can be a potential solution to improve interaction. We evaluated the effects of an SDM intervention, including an SDM communication training program for physicians, in a randomized controlled trial with FMS patients. The main objective was to assess whether SDM improves the quality of physician-patient interaction from patients' perspective.Patients were randomized to either an SDM group or an information-only group. The SDM group was treated by physicians trained in SDM communication and had access to a computer-based information package; the information-only group received only the information package and was treated by standard physicians. All patients were offered the same evidence-based treatment options for FMS. Patients were assessed with questionnaires on physician-patient interaction (main outcome criteria) and decisional processes. Physicians filled out a questionnaire on interaction difficulties. Assessment took place immediately after the initial consultation.	Data from 85 FMS patients (44 in the SDM group and 41 in the information-only group) were analyzed. The mean age was 49.9 years (S.D.=10.2), and 91.8% of patients were female. The quality of physician-patient interaction was significantly higher in the SDM group than in the information-only group (P<.001). We found no differences in secondary outcome measures.	SDM with FMS patients might be a possible means to achieve a positive quality of physician-patient interaction. A specific SDM communication training program teaches physicians to perform SDM and reduces frustration in patients.	
18154217	Dermatologic toxicities associated with EGFR inhibitors can have a profound impact on patients' health-related quality of life (HRQL) and may interfere with treatment adherence. We interviewed 20 patients and 12 expert clinicians to identify the most bothersome aspects of dermatologic toxicities to better understand the impact on patients' HRQL Patients and expert clinicians reported that dermatologic toxicities have an impact on patients' physical, functional, emotional, and social well-being. Patients identified the physical discomfort as having the most impact on their HRQL, specifically the sensations of pain, burning, and skin sensitivity. Patients experienced worry, frustration, and depression because of their dermatologic symptoms and reported withdrawing from social activities. Cognitive behavioral strategies such as guided imagery and symptom reframing (eg, rash means treatment is working) may provide patients with valuable skills for the management of this physical discomfort. Cognitive behavioral strategies may also be useful in helping patients manage anxiety and depression associated with any changes in their social function caused by skin rash, as well as distress associated with having a cancer diagnosis.
18098106	Fetal chromosomal examination helps screen fetal chromosomal abnormalities prenatally. Diagnosis of such anomalies allows pregnancy termination, but causes tremendous trauma during pregnancy. The purpose of this study was to explore the lived experience of women suffering from fetal chromosomal abnormalities who are urgently required to terminate their pregnancy. The qualitative field study was conducted at a medical center in Taipei. The researcher, a primary nurse, conducted interviews with five women face to face or over the phone to collect the data. The period of care lasted for two weeks, beginning with confirmed diagnosis of fetal chromosomal abnormalities, followed by the subjects' decision on pregnancy termination, and ending up with their discharge from the hospital. The study is presented in narrative form and the data analyzed using interpretive research strategies of phenomenology. Three categories of lived experience emerged from the data: (1) recurring nightmares, (2) the torment from making the decision of pregnancy termination, and (3) frustration or sadness afterwards. The results illustrated that the lived experience of the women suffering from fetal chromosomal abnormalities and receiving termination was a continuous process. We suggest that medical staff concern themselves with the issue and provide humanistic caring for patients during the various different phases.
18090189	Patients with advanced heart failure (HF) have an uncertain prognosis and low rates of advance care planning and hospice use. The purpose of this study was to describe how patients view and plan for their future.Twenty-four (N = 24) patients took part in a semistructured interview in which they were asked to describe their experiences in living with heart disease and their understanding and planning for their future. Interviews were transcribed and analyzed using the constant comparative method to generate a grounded theory.	The core category, "Living with HF," encompassed the subcategories of "My Experience of HF," "Help with HF," and "My Future with HF." This article reports on "My Future with HF." Patients wanted to discuss how HF affected their future with their providers, but initiation of these discussions was difficult and the absence of discussion led to frustration. Patients did not find specific life expectancy estimates helpful in coping or planning their future care.	Patients with advanced HF do not plan well for end-of-life care and tend to drift along while vaguely hoping for the best. End-of-life care in advanced HF should address difficulties in decision making and provider communication.	
18077100	Functional neuroimaging studies of cue-elicited craving in smokers have identified a distributed system of brain activation which includes the frontal cortex. As electroencephalographic (EEG) activity recorded from frontal brain regions indexes emotive functions, which are believed to play a key role in craving processes, this study examined frontal EEG in 20 cigarette smokers (10 male) exposed to imagery scripts containing positive, negative, or neutral affective content with and without descriptions of smoking urges. Urge scripts increased subjective cravings related to both the rewarding and withdrawal-relief properties of smoking, the latter tending to be greater in female smokers, as were self-reports of frustration. The emotional content of scripts did not moderate urges or EEG but urge scripts were found to: a) decrease activity of delta in male smokers and to increase activity of beta, a pattern which has also been seen with acute smoking, and b) increase activity of theta, a response which has also been seen with smoking abstinence. This imagery-elicited neuroelectric profile, appearing to reflect opposing actions of reward and withdrawal, suggests that EEG may be a sensitive tool for probing the multidimensional nature of craving.
18076697	There is little information concerning how much health-related quality-of-life (HRQoL) information is elicited in dermatology outpatient consultations.To observe and record ad hoc HRQoL discussion in inflammatory skin disease consultations, to systematically measure the patient's HRQoL and to measure patient satisfaction with dermatology care.	Clinic consultations of patients with inflammatory skin conditions attending a secondary care clinic were observed by a single researcher (CP). Data were collected on the 10 subject areas of the Dermatology Life Quality Index (DLQI) and on sleep, burden, frustration and depression. Patients were sent the DLQI and Medical Interview Satisfaction Scale (MISS)-21 questionnaires after the consultation.	In total, 100 consultations were observed (psoriasis n = 50, eczema n = 17, acne n = 13 and others n = 20). In 26% (n = 26), there was no mention of HRQoL issues. In 59% (n = 44), HRQoL discussions were initiated by the clinician. In only 26% (n = 19) of consultations were > or = 3 items on the observer's checklist raised. In all, 57 evaluable DLQI and MISS-21 questionnaires were returned. The mean +/- SD DLQI score was 7.2 +/- 7.0 (n = 18) for patients with whom there was no HRQoL discussion and 10.8 +/- 6.7 (n = 39, P = 0.038) for those with whom HRQoL was discussed. The mean +/- SD MISS-21 score was 108.8 +/- 16.5 (n = 18) for the patients with whom there was no HRQoL discussion and 111.3 +/- 13.6 (n = 39, P = 0.42) for those with whom HRQoL was discussed. The mean +/- SD patient expectation score was 5.5 +/- 1.0 (median 5, range 3-7). There was a positive correlation between the patient expectation and MISS-21 scores (r(s) = 0.815, P < 0.0001).	Despite little extent or depth to HRQoL discussion, HRQoL issues were raised in the majority of inflammatory skin disease consultations. The consultations usually met the patients' expectations and most patients were satisfied.	
18067526	The aim was to explore patients' experiences of the rehabilitation process after anterior cruciate ligament (ACL) reconstruction. Ten participants were enrolled in the study. Semi-structured interviews were performed, focusing on challenges during the post-operative rehabilitation to 1 year after ACL reconstruction. The participants perceived no real choice between operative and non-operative treatment. Only surgery symbolized a full return to the pre-injury level of sports, and surgery was understood as the only way to become a completely restored "functional human being." A major source of frustration was that the meaning of and progress during the rehabilitation did not match their expectations. Three different responses to the challenge of a prolonged rehabilitation were expressed: "going for it,""being ambivalent," and "giving in." Fear of re-injury was common; however, some participants decided not to return to their pre-injury level of sports due to reasons other than physical limitations or fear of re-injury. From a patient perspective, it seems important that the choice of operative or non-operative treatment should be discussed in terms of the meaning and extent of the post-operative rehabilitation and the expected outcomes. There also seems to be a need for more guidance in realistic goal setting and coaching throughout the rehabilitation process.
18065145	Continuous positive airway pressure (CPAP) devices are effective in preventing the sequela of obstructive sleep apnea (OSA); however, compliance with the device is problematic. This study's purpose is to longitudinally discover OSA patients experiences with CPAP. A hermeneutic phenomenological approach was used to obtain narrative stories for interpretive analysis. 20 patients were prescribed CPAP at an urban sleep center Five themes and one constitutive pattern included (1) trouble using CPAP, (2) needing to persist through initial and recurring frustration, (3) difficulty recognizing subtle improvements, (4) accessing help and problem solving, and (5) becoming part of the routine or abandoning the device. Perseverence through tribulations by developing a positive mind-set was the constitutive pattern. The implications are that rehabilitation nurses should understand the difficulties with CPAP compliance so that they may assist patients with device issues and offer encouragement.
18048882	Making the decision to use complementary and alternative medicine (CAM) for cancer treatment is difficult in light of the limited available evidence for these treatments. It is unclear how patients use evidence to make these decisions.(1) Describe the type of information about CAM that cancer patients use in their decision making; (2) understand why certain types of information about CAM are accepted as evidence by cancer patients; and (3) explore the role of scientific evidence in treatment decision making.	A qualitative study design using in-depth semistructured interviews with cancer patients attending 4 conventional and integrative health care institutions in Alberta and British Columbia, Canada, was used.	Twenty-seven patients were interviewed. Patients sought CAM information from a range of sources, including the Internet, health care providers, friends, relatives, and newspapers. Many expressed frustration about the overwhelming amount of available information and found it difficult to identify reliable information. Information was described as reliable if it supported them in arriving at a decision about CAM. Types of information participants identified included anecdotes, expert opinion, gut feeling, popular literature, scientific evidence, testimonials, advertising and trial and error. Profound differences were found between new CAM users, experienced CAM users, and users with late-stage cancer in type of information sought, the role of scientific evidence in decision making, and overall information needs.	Although this was a relatively small qualitative study, the results suggest that (1) many patients do not value scientific evidence as highly as conventional providers and (2) it is important for clinicians and other information providers to be aware of the different types of information that patients seek out and access when making choices and decisions regarding CAM treatments and why they seek out these sources.	

18038186	Colorectal cancer (CRC) screening rates are comparatively low for U.S. Hispanics. To learn more about the factors influencing CRC screening among Hispanics living along the U.S.-Mexico border, 12 focus groups were conducted with Hispanic men and women aged 50 years and older in three Texas counties; Cameron County (Brownsville), Webb County (Laredo), and El Paso County, (El Paso). The focus group guide contained questions about health care behavior, knowledge about CRC, experiences with cancer, and factors that influence CRC screening. A total of 92 individuals participated with the majority aged 50-69 (75%). Twenty percent were born in the United States and 51% had lived in the United States for more than 20 years. Participants had low levels of education, income, and insurance coverage. The analysis revealed several overarching and contextual themes relating to knowledge, attitudes, beliefs, and emotions about cancer and CRC screening. A prevalent theme that emerged from all groups was frustration and a lack of confidence in the U.S. healthcare system. Few participants had been advised by their providers to obtain CRC screening. Lack of patient knowledge about colorectal cancer and screening appeared to be a critical factor influencing screening. Themes about death and pain due to cancer were prevalent as were cultural factors such as machismo and embarrassment. System level barriers such as cost, medical insurance and transportation also impacted screening. These findings suggest that strategies are needed to educate Hispanic residents of border communities about CRC and to motivate them to undergo CRC screening.
18000045	Without joint benefits, joint actions could never have evolved. Cooperative animals need to monitor closely how large a share they receive relative to their investment toward collective goals. This work documents the sensitivity to reward division in brown, or tufted, capuchin monkeys (Cebus apella). In addition to confirming previous results with a larger subject pool, this work rules out several alternative explanations and adds data on effort sensitivity. Thirteen adult monkeys exchanged tokens for rewards, showing negative reactions to receiving a less-favored reward than their partner. Because their negative reaction could not be attributed to the mere visibility of better rewards (greed hypothesis) nor to having received such rewards in the immediate past (frustration hypothesis), it must have been caused by seeing their partner obtain the better reward. Effort had a major effect in that by far the lowest level of performance in the entire study occurred in subjects required to expend a large effort while at the same time seeing their partner receive a better reward. It is unclear whether this effort-effect was based on comparisons with the partner, but it added significantly to the intensity of the inequity response. These effects are as expected if the inequity response evolved in the context of cooperative survival strategies.
17976282	Guidelines for depression management have been developed but little is known about GP and patient goals, which are likely to influence treatment offers, uptake, and adherence.To identify issues of importance to GPs, patients, and patients' supporters regarding depression management. GP and patient goals for depression management became a focus of the study.	Grounded theory-based qualitative study.	GPs were drawn from 28 practices. The majority of patients and supporters were recruited from 10 of these practices.	Sixty-one patients (28 depressed, 18 previously depressed, 15 never depressed), 18 supporters, and 32 GPs were interviewed.	GPs described encouraging patients to view depression as separate from the self and 'normal' sadness. Patients and supporters often questioned such boundaries, rejecting the notion of a medical cure and emphasising self-management. The majority of participants who were considering depression-management strategies wanted to 'get out' of their depression. However, a quarter did not see this as immediately relevant or achievable. They focused on getting by from day to day, which had the potential to clash with GP priorities. GP frustration and uncertainty could occur when depression was resistant to cure. Participants identified the importance of GPs listening to patients, but often felt that this did not happen.	Physicians need greater awareness of the extent to which their goals for the management of depression are perceived as relevant or achievable by patients. Future research should explore methods of negotiating agreed strategies for management.	
17973942	Previous studies using quality of life (QoL) questionnaires have shown poor QoL in patients with thyroid eye disease (TED). However, predetermined questionnaires limit in-depth investigation of psychosocial and emotional effects of TED. A qualitative approach allows detailed exploration of patients' perceptions of wellbeing and can capture their lived experiences.To explore the experience of living and coping with TED.	A qualitative study involving individual, tape-recorded, semistructured interviews with 25 participants with TED (20 female subjects, median age 54 years, range 28-90 years). Thematic content analysis identified themes, from which theoretical interpretations were formed.	Three key themes were identified: (1) development of an altered identity as a result of changes in appearance, abilities and roles due to physical consequences of TED. This was described in the context of life before and after TED; (2) creation of coping strategies including denial, social avoidance, adjustment and stoicism; (3) difficult interactions with healthcare practitioners due to uncertainty surrounding the diagnosis, prognosis and treatment choices, resulting in patients' disengagement, anger and frustration.	This qualitative study has identified the phenomenon of an altered identity due to direct consequences of TED that impact upon patients' wellbeing, coping strategies and interactions with healthcare professionals.	
17970363	The first article in this series highlighted the challenges that mothers face in establishing breastfeeding (Wallis and Harper 2007). Breastfeeding a sick infant in hospital presents additional challenges such as small, sleepy babies, babies who may be nil by mouth for prolonged periods and babies who may find breastfeeding difficult due to mechanical problems. There is very little published abut the needs of babies with complex medical or surgical conditions who may have had significant delays in their feeding or numerous starts and stops along the way. This article and Part 2b in the November issue illustrate some of the common challenges and propose principles of care that are transferable to caring for other sick babies with similar problems.
17968034	The author explored communication experience of nonvocal ventilated individuals in rehabilitation settings with an aim to understand the reality of being voiceless using interpersonal relations theory as the theoretical study framework. Nineteen participants of varied ages and with varied ventilator courses shared their experiences while they were still nonvocal. The author used an interpretive phenomenological approach and analyzed the data using thematic analysis. Participants described the meaning of their nonvocal experience as "Being trapped in a silent world makes me feel frustrated and incomplete," "Days pass in slow motion while the rest of the world speeds by," "Making and preserving connections is of paramount importance," and "The powerlessness of being nonvocal was ameliorated by developing coping strategies and by consistent and reliable nursing care." In the discussion, the author provides an expanded understanding of the complexities of living in a silent, slow world.
17958674	Voluntary counseling services are seen as a cost-effective strategy for HIV prevention and management because they help people to cope with their illness and reduce infection rates in others. This study explored and described the experiences of 20 nurses who rendered voluntary counseling in the Vhembe district, Limpopo Province, South Africa. A qualitative and contextual research design was used, with data gathered from in-depth individual interviews and analyzed using an open-coding method. The main experiences of the nurses rendering voluntary counseling and testing arose in the following themes: challenges related to inadequate resources; the emotional drain associated with stress and burnout; and frustration related to certain behaviors and practices of clients and community members. The main conclusions drawn from the findings were that nurses are continuously exposed to emotionally draining activities with very little support from their supervisors, which makes them prone to experiencing burnout.
17957456	Accumulating evidence suggests that folktales in some societies are characterized by a culturally constructed underlying emotional structure, or Cultural Emotion Schema. In this paper we argue that Matsigenka illness narratives and folk stories share an underlying emotion schema, in which death and suffering result from conflicts between strong-willed individuals prompting anger and aggression. Analysis of illness narratives collected by Izquierdo in the Matsigenka community of Kamisea in the Peruvian Amazon between 1996 and 1999 reveals a common pattern in which envy and frustration lead to the belief in sorcery as the main cause of illness and death. This pattern contrasts with the typical stories of a previous generation collected by the Johnsons among the Matsigenka of Shimaa and other Matsigenka researchers, where sorcery beliefs were virtually absent. Our argument is that important changes in ecology, community, politics, and religion have led to a systematic rise in feelings of envy and frustration, and that these have increased the likelihood that sorcery accusations will occur. We explore the likelihood that such beliefs increase as egalitarian peoples become more crowded into settlements where they are likely to experience greater inequality, more competition for resources and increased societal and personal stress.
17935595	Current treatment of children with dental behaviour management problems (DBMP) is based on the presupposition that their difficulties are caused by dental fear, but is this always the case?The aim of this study was to study temperamental reactivity, negative emotionality, and other personal characteristics in relation to DBMP in 8- to 12-year-old children.	Forty-six children referred because of DBMP (study group) and 110 children in ordinary dental care (reference group) participated. The EASI tempramental survey assessed temperamental reactivity and negative emotionality, the Child Behaviour Questionnaire internalizing and externalizing behaviour problems, and the Children's Fear Survey Schedule general and dental fears. Cluster analyses and tree-based modelling were used for data analysis.	Among the five clusters identified, one could be characterized as 'balanced temperament'. Thirty-five per cent of the reference group compared to only 7% of the study group belonged to this cluster. Negative emotionality was the most important sorting variable.	Children referred because of DBMP differed from children in ordinary dental care, not only in dental fear level, but also in personal characteristics. Few of the referred children were characterized by a balanced temperament profile. It is important to consider the dual impact of emotion dysregulation and emotional reactivity in the development of DBMP.	
17924429	The health benefits of engaging in regular physical activity are widely known: enhanced cardiorespiratory fitness, increased muscular strength and endurance, and favorable cholesterol and other profiles. Nevertheless, particularly in youth sports programs run by volunteer, and perhaps inadequately trained, coaches, many youth may not realize the health benefits of sports participation due to a number of factors, among them, inappropriate coach-child ratios, limited space, or mismatched expectations between coaches and those of children and their parents. There are specific strategies that can be implemented to ensure that youth receive the maximize benefits from participation in sports. These strategies are presented in the following areas: frequency, intensity, and duration; cross-training or complementary exercise; access points; utilization of space and time; nutrition; and rest. For instance, with regard to the frequency of physical activity, some sports, including soccer, basketball, and singles tennis, require extensive physical effort over an extended period of time, while others, such as baseball and football, have a lot of downtime. Thus, in order for children and youth to meet the recommendation of participating in moderate or vigorous physical activity at least four times per week, sports programs need to have opportunities for all athletes to practice hard. Finally, the author discusses the point at which participation in sports might be too much, leading to significant injuries, frustration, and resentment.
17924184	This study examined whether children exposed to prenatal smoking show deficits in "hot" and/or "cool" executive functioning (EF). Hot EF is involved in regulation of affect and motivation, whereas cool EF is involved in handling abstract, decontextualized problems. Forty 7 to 9-year-old children (15 exposed to prenatal smoking, 25 non-exposed) performed two computerized tasks. The Sustained Attention Dots (SA-Dots) Task (as a measure of "cool" inhibitory control) requires 400 non-dominant hand and 200 dominant hand responses. Inhibitory control of the prepotent response is required for dominant hand responses. The Delay Frustration Task (DeFT) (as a measure of "hot" inhibitory control) consists of 55 simple maths exercises. On a number of trials delays are introduced before the next question appears on the screen. The extent of response-button pressing during delays indicates frustration-induced inhibitory control. Prenatally exposed children showed poorer inhibitory control in the DeFT than non-exposed children. A dose-response relationship was also observed. In addition, prenatally exposed children had significantly higher (dose-dependent) conduct problem- and hyperactivity-inattention scores. There were no significant group differences in inhibitory control scores from the SA-Dots. These results indicate that children exposed to prenatal smoking are at higher risk of hot but not cool executive function deficits.
17922490	Following a diagnosis of rheumatoid arthritis (RA), patients have to adapt to lifelong, unpredictable but repeated episodes of pain and disability, potentially leading to permanent loss of function and its consequences on their lives. We established nurse clinics with the aim of supporting newly diagnosed RA patients in adapting to and managing their long-term condition. The aim of this study was to explore the content of clinic discussions in this new clinical service, in order to ascertain patients' needs upon diagnosis.All clinic letters from the nurse to the family doctor were analysed. Every topic mentioned was systematically coded independently by a researcher and a patient research partner, who compared and agreed codes. Codes were organized into categories, and, finally, into overarching themes.	Twenty-four patients had 74 appointment letters. A total of 79 codes were identified, from which ten categories emerged, and, finally, three overarching themes. The first theme related to 'Emotional support', which underpinned the other two themes and was discussed in almost all appointments. Issues included discussions about the emotional consequences of RA, needing time to adjust, frustration and fears for the future. The second theme 'Practicalities of the treatment of RA', included subordinate themes relating to the nature of RA, such as identity, cause, timeline, consequences and treatment. Medication issues were discussed and referrals to the multidisciplinary team were made. The final theme related to the 'Self-management of RA', and included discussions on physical symptoms and their management.	The offer to attend a nurse clinic soon after diagnosis allowed RA patients to discuss a wide range of practical and self-management issues. However, most patients also took the opportunity and time to discuss emotional reactions and adaptations to diagnosis. The data suggest an unmet need for emotional support that a nurse clinic might be able to provide.	
17919912	Internationally literature emphasises concern regarding the phenomenon of violence and aggression within the emergency field. This paper emphasises the important role education and training may play in reducing the risk of staff being exposed to violent or aggressive experiences. Furthermore, the paper emphasises, explores and discusses well recognised theories relating to aggression development. These theories can be used to explain both organisational strategies designed to minimise aggression in the emergency department and situational factors contributing to the development of aggressive interactions.
17908125	This paper is a report of a study to elucidate families' lived experience of diabetes one year after a child was diagnosed with type 1 diabetes.The incidence of type 1 diabetes is rapidly increasing worldwide, with a shift towards younger age groups. This illness is treated by means of an intensive management regimen that often disrupts the child's usual activities and requires disease-focused behaviours from the child and his or her family. However, research elucidating families' lived experience from the perspective of all its members is sparse.	A hermeneutic phenomenological study was carried out in 2004, based on interviews one year after diagnosis with 11 consecutively chosen Swedish-speaking family members with children aged between 9 and 14 years.	The families described their one year of lived experience as living an ordinary yet different life. They experienced their lives to be neither particularly difficult nor as easy as they had been before the child was diagnosed with diabetes. Related themes were 'feeling acceptance yet frustration', 'being healthy yet invisibly ill', 'feeling independent yet supervised' and 'feeling confident yet insecure'.	It may be helpful if healthcare professionals make use of the knowledge and experience of families living with the illness to meet their specific needs, especially when the affected child is experiencing fluctuating blood sugar levels. Thus, health-promoting collaboration should be tailor-made for every individual and proceed from each family's everyday life.	
17901189	Primary care presents distressful moral problems for nurse practitioners (NPs) who report frustration, powerlessness, changing jobs and leaving advanced practice. The purpose of this grounded theory study was to describe the process NPs use to manage moral problems common to primary care. Twenty-three NPs were interviewed, commenting on hypothetical situations depicting ethical issues common to primary care. Coding was conducted using a constant comparative method. A theory of maintaining moral integrity emerged consisting of the phases of encountering conflict, drawing a line, finding a way without crossing the line, and evaluating actions. The NPs varied in their awareness and the discord encountered in conflict, and in clarity, flexibility and justification of the line drawn. A critical juncture occurred when NPs evaluated how well integrity had been maintained. Some experienced no distress while others experienced self-doubt, regret, outrage and frustration at external constraints, and attempted to reconcile through avoiding, convincing themselves, and compensating.
17898237	Semistructured interviews with 32 domestic violence victim advocates illuminate how advocates explain "battered women who stay." The interviews show that this behavior is a source of great frustration for advocates, who struggle to simultaneously conceive of battered women as victims trapped by social, psychological, and interactional forces and as agents whose choices must be respected. The authors argue that their organizational subculture and the culture of individualism in the contemporary United States do not provide the ideological and linguistic resources necessary for managing this dilemma. This results in a tendency to overemphasize battered women's choice and thereby diminish the constraints they face.
17896220	This article presents a more dynamic and constructive paradigm than the current dominant ones (for example medical or social models), to describe and change the impact of impairment and disability. The reflections contained are inspired by personal and professional frustration with the existing polarized ideology of human function, which fails to adequately describe the diversity of physiological and psychosocial function amongst people. It aims to provoke and inspire dialogue about our current paradigm of human function in relation to value and capacity.Within this paper: I critique society's biases regarding of functional deficit relative to the subconscious fear of losing function; I question the polarity of the negatively framed language of impairment and disability; I offer constructive, creative 'solutions' to describe the experience of atypical function. In so doing, an entirely new language of diverse human function and a concept of Constructive Functional Diversity (CFD) is proposed, which includes a complex yet logical array of modes and outcomes of function.	Finally I suggest the benefits of a more dynamic paradigm of functional change in enhancing rehabilitative outcomes, including client-directed practice.	
17895916	Altered impulse control is associated with substance use disorders, including cocaine dependence. We sought to identify the neural correlates of impulse control in abstinent male patients with cocaine dependence (PCD). Functional magnetic resonance imaging (fMRI) was conducted during a stop signal task that allowed trial-by-trial evaluation of response inhibition. Fifteen male PCD and 15 healthy control (HC) subjects, matched in age and years of education, were compared. Stop signal reaction time (SSRT) was derived on the basis of a horse race model. By comparing PCD and HC co-varied for stop success rate, task-related frustration rating, and post-error slowing, we isolated the neural substrates of response inhibition, independent of attentional monitoring (of the stop signal) and post-response processes including affective responses and error monitoring. Using region of interest analysis, we found no differences between HC and PCD who were matched in stop signal performance in the pre-supplementary motor area (pre-SMA) previously shown to be associated with SSRT. However, compared with HC, PCD demonstrated less activation of the rostral anterior cingulate cortex (rACC), an area thought to be involved in the control of stop signal inhibition. The magnitude of rACC activation also correlated negatively with the total score and the impulse control subscore of the Difficulty in Emotion Regulation Scale in PCD. The current study thus identified the neural correlates of altered impulse control in PCD independent of other cognitive processes that may influence stop signal performance. Relative hypoactivation of the rACC during response inhibition may represent a useful neural marker of difficulties in impulse control in abstinent cocaine-dependent men who are at risk of relapse.
17889320	In Tanzania, women of reproductive age constitute the largest group infected by HIV. This study aimed to explore the lived experiences related to health and sexuality of Tanzanian women who had known their positive serostatus for 1 year. In-depth interviews with 10 women were analyzed using a phenomenological-hermeneutic approach and showed frustration and despair at not having resources to maintain daily life. The women needed regular medical treatment for themselves and for their HIV-positive children. Their sexual desires had declined or vanished, and they had come to view sexuality as a source of transmittable disease. For some women, casual sex was an option to solve urgent financial needs. Happiness was something for their children, not for them. Access to social support from the women's community would help prevent further HIV transmission and enhance survival so the children could grow up with at least one devoted parent.
17885636	The Case Management Society of America (CMSA) developed evidence-based guidelines (Case Management Adherence Guidelines, CMAG) for case managers to support increased efficacy of case managers in helping patients become more adherent to medication regimens. The effort was in response to documented high levels of nonadherence, and evidence demonstrating that lack of adherence negatively impacts patient health status. The CMSA engaged in a massive training program to support case manager adoption of the CMAG tools and approaches to improve patient knowledge and motivation. This article reports on findings of a follow-up survey that evaluated case manager's use of the tools and strategies discussed in the CMAG.Seven hundred fifty case managers from all settings were trained in the use of the CMAG.	In a follow-up survey, 42% of respondents reported that there has been a very, or fairly, significant impact of using their new skills to increase their effectiveness in helping patients reach their outcome improvement goals. In addition, 43% reported that there has been a very, or fairly, big improvement in patient adherence since they took the training, while 39% did not see a major impact. At the time of the survey (up to 1 year after training), 43% of respondents indicated that the training was very valuable; another 39% reported that it was fairly valuable. Participants continue to use the skills and information adopted in the training sessions: 26% report that they currently use at least some of the information and skills very often, while another 49% use them fairly often. Sixty-six percent of respondents indicated that they specifically use motivational interviewing to help address patient knowledge and motivation regarding medication adherence.	Medication adherence is a key issue in case management practice; efforts to positively impact low patient knowledge and motivation can be frustration for case managers. The CMAG offer evidence-based assessment tools to evaluate patient knowledge of medications and their motivation to adhere, and recommend the strategy of motivational interviewing to help case managers address adherence more effectively with patients. A 1-time training on the CMAG and motivational interviewing had some effect on self-reported case manager effectiveness in addressing medication adherence. Case managers appreciated the training; many reported that they continue to use skills and that they have observed changes in patient outcomes. Additional training, skill building, and reinforcement may help case managers apply CMAG and motivational interviewing effectively to support patients' adherence to medication regimens. The CMSA may continue to evaluate the impact of the CMAG and CMAG training to refine the tools and the training approach.	
17874688	Spinal cord injury (SCI) occurring during adolescence poses additional challenges because of the concurrent age-specific bio-psychosocial development. Full understanding of the psychosocial dimensions of rehabilitation requires exploration of the patient perspective. The objective of this study was to focus on psychosocial factors from the patient perspective in persons who had previously sustained a SCI during early and mid-adolescence (11-15 years of age).Twenty-four of the 28 persons who had sustained a SCI in Sweden from 1985 to 1996 participated in the study. Semistructured interviews were made an average of 10 years after injury. Narratives were analyzed qualitatively according to content analysis.	Parents and peers were found to have formed a crucial network. Parents frequently acted as advocates in interactions with health care providers, as supporters, and as containers of sorrow, frustration, and anger. Peers acted as promoters of activity and identity development. However, health care providers were perceived as not making sufficient use of this network.	Rehabilitation professionals might be encouraged to increase their knowledge of adolescence medicine to better meet the specific needs and demands of persons in this age group. It is further suggested that parents and peers be considered important partners in the joint rehabilitation effort.	
17853170	To evaluate how Belgian health care providers deal with a request for emergency contraception.In 2002-2003 we conducted 12 focus groups with pharmacists, general practitioners and school physicians. A skilled moderator accompanied by an observer conducted the focus groups using a semi-structured screenplay.	All these health care providers agree with the free access to emergency contraception (EC), but experience considerable frustration with regard to the practical aspects and the legal framework. General practitioners (GPs) claim to spend a lot of time on requests for EC and they are concerned about the quality of the counselling provided in pharmacies. Pharmacists are creative when giving counselling in the pharmacy, but there is, nevertheless, a problem with a lack of privacy. School physicians are frustrated that there is no legal possibility to respond to a request for EC when they feel they are ideally placed to advise adolescents.	The over-the-counter sale of EC offers women better access, but many barriers still interfere with optimal care. Pharmacists experience a lack of skills to communicate with adolescents and a lack of privacy to give counselling. GPs have good intentions, but are confronted with a lack of willingness on the part of the patients and also financial barriers. School physicians want more possibilities to help adolescents.	
17762982	To explore and describe attitudes to oral health among adolescents with high caries risk.A strategic selection of 45 subjects (15 to 19 years of age) assessed with high caries risk were invited to participate in the study, and 7 girls and 10 boys gave their informed consent. Semi-structured interviews performed, recorded, and transcribed verbatim were evaluated using qualitative content analysis.	Three categories and seven associated subcategories could be determined, and cognitive consistency in parallel with emotional inconsistency in relation to oral health was disclosed. On a cognitive level, attitudes to oral health were characterized by an awareness of the determinants (diet, plaque, fluoride) for caries. Fresh breath and even, white, teeth were considered signs of good oral health. Breath and esthetic appearance were important inducements for home care. Although toothbrushing was considered the most important activity for maintaining good oral health, forgetfulness and lack of time were the main reasons for not brushing. The provision of adequate information on caries risk was perceived as important. On the emotional level, the three subcategories were: (i) a positive attitude to oral health and clear self-confidence that improved health would be achieved, (ii) an impassive attitude that everything would be all right and fixed by the dentist, and (iii) a negative attitude characterized by frustration and a tendency to give up.	Allowing adolescents with high caries risk to relate their views on oral health is important for dental professionals when encouraging patients at caries risk towards healthy behavior.	

17727403	This paper is a report of a study to describe the lived experiences of people with early-stage dementia and their ways of coping with the illness.Emerging models of subjective experience and coping with early dementia have been developed in Western cultures. Understanding how Chinese people with early-stage dementia adjust and cope is an important starting point in developing interventions that can enhance their adaptive coping.	A convenience sample of 15 Chinese people in the early stages of dementia were interviewed and observed during home visits. The study involved in-depth transcribed interview data using a phenomenological approach. The data were collected in 2005.	Four themes were identified in the data: attribution of illness, experiencing losses resulting in frustration and uncertainty, adapting to a new role in relationships with family and friends and continuing to live. People with early dementia who adopted a positive outlook did so because they had made sense of and accepted the illness, received understanding and support from family and friends and were being listened to and respected.	The themes emerging from the findings could be used as a framework in understanding how people cope with the onset of early dementia. The framework includes specific implications for the provision of intervention services and highlights the importance of understanding people's own constructions of their illness and how they adjust their lives in coping.	
17720594	Health care providers are increasingly concerned about the escalating incidence of verbal and physical abuse to healthcare staff. Factors, such as long wait in hospital areas, which lead to client frustration over an inability to obtain needed services promptly, are influencing these situations. Nonetheless, incidents of this nature can cause immense psychological harm as well as physical damage among medical employees. The current study aimed to ascertain from staff members aggressive experiences in the workplace, and the effects on the individual. The results of this study mirrored those of similar surveys in Turkey. Non-reporting was revealed as a major problem. Respondents believed they were treated less seriously than similar incidents involving private citizens. Accordingly, staff criticized hospital managers, the police, and the courts for their attitude about assaults towards hospital employees. They reported feeling vulnerable to abuse and there was a general desire for training in preventing and protection. These include teaching staff breakaway techniques, increasing the number of trained security officers on duty, issuing personal alarms, and encouraging staff to officially report all incidents.
17715660	According to the international ICD classification, burnout is not a defined disease. Signs of burnout are frequently associated with psychiatric symptoms. Many doctors experience a reality shock at the beginning of their professional careers due to the great discrepancy between expectations and reality. Frustration and overwork eventually develop into exhaustion, often substance misuse and resignation. Especially doctors usually resort to medical help only in the final stage of burnout when clear psychiatric symptoms are recognizable. Hence, it is all the more important to heed the early warning signs and to counteract increasing stress.
17715592	This article presents a cognitive-motivational theory (CMT) of the mechanisms associated with three basic dimensions of personality vulnerability to alcoholism, impulsivity/novelty seeking, harm avoidance, and excitement seeking. CMT describes the interrelationships between activity in basic motivational systems and attentional, decision-making and working memory processes as the mechanisms associated with variation in each personality trait. Impulsivity/novelty seeking reflects activity in both appetitive and inhibitory motivational systems, greater attention to reward cues, and increased emotional reactivity to reward and frustration. Harm avoidance reflects individual differences in fearfulness and activity in specific inhibitory systems. Excitement seeking reflects the need to engage in appetitive behaviors in less predictable environments to experience positive affect. CMT also describes the impact of working memory and the specific motivational processes underlying each trait dimension on the dynamics of decision making from the perspective of decision field theory.
17705224	In February 2005, the unemployment rate in Germany surpassed the 10% mark. Derived from the revised version of the frustration-aggression hypothesis [Berkowitz, 1989], the present studies investigated the association between unemployment and aggression, as well as the moderating role of the self in this context. Because previous research on unemployment and aggression has been plagued by the cause-and-effect issue, the present research employed both an experimental and a correlational field approach. Three studies revealed that participants who expected to be unemployed after their degree (Studies 1 and 3), or who were currently unemployed (Study 2), reported stronger aggressive inclinations than participants who expected not to be unemployed or who were not unemployed at the time of data collection. However, this aggression-eliciting effect of expected or real unemployment only occurred for participants with low self-awareness. Participants who could actualize their self prior to reporting on aggression were not differently affected by different expectations or states of unemployment.
17693115	To compare perceptions of patients with rheumatoid arthritis (RA) to those of their families and usual physicians regarding pain and subjective experience of the disease.Questionnaires were mailed to patients listed in the files of a non-profit patient organization (Association Française des Polyarthritiques). Each patient, one family member (or close friend), and the usual physician were each asked to complete a questionnaire. Concordance among replies made by patients, family/friends, and physicians was evaluated using the kappa coefficient.	Questionnaires were sent to 20,468 patients, among whom 7702 (38%) mailed back adequate data. The family member was usually the spouse (70%) and the usual physician a rheumatologist (68%). Joint pain was described by patients as variable (80%) and unpredictable (68%). Patients reported a need to push themselves (86%), frustration (86%), anxiety about possible disease progression (89%), and being prevented from making plans for the future (6%). A negative impact was reported on recreational activities (84%), work (56%), and family life and sexuality (51%). Concordance was excellent for pain severity (kappa>0.90) and good for the main joint-pain characteristics and experience of the disease (kappa>0.70), although family members tended to overestimate, and physicians to underestimate, the intensity of the pain.	We found good overall agreement between perceptions of patients, their families, and their physicians, despite differences between these last two groups. Our qualitative analysis showed not only a major physical impact of the disease, but also marked negative psychosocial effects.	
17693048	To explore how the information provided on labels as mandated by the new Canadian natural health product (NHP) regulations impacts consumers' perceptions of risks associated with using NHPs.Six focus groups were conducted in three locations across Ontario. Consumers were asked to react to two labels for a fictitious product called Saturnflower that represented the "old" standards (label 1) and the new standards (label 2). Groups were audio-taped and transcribed verbatim. Qualitative content analysis was used to identify key themes.	The 38 participants criticized label 1 for lacking information about the uses of the product and discussed their frustration at trying to obtain good quality information about NHPs. The lack of risk information on label 1 reinforced their perceptions of NHPs as natural, mild and safe. The majority of participants found label 2 much more informative, but a few were unsettled by the extent of the risk information, questioning if it was necessary.	The label requirements of the new NHP regulations were generally viewed positively by the consumers who participated in this study.	The additional risk information may generate more NHP-related questions for health care practitioners especially with respect to possible interactions between NHPs and conventional medicines.	
17681898	The prevailing notion in the psychoanalytic literature is that Freud's thinking on neonatal object relations is completely captured in terms of his concepts of autoerotism and primary narcissism. Indeed, for Freud, autoerotism and primary narcissism conceptualize the earliest libido distributions, but these concepts do not exhaust Freud's model of early mental life. In this paper, the author endeavors to show that Freud's hypothetical infant arrives at autoerotism and narcissism at the expense of, and secondary to, primitive object-relatedness. More specifically, an appreciation of Freud's views on primitive object relations in light of the self-preservative instinct demonstrates his view that the infant is born into a state of mutual adaptation with the mother. The author makes detailed use of Freud's writings to show his conception of an infant who, from the inception of neonatal life, has the mental sophistication to maintain complex relations with instinctual objects, the sources of gratification or frustration, part-objects confusedly perceived because of cognitive immaturity and/or fantasy distortion. Such complexity includes the infant's capacity for primitive forms of perception, boundary formation, reality testing, and defensive, splitting-based projections and introjections.
17679585	This study examined the meaning of cardiac pain for chronic stable angina (CSA) patients who participated in a standardized angina psychoeducation program. The patients documented what angina meant to them at sessions 1 and 6 of a 6-week standardized psychoeducation program aimed at enhancing CSA self-management. At session 1, angina was described as a major negative life change characterized by fear, frustration, limitations, and anger. At session 6, angina signified a broad and ongoing pain problem requiring continual self-management in order to maximize quality of life. The findings suggest that the perceived meaning of angina as a burdensome and debilitating life change shifts, during psychoeducation, to one of angina as a broad pain problem requiring ongoing self-management in order to preserve life goals and functioning. How such perceptual shifts in the meaning of cardiac pain might contribute to the overall effectiveness of psychoedcuation warrants further investigation.
17675926	In Occidental countries the frame of modern families has been reshaped, and vast economical and social changes have taken place over the last thirty years. They have been marked by the disengagement of the State in the marriage, a giant evolution in conjugality which is becoming privatized and made insecure, changes in gender relations, new motives and conditions for the arrival of the child in the couple, i.e. planned birth, wished or desired infant, infant conceived for oneself, and parenthood has been turned upside down through the extensive evolution of its laws and symbolic-landmarks as well as in practical experience. As these new coordinates of the family are now centred on the consensus instead of authority for the organisation of relationships between its members and on hedonism instead of duty as main value, with a child issued from the desire and acknowledged, from the onset, as a full person "the baby is a person" a child made "for oneself and for him/herself" (and not for the society), brought up in an environment where the media can be considered as a "third parent" because of it's growing importance, the structure of the child's psyche no longer matches the neurotic model.Studies made by anthropologists have led us to hypothesise a new "basic personality" in order to reflect the consequences of the new landmarks in society and the new family, as well as the outcome of new educational practices; this new "basic personality" would replace the basic normal/neurotic one, which dominated over the first half of the twentieth century.	This basic personality, which could be termed as "narcissistic-hedonistic", is characterized by few internalizations, a poorly efficient Superego, nearly no guilt feeling, a weakly socialized Ideal Self suggesting more the Ideal Self of the early childhood, and finally a difficulty in experiencing or testing oneself as a free subject. The resulting narcissistic fragility leads the subject to be more dependent on external objects, to be allergic to frustration, to find delay in the achievement of instinctive aims hard to take, to develop an exaggerated pursuit of perception and sensations. The relation to time is also affected through a privileged investment in the present and the shading off of historical time. These changes must lead to a different subjectivity stemming from a new basic personality. Disorders may stem from three axis of this new basic personality: dependency with attachment disorders, narcissistic fragility, and a high risk of depression; guilt-free "narcissistic perversion" with people, who use other people for their own and exclusive interest, without real empathy; "light" psychopathy, with people capable of social integration for shorts periods of time, with a lot of breaking off in love, friendship, and professional ties.	This new configuration where specific pathologies are associated with a new basic personality implies serious thought with regards to care practices so as to adapt them to the patterns of patients.	
17666903	This phenomenological study explored the interactions between new nursing graduate orientees and their preceptors during the orientees' professional orientation. Six themes of caring and four themes of noncaring preceptor behaviors emerged through participants' journals and interviews. The six themes of caring preceptor behaviors included advocating, welcoming, including, autonomy with appropriate preceptor presence, making human connections, and genuine feedback. Four themes emerged indicating noncaring preceptor behaviors and included unwelcoming, autonomy with preceptor overpresence or underpresence, and nongenuine feedback.
17645233	The authors' goal in conducting this study was to explore the association between temperament and future-oriented decision making. Forty-three preschoolers (mean age = 51 months) were given a child variant of the Iowa Gambling Task (IGT) and asked to choose between a deck with higher immediate rewards and a deck with higher future rewards. Children who were higher on the Extraversion/Surgency factor of the Child Behavior Questionnaire chose more frequently from the higher immediate rewards deck early in the game. The externalizing dimension of Negative Affectivity (anger/frustration, soothability and discomfort) made the greatest contribution to prediction of performance in the last block of the game. Children who were more easily frustrated and had difficulty regulating negative emotions chose more from the deck with higher immediate rewards. There was a significant interaction between the externalizing dimension of Negative Affectivity, the internalizing dimension of Negative Affectivity (sadness and fear) and Extraversion/Surgency on the last block. These results suggest a complex association between IGT performance and temperament in preschoolers.
17644864	The aim of this study was to assess the antecedents and consequences of binge eating in ten obese binge eaters. The subjects completed retrospective measures and monitored themselves at the time binge eating occurred. The results show that the common temporally remote antecedents to binge eating included being very busy throughout the day, feeling unusually tired/fatigued, having consumed too much food during the day, and feeling down or irritable. A number of affective variables (e.g., anxiety, anger, frustration, sadness, guilt, agitation) temporarily decreased during a binge eating episode, yet increased again following binge eating. Furthermore, the antecedents and consequences surrounding binge eating episodes were moderately to highly variable both between and within subjects, thus supporting the need for individualised functional assessments of the antecedents and consequences of binge eating. The implications for treatment and future research are discussed.
17638495	"Service with a smile" is satisfying for the customer, but such display rules may be costly to the employee and the organization. Most previous research on such costs has used self-reported and cross-sectional designs. The authors use an experimental approach to test tenets of resource depletion theories; specifically, whether the self-regulation of emotions required by display rules depletes energy and attentional resources during a service encounter. Using a call center simulation with three "customer" interactions, the authors found that participants given positive display rules (e.g., be enthusiastic and hide frustration) reported more postsimulation exhaustion and made more errors on the order form compared to those with display autonomy. Customer hostility during one of the calls also increased exhaustion overall and the number of errors during that specific call, though proposed interactions with display rules were not supported. Surface-level emotion regulation, but not deep-level, was the mechanism for the energy depletion effect of display rules, while display rules had a direct effect on performance decrements. Theoretical and practical implications for display rules as part of job requirements are discussed.
17626618	There is evidence that medical students are more aware of the benefits of psychotropic treatment than are members of the general public, and that the more knowledge students acquire about psychiatry and pharmacology, the more favorable their attitudes become towards psychotropic drugs and other treatments.This study among students investigates the relationship between certain aspects of personality and attitudes towards advising adolescents with psychosocial problems about the use of psychotropic medication.	Two groups of healthcare students were recruited from universities in Eastern France. 41 fourth-year medical students (MS) who had completed their psychiatry course, and 76 third-year psychology students (PS) in the faculty of human sciences. Respondents completed a self-administered instrument (20 brief case studies, and a personality inventory) at the end of a lecture. Participation was voluntary and unpaid.	MS would recommend psychotropic drugs in 40% of the 20 cases, PS in 27%. MS who would prescribe psychotropic medication differed in personality profile from PS. MS with a tendency to experience anger and related states such as frustration, and who did not see fulfilling moral obligations as important were more likely to prescribe psychotropic drugs. Also more likely to recommend psychotropic drugs, but for different reasons, were PS who were susceptible to stress but not shy or socially anxious, who showed friendliness but little interest in others, and who lacked distance in their decision-making.	Health promotion is not simply a matter of educating those young people who take psychotropic drugs - health professionals must also question the criteria that inform their decisions. It is as important to investigate the attitudes of the future health professionals (advisers or prescribers) as it is to focus on consumer-related issues.	
17619068	Nurses and social workers are fundamental to the delivery of quality health care across the continuum of care. As health care becomes increasingly complex, these providers encounter difficult ethical issues in patient care, perceive limited respect in their work, and are increasingly dissatisfied. However, the link between ethics-related work factors and job satisfaction and intent-to-leave one's job has rarely been considered. In this paper, we describe how nurses and social workers in the US view the ethical climate in which they work, including the degree of ethics stress they feel, and the adequacy of organizational resources to address their ethical concerns. Controlling for socio-demographics, we examined the extent to which these factors affect nurses and social workers' job satisfaction and their interest in leaving their current position. Data were from self-administered mail questionnaires of 1215 randomly selected nurses and social workers in four census regions of the US. Respondents reported feeling powerless (32.5%) and overwhelmed (34.7%) with ethical issues in the workplace and frustration (52.8%) and fatigue (40%) when they cannot resolve ethical issues. In multivariate models, a positive ethical climate and job satisfaction protected against respondents' intentions to leave as did perceptions of adequate or extensive institutional support for dealing with ethical issues. Black nurses were 3.21 times more likely than white nurses to want to leave their position. We suggest several strategies to reduce ethics stress and improve the ethical climate of the workplace for nurses and social workers.
17618118	Receiving a patient handover from an ambulance crew occurs many times during the day across the country. Handover has major implications for subsequent patient care but there has been little investigation of the handover process between ambulance and emergency department staff.Four emergency departments and one ambulance service were included within one geographical area in the UK. The research was based on a quantitative approach using a descriptive, non-experimental cross-sectional survey. A questionnaire was distributed to a convenience sample of ambulance paramedics and emergency department nurses and doctors. The questionnaire was constructed using mainly closed questions with some qualitative date collected through open questions. Data was analysed using SPSS version 11.5.	Of the 101 questionnaires distributed, a total of 80 (68%) participants contributed towards the study. The results indicated emergency department staff need to appreciate that a lack of active listening skills can lead to frustration for ambulance staff. Ambulance staff must expect to repeat their handover, especially for patients in the resuscitation room. Handovers for critically ill patients should be delivered in two phases, with essential information given immediately and again thereafter to give further information when initial treatment has been undertaken.	Suggestions are made for improving handovers by developing national guidelines and by incorporating handover in emergency department education.	
17617427	The impact of breakfasts of different glycaemic loads on the performance of nineteen children, aged six to seven years, was explored. Over a four week period, children attended a school breakfast club each day and ate one of three meals. Each meal offered a similar amount of energy but differed in their glycaemic load. When working individually, the behaviour of a child was rated in the classroom every ten seconds for 30 min to produce a measure of time spent on task. Memory was assessed by asking for the recall of a series of objects. The ability to sustain attention was measured by asking for a response after various delays. The incidence of negative behaviour was recorded when playing a video game that was too difficult to allow success. Two to three hours after a low glycaemic load breakfast had been consumed, performance on the tests of memory and the ability to sustain attention were better, fewer signs of frustration were displayed and initially more time was spent on task when working individually in class. The importance of the results was discussed in the context of the wide range of factors that influence behaviour in school.
17609175	We investigated the use of water as a tool by presenting five orangutans (Pongo abelii) with an out-of-reach peanut floating inside a vertical transparent tube. All orangutans collected water from a drinker and spat it inside the tube to get access to the peanut. Subjects required an average of three mouthfuls of water to get the peanut. This solution occurred in the first trial and all subjects continued using this successful strategy in subsequent trials. The latency to retrieve the reward drastically decreased after the first trial. Moreover, the latency between mouthfuls also decreased dramatically from the first mouthful in the first trial to any subsequent ones in the same trial or subsequent trials. Additional control conditions suggested that this response was not due to the mere presence of the tube, to the existence of water inside, or frustration at not getting the reward. The sudden acquisition of the behaviour, the timing of the actions and the differences with the control conditions make this behaviour a likely candidate for insightful problem solving.
17606557	Despite the dangers of vaccine-preventable infections and efforts by health care professionals to promote immunization, parents' resistance to routine childhood immunizations continues to grow. This phenomenon can give rise to frustration among health care providers, as well as create barriers in providing medical care to children in need. In response, we developed a CD-ROM-based tutorial that (1) explains the nature and origins of parents' concerns, (2) addresses clinical implications of resistance to immunization, (3) explores ethical and professional obligations that physicians have toward children and their parents, and (4) discusses how physicians can effectively address parents' concerns.Our goals were to evaluate the tutorial's effectiveness in improving physicians' (1) general knowledge about parents' resistance to childhood immunizations, (2) knowledge of adverse effects of immunization, and (3) attitudes toward parents' resistance to childhood immunization.	After pretesting, expert review, and revision, the 45-minute Penn State Immunization Project tutorial was pilot tested with pediatric and family medicine residents at 7 training programs in 4 states (Pennsylvania, New York, Maryland, and Iowa). Knowledge and attitudes were assessed by using a 26-item pretest/posttest, the results of which were then analyzed by using standard statistical methods.	A total of 122 residents completed the pretest/posttest. Statistically and clinically significant improvements were seen in residents' general knowledge, knowledge of adverse events, and all 5 attitudinal measures regarding childhood immunizations.	The tutorial Addressing Parents Concerns About Childhood Immunizations: A Tutorial for Primary Care Providers is effective in improving resident physicians' general knowledge, knowledge of adverse events, and attitudes. As such, this tutorial has the potential to enhance communication between parents and primary care providers and, more generally, improve clinicians' response to the growing resistance toward routine childhood immunizations.	
17604694	The aim of this study is to gain knowledge about women's perceptions of illness based on their abnormal PAP smears, following screening for cervical cancer. The study uses a phenomenological, hermeneutic approach inspired by Ricoeur's theory of interpretation. Twelve women, aged between 23 and 59 years, were consecutively selected and then followed by participant observation during their examinations and treatment in hospital. They were interviewed on entering the study, a week following their surgery, and 6 months later. The material collected was analysed through a dialectic process consisting of a face-value review of participant experiences (naive reading), structural analysis and, critical interpretation of what it means to be potentially ill. The women were unprepared to find that their screening results showed abnormal cells, indicative of incipient genital cancer. They were frustrated by the results as they had not experienced any symptoms and felt well, despite being diagnosed with a potential disease. Being diagnosed with abnormal cells caused the participants to feel anxious. Their anxiety had subsided 6 months after the cells had been removed. For those who did not require treatment, anxiety flared up with recurrent check-ups. The bio-medical differentiation between pre-stage and actual cancer provided no comfort to the participants, who continued to see themselves as having early stage cancer.
17595007	We tested the hypothesis that ruminating about a previous aggressive prime interacts with a subsequent minor frustration to augment aggression. Sixty participants watched a video showing a murder during a bank robbery (the aggressive prime). Those in the rumination condition were asked to write about the video for 20 min. In the no rumination condition, participants were given 20 min to complete an irrelevant task. Participants were then either frustrated or not frustrated. Our results supported the main hypothesis. Relative to the control condition, neither rumination nor frustration alone impacted aggression. Rumination, in combination with a minor frustration, however, increased the recommended prison sentence towards the targets. We discuss the implications of our findings.
17591413	In Australia, more than 346,000 individuals who experience a stroke return to living in their homes with varying degrees of disability. They rely on emotional and physical support from informal carers, typically family members. Informal carers have an indispensable role in patient care poststroke, and the ability of carers to manage this role effectively is crucial for stroke survivors to be able to return home. The aim of this study was to examine the impact of the caring role on carers of stroke survivors, particularly the services provided and the levels of depression and well-being experienced. The study used a longitudinal design incorporating survey methods. Stroke survivors were assessed for functional ability, quality of life, and depression using three assessment tools: the Stroke Impact Scale, World Health Organization Quality of Life-BREF scale, and Zung Self-Rating Depression Scale. A total of 26 people were surveyed: 13 stroke survivors and their 13 carers. Carer knowledge of stroke support services was also explored. Information was collected by using survey methods and structured interviews at 3 weeks and at 3 months postdischarge. The main finding was that depression scores for carers and stroke survivors were below Australian norms at both assessment time points. The major concern identified by carers was poor follow-up procedures for initiating rehabilitation in the home. This study highlighted that a lack of appropriate discharge planning, in conjunction with early discharge of stroke survivors, can have an impact on the rehabilitation process and place increased and unrealistic demands on carers.
17577177	Moral distress in nursing is a prevalent theme in the literature. Although this issue has been investigated in other nursing disciplines, it has not been investigated by empirical research in the emotionally and ethically sensitive area of providing care to dying babies. Moral distress occurs when nurses are prevented from translating moral choices into moral action. The response to moral distress is anger, resentment, guilt, frustration, sorrow and powerlessness. If not addressed, self-worth may be jeopardised, affecting personal and professional relationships. A review of the literature was conducted to explore moral distress in neonatal nursing when providing care to dying babies. This literature review provides a basis for the direction of further research and hypothesis testing. Further focused research is necessary in this under-theorised area of nursing practice to clarify the significance of moral distress for neonatal nurses caring for dying babies.
17574686	Stressful life events increase the probability of depressive problems in early adolescence. Several genetic and environmental risk factors may change individual sensitivity to the depressogenic effect of these events. We examined modification by parental depression and gender, and mediation of the former by temperament and family environment.Data were collected as part of a longitudinal cohort study of (pre)adolescents (n = 2127). During the first assessment wave at approximately age 11, we assessed parental depression, family functioning, perceived parenting behaviours, and temperamental frustration and fearfulness. At the second wave, about two and a half years later, stressful life events between the first and second assessment were assessed. Depressive problems were measured at both waves.	Adolescents with parents who had a (lifetime) depressive episode were more sensitive to the depressogenic effect of stressful events than adolescents without depressed parents. Furthermore, girls are more sensitive to these effects than boys. The modifying effect of parental depression was not mediated by temperament, family functioning and perceived parenting.	Life events were assessed without consideration of contextual information. Depressive problems were measured by questionnaires that did not directly represent DSM-IV criteria. The measure of parental depression was unspecific regarding severity and timing of depressive episodes.	The results suggest that gender and parental depression are associated with increased sensitivity to depression after experiencing stressful life events during adolescence.	
17570526	Adolescent development is accompanied by the emergence of a population-wide increase in vulnerability to depression that is maintained through adulthood. We provide a model for understanding how this vulnerability to depression arises, and why depression is so often precipitated by social rejection or loss of status during this phase. There is substantial remodeling and maturation of the dopaminergic reward system and the prefrontal cortex during adolescence, that coincides with the adolescent entering the complex world of adult peer and romantic relationships, where the rewards that can be obtained (feelings such as belonging, romantic love, status and agency) are abstract and temporally distant from the proximal context. Development of the prefrontal cortex makes it possible to pursue such complex and distal rewards, which are, however, tenuous and more readily frustrated than more immediate rewards. We hypothesize that when these distant rewards are frustrated they suppress the reward system, and that when such suppression is extensive and occurs for long enough, the clinical picture that results is one of depression.
17566898	Northern Ireland lived through a campaign of terrorism for thirty years. This has now ended and substantial progress has been made towards political stability through a long-term peace process. Using his experience as a psychiatrist and psychotherapist, but also as leader of a political party, negotiator in the peace process and subsequently Speaker of the Northern Ireland Assembly, Lord Alderdice explores the psychology of political terrorism. He examines the role of individual and group psychology, the evolution and dissolution of a 'group mind', splitting, and the factors that contribute to division and violence. He describes the frustration of healthy pathways for change, and humiliation, shame and rage as key factors in triggering regression into political violence. Containment, respect and a group psychological process are identified as necessary for evolution towards a more healthy state. It is suggested that application of these Northern Irish insights to the issue of terrorism in other places and especially in the Middle East, may open new and more psychologically sophisticated ways of addressing the problem of terrorism.
17544129	Chronic noncancer pain (CNCP) is a major problem in health care today. Management of patients who have CNCP often poses a challenge for health care providers because their goals are nonspecific and as a group they are prone to frustration and depression. This article evaluates the characteristics of therapeutic goal setting, barriers to goal setting, and potential solutions to this problem. If the patients with CNCP can be assisted to set realistic goals, both patient care and its outcomes will improve.

17522111	To create Parent and Adolescent Medication Barriers Scales (PMBS and AMBS) for assessing perceived barriers to medication adherence in adolescent transplant recipients.These scales were developed and initially validated with 78 families. Participants responded to questions concerning perceived barriers to medication adherence. To assess validity, data on contextual factors (e.g., family functioning) and adherence measures were collected.	A principal components factor analysis resulted in the following subscales for the PMBS and AMBS: (a) Disease Frustration/Adolescent Issues, (b) Regimen Adaptation/Cognitive Issues, (c) Ingestion Issues, and (d) Parent Reminder (PMBS only). Significant associations were found between barrier scale scores, contextual factors, and adherence.	The PMBS and AMBS are brief and psychometrically promising scales for assessing perceived barriers to adherence in adolescent transplant recipients.	
17519874	The case of a couple of monozygotic twins, for whom the diagnosis of Specific Learning Disabilities was made when they were 14.5 years old, even if reading and writing difficulties had been present since the beginning of primary school, is described. The consultation had been required due to difficulties in relating with same age boys, with social withdrawal and depressive traits, leaving in second place school difficulties; clinical suspect has led to extend the evaluation to include the neuropsychological aspects and so to reach the diagnosis. The differences in terms of adaptive modalities facing the discomfort, probably based on temperament differences, and neuropsychological disorder (low grade dyslexia for one twin, dis-orthography and low-to-medium grade dyslexia for the other one) are discussed. The acquired awareness of being intelligent has permitted the boys to look back in a new way to the school failures they had collected through years; namely, understanding that their difficulties reflected a specific neuropsychological deficit has permitted to reconsider their own past history with a consequent modification of the ''beliefs'' about their abilities. This all has led as a consequence to an increase of life quality (with an improved school and relational adaptation), without cancelling but instead supporting the research of on individuality based on temperament differences. This was possible in spite of the evident delay in reaching the diagnosis and the consequent accumulation of frustration and inadequacy experiences for many years; it's therefore demonstrated the importance of a global evaluation of patients with anamnesis of difficulties in learning to read and write, also in order to treat the possible psychopathological aspects of the clinical picture, which can be the result of a sense of helplessness.
17518888	To explore the reasons and motivation identified by qualified nurses for working within the surgical area.Little is known about the career decisions qualified nurses make, although it is clear that some areas of practice are more popular than others. This qualitative descriptive study considers one common area, surgery, and explores the motivation for decisions made by Registered Nurses (RNs) to work in this area.	A sample of 16 RNs working within surgical areas participated in semi-structured interviews, using a thematic interview schedule. Findings were analysed using the framework suggested by Morse and Field.	Analysis of findings indicates that all participants actively chose to work within surgery and that this was because of the pace and turnover of surgical work, personal satisfaction at the recovery of patients; the close links between this type of work; and participants' original aims when first entering nursing and participants' preference of surgery to other areas of nursing work. Participants actively rejected working in areas where patients were likely to suffer from chronic long-term conditions where recovery was unlikely and felt that these areas were likely to be depressing and unrewarding.	These findings suggest that participants actively chose to work with 'healthy' patients in preference to those who may be considered 'ill', and this is closely linked to the identified need of participants to be able to 'make patients better'. Participants were reluctant to work in areas where they would be unlikely to achieve this aim.	The reluctance of surgical nurses to work with patients who were considered 'ill', in preference to 'healthy' patients must be acknowledged. Findings reflect different professional perspectives on the purpose of nursing work and suggest that qualified staff choose their clinical specialism based on their own personal sense of professional purpose, with consequent implications for both the recruitment and retention of qualified staff.	
17518822	This article reports on research that examines newly qualified UK nurses' experiences of implementing their ideals and values in contemporary nursing practice. Findings are presented from questionnaire and interview data from a longitudinal interpretive study of nurses' trajectories over time. On qualification nurses emerged with a coherent and strong set of espoused ideals around delivering high quality, patient-centred, holistic and evidence-based care. These were consistent with the current UK nursing mandate and had been transmitted and reinforced throughout their 'prequalification' programmes. The existence of professional and organisational constraints influenced their ability to implement these ideals and values once in practice. Data analysis revealed that within 2 years in practice the newly qualified nurses could be categorised as sustained idealists, compromised idealists, or crushed idealists. The majority experienced frustration and some level of 'burnout' as a consequence of their ideals and values being thwarted. This led to disillusionment, 'job-hopping' and, in some cases, a decision to leave the profession. These data are explored and discussed to inform the question of whether the current nursing mandate is sustainable.
17516817	The authors experimentally examined the effects of anger suppression on pain perception. On the basis of ironic process theory, they proposed that efforts to suppress experiential or expressive components of anger may paradoxically enhance cognitive accessibility of anger-related thoughts and feelings, thereby contaminating perception of succeeding pain in an anger-congruent manner. Participants were randomly assigned to nonsuppression or experiential or expressive suppression conditions during mental arithmetic with or without harassment. A cold-pressor task followed. Results revealed that participants instructed to suppress experiential or expressive components of emotion during harassment not only reported the greatest pain levels, but also rated the anger-specific dimensions of pain uniquely strong. Results suggest that attempts to suppress anger may amplify pain sensitivity by ironically augmenting perception of the irritating and frustrating qualities of pain.
17515321	This article reports on a research study done in Katutura Township, near Windhoek. A qualitative, exploratory, descriptive and contextual design was followed to answer the research question investigating experiences of mothers caring for mentally retarded children at home. Phenomenological interviews were conducted with a purposefully selected sample of twelve mothers. The meaning of their experiences was analysed by using Teschxs method (1990 in Creswell, 1994:155) of analysing qualitative data. The results indicated various emotions and challenges experienced by these mothers during the care of their children. Feelings of shock, despondency and sadness dominated the early stages when the retarded children were still young. During later years, as the children were growing up, the mothers felt shame, fear, frustration, anger, disappointment and worry. However, acceptance followed, as the children grew older. Stigma seemed to affect all the respondents. Support in any form or lack thereof seemed to be the decisive factor-positioning mothers along a continuum of two extremes, namely despairing isolation and integrated happiness. Recommendations were made regarding the improvement of heath care services and education of the mothers and their families.
17512168	Because voice disorders in childhood may have a negative impact on communicative effectiveness, social development, and self-esteem, the objective was to determine the impact of voice disorders on lives of children from the perspective of chronically dysphonic children and their parents. This study consisted of focused interviews with chronically dysphonic children and their caregivers. Focused interviews were conducted with 10 children in each of the following age groups: Toddler (2-4 years old), Young Child (5-7 years old), School-Aged Child (8-12 years old), and Adolescent (13-18 years old). Interview questions were formulated to elicit attitudes in the following conceptual domains: emotional, social/functional, and physical. Interviews were transcribed and subjected to systematic qualitative analyses that identified common themes within each age group for each conceptual domain. For Toddlers, interviews relied heavily on parents and the biggest concerns were found in the physical and functional domains. Young Children expressed that their biggest issues related to voice were physical ("run out of air," "sometimes voice does not work"). Ninety percent of Young Children were repeatedly asked to use a quieter voice. Emotional factors and physical factors were prominent in the interviews of School-Aged Children and Adolescents. Children and Adolescents often felt that their dysphonic voice received undue attention and also limited their participation in important events. Anger, sadness, and frustration were also expressed. Chronic dysphonia negatively affects the lives of children. This work will serve as the basis for development of a valid, reliable, and age-appropriate measure of voice-related quality of life in children.
17508607	The family of patient suffering from alcoholism was investigated form the standpoints of systemic analysis, that allowed revealing the leading personal characteristics of married couples. The men suffering from alcoholism are characterized by weak will, inclination to dependence, disregard of behavioral social norms, increased excitability and tendency to frustration in combination with high level of aggressiveness against the background of decreased masculine and prevailing feminine characteristics. Co-dependent wives of men suffering from alcoholism are characterized by predominance, observance of social norms, pronounced autoagression and orientation to masculine characteristics against the background of high indices of both femininity and masculinity. Such combination of married couples' personal characteristics forms the basis for development of dysfunctional relations in a family of man suffering from alcoholism. The families where husband and wife had no alcohol dependence, with harmonic functional relations served as the control group.
17484562	This article examines parallel models of union joining and leaving using individual-level longitudinal panel data collected over a 5-year period. The authors utilized objective measures of joining and leaving collected from union and organizational records and took into account time by using event history analysis. The results indicated that union joining was negatively related to procedural justice and higher performance appraisals and positively related to partner socialization and extrinsic union instrumentality. Conversely, members were most likely to leave the union when they perceived lower procedural justice, where there was no union representative present in the workplace, and where they had individualistic orientations. The authors discuss the implications of these findings for theory and practice for trade unions.
17468941	Health-related quality of life (HRQoL) is an important outcome measure of migraine treatments. Although a number of migraine-specific HRQoL questionnaires exist, their measurement characteristics have only been examined for patients undergoing acute treatment of migraine. The goal of the current study was to evaluate measurement properties of the widely used Migraine-Specific Quality of Life Questionnaire version 2.1 (MSQ v. 2.1) within a group of patients undergoing prophylactic migraine treatment.Various measurement properties of the MSQ were examined in a sample of 916 migraineurs undergoing prophylactic treatment who had scores at baseline and follow-up, as well as baseline SF-36. First, we used confirmatory factor analysis (CFA) and differential item functioning (DIF) to assure the accuracy and stability across groups of the MSQ scoring for all three subscales (Role Restrictive, Role Preventive, and Emotional Functioning). Next, item- and scale-level properties were examined, such as item-total correlations, internal consistency, and convergent and discriminant validity.	Initial findings revealed that item 12 (measuring frustration on the Emotional Functioning subscale) performed poorly. Subsequent to its removal, the 13-item MSQ displayed excellent measurement properties, including stable latent structure at baseline and endpoint, no gender or age biases on items, appropriate item-level and scale-level reliabilities, and markedly higher convergent validity compared to discriminant validity.	The 13-item MSQ appears to be an appropriate measure of migraine-specific HRQoL for patients undergoing migraine prophylaxis. Moreover, given the stability of the latent structure over time, the interpretation of scores is likely to remain quite consistent throughout a clinical trial.	
17467051	The present study examined the relations between self-reported reactive and regulative temperament factors and psychopathological symptoms and personality traits in a group of non-clinical youths aged 9-13 years (N=208). Results showed that the reactive temperament factor of negative affectivity was positively associated with internalizing and externalizing symptoms, whereas the regulative temperament factor of effortful control was negatively related to such symptoms. Further analyses provided some support for the notion that in particular the combination of high negative affectivity and low effortful control was associated with high symptom levels. Results also revealed specific relations between lower-order temperament traits and internalizing and externalizing symptoms. That is, fear and (low) attention control appeared to be more clearly associated with internalizing symptoms, whereas anger/frustration and (low) activation and inhibitory control were more convincingly linked to externalizing symptoms. Finally, relations with the "Big Three" personality traits were as anticipated, with high positive correlations between negative affectivity and extraversion/surgency and their Eysenckian counterparts of neuroticism and extraversion, respectively.
17459818	Registered nurses (RNs) employed in an urban medical center in the USA identified moral distress as a practice concern. This study describes RNs' moral distress and the frequency of morally distressing events. Data were collected using the Moral Distress Scale and an open-ended questionnaire. The instruments were distributed to direct-care-providing RNs; 100 responses were returned. Morally distressing events included: working with staffing levels perceived as 'unsafe', following families' wishes for patient care even though the nurse disagreed with the plan, and continuing life support for patients owing to family wishes despite patients' poor prognoses. One high frequency distressing event was carrying out orders for unnecessary tests and treatments. Qualitative data analysis revealed that the nurses sought support and information from nurse managers, chaplaincy services and colleagues. The RNs requested further information on biomedical ethics, suggested ethics rounds, and requested a non-punitive environment surrounding the initiation of ethics committee consultations.
17459182	This study examined the extent to which effortful control moderated the risk of internalizing or externalizing problems associated with high negative emotionality in a Dutch population sample of pre- and early adolescents (N = 1,922). Internalizing and externalizing problems were assessed with the Child Behavior Checklist, Youth Self-Report, and Teacher Checklist of Psychopathology. Temperament (effortful control, fearfulness, frustration) was assessed with the parent version of the Revised Early Adolescent Temperament Questionnaire. The effects of fearfulness and frustration appeared to be attenuated by high levels of effortful control. The associations differed between the two domains of mental health investigated: effortful control reduced the effect of fearfulness on internalizing problems and the effect of frustration on externalizing problems. The effects were stronger for externalizing problems and similar for preadolescent (age 11) and adolescent (age 13/14) outcomes.
17459176	The purpose of the study was to examine the zero-order and unique relations of effortful attentional and behavioral regulation, reactive impulsivity, and anger/frustration to Chinese first and second graders' internalizing and externalizing symptoms, as well as the prediction of adjustment from the interaction of anger/frustration and effortful control or impulsivity. A parent and teacher reported on children's anger/frustration, effortful control, and impulsivity. Parents reported on children's internalizing symptoms, and teachers and peers reported on children's externalizing symptoms. Children were classified as relatively high on externalizing (or comorbid), internalizing, or nondisordered. High impulsivity and teacher-reported anger/frustration, and low effortful control, were associated with externalizing problems, whereas low effortful control and high parent-reported anger were predictive of internalizing problems. Unique prediction from effortful and reactive control was obtained and these predictors (especially when reported by teachers) often interacted with anger/frustration when predicting problem behavior classification.
17459138	The aim was to describe critical care nurses' experiences of close relatives within intensive care.There is a lack of research describing critical care nurses' experiences of the significance of close relatives in intensive care. Knowledge in this area will support critical care nurses to develop good nursing care for the critically ill person and their close relatives.	The design of the study was qualitative. Data collection was carried out through focus group discussions with 24 critical care nurses in four focus groups during spring 2004. The data were subjected to qualitative thematic content analysis.	The focus groups discussions showed that the presence of close relatives was taken for granted by critical care nurses and it was frustrating if the critically ill person did not have any. Information from close relatives made it possible for critical care nurses to create individual care for the critically ill person. They supported close relatives by giving them information, being near and trying to establish good relations with them. Close relatives were important. Critical care nurses lacked forums for reflection and discussion about the care given.	This study indicates that close relatives are a prerequisite for critical care nurses to give good nursing care to meet the needs of the critically ill person. A communication based on mutual understanding is necessary if critical care nurses are to be able to support close relatives. Dealing constantly with situations that were ethically difficult without any chance to reflect was an obstacle for critical care nurses to improve their work with close relatives.	
17451044	This study examined age differences in topics that generate interpersonal tensions as well as relationship level characteristics that may account for variability in the content of interpersonal tensions. Participants aged 13 to 99 years (N = 184) diagramed their close and problematic social networks, and then provided open-ended descriptions of recent tensions with up to 6 social partners. Multilevel models were conducted to examine variability in 5 types of tensions (i.e., financial issues, daily activities, scheduling, job/school, and self). Older adults were less likely than younger ages to describe tensions over job/school and daily activities. Job/school tensions were more likely to occur with acquaintances and negative network members. Tensions over scheduling were more likely to occur with positive and ambivalent network members, and tensions over daily activities were associated with less emotional distress. Results suggest relationship characteristics contribute to the content of tensions.
17451010	Young adolescents (N=144; 66 boys, 78 girls), ages 12 to 14 years (M=12.2, SD=.8), who reported lower scores on the Low Frustration Tolerance Beliefs Instrument had higher scores on the Perceived Stress Scale and the Profile of Mood States Subscales of Depression and Anxiety.
17449899	Cognitive ability and behavioral adaptability are distinct, yet related, constructs that can impact childhood development. Both are often reduced in deaf children of hearing parents who do not provide sufficient language and communication access. Additionally, parental depression is commonly observed due to parent-child communication difficulties that can lead to parents' feelings of inadequacy and frustration. We sought to assess whether adaptive behavior in deaf children was associated with nonverbal intelligence and parental depression. Parents of precochlear implant patients seen for neuropsychological assessment were administered the Parenting Stress Index and Vineland Behavior Adaptive Scales to obtain measures of parental distress and child's behavioral adaptability. Precochlear implant patients' cognitive functioning was assessed via the Mullen Scales of Early Learning or the Leiter International Performance Scale-Revised, depending on the child's age at the time of testing. Regardless of age or neurological status, the deaf child's adaptive behavior consistently showed a strong relationship with intelligence. Moderate correlation between parental depression and the child's adaptive behavior was observed only in the younger group. The relationship between parental depression and communication subscale was moderated by intelligence for deaf children without neurological complications. The findings provide important implications for promoting family-centered interventions with early communication and language development.
17444533	We theorize that the reported association between economic indicators and the incidence of civil commitment for mental illness may result, at least in part, from reduced tolerance in the community for impaired behavior among minorities. Earlier work suggests that economically induced intolerance will be focused primarily on minority males. Based on this literature, we hypothesize that the median level of functioning among African-American males subjected to civil commitment will vary positively with earlier changes in the unemployment rate. The test applies Box-Jenkins methods to 156 months (August 1985-July 1998) of data from California. Consistent with theory, results support the hypothesis.
17443382	Physicians associate empathy with benevolent emotions and with developing a shared understanding with patients. While there have been many articles on managing "difficult" patients, little attention has been paid to the challenges physicians face during conflicts with patients, especially when both parties are angry and yet empathy is still needed. This topic is especially important in light of recent studies showing that practicing medicine increasingly requires physicians to manage their own feelings of anger and frustration. This article seeks to describe how physicians can learn to empathize with patients even when they are both subject to emotions that lead to interpersonal distancing. Empathy is defined as engaged curiosity about another's particular emotional perspective. Five specific ways for physicians to foster empathy during conflict are described: recognizing one's own emotions, attending to negative emotions over time, attuning to patients' verbal and nonverbal emotional messages, and becoming receptive to negative feedback. Importantly, physicians who learn to empathize with patients during emotionally charged interactions can reduce anger and frustration and also increase their therapeutic impact.
17427426	The authors have shown in the artcile personality characteristics and neuropsychic disorders in patients with duodenal peptic ulcer. These characteristics are the following: increased level of anxiety, presence of frustration, agressiveness, apparent rigidity and astenic, depressive, affective derangements. It does have not positive influence on the course of the disease and requires adequate correction. Psychotherapy use in a complex treatment makes for ulcers healing, dicreasing treatment period and numbers of relapses. It eliminates disorders of psychoemotional status of patients, enhances quality of life of patients from the beginning of the treatment.
17419880	Few empirical studies have been found that explore ethical challenges among persons in high public positions that are responsible for elder care. The aim of this paper was to illuminate the meaning of being in ethically difficult situations related to elder care as experienced by high level decision-makers.A phenomenological-hermeneutic method was used to analyse the eighteen interviews conducted with political and civil servant high level decision-makers at the municipality and county council level from two counties in Sweden. The participants worked at a planning and control as well as executive level and had both budget and quality of elder care responsibilities.	Both ethical dilemmas and the meaning of being in ethically difficult situations related to elder care were revealed. No differences were seen between the politicians and the civil servants. The ethical dilemmas mostly concerned dealings with extensive care needs and working with a limited budget. The dilemmas were associated with a lack of good care and a lack of agreement concerning care such as vulnerable patients in inappropriate care settings, weaknesses in medical support, dissimilar focuses between the caring systems, justness in the distribution of care and deficient information. Being in ethically difficult situations was challenging. Associated with them were experiences of being exposed, having to be strategic and living with feelings such as aloneness and loneliness, uncertainty, lack of confirmation, the risk of being threatened or becoming a scapegoat and difficult decision avoidance.	Our paper provides further insight into the ethical dilemmas and ethical challenges met by high level decision-makers', which is important since the overall responsibility for elder care that is also ethically defensible rests with them. They have power and their decisions affect many stakeholders in elder care. Our results can be used to stimulate discussions between high level decision-makers and health care professionals concerning ways of dealing with ethical issues and the necessity of structures that facilitate dealing with them. Even if the high level decision-makers have learned to live with the ethical challenges that confronted them, it was obvious that they were not free from feelings of uncertainty, frustration and loneliness. Vulnerability was revealed regarding themselves and others. Their feelings of failure indicated that they felt something was at stake for the older adults in elder care and for themselves as well, in that there was the risk that important needs would go unmet.	
17419791	This study explores the scope and potential contribution of the Clinical Research Nurse (CRN) role to clinical trials of a nursing-specific topic.Over the past two decades, there have been increases in the numbers of nurses working as CRNs because of the increasing global demand for clinical trials. CRNs can influence the quality of clinical trials but the scope and contribution of the role to clinical trials is not known.	Qualitative focus group study.	A focus group interview was carried out with CRNs (n = 9) employed on a large, multi-centre (six NHS Trusts) randomized controlled trial of pressure area care. The focus group interview was recorded, alongside field notes of participant interactions and behaviours, and transcribed verbatim. Data were analysed for thematic content and process.	CRNs described their transition to a clinical research role. They reported a lack of confidence, role conflict as researcher and nurse, the challenges of gaining cooperation of clinical nursing staff to comply with trial protocols and difficulties maintaining their own motivation. CRNs provided their perceptions and observations of pressure area care and prevention. They identified areas of inadequate treatment, management and care, influenced by organizational and clinical aspects of care delivery.	The study reveals challenges associated with training and management of CRNs. CRNs are usually associated with trial recruitment and data collection. This study highlights the additional contributions of CRNs for the study of topics specific to nursing as the result of their unique placement in the research centres as informal 'participant observers.' Such observations enhance understanding of the contexts being studied.	These findings are relevant to the design and conduct of research studies of nursing care and practice and present ways for investigators to optimize the skills and knowledge of nurses working as CRNs.	
17416702	The author draws on an Australian study using multiple qualitative methods to investigate truth telling in aged care. Thematic analysis of data from five nursing homes involving 23 personal care assistants revealed participants' role understanding as influencing their perceptions about truth telling in practice. Five themes emerged: role as the happy comfort carer, division of labor, division of disclosure, role tension and frustration, and managing the division of disclosure. Role emphasis on comfort and happiness and a dominant perception that telling the truth can cause harm mean that disclosure will be withheld, edited, or partial. Participants'role understanding divides labor and disclosure responsibility between the personal carer and registered nurse. Personal carers' strategies for managing the division of disclosure include game playing, obfuscation, lying (denial), and the use of nonverbals. These perceptions about personal carer role, information sharing, and truth telling are paramount for understanding and improving nursing home eldercare.
17406972	Pain catastrophizing is generally viewed as an important cognitive factor underlying chronic pain. The present study examined personality and temperament correlates of pain catastrophizing in a sample of young adolescents (N = 132). Participants completed the Pain Catastrophizing Scale for Children, as well as scales for measuring sensitivity of the behavioral inhibition and behavioral activation systems (BIS-BAS), and various reactive and regulative temperament traits. Results demonstrated that BIS, reactive temperament traits (fear and anger-frustration), and perceptual sensitivity were positively related to pain catastrophizing, whereas regulative traits (attention control, inhibitory control) were negatively associated with this cognitive factor. Further, regression analyses demonstrated that only BIS and the temperamental traits of fear and perceptual sensitivity accounted for a unique proportion of the variance in adolescents' pain catastrophizing scores.
17401613	Internalizing psychopathology, anxiety in particular, is assumed to contribute to the development of gender Identity disorder (GID). Until now, anxiety has only been reported in studies using parent-report questionnaires; physiological correlates of anxiety have not been studied. In this study we assessed anxiety and stress in children with GID by measuring their cortisol, heart rate (HR) and skin conductance levels (SCL) and asking them to repeat their moods and experience of control.By using an established psychological challenge, involving provocation and frustration, we investigated whether children with GID as compared to healthy controls react in a more anxious way under these experimental circumstances. We assessed anxiety levels in 25 children with GID and 25 matched controls by measuring cortisol, HR and skin conductance and examined whether a pattern of increased physiological activity corresponded with the feeling of being less in control and having more intense negative emotions.	The results showed that children with GID had more negative emotions and a tonically elevated SCL. There were no differences between the groups in cortisol and HR.	This is the first study that shows that children with GID have a more anxious nature as compared to their normal counterparts.	
17394519	This paper details one of the findings of a large phenomenological study into the effects of nurse-patient encounters on clinical learning and practice. Every nurse faces the challenge of caring for a patient with cancer at some point in his or her nursing career. The participants, 392 nurses, were asked to discuss a care episode from their practice and the impact this encounter had on clinical learning and practice. The data collection method was by way of a written narrative/clinical exemplar. Meaning units and themes were identified using the Nvivo computer program. The procedural method of Giorgi was followed in all phases of analysis. The participants provided a detached description of the patients' diagnoses but tended to become emotive when discussing the cancer treatment experience. Nurses detailed care episodes with insight and understanding of the consequences of cancer for the patient. Nurses used powerful language to illustrate the enormity of the cancer experience for the patient and family. Although the nurses recognized the emotional impact themselves, they attempted to understate it. Participants spoke of their frustration and their sadness when describing the nurse-patient encounters. The life-threatening potential of cancer for the patient and the perception of potential or actual suffering do impact on nurses, their learning and their clinical practice. This is particularly evident when the cancer experience for the patient is not predictable. Participants clearly felt the influence of patients' cancer experience, personally and professionally. Participants detailed learning from the encounters and reflected with great insight on themselves and their practice. Identifying the learning potential of nurse-patient encounters can contribute to change in clinical practice.
17376540	This study examined the relationship between expressed emotion (EE), attributions of control, beliefs about the utility of EE behaviors, and distress in parents of young people with first episode psychosis. Fifty-three parents completed self-report measures of EE, attributions of patient and parent control over the psychotic illness, and beliefs about the utility of EE behaviors in controlling the patient's symptomatology. Measures of parental distress and parental assessment of patient symptomatology were also completed. Parents high on criticism EE were more likely to make attributions that the psychotic illness was controllable by the young person, and to endorse the potential utility of person-focused criticism (i.e., telling the patient about the parents' dissatisfaction and frustration with them as a person) in controlling the patient's symptoms. Beliefs in the utility of person-focused criticism and self-sacrifice were significantly associated with distress, but attributions that the illness was controllable by the patient or the parent were not. Beliefs about the utility of criticism may play an important role in EE among parents of young people with first episode psychosis, and may provide further direction for interventions designed for this group.
17370151	Vocal cord dysfunction (VCD) is characterised by recurrent attacks of paradoxical adduction of the vocal cords during inspiration, accompanied clinically by dyspnoea attacks with inspiratory stridor lasting between minutes and hours. The aim of the study is to evaluate the self-perception of patients suffering from VCD and how they deal with aggressivity.The Giessen Test (GT) and the Picture Frustration Test (PFT) were used on 6 patients with VCD.	Five variables show significant differences between the patients with VCD and the values of the normative groups. VCD-patients show an idealized image of themselves, ie relaxed, open, sociable, and capable of devotion. They do not reject accusations against them by others and rarely make self-criticism. In conflicts they behave passively, thus blocking their expression of aggressivity.	In many cases organic disposition and trigger stimuli are thought to be responsible for provoking dyspnoea attacks in VCD. However, the self-perception of patients and their way of dealing with aggressivity strongly suggests that psychosocial factors play a great role in the development of VCD. This requires not only symptom-orientated therapy but also psychological counselling.	
17368941	While ethics of placebo use has been debated since discovery of the phenomena, there has yet to be a study that examines the aftereffect of individuals learning of a personal placebo response on their future ability to experience a placebo response. In the first study, eleven participants diagnosed with irritable bowel syndrome in a placebo study were interviewed individually about their personal placebo response. We found no changes in attitudes about the likelihood of using medical and non-medical treatments for pain, likelihood of participating in future studies or likeability and trust of experimenters. In addition, we found no changes in mood except for a slight improvement in frustration. In the second study, 77 undergraduate students from the University of Florida were divided into three conditions: placebo, control and repeated baseline. We used a double placebo design with verbal placebo suggestion and conditioning to induce a placebo response and to examine the effect of providing information about a participant's personal placebo response on their future placebo response. Using a heat thermode, we discovered that there were no differences in future pain responding between participants who were told that they experienced a placebo response versus those who were not. In addition, similar to the first study, we found no detrimental effects of the placebo information variables measured. These studies suggest the placebo response persists even after revelation of a personal placebo response and placebo use does not appear to cause adverse effects on mood and other attitude variables assessed.
17364481	This study examined the overlap and validity of several measures of mother - child attachment developed for preadolescents. Validity was assessed in part by examining how attachment is related to children's mood and emotion regulation. Mother - child attachment was assessed in a sample of 9 to 11 year-old children using a story stem interview technique and questionnaires. Positive and negative mood were scored from daily logs completed by children. Emotion regulation was assessed with mothers' reports of constructive coping and teacher reports of children's ability to tolerate frustration. Interview and questionnaire measures of attachment were not consistently related to one another, although both were related to mood and emotion regulation. As expected, secure attachment and maternal secure base support were related to higher levels of positive mood, more constructive coping, and better regulation of emotion in the classroom, with effects stronger for emotion regulation than for mood. Children classified Disorganized or Ambivalent displayed the most negative mood. All effects remained significant after controlling for child temperament.
17364400	Little research has focused on experiences of volunteers for people living with HIV/AIDS but other research on caregivers for this population illustrates the stress often experienced. This study identifies stressors experienced by volunteers for people with HIV/AIDS, and determines the types of social support needed to help volunteers cope with the stressors identified. Six volunteers were interviewed at a small non-profit organization in Appalachia providing such services. Participants indicated that providing services for people with HIV/AIDS is a rewarding experience; however, stress and frustration played a large role in their experiences with the organization. Further, the results of this study indicate that emotional and informational social support may help volunteers cope with stressors associated with providing services for people with HIV/AIDS.
17354495	Vignettes from an ongoing psychoanalysis with a patient, Michael, are presented to illustrate the various dimensions of the erotic transference at different phases of the treatment. The relation to power, the experience and expression of aggression, how these may be organized by gender, and the female analyst's countertransference are discussed as potentially fostering or inhibitory in the development of an erotic transference. Traditional sociocultural gender stereotypes kept alive in fantasy can cause female analysts to subtly foreclose the impending threat of an intense erotic transference with male analysands due to a fear of outwardly directed male aggression. It is suggested that the maternal/containing transference can be unconsciously fostered by both analyst and analysand to defensively avoid expression of the aggressivized erotic transference in its full intensity. Similarities and differences in cases of sexual boundary violations with opposite-gender pairings are discussed.
17347350	The balance between optimal levels of emotional arousal and cognitive performance reflects the integration of several dopaminergically and adrenergically regulated neural systems. The amygdalar system is a key region for gating stimulation to cortical regions and the medial amygdala appears to play an especially key role in mediating the fear response. More generally, these arousal regulatory neural systems are key to frustration or stress impact prefrontal cortical function. Further, the threshold for when the level of stress is overwhelming and hence impairs cognitive function reflects minimally genetic and experiential influence. An important interface between Drs. Lewis and Davis's work is how early experience, especially through early parenting, may set the threshold of responsiveness for these arousal regulatory neural systems.
17344261	Anorexia/cachexia is a frequent complication of advanced cancer with poorly understood psychosocial impact or eating-related distress (ERD) on both patients and family members. To assist palliative care practitioners manage this important psychosocial aspect of care, we aimed to discover and describe elements of ERD, focusing on male patients with advanced cancer and their female partners.Nineteen male patients and their partners were systematically investigated by (1) focus group interviews and data analysis inspired by Grounded Theory, and (2) a comparative survey with categorical questions.	For patients, eating-related distress was characterised by obstruction to eating, poor and capricious appetite, a disconnection of oral intake and ability to gain weight, and continuous efforts to eat. Partners expressed feelings of deep concern, frustration, and insufficiency in their loving and innovative efforts to prepare appealing food. Partners were more concerned about patients' weight loss than patients themselves (P =0.002). Patients felt more pressure to eat from partners than they estimated (P =0.007).	Anorexia/cachexia of male cancer patients affects the cooking at home, a couple's daily eating routines, and their spousal relationship. Identification of ERD may trigger targeted psychosocial interventions.	
17335519	The aim of the study was to illuminate patients' experiences of dissatisfaction with hospital care.During the last decade, interest in measuring patient satisfaction has become an important indicator of the quality of care. Researchers have, however, criticized the concept theoretically and methodologically. Subsequently, researchers have increasingly argued that the focus of attention should shift to explore patient dissatisfaction.	A qualitative approach.	Narrative interviews were conducted with six people who had experienced dissatisfaction during a hospital care episode. The interview text was analysed using qualitative content analysis.	The results show the patients' struggle for confirmation, the feeling of distrust in health care and what they have been forced to sacrifice because of lack of treatment. A feeling of being a troublesome patient is also apparent. At the same time a positive encounter is described, as well as situations of confirmation from caregivers. The results also show hope and a will to get on with life.	Dissatisfaction relating to aspects of encounter is a common problem in health care and conceivable causes and possible solutions are discussed from different perspectives. RELEVANCE TO CLINICAL:	Caregivers as well as patients are in need of confirmation. If management were to take notice of and confirm caregivers this could consequently help them to gain the strength and energy necessary to provide care permeated with confirmation. A veritable, trustworthy care can be established through personal presence. To take notice of, confirm and listen to patients, creates opportunities for providing them with a positive experience of human encounter, which in the long run is rewarding from all perspectives.	
19069856	Cigarette smoking is highly prevalent among scholars and university students in Jordan. The aim of this study is to discover the environmental factors and social influences that motivate Jordanian students to smoke and to recommend adequate programs in order to stop adolescents from smoking. A questionnaire of (28) items was designed to assess students and professor's attitudes towards smoking, the sample of the study consisted of(851) participants from different levels in a community nearby Al-Isra Private University. The study also attempted to examine the effects of the following factors: social status, age, gender, parental education and mode of spending free time, having parents, siblings, friends and teachers who smoke. The results show that the proportion of smokers to nonsmokers was of (33:67). The first cigarette smoked by 65% of the sample, was before the age of 18 years and 88.5% was before the age of 21 years. The environmental factors and social influences that motivate students to smoke were related to teachers and friends behavior. The major reasons to start smoking were to try something new and Spending free time with friends more than with family. Also Health disturbances suffered by smokers (fatigue, stress, frustration and depression) were as two times greater compared to nonsmokers. Desire to quit smoking among participants were very high and there was a positive correlation between nonsmokers and high level of education. Desire were greatly negative to have smoker mate = 93%, smoker children = 96% or smoker friends = 87%. In conclusion the increased rate of smoking before age of 18 years indicates that smoking prevention programs need to be started at an earlier age. The risk factors of smoking onset are subject to modification and families must be aware of the potential risks of certain ways of spending time and modifying attitudes.
17320308	This article develops the idea that many inflammatory, auto-immune or auto-aggressive diseases might result from conditioned responses acquired when occasional, possibly minor pathological conditions, normal organ fatigue, or similar sensations, are reinforced by an intense neural reward coinciding, often by pure bad luck, with these minor troubles. After such conditioning, and especially in times of frustration or distress, the brain will repeatedly try to obtain the reward again by recreating, with an intensity in proportion to the degree of frustration, the sensorial pattern of the initial minor trouble, producing auto-aggressive effects. This leads naturally to the idea of trying to extinguish diseases implying self-aggression by applying negative reinforcement. This behavioural strategy has been tested for some minor or medium-severity inflammatory/auto-immune troubles and, essentially, it works, although it implies practical difficulties that are reviewed in the text. Furthermore, the experience was very limited because of the difficulty of convincing people to try for good a scarcely tested technique requiring intense mental effort and completely different from the medical treatments people are used to. The article describes the physiological-behavioural model underlying our proposal, evaluates different possibilities of treatment, and provides useful practical advice. In particular, it appears that our proposal seems best suited for diseases in which the mental abilities of the person are intact and the inflammatory aggression is clearly identifiable by its symptoms, for example pain, itching, fatigue or paralysis. Possible candidate diseases could be, for example, superficial allergies or irritations, digestive inflammatory problems, rheumatoid or circulatory troubles, or motor neurological diseases like multiple sclerosis, Guillain-Barré syndrome and possibly ALS or Parkinson. The article is completed by some guidelines on the prevention of diseases implying auto-aggression, based on self-control, diet, exercise, mutual help, and avoidance of psychoactive or aggressive agents.

17317076	The aim of this study was to discover the ways in which a training program on intimate partner abuse affected a doctor's daily practice.Eighteen family doctors who participated in a training program on partner abuse were interviewed.	The interviewees evaluated the training program to be useful in raising their awareness and suspect criteria on partner abuse. Any questions and frustrations they had concerning the subject were resolved. They felt more confident and equipped to discuss and aid abused patients after the training.	In order to improve doctors' awareness of partner abuse in daily practice, they must need first realize the scale of the problem and then become more comfortable in their own attitude and finally more confident in their ability to aid these patients.	Training on partner abuse should be specifically tailored to change awareness, attitudes and consultation skills.	
17308311	Illness perceptions may influence health outcomes, including pain. The objective of the study was to investigate the illness perceptions associated with health and behaviour in a population of older adults with musculoskeletal hand problems.A two-stage cross-sectional postal survey was sent to individuals aged 50 yrs and over, registered with three general practices in North Staffordshire. Stage 1, a Health Survey questionnaire, was sent to 11,230 individuals and enquired about general health status, including anxiety and depression. Individuals reporting hand problems at Stage 1 were sent Stage 2, a detailed hand questionnaire. The hand questionnaire included: the Arthritis Impact Measurement Scales 2 (AIMS2) (hand and finger function, pain and medication scales), and questions on self-reported diagnoses and general practitioner (GP) consultation. Perceptions were measured by the Illness Perceptions Questionnaire-Revised (IPQ-R), and an item on perceived frustration with their hand problems. Of the 7878 responders to the Health Survey questionnaire 3749 (47.6%) reported 'hand problems' and 2695 (71.9%) gave permission to be re-contacted. The hand questionnaire was completed by 2113 (adjusted response rate 78.6%).	A belief that their hand problem had a profound impact on life, caused a range of symptoms and made them frustrated were the perceptions most strongly and consistently associated with health and behaviour. There was little difference between individuals who did and those who did not report their hand problem to be osteoarthritis with respect to perceptions or between perceptions associated with health and behaviour.	The results suggest that older people who consider their musculoskeletal hand problem to have negative effects on their life will be more likely to encounter difficulties that may lead them to consult, take medication or both. Understanding the illness perceptions of these individuals may identify opportunities for intervention.	
17302509	There is a general paucity of research in the area of rural adolescent mental health in Australia, and in particular a lack of data regarding the experiences of rural adolescents who seek help for mental health problems. This study used a qualitative approach to data collection and analysis in order to assist understanding of the barriers to mental health service utilization for young people in rural communities.A series of interviews were conducted with each of the study's participants, who ranged in age from 15 to 17 years. All participants were clients of the Child and Adolescent Mental Health Services in the rural cities of Horsham and Ararat, Victoria, Australia.	Participants described how the lack of reliable transport to and from the mental health service affected the utilization of the service by rural young people. They also expressed concern regarding a lack of qualified professionals in their region who specialize in child and adolescent mental health. Participants reported frustration at long waiting lists and the lack of an after-hours service. One participant shared her experiences of deliberate self-harm to in order to gain access. Results also revealed that rural gossip networks and social visibility within rural communities compounded the experience of stigma and social exclusion for these young people. Furthermore, participants explained how these experiences negatively impacted on their utilization of the mental health service and their progress towards recovery.	There are several barriers to mental health service utilization for rural adolescents which affect both their decision to access help as well as their ability to engage effectively with mental health services over time. Clinicians who work with rural adolescents need to be mindful of the influence of rural culture on mental health service utilization by young people. The co-location of mental health services and general health services is suggested as one way to reduce the fear associated with 'being seen' entering a stand-alone mental health service. It is suggested that treatment programs for adolescents in rural areas address the different types of stigma that these young people are likely to encounter. Furthermore, community and school-based interventions aimed at reducing the social stigma of young people with mental illness in rural areas is recommended.	
17293610	The authors compared three approaches to feedback of clinical audit findings relating to miscarriage in 15 Scottish maternity services (printed report alone; report plus action planning letter; report plus face-to-face facilitated action planning). Clinicians were surveyed to measure theory of planned behavior constructs (in the context of two audit criteria) before and after feedback (n = 253) and assessed perceptions of the audit through in-depth interviews (n = 17). Prefeedback, clinicians had positive attitudes and strong subjective norms and intentions to comply, although perceived behavioral control was lower. Generally, positive attitudes, subjective norms, and intentions increased after feedback but for one of the two criteria (providing a 7-day miscarriage service), perceived behavioral control decreased. No changes over time reached statistical significance, and analysis of covariance (adjusting for prefeedback scores) showed no consistent relationships between method of feedback and postfeedback construct scores. Interviews revealed positive perceptions of audit but frustration at lack of capacity to implement changes. Although interventions that increased intensity of feedback proved feasible and acceptable to clinicians, the authors were unable to demonstrate that they increased intention to comply with audit criteria.
17292131	The National Center for Health Workforce Analysis projects that the shortage of registered nurses in the United States will double by 2010 and will nearly quadruple to 20% by 2015 (Bureau of Health Professionals Health Resources and Services Administration. [2002]. Projected supply, demand, and shortages of registered nurses, 2000-2020 [On-line]. Available: http:bhpr.hrsa.gov/healthworkforce/reports/rnprojects/report.htm). The purpose of this study was to use the conceptual framework of emotional intelligence to analyze nurses' stories about their practice to identify factors that could be related to improved nurse retention and patient/client outcomes. The stories reflected evidence of the competencies and domains of emotional intelligence and were related to nurse retention and improved outcomes. Nurses recognized their own strengths and limitations, displayed empathy and recognized client needs, nurtured relationships, used personal influence, and acted as change agents. Nurses were frustrated when organizational barriers conflicted with their knowledge/intuition about nursing practice, their communications were disregarded, or their attempts to create a shared vision and teamwork were ignored. Elements of professional nursing practice, such as autonomy, nurse satisfaction, respect, and the professional practice environment, were identified in the excerpts of the stories. The shortage of practicing nurses continues to be a national issue. The use of emotional intelligence concepts may provide fresh insights into ways to keep nurses engaged in practice and to improve nurse retention and patient/client outcomes.
17291832	Obstructive sleep apnoea syndrome (OSAS) is independently associated with an increased risk for hypertension and cardiovascular disease. Continuous positive airway pressure (CPAP) can reduce mortality and morbidity, but low compliance rates are seen.To explore and describe the experiences of CPAP-treatment in a young male patient with severe OSAS during a 6-month period from the couple's perspective. METHODS AND THE CASE: A single case study with a phenomenographic approach was employed. Diagnostic procedures of OSAS and initiation of treatment with Auto-CPAP, humidifier and a nasal mask were performed during 4 visits. Conceptions were collected at 4 different occasions during the 6-month period (before, and 2 weeks, 3 months, and 6 months after treatment initiation) by means of interviews with a 33-year old male patient and his female partner.	Totally 17 different structural aspects were found to fluctuate during the 6-month period in relation to; influence of stressors, social reactions and adaptation to increase compliance.	An increased knowledge about the influence of stressors, the social reactions, and the adaptation can help healthcare personnel to identify and better understand concerns of other patients and spouses during different time phases of the initial 6-month period of CPAP-treatment.	
17291319	Treatment of childhood cancer occurs over a 2- to 3-year period, with initial intense phases of chemotherapy followed by less severe treatment periods. From first diagnosis, families are encouraged by healthcare professionals (following government guidelines) to try to maintain a normal life. The aim of this paper is to contribute to our understanding of how 'normal' family life is compromised from the perspective of the families themselves during this period of extreme stress and concern for the health and well-being of their child.This study was longitudinal and involved a cross section of 32 mothers of children recently diagnosed with acute lymphoblastic leukaemia (ALL) currently participating in the Medical Research Council ALL-97 randomized control trial. Mothers were interviewed at three time points (3-4 months post diagnosis, 15 and 27 months) using a semi-structured format with open-ended questions. A qualitative methodology was employed to analyse interview data using Thematic analysis.	Mothers reported understanding the importance of achieving normal life, but described how this was difficult to realize. At first interview, mothers were optimistic that they could achieve the 'normal life' as advised by healthcare workers. At 12 and 24 months, although all mothers reported that life was not back to normal, there were differences in how they perceived this lack of normality. Whereas some families experienced frustration and disappointment, others had adjusted and managed to accept the new order.	Families felt encouraged on diagnosis to be told that despite the severity of the disease and treatment regime, a normal life was possible and should be pursued. Our findings indicate that over time, more concrete information is needed to guide parents through the treatment process in order to help them achieve this.	
17287371	Qualitative methods were used to identify characteristics of "passionately committed psychotherapists" (experienced psychotherapists who would describe themselves as having found the vocation that suits them better than any other) identified by peers in the Utah public mental health system. Six themes were identified by all 15 interviewees: balance between work and nonwork passions, adaptiveness and openness, transcendence (the belief that the practice of psychotherapy has extraordinary significance), intentional learning, personal fit with the role, and passion-supporting beliefs. These are characteristics that psychotherapists should nurture in themselves, that program supervisors should seek in potential employees, and that training programs should develop in trainees.
17285786	To identify the factors that patients consider most concerning about their cough.All consecutive patients who presented with a complaint of chronic cough between November 1, 2000, and February 28, 2001, were prospectively surveyed for cough-related complaints using an 18-item symptom-complaint questionnaire. We analyzed frequencies of responses and response patterns to specific items on the questionnaire. We also examined whether the responses to individual items related to the patient's age, sex, and duration of cough.	Of the 146 consecutive patients referred for evaluation of chronic cough, 136 were eligible for inclusion in the study. These patients cited feelings of frustration, irritability, or anger (43%), frequent physician visits and testing (41%), and sleep disturbances (38%) as the most prevalent major problems. The responses to individual items on the questionnaire were not related to patients' age, sex, and cough duration. Anxiety about underlying serious illness continued to be a concern for most patients.	Frustration, anger, or anxiety was the most frequent major problem cited by patients. Frequent physician visits and testing was the unexpected second most frequent major problem. These findings are important because most chronic cough guidelines are based on clinical efficacy and cost-effectiveness considerations rather than on patient satisfaction. Future studies regarding chronic cough evaluation should take into account patient satisfaction and perceived burden of disease as outcome variables.	
17284487	This study aims to explore the relationships between cognitive coping, goal disturbance and psychological distress in HIV-infected persons. A sample of 43 HIV positive persons completed questionnaires that assessed cognitive coping, goal frustration, depressive symptoms and quality of life. Goal frustration and, to a lesser extent, the cognitive coping strategy 'positive reappraisal' were related to psychological distress. Intervention programmes might usefully implement the topics of goal disturbance and positive reappraisal.
17273501	To investigate the psychological sequelae of acne vulgaris.Qualitative study using a grounded-theory approach.	General practices and specialty dermatology practices in Newcastle, Australia.	Patients with current acne recruited from the practices.	We used semistructured interviews and recorded participants' comments verbatim. Data analysis was cumulative and concurrent throughout the data-collection period. Coding and analysis was done in the inductive tradition.	Interviews were conducted with 26 subjects who represented a range of ages and acne severity. Psychological morbidity was considerable. Though participants had mood and anxiety symptoms, these symptoms tended to be subsyndromal and evanescent. More prominent symptoms were embarrassment, impaired self-image, low self-esteem, self-consciousness, frustration, and anger. Some subjects thought that acne had affected their personalities permanently and adversely. Psychological sequelae were attributed to the effects of facial acne on appearance.	The psychological effects of acne can be considerable. The psychological morbidity is complex and often does not conform to standard psychiatric disease criteria. Recognition and management of the psychological sequelae of acne by general practitioners is of considerable importance.	
17272578	We assessed associations between parenting a child with autism and stress indicators.In the 2003 National Survey of Children's Health, parents or other knowledgeable adult respondents for children aged 4 to 17 years reported their recent feelings about their life sacrifices to care for their child, difficulty caring for their child, frustration with their child's actions, and anger toward their child. Responses were compiled in the Aggravation in Parenting Scale. Parents of children reported to have autism (N = 459) were compared with parents of: (1) children with special health care needs including emotional, developmental, or behavioral problems other than autism that necessitated treatment (children with other developmental problems [N = 4545]); (2) children with special health care needs without developmental problems (N = 11475); and (3) children without special health care needs (N = 61826). Weighted estimates are presented.	Parents of children with autism were more likely to score in the high aggravation range (55%) than parents of children with developmental problems other than autism (44%), parents of children with special health care needs without developmental problems (12%), and parents of children without special health care needs (11%). However, within the autism group, the proportion of parents with high aggravation was 66% for those whose child recently needed special services and 28% for those whose child did not. The parents of children with autism and recent special service needs were substantially more likely to have high aggravation than parents of children with recent special service needs in each of the 3 comparison groups. Conversely, parents of children with autism but without recent special service needs were not more likely to have high aggravation than parents of children with other developmental problems.	Parenting a child with autism with recent special service needs seems to be associated with unique stresses.	
17267795	Researchers disagree as to whether irritability is a diagnostic indicator for pediatric mania in bipolar disorder. The authors compared the behavioral and psychophysiological correlates of irritability among children with severe mood dysregulation (i.e., nonepisodic irritability and hyperarousal without episodes of euphoric mood) and narrow-phenotype bipolar disorder (i.e., a history of at least one manic or hypomanic episode with euphoric mood) as well as those with no diagnosis (i.e., healthy comparison children).Subjects with severe mood dysregulation (N=21) or narrow-phenotype bipolar disorder (N=35) and comparison subjects (N=26) completed the affective Posner task, an attentional task that manipulated emotional demands and induced frustration. Mood response, behavior (reaction time and accuracy), and brain activity (event-related potentials) were measured.	The severe mood dysregulation and narrow-phenotype bipolar disorder groups both reported significantly more arousal than comparison subjects during frustration, but behavioral and psychophysiological performance differed between the patient groups. In the frustration condition, children with narrow-phenotype bipolar disorder had lower P3 amplitude than children with severe mood dysregulation or comparison subjects, reflecting impairments in executive attention. Regardless of emotional context, children with severe mood dysregulation had lower N1 event-related potential amplitude than comparison subjects or children with narrow-phenotype bipolar disorder, reflecting impairments in the initial stages of attention. Post hoc analyses demonstrated that the N1 deficit in children with severe mood dysregulation is associated with oppositional defiant disorder symptom severity.	Results indicate that while irritability is an important feature of severe mood dysregulation and narrow-phenotype bipolar disorder, the pathophysiology of irritability may differ among the groups and is influenced by oppositional defiant disorder severity.	

17267721	An excess in abdominal fat may predispose African American women to chronic health conditions such as diabetes and cardiovascular disease. Because stress may increase body fat in the center-body region, we used the waist-to-hip ratio (WHR) to examine associations between excess abdominal fat and perceived racism (a chronic stressor) and daily stress. Passive emotional responses to perceived racism, hypothesized to have particularly adverse effects, were also examined.We controlled for body mass index in multiple logistic regression models among 447 African American women who completed a telephone interview on perceived racism.	Passive emotional responses were not related to WHR (odds ratio [OR]=1.4; 95% confidence interval [CI]=0.8, 2.4). High perceived racism was associated with a low WHR in this population (OR=0.4; 95% CI=0.3, 0.8). However, high daily stress was related to a high WHR (OR=2.7; 95% CI=1.1, 6.7).	Findings support an association between daily stress and WHR but do not support our hypothesis that passive emotional responses to perceived racism increase abdominal fat. Further study of the stress physiology of perceived racism in African American women is warranted.	
17264419	The workers' compensation system was established to provide fair access to compensation for workers who have experienced occupational injury and can no longer work. It was expected that such a system would reduce individual legal claims. Evidence indicates that many injured workers proceed with a variety of appeals indicating dissatisfaction with the current system. The fishing industry is extremely dangerous. The aim of this research was to explore the experience of injured fish harvesters who were making use of a compensation system. Interviews were held with a sample of injured in-shore and deep-sea fish harvesters. In general, they identified themselves strongly as hard-working people who did not deserve their injury. They also reported substantial frustration with the staff of the compensation system who they believed treated them with suspicion and disrespect. The deep-sea fish harvesters were more concerned with the amount of compensation. This dissatisfaction with the system contributed to the fish harvesters' use of the appeals procedure. The fish harvesters' complaints are discussed with reference to the concepts of distributive and procedural justice.
17263046	The doctor-patient relationship is inclined nowadays, for many reasons, to become difficult or even conflictual: this prevent the cooperation and the building of a therapeutic alliance. To forestall a situation which can produce anger and frustration in the patient as well as in the doctor, it is important and usefull, for the latter, to learn communication techniques and counselling skills: the professional communication cannot in fact be spontaneous. Such techniques allow to avoid the so called communication barriers: doctor's interventions which can cause in the patient noncompliance and hostile attitudes towards changes; in this context it is particularly interesting a motivational state known as psychological reactance, the importance of which has been recently stressed in medical setting. Some communicative modalities, which may facilitate the building (or rebuilding) of an effective relationship between doctors and patients, are here examined and debated: good communication and partnership are goals not only desirable, but also possible.
17262813	Eating in response to negative emotions is associated with binge or loss of control (LOC) eating in adults. Although children report engaging in LOC eating, data on emotional eating among youth are limited.We adapted the adult Emotional Eating Scale (Arnow et al., Int J Eat Disord, 18, 79-90, 1995) to be used with children and adolescents (EES-C). Fifty-nine overweight (BMI > or = 95th percentile for age and sex) and 100 non-overweight (BMI 5th-94th percentile) participants (mean age +/- SD 14.3 +/- 2.4 years) completed the EES-C, and measures of recent LOC eating and general psychopathology. Test-retest reliability was assessed in 64 children over a 3.4 +/- 2.6 month interval.	A factor analysis generated three subscales: eating in response to anxiety, anger, and frustration (EES-C-AAF), depressive symptoms (EES-C-DEP), and feeling unsettled (EES-C-UNS). Internal consistency for the subscales was established; Cronbach's alphas for the EES-C-AAF, EES-C-DEP, and EES-C-UNS were 0.95, 0.92, and 0.83, respectively. The EES-C had good convergent validity: children reporting recent LOC eating episodes scored higher on all subscales (p's < 0.05). The EES-C-AAF and EES-C-UNS subscales demonstrated good discriminant validity and the EES-C-DEP revealed adequate discriminant validity. Intra-class correlation coefficients revealed good temporal stability for each subscale (EES-C-AAF = 0.59, EES-C-DEP = 0.74, EES-C-UNS = 0.66; p's < 0.001).	The EES-C has good convergent and discriminant validity, and test-retest reliability for assessing emotional eating in children. Further investigation is required to clarify the role emotional eating may play in children's energy intake and body weight.	
17257068	The aim of the study is to test the assumption that laissez-faire leadership behavior is not a type of zero-leadership, but a type of destructive leadership behavior that shows systematic relationships with workplace stressors, bullying at work, and psychological distress. A survey of 2,273 Norwegian employees was conducted and analyzed. Laissez-faire leadership was positively correlated with role conflict, role ambiguity, and conflicts with coworkers. Path modeling showed that these stressors mediated the effects of laissez-faire leadership on bullying at work and that the effects of laissez-faire leadership on distress were mediated through the workplace stressors, especially through exposure to bullying. The results support the assumption that laissez-faire leadership behavior is a destructive leadership behavior.
17254909	This study examines how acute hand injuries affect patients in their roles as spouse, caregiver, and/or worker. Qualitative data from patient interviews were used to analyze how these life roles were affected by the individuals' hand injuries. Data were extracted from interviews of three hand patients who had one or more roles of spouse, caregiver, and/or worker affected by their injury. Data were then examined and categorized for each life role by participant. Participants' views of how hand therapy affected their recovery and resumption of occupational role performance were also examined. Results showed that the participants expressed profound degrees of change in their ability to perform satisfactorily in their various life roles.
17244273	Individual differences in conduct problems arise in part from proneness to anger/frustration and poor self-regulation of behavior. However, the genetic and environmental etiology of these connections is not known.Using a twin design, we examined genetic and environmental covariation underlying the well-documented correlations between anger/frustration, poor attention regulation (i.e., task persistence), and conduct problems in childhood. Participants included 105 pairs of MZ twins and 154 pairs of same-sex DZ twins (4-8 year olds). Independent observers rated child persistence and affect based on behavior during a challenging in-home cognitive and literacy assessment. Teachers and parents provided reports of conduct problems.	Persistence, anger/frustration, and conduct problems included moderate heritable and nonshared environmental variance; conduct problems included moderate shared environmental variance as well. Persistence and anger/frustration had independent genetic covariance with conduct problems and nonshared environmental covariance with each other.	The findings indicate genetically distinct though inter-related influences linking affective and self-regulatory aspects of temperament with behavior problems in childhood.	
17244008	Although nurses encounter self-harm patients in various settings, self-harm has seldom been addressed in psychiatric nursing research. The research question was: 'What are nurses' descriptions of experiences of caring for psychiatric patients who self-harm?' The data were comprised of text based on narrative interviews with six nurses employed in a psychiatric hospital in Sweden. By using qualitative content analysis, two themes and seven sub-themes were constructed. The theme 'Being burdened with feelings' involved the sub-themes: 'Fearing for the patient's life-threatening actions', 'Feeling overwhelmed by frustration' and 'Feeling abandoned by co-workers and management'. The theme 'Balancing professional boundaries' involved the sub-themes: 'Maintaining professional boundaries between self and patient', 'Managing personal feelings', 'Feeling confirmed by co-workers' and 'Imagining better ways of care'. Of significance are the nurses' feelings of fear, frustration and abandonment creating the sense of being burdened. This study points to the importance of releasing these burdens, not only for the sake of the nurses, but to improve the care of the patients. The importance of increased knowledge, support and supervision for professionals working with people who self-harm, not only in psychiatric care, needs to be addressed in research, education and development of practice.
17243854	To review the literature for self-injurious behavior (SIB) in the elderly and compare it with SIB in other populations.Literature searches were conducted using MEDLINE/PubMed, Merck-Medicus, clinicaltrials.gov, OVID, and an Internet search for "self-injurious behavior, SIB, and self-mutilation."	Sixteen studies were reviewed. Studies used provided data relative to SIB in general or treatment for the geriatric population.	The data suggest that young children, adolescents, young adults, and developmentally disabled patients most commonly exhibit self-injurious behaviors. The elderly population, in particular those with certain psychiatric and neurodegenerative illnesses, also can exhibit these behaviors. There has been little published for this cohort in comparison with other populations. The authors reviewed the literature for papers on SIB and its management in the elderly. A general overview of SIB is provided, including specific factors for the elderly. Management strategies including pharmacological and behavioral interventions are also discussed.	Although the prevalence of SIB appears to be relatively small, patients who do exhibit this behavior are of great concern to their families and caregivers. Risk factors such as dementia, depressive disorders, physical illness, and loss of a spouse, which are commonplace in the elderly, all may contribute to those who do exhibit SIB. The literature is devoid of specific drug therapies or treatments that demonstrate significant efficacy in patients with SIB, particularly the elderly. Additionally, while there is some understanding of why younger people engage in SIB, it is hypothesized that elderly SIB is different and is related to frustration, as well as to deficits in the ability to communicate effectively with others. Recognition of behavioral triggers, behavioral-care planning, and safety management are key.	
17238946	To assess the extent that anticipated maternal emotions in response to infant care (infant care emotionality or frustration and dissatisfaction with infant crying or fussing, or both), several forms of social support, and socioeconomic status explain fourth-week postpartum depressive symptoms of adolescent mothers.Secondary multiple regression analysis of a subset of variables from a larger longitudinal study that examined adolescent mothers and infants.	Two university teaching hospitals in Western Canada.	Convenience sample of 78 healthy adolescent mothers.	Prenatal anticipated infant care emotionality, perceived family and friend social support, socioeconomic status, enacted social support, and postpartum depressive symptoms.	Anticipated infant care emotionality (R2=.19) and socioeconomic status (R2=.07) significantly predicted postpartum depressive symptoms. Family support, friend support, and enacted social support were not significant predictors of postpartum depressive symptoms.	Nurses in various settings can assess the pregnant adolescent's anticipated infant care emotionality and socioeconomic status to determine their potential risk or vulnerability to postpartum depressive symptoms. More negative prenatal infant care emotionality was the strongest predictor of postpartum depressive symptoms. Validation of study findings with a larger, more representative sample is recommended.	
17238944	To construct a substantive theory of postpartum fatigue.Grounded theory.	Participants were recruited in the hospital after delivery and interviewed in their homes.	Thirteen primiparae (n=5) and multiparae (n=8) women between 2 and 5 weeks postpartum from diverse ethnic, age, obstetric, and financial contexts were theoretically sampled.	Persevering was the central human process around which the grounded theory emerged. The process of persevering was explained through the relationships of influencing factors, postpartum fatigue, coping techniques, self-transcendence, and caregiving. Participants persevered in caregiving of infants and older children in spite of an overwhelming desire to rest and sleep using self-identified coping techniques in combination with the belief that their children brought purpose and meaning to their lives.	The theory "Persevering Through Postpartum Fatigue" contributes a more complete understanding of the complex phenomenon of postpartum fatigue as it is expressed in the everyday lives of women during the postpartum period. The results may be used to develop and implement health-promoting nursing interventions to reduce postpartum fatigue and its health-related consequences.	
17238144	The original Rosenzweig Picture-Frustration Study (PFS), designed to measure reactive aggressive behaviour in adults, contains 24 pictures of ambiguous situations in which someone is making a remark that can be interpreted as provocative.An adapted version of Rosenzweig's PFS (PFS-AV) was developed to assess the hostile thoughts elicited by interpersonal frustrating situations in forensic psychiatric patients with a conduct disorder or an antisocial personality disorder.	Patients were asked to give their responses in a few words on paper, which were then evaluated for hostility using a seven-point Likert scale. The patients also completed questionnaires on personality and on aggressive and socially competent behaviour.	Twelve of the 24 pictures that had a good internal consistency, inter-rater reliability, and test-retest reliability were selected. In support of the instrument's concurrent validity, scores on the PFS-AV were positively correlated with those on the aggressive behaviour questionnaires but less strongly than the correlations between the aggressive behaviour questionnaires mutually. The validity of the PFS-AV was demonstrated by the positive correlation between PFS-AV hostility and neuroticism, and by the negative correlation with extraversion, openness, agreeableness and conscientiousness. A relatively low but positive correlation was found with social anxiety and a negative correlation was found with social skills in situations where approaching behaviour may be exhibited.	The adapted version of the PFS-AV appears reliably and validly to measure hostility in violent forensic psychiatric patients.	
17234304	This paper reports on newly qualified nurses' experiences of the transition from being a nursing student to becoming a registered nurse. The aim of the study was to ascertain how newly qualified nurses perceived their role transition in an Irish general hospital. Data were gathered using in-depth interviews with 12 nurses who were within one year of qualification. A grounded theory approach was used to generate, analyse and synthesise the data. The findings revealed that newly qualified nurses have specific needs, many of which are unrealised. The vast and increased workload, which involved less patient-contact and more non-nursing duties, came as a surprise to participants in this study. The expectation of in-depth knowledge, coupled with feelings of increased responsibility and compounded by relatively little experience did little to ease the transition to becoming a newly qualified nurse. There is a need to contextualise the transition to registration so that expectations of newly qualified nurses are realistic. Management and staff must remain cognisant of the fact that many newly registered nurses have relatively limited clinical experience at the time of registration.
17233651	This paper reports a descriptive study of how untreated patients with obstructive sleep apnoea syndrome perceived their sleep situation and how the syndrome affected their life situation.Obstructive sleep apnoea syndrome is a prevalent problem independently associated with an increased risk for hypertension, cardiovascular disease, chronic heart failure and mortality. Increased consumption of healthcare resources can often be seen among patients over a long period of time since many have been undiagnosed and untreated.	A phenomenographic approach was employed. Data were collected by interviews during 2005 with 20 purposively selected participants with untreated obstructive sleep apnoea syndrome. Findings. Participants described loud snoring, frequent awakenings, dyspnoea, frustration over nocturia, fear of dying during sleep and partners' anxiety about the apnoea, as being night-time effects of obstructive sleep apnoea syndrome. They described dry and sore throats, tiredness and daytime sleepiness, shame about falling asleep and snoring, thoughts about complications and depressed mood as daytime effects. Needs, such as increased alertness, improved ability to concentrate, improved relationship, adequate information as well as effective treatment, were described. Participants tried self-care strategies such as information-seeking about sleep disturbances and treatment, adapted sleeping routines, change of bedroom arrangements, adapted daily schedules, hyperactivity and avoidance of difficult situations.	The perceived effects and needs, as well as tried self-care actions by the patients with obstructive sleep apnoea syndrome in this study, could be used to identify and evaluate concerns of other patients with obstructive sleep apnoea syndrome waiting for treatment.	
17207010	To describe a pilot project on self-scheduling (self-rostering) for hospital nurses and assess its potential values and difficulties in implementation.Self-scheduling is one aspect of the effort to make the hospital nursing environment more accommodative of nurses' lives. It is part of the good employment practices that nurses want and that can help recruitment, retention and--possibly--patient care.	A self-scheduling programme was implemented on one nursing floor for a year. Its effect on nursing perceptions was gauged by an informal questionnaire, and its effect on the nurse manager was gauged by counting change requests and sick calls, as well as her time spent on scheduling and her perceived annoyance in doing it.	During the time of the pilot project nurses felt that they had better control of their time and were able to give better patient care. Also, change requests decreased, as did the time spent by the nurse manager and her sense of annoyance. But since the nurses did not adhere to the rules of the programme, despite repeated efforts by the nurse manager, the attempt floundered.	Self-scheduling can have positive results for nurses and benefit the nurse manager. But if nurses see this as an individual entitlement instead of a balance between individual and unit benefit, everyone loses. This experience may be of use to others trying to implement a self-scheduling system.	
21319054	Psychological symptoms are often seen in pediatric patients who are confined to a germ-free unit while undergoing bone marrow transplants. The Picture-Frustration Study( P-F study) was performed at the outpatient clinic before admission to the germ-free unit. After admission to the germ-free unit, the patients were interviewed once a week in the germ-free unit, and their mental symptoms were recorded in their clinical records. Condition of anxiety, unresponsiveness, resistance to treatment, and aggression have been noted in pediatric patients below the age of 18 in the Tokai University Hospital. Insomnia, appetite loss, anxiety, unresponsiveness showed a significant correlation with the patient's age. Forty-seven children were given the P-F study before entering the germ free unit. Anxiety, depression, and unresponsiveness correlated significantly with several items in the P-F study. The results of P-F study are useful in predicting the appearance of psychological or physical symptoms of patients confined to the germ-free unit.
17193943	Although ethical values and principles guide oncology nursing practice, nurses often are challenged to fulfill every professional core duty and responsibility in their everyday practice. Nurses commonly encounter clinical situations that have ethical conflicts, and they often have difficulty recognizing and articulating them. Unresolved conflicts can cause feelings of frustration and powerlessness, which can lead to compromises in patient care, job dissatisfaction, disagreements among those in the healthcare team, and burnout. This article reviews the ethical principles and values individual nurses bring to their practice as well as those basic to the profession of nursing. This article also discusses ethical conflicts in oncology practice and describes how nurses, especially students and novice nurses, may react to such situations with moral uncertainty or distress. In addition, a process for analyzing and resolving ethical problems in clinical situations is outlined. Increasing awareness and dialogue about ethical issues is an important first step in the process. Additional resources in the clinical setting may encourage nurses to actively participate in ethical decision making and take deliberate action as moral agents.
17181679	To explore patients' evaluation of a specialized diabetes clinic for management of women with gestational diabetes born in Sweden and the Middle East and its contribution to a decreased level of stress and improved coping capability to promote health in patients receiving care.No studies comparing patients' perceptions of healthcare in women of different origin with gestational diabetes have been found. A perceived clinical problem in specialized diabetes care is of lower activity level in self-care in foreign- than Swedish-born women and the question is whether the healthcare organization is optimal in meeting different individuals' needs.	Explorative study.	Semi-structured individual interviews by external evaluators.	Consecutive sample. Females with gestational diabetes, 13 born in Sweden and 14 born in the Middle East.	The healthcare model was perceived as functioning well. Swedish women were problem focused and information seeking. Frustration and stress were increased due to perceived delay in information concerning gestational diabetes, limited access to telephone service and lack of confidence in staff because they lacked the expected competence. Control of gestational diabetes and pregnancy by different persons led to perceived lack of holistic care. Women from the Middle East felt cared, had been given the necessary information and claimed to follow advice. Adequate information reduced respondents' anxiety and increased their control over the situation.	The clinic needs to be further improved by adapting programmes to persons to become problem focused by giving adequate information immediately.	Cultural differences in coping strategies and attitudes to gestational diabetes need to be considered. Training of staff working with gestational diabetes patients is urgently needed.	
17176300	Pigmentation disorders, such as melasma, greatly influence the quality of life (QoL) of affected individuals who usually consider the disorder to be more severe than the objective clinical scores. Several instruments have been successfully developed to evaluate QoL. However, they must be adapted to the target population in terms of language and cultural diversity. The first, specific QoL questionnaire for melasma (MelasQoL) was developed for English speaking patients.To validate the Brazilian Portuguese version of the MelasQoL evaluation questionnaire for patients with melasma (MelasQoL-BP) and to assess the impact of treatment with a triple combination cream (hydroquinone, fluocinolone acetonide and tretinoin) on the QoL of patients with moderate-to-severe melasma.	Three hundred individuals from the five Brazilian geographic regions took part in this multicentre study. Their mean age was 42 years and skin phototype distribution was: type II 7.0% of patients, III 23.7%, IV 42.7% and V 22.7%. Melasma Area and Severity Index (MASI), MelasQoL-BP and the short version of the QoL assessment instrument from the World Health Organization (WHOQOL-BREF) were used to assess melasma severity and QoL at baseline. MelasQoL-BP was previously translated and culturally adapted from the English version, with participation of the authors and according to the standards of the World Health Organization (WHO). From the original sample, we randomized150 volunteers to treat melasma and repeated the evaluation after 8 weeks. The analysis of the MelasQoL-BP baseline answers demonstrated an important impact of the disease on skin appearance (65% of patients were bothered all the time or most of the time), frustration (55%), embarrassment (57%) and influence of the disease on interpersonal relationships (42%). Forty-three per cent of patients felt not attractive or even dirty due to their skin condition. MelasQoL-BP results showed significant internal consistency (Cronbach's alpha coefficient 0.919; P < 0.001) and good correlation with MASI scores. After treatment, the global assessment showed good or excellent results in 91.4% of the patients. The clinical outcome was not associated with the initial MASI score (P = 0.814; chi-square), skin colour (P = 0.449; probability ratio) or skin pigmentation (P = 0.814; chi-square). There was also a significant reduction on MelasQoL-BP scores (Wilcoxon test; P < 0.001) after treatment, with the mean +/- SD results shifting from 44.4 +/- 14.9 at baseline to 24.3 +/- 15.5 after treatment. The analysis of the MelasQoL-BP before and after treatment showed an important effect of the impact of treatment on a number of QoL measures. Of note, skin appearance (69.8 vs. 10.1% of patients were bothered all the time or most of the time, respectively), frustration (59.7% vs. 12.2%, respectively), embarrassment (56% vs. 9.3%, respectively) and influence of the disease on interpersonal relationships (35.3% vs. 5.8%, respectively) were greatly improved.	This study demonstrates that MelasQoL-BP is a valid instrument and can be used to evaluate the quality of life and response to melasma treatment in Brazilian patients. The triple combination treatment produced significant results, regarding both clinical severity and quality of life.	
17170690	Compression therapy is advocated for the treatment of chronic venous leg ulceration and the proportion of patients whose ulcers heal appears to be directly related to adherence (Moffatt, 2004). The aim of this study was to examine patients' understanding of adherence, in terms of their own experiences of compression bandage systems. Following full ethical approval, a purposeful sample of 6 participants was recruited to take part in a focus group. Free-flowing conversation was encouraged so that the participants could discuss issues that were important to them, although a series of prompts were available to stimulate the conversation when necessary. Four major themes were identified using a phenomenological approach: frustration with the healthcare system leading to a feeling of complacency with primary healthcare teams; functional limitations leading to adaptation of everyday life situations (e.g. bathing and coping with pain); emotional reactions affecting well-being and body image, and perception of others; and avoidance of transport, shopping and holidays.
17153837	The prevalence of burnout in oncology staff was compared with that of the ophthalmology staff, who normally present a low prevalence of burnout as described in this literature. The correlation of burnout with the emotion of anger was also investigated. Thirty-six subjects working in an oncology department and 32 working in an ophthalmology department were examined using the Maslach Burnout Inventory and the State-Trait Anger Expression Inventory. The oncology group showed higher mean scores on the MBI Emotive Exhaustion and Depersonalization scales with respect to ophthalmology staff. Correlation analysis showed that increasing burnout was associated with higher anger expressed towards the environment and loss of anger control. Anger, as a response to frustration, appears to be a feature constantly associated with the clinical expression of burnout and it should not be underestimated in theoretical and preventive contexts.
17152325	The recently revised version of the practice guideline 'Problematic alcohol consumption' from the Dutch College of General Practitioners offers realistic advice to general practitioners on how to manage problem drinkers. The number of patients with alcohol problems tends to increase among women of middle age. The proportion of patients that report an alcohol problem themselves is larger than is usually assumed. Questionnaires are oflimited value in the detection of an alcohol problem. The general practitioner should look at problem drinking as a chronic disease that demands structured disease management and monitoring. This perspective will lead to less frustration in handling both the problem and the patients.
17149047	Norton Healthcare has launched Norton Navigators, an 18-month mentoring program that matches recent nursing school graduates with experienced nurses. The program has improved Norton Healthcare's retention rate of new nurses and reduced the overall turnover rate for new graduates. Other benefits include saving 40,000 dollars per retained nurse, higher patient satisfaction, and an increase in recruitment.
17144951	Bone-bridging (arthrodesis of the distal tibia and fibula) at the time of transtibial amputation is a controversial operative technique that is anecdotally reported to improve the weightbearing capacity of the residual limb and to decrease residual limb discomfort.Thirty-two consecutive patients with multiple diagnoses had transtibial amputation with a distal tibial-fibular bone-bridge, all done by a single surgeon (MAP). At an average of 16.3 months after surgery all patients completed the Prosthetics Evaluation Questionnaire (PEQ), a validated outcomes instrument specifically created to evaluate quality of life and functional demands in patients with a lower extremity amputations. Their responses were compared with those of 17 preselected, highly functional transtibial amputees from two academic medical centers who previously had transtibial amputations using a traditional non bone-bridge operative technique; their time since amputation averaged 14.7 years.	The "nonselected" consecutive patients with a bone-bridged residual limb scored higher (more favorable) in the Ambulation (p = 0.037) and Frustration (p < 0.001) domains of the PEQ and lower (less favorable) in the Appearance (p = 0.025) subscale. Their scores were similar in the other six domains.	Patients of multiple ages with multiple diagnoses who had bone-bridging of the distal tibia and fibula at the time of transtibial amputation had scores on a validated outcomes instrument that were better than or comparable to those of a selected group of highly functional transtibial amputees. The results of this study suggest that bone-bridging at the time of transtibial amputation may enhance patient-perceived functional outcomes.	
17139636	To compare the health experiences of middle- and older-age adults with moderate osteoarthritis (OA) symptoms with experiences of individuals with no chronic health conditions. Similarities and differences in health changes, the meaning of these changes, and their impact were examined.Sixteen focus groups (10 OA, 6 control) were conducted with 53 women and 37 men (age 39-88 years). OA participants were recruited from practitioners' offices and The Arthritis Society, Ontario Division. Additional OA participants and controls were recruited from community centers and newspaper advertisements. All participants were asked about changes in health, the impact of these changes, and self-management strategies. Participants also completed standardized measures including demographic information; the Short Form 36; Western Ontario and McMaster Universities Osteoarthritis Index; and Disabilities of the Arm, Shoulder and Hand questionnaire.	Differences in the depth, breadth, and meaning of symptoms such as pain, stiffness, and fatigue were reported with little overlap between OA and control groups. OA was often seen as part of a normal aging process requiring acceptance, not treatment. However, younger OA participants reported more distress and frustration managing the disease. OA participants reported an impact of their health on work, leisure, social activities, and relationships that was described as upsetting compared with controls.	This study illuminates personal and social factors associated with OA by comparing health experiences of individuals with OA and controls. It highlights directions for future research that can improve our understanding of the needs of individuals with OA and can help link individuals' health status to the broader framework of their lives.	
17138262	This study examined the continuity, stability, and change of infants' responses to a frustrating event (i.e., arm restraint) between 2 and 6 months in terms of both negative reactivity and its regulation. Fifty-two healthy, full-term infants and their mothers participated in an arm restraint procedure. Infant behaviors were observed and coded at 3-s intervals. The results showed that infants' reactivity to frustration and their ability to regulate such reactivity significantly changed in level over time. Individual differences in frustration reactivity were stable across the two ages; two regulatory behaviors (i.e., orientation to mother and avoidance) could be observed in the same percentage of babies at both 2 and 6 months. At 6 months, several significant associations between frustration reactivity and infant regulatory behaviors emerged. These findings suggest that the arm restraint procedure may be usefully employed to study individual differences in infants as young as 2 months of age.
17133927	Stroke continues to be the third leading cause of death in the United States. According to the National Stroke Association (NSA, 2004) and the American Heart Association (AHA, 2004), there are over 750,000 new or recurrent strokes per year, with many resulting in residual disability. Stroke survivors often deal with the physical, psychosocial, and emotional consequences of stroke long after they have left the safety of professional rehabilitation. Patient instruction from nurses prior to discharge, while necessary, may be done at a point in the recovery process when the stroke survivor is not ready to learn how to deal with such consequences. Using the Mauk Model for Poststroke Recovery, nurses can identify which phase of recovery a survivor is in, and thus tailor care to his or her needs. The purpose of this article is to use the Mauk Model for Poststroke Recovery to present nursing interventions that are appropriate to each of the previously identified six phases of stroke recovery.
17131613	A qualitative, exploratory and descriptive study was conducted with the purpose of exploring and describing the views of undergraduate nursing students on caring for HIV/AIDS patients. The study population consisted of BCur III nursing students studying at the Medical University of Southern Africa (Medunsa). Participants were purposively selected. Focus group interviews were used as a data collection instrument. Guided by a group moderator and responding to a central research question, participants shared their views about caring for HIV/AIDS patients. Tesch's qualitative method of data analysis, as described by Cresswell (1994:155), was used to analyse the data. Caring for HIV/AIDS patients evoked emotions such as fear, anger and frustration among undergraduate nursing students. Students expressed needs such as the acquisition of knowledge and a reduction in the stigmatisation of patients with HIV/ AIDS, while the data analysis revealed demands such as more intensive clinical accompaniment by lecturers and antiretroviral therapy delivery by government. Suggested solutions included student participation in HIV/AIDS prevention campaigns and the upholding of patients' rights. Curriculum innovation was recommended to improve students' knowledge of HIV/AIDS and to ensure the provision of quality care for these patients.
17131610	Changes in nursing education involve the move from traditional teaching approaches that are teacher-centred to facilitation, a student centred approach. The student-centred approach is based on a philosophy of teaching and learning that puts the learner on centre-stage. The aim of this study was to identify the challenges of facilitators of learning using facilitation as a teaching method and recommend strategies for their (facilitators) development and support. A qualitative, explorative and contextual design was used. Four (4) universities in South Africa which utilize facilitation as a teaching/ learning process were identified and the facilitators were selected to be the sample of the study. The main question posed during in-depth group interviews was: How do you experience facilitation as a teaching/learning method?. Facilitators indicated different experiences and emotions when they first had to facilitate learning. All of them indicated that it was difficult to facilitate at the beginning as they were trained to lecture and that no format for facilitation was available. They experienced frustrations and anxieties as a result. The lack of knowledge of facilitation instilled fear in them. However they indicated that facilitation had many benefits for them and for the students. Amongst the ones mentioned were personal and professional growth. Challenges mentioned were the fear that they waste time and that they do not cover the content. It is therefore important that facilitation be included in the training of nurse educators.
17131606	A non-experimental, explorative, descriptive, quantitative study was undertaken. The purpose was to explore and describe the views of preceptors and preceptees regarding the fulfilment of the role of the preceptor in selected clinical nursing practice settings in the Botswana context. The study included 72 preceptors and 200 nursing students/preceptees who voluntary agreed voluntarily to participate in the study. A questionnaire was used to collect data, which was analyzed by using descriptive and inferential statistics. The findings of this study indicated that the preceptor lacked leadership characteristics in the accompaniment of the preceptee. These constraints included the lack of desirable characteristics such as intellectual, emotional, physical and other traits that are common to all good leaders. Recommendations were stated for improvements in selecting preceptors with certain leadership skills for the clinical practice settings. The limitations of this study were highlighted.
17117946	To describe the phenomenon of stress overload as a nursing diagnosis.A qualitative study using case study method was conducted with nine adults experiencing stress overload to fully describe the experience and identify possible defining characteristics. Current literature sources on stress and its related factors were examined to support stress overload as a nursing diagnosis for inclusion in the NANDA International classification.	Stress overload, defined as excessive amounts and types of demands that require action, is a human response that is experienced as a problem and contributes to the development of other problems. The proposed defining characteristics are perceives situational stress as excessive, expresses a feeling of tension or pressure, expresses difficulty in functioning as usual, expresses problems with decision-making, demonstrates increased feelings of anger and impatience, and reports negative effects from stress such as physical symptoms or psychological distress.	Nursing interventions such as active listening and decision-making support are needed to help people reduce stress levels. Studies are needed to further validate the defining characteristics and related factors of this new diagnosis.	
17116608	To identify potentially successful strategies, barriers, and facilitators for health promotion in preschool child care settings.We conducted 6 focus groups including each of the following: parents of children attending child care centers and home-based family child care (2 in English, 1 in Spanish) and directors of child care centers and family child care providers (2 in English, 1 in Spanish). Systematic thematic analysis was conducted to generate themes to address study questions.	A total of 24 parents and 45 child care providers, serving predominantly urban, low-income children in Boston, participated. Parents and child care providers agreed that in-person group discussions would be the most effective strategy for providing health education information to parents. Several barriers that could affect implementation emerged. First, some providers expressed frustration toward parents' attitudes about child safety and health. Second, there was diversity of opinion among providers on whether conducting health promotion activities was consistent with their training and role. In addition, literacy, language, and cultural barriers were identified as potential barriers to health promotion in child care.	In order to be successful, health promotion strategies in child care settings will need to overcome tensions between providers and parents, allow professional growth of child care providers to serve in a health promotion role, and better integrate external health resources and personnel. Group sessions and peer learning opportunities that are culturally and linguistically sensitive are potentially successful strategies for implementation of health promotion interventions for many parents.	
17114094	Two simulator studies were conducted that assessed the effect of driver eye height on speed choice, lane-keeping, and car-following behavior. The effect of eye height on the subjective variables of mental workload, frustration, and confidence was also investigated, as was the contribution of drivers' aggression.A total of 43 participants drove a simulated route while seated at two different eye heights: one that represented the view of the road from a large SUV and one that represented the view of the road from a small sports car. Driving scenarios were comprised of both open road and car-following segments. Dependent variables included driver-selected speed, speed variability, lane position, following distance to a slower-moving lead vehicle, and the subjective variables of frustration, confidence, and mental workload.	When viewing the road from a high eye height, drivers drove faster, with more variability, and were less able to maintain a consistent position within the lane than when viewing the road from a low eye height. Driver eye height did not influence following distance to a slower-moving lead vehicle. Driver aggression had no effect on any of the dependent variables except level of frustration.	The two studies demonstrate that, when they are not able to reference a speedometer, drivers choose to drive faster when they view the road from an eye height that is representative of a large SUV compared to that of a small sports car. There is a need to educate drivers of SUVs and other tall vehicles of this perceptual phenomenon in order to prevent collisions that may occur in conditions where it is impossible for drivers to base their speed selection solely on posted speed limits, such as in inclement weather.	
17105521	Traditional methods of setting curricular guidelines using experts or consensus panels may miss important areas of knowledge, skills, and attitudes that need to be addressed in the training of medical students and residents.To seek input from medical students and internal medicine residents ("trainees") on their perception of their needs for training in Geriatrics.	Two assessment methods were used (1) focus groups with students and residents were conducted by professional facilitators and the transcripts analyzed for areas of agreement and divergence and (2) geriatric medicine experts and ward attendings were surveyed to examine training gaps raised by trainees during Geriatric Guest Attending Rounds.	Trainees perceived training gaps in caring for elderly patients in the areas of (1) recognizing and addressing the complex, multifactorial nature of illness; (2) setting priorities and goals for work-up and intervention; (3) communication with families and with patients with cognitive disorders; (4) assessment of a patient for discharge from the hospital and the services at different sites in which patients may receive care. They recounted feeling overwhelmed by complex patients and social situations while acknowledging the special aspects of connecting with older patients. The gaps identified by trainees differ from and complement the curriculum guidelines set by expert recommendations.	Trainees identified gaps in skills and knowledge leading to trainee frustration and potentially adverse outcomes in caring for elderly patients. Development of curriculum guidelines should include assessment of trainees' perceived learning needs.	
17101624	This article reports on children's experiences of hospitalization. Data were collected via semi-structured interviews with 11 children aged between seven and 14 years from four paediatric units in England. The children identified a range of fears and concerns, which included: separation from parents and family; unfamiliar environment; investigations and treatments; and loss of self-determination. The children's loss of self-determination over personal needs exacerbated their fears and concerns. It needs to be recognized that compliance with hospital routines is a variable, which influences children's reaction to hospitalization. The findings clearly indicate that children need adequate information tailored to their needs, that their views are sought in the planning and delivery of their care and that hospital environments need to be made more child-centred. Interventions designed to reduce children's stress during hospitalization are not only likely to decrease their stress at the time, but also likely to influence how future experiences are appraised and managed.

17098155	Some patients receiving mechanical ventilation experience an intensified need to communicate while their ability to do so is compromised as the endotracheal tube prevents speech. Although the use of a communication board to enhance communication with such patients has been suggested, few descriptive or empirical studies have addressed the content and format of these devices or of patients' perspectives on decreasing frustration with communication.The objectives of this study were: (1) to identify the perceived level of frustration of patients receiving mechanical ventilation while they attempt to communicate; (2) to determine patients' perceived level of frustration if a communication board had been used; and (3) to describe patients' perceptions of the appropriate content and format of a communication board.	Twenty-nine critically ill patients who were extubated within the past 72 hours were included in this descriptive study. Subjects participated in a 20- to 60-minute audiotaped interview consisting of questions about their perceived level of frustration when communicating with and without a communication board and their thoughts about the appropriate content and format of a board. Transcripts were analyzed by questions for meaning and overall themes.	Sixty-two percent (n = 18) of patients reported a high level of frustration in communicating their needs while receiving mechanical ventilation. Patients judged that their perceived level of frustration in communicating their needs would have been significantly lower (P < .001) if a communication board had been offered (29.8%) than if not (75.8%). Most patients (69%; n = 20) perceived that a communication board would have been helpful, and they also identified specific characteristics and content for a communication board. A communication board may be an effective intervention for decreasing patients' frustration and facilitating communication.	Most patients receiving mechanical ventilation experienced a moderate to a high level of frustration when communicating their needs. In this study, a communication board, if used patiently during mechanical ventilation, has been shown to alleviate frustration with communication. Patients have specific ideas about what terms and ideograms are useful for a communication board. Further research is needed to test the effects of a communication board and other methods of facilitating communication on outcomes such as satisfaction and anxiety of patients, adequate and appropriate management of pain, and length of mechanical ventilation time and hospital stay.	
17090786	Nearly all family physicians have patients that engender a sense of frustration or dislike, often described as "difficult." Most research in this area focuses on describing these patients and their physicians, not management or coping.To describe how respected family physicians identify, manage, and cope with difficult patient encounters.	Qualitative semi-structured interview study. Participant physicians described as "excellent" were recommended by medical school family medicine faculty around the county. Interview questions included "describe the patient you least like seeing," and "how do you keep sane but still assure adequate care for the patient?" Interviews were analyzed using the editing method, looking for common categories and themes.	102 physicians were interviewed. Physicians described both patient behaviors (stay sick and demanding) as well as medical problems (multiple, chronic pain, drug seeking, psychiatric) that they found frustrating. Difficult encounters occurred when these patient behaviors and medical problems clashed with physicians' personal and practice traits. Their management strategies to return the encounter to success incorporated collaboration, appropriate use of power and empathy.	We propose a model where clashes between patient behaviors and physicians' traits turn a successful encounter of collaboration, appropriate use of power and empathy into a difficult encounter of opposition, misuse of power and compassion fatigue. Management strategies used by our participants aim to return success to the encounter and may serve as a guide for practicing physicians and for future research.	
17081925	Urinary incontinence (UI) affects approximately 17 million American women. Women with UI have reported a lower quality of life than women who do not experience UI. In many cases, UI affects a woman's ability to take part in a variety of recreational and social activities, and has negative psychological effects including depression, anxiety, and frustration. Studies show that fewer than 50% of women with UI discuss their symptoms with their health care provider. Although researchers have examined help-seeking behaviors in people with UI, few have examined women of all ages with all types of UI. The purpose of this integrative literature review is to summarize the help-seeking behaviors for UI symptoms among noninstitutionalized women of all ages with all types of UI. Five studies were reviewed. In all of the studies, less than 38% of women sought help for their UI symptoms. Factors affecting help seeking included quality of life scores, perceptions women had regarding the normalcy of UI, and beliefs about treatment options available for the problem. Age, type of UI, severity of UI, and embarrassment were found to be significantly related to help-seeking in most, but not all of the studies.
17071365	Auditory and visual versions of the Adjusting-PSAT [Tombaugh, T. N. (1999). Administrative manual for the adjusting-paced serial addition test (Adjusting-PSAT). Ottawa, Ontario: Carleton University] were used to examine the effects of mild and severe traumatic brain injury (TBI) on information processing. The Adjusting-PSAT, a computerized modification of the original PASAT [Gronwall, D., & Sampson, H. (1974). The psychological effects of concussion. Auckland, New Zealand: Auckland University Press], systematically varied the inter-stimulus interval (ISI) by making the duration of the ISI contingent on the correctness of the response. This procedure permitted calculation of a temporal threshold measure that represented the fastest speed of digit presentation at which a person was able to process the information and provide the correct answer. Threshold values progressively declined as a function of the severity of TBI with visual thresholds significantly lower than auditory thresholds. The major importance of the current study is that the threshold measure offers a potentially more precise way of evaluating how TBI affects cognitive functioning than is achieved using the traditional PASAT and the number of correct responses. The Adjusting-PSAT offers the additional clinical advantages of eliminating the need to make a priori decisions about what ISI should be used in different clinical applications, and avoiding spuriously high levels of performance that occur when an "alternate answer" or chunking strategy is used. Unfortunately, the Adjusting-PSAT did not reduce the high level of frustration previously associated with the traditional PASAT.
17062520	Although there is an extensive literature on dementia caregiving, research on family members' adjustment to the onset of dementia and on the early stage of caregiving is limited. This article describes a phenomenological study based on twenty semi-structured interviews with spouses and adult daughters of someone with early/mild dementia or mild cognitive impairment (MCI). Participants were asked to describe the earliest changes in the parent or spouse and the changes to their everyday lives and in their relationships brought by cognitive impairment. These family members reported taking on many new responsibilities in a highly interactive caregiving process consisting primarily of decision-making and supervision. Many participants reported experiencing frustration, resentment, grief, and relational deprivation, along with increased protectiveness and tenderness towards the person with dementia. Most of the participants were ambivalent about seeking or accepting help from others and seemed to want to maintain the status quo as long as possible. Social workers meeting with families in the context of disclosure of a dementia diagnosis or the early adjustment period may help by identifying their losses, normalizing negative feelings, and helping families envision ways they could use outside help.
17048795	War experience in interaction with personality structure can have a traumatic effect and provoke various psychopathological responses and even disorders at the psychological level. PTSD is one of the possible psychopathological responses to war trauma, which provokes a range of different emotions in those working with such patients. The heterogeneity of the clinical aspect of the disorder, the comorbidity and social malfunctioning of the patients represent a frequent source of difficulties in the psychiatrist's work. The disorder brings about alterations at the somatic, psychological, social and occupational level of the affected individual, requiring a complex approach to treatment. The psychotherapeutic treatment of PTSD patients gives rise to different counter-transfer emotions at different stages of the therapeutic process. The therapist experiences fright, anger, guilt, frustration, and sometimes even a tendency to avoid the patient. His ability for empathy and understanding of the patient can be exhausted and become the cause of a reduced capacity for sympathy, a secondary traumatic stress and a vicarious trauma.
17048160	Beauty is important. As psychiatrists, we see the interface of beauty with mental health, self-esteem, and mental illness. As physicians who enhance cosmetic appearance, you encounter a broad spectrum of patients ranging from those with a healthy pursuit of enhanced appearance to those whose behavior is extremely maladaptive. This article provides some examples of unhealthy pursuit and how to recognize patients who may be inappropriate for cosmetic procedures. Patients with body dysmorphic disorder and narcissistic and histrionic personality disorders are suffering from psychiatric illnesses that interfere with their judgment and can lead them to make poor choices when considering cosmetic procedures. Clinicians who acquire a basic understanding of these psychiatric conditions can properly screen their patients and enhance their understanding of their patients' goals, both realistic and unrealistic, thus saving them from performing inappropriate procedures that cause frustration to both the clinician and the patient.
17043264	To describe and evaluate psychosocial factors in nonorganic voice disorders (NVDs). Nonorganic voice disorders are presumed to be the result of increased muscular tension that is caused to varying extents by vocal misuse and emotional stress. It is therefore necessary to include both of these in the diagnosis and treatment of patients with voice disorders.Clinical survey.	Academic tertiary referral center.	To evaluate psychosocial factors in NVDs, a sample of 74 patients with NVDs was examined psychologically using the Giessen Test and Picture Frustration Test. The results were compared with a control group of 19 patients with an organic dysphonia (vocal cord paralysis).	Six scales of the Giessen Test (social response, dominance, control, underlying mood, permeability, and social potency), 3 reaction types of the Picture Frustration Test (obstacle dominance, ego defense, and need persistence), and 3 aggression categories of the Picture Frustration Test (extrapunitivity, intropunitivity, and impunitivity).	The most striking significant difference between the 2 groups was that in conflict situations, patients with NVDs sought a quick solution or expected other people to provide one, which prevented them from understanding the underlying causes of the conflict.	Only if the psychosocial aspects are taken into account can patients with NVD be offered a therapy that treats the causes of the voice disorder. It must be decided individually whether and when a voice training approach or a more psychological-psychotherapeutical approach is preferable.	
17026762	Literature on difficult doctor-patient relationships has focused on the "difficult patient." Our objective was to determine physician and practice characteristics associated with greater physician-reported frustration with patients.We conducted a secondary analysis of the Physicians Worklife Survey, which surveyed a random national sample of physicians. Participants were 1391 family medicine, general internal medicine, and medicine subspecialty physicians. The survey assessed physician and practice characteristics, including stress, depression and anxiety symptoms, practice setting, work hours, case-mix, and control over administrative and clinical practice. Physicians estimated the percentage of their patients who were "generally frustrating to deal with." We categorized physicians by quartile of reported frustrating patients and compared characteristics of physicians in the top quartile to those in the other three quartiles. We used logistic regression to model physician characteristics associated with greater frustration.	In unadjusted analyses, physicians who reported high frustration with patients were younger (p < 0.001); worked more hours per week (p = 0.041); and had more symptoms of depression, stress, and anxiety (p < 0.004 for all). In the final model, factors independently associated with high frustration included age < 40 years, work hours > 55 per week, higher stress, practice in a medicine subspeciality, and greater number of patients with psychosocial problems or substance abuse.	Personal and practice characteristics of physicians who report high frustration with patients differ from those of other physicians. Understanding factors contributing to physician frustration with patients may allow us to improve the quality of patient-physician relationships.	
17022924	The purpose of this study was to examine patterns and predictors of complementary and alternative medicine (CAM) among breast cancer patients. A review of the existing survey literature on CAM use for breast cancer was conducted with a series of eight focus groups (N = 67) to further examine the perspectives of breast cancer patients on CAM. The rates of CAM use varied from 17 to 75%, with a mean of 45%. Vitamins and minerals and herbs were the most frequently cited categories. Users tended to be younger, more educated, and more likely to have used CAM prior to their diagnosis. Focus group data indicate that breast cancer patients use a wide array of CAM for a variety of reasons, including symptom management, improving quality of life, and enhancing immune function. Although women rely on a variety of resources for information, they frequently experience frustration owing to the absence or conflicting nature of such information. Communication with conventional providers about CAM is frequently experienced as either unsupportive or not helpful by many patients. The results point to the value of developing better evidence-based informational resources related to CAM and cancer and the need for physicians to become better educated about CAM and how to communicate more effectively with their breast cancer patients about it.
17019895	Little is known of the concordance between ratings of expressed emotion (EE) derived from the Camberwell Family Interview (CFI) and Five-minute Speech Sample (FMSS) for parents of children with behaviour problems. Concordance between CFI and FMSS ratings of EE was assessed prior to intervention and compared to parent-rated behaviour after intervention, at follow-up, 12 months later. Female primary caretakers of 75 children (3-10 years) showing behavioural difficulties were interviewed using FMSS and CFI. Interviews were coded independently by criterion-standard raters. Using CFI, 57 families were classified high EE, and 18 low EE. Using FMSS, 65 families were classified high EE and 10 low EE. 55/75 pairs of ratings (73%) were the same (high, n = 51: low, n = 4) and 20 mothers (27%) were allocated different EE status (Kappa = 0.14, n.s.). The FMSS ratings at initial interview appeared more closely related to behaviour rating at follow-up than CFI. Further investigation is required to establish comparability of CFI and FMSS results for carers of children.
17018069	This paper reports a study to evaluate and increase understanding of contemporary Registered Nurses' discontents, and to compare these discontents and their effects with those of nurses 20 years ago.In 1986, Turner argued that nurses' discontents were reflected in a discourse or 'vocabulary of complaint' that provided a sense of solidarity amongst practising nurses, and defused their frustrations rather than channelling them into demands for workplace reform. In this paper, we revisit Turner's notion of a vocabulary of complaint in the context of a study of nurse retention in the contemporary Australian healthcare workplace.	This paper draws on the qualitative data from a larger project (completed in 2001) exploring the relationship between job satisfaction and self-concept in both recently graduated and experienced nurses. Here, we elaborate on thematic analyses of the comments of 146 Australian Registered Nurses with more than 5 years' nursing experience.	There is still a high level of discontent amongst contemporary practising nurses, although the focus of their complaints and their responses to them have changed since Turner's study. Conflicting expectations of nurses and managers and lack of opportunity to provide comprehensive care emerged as the most important issues for experienced nurses today. Rather than contributing to a sense of solidarity as in Turner's study, contemporary nurses' discontents reflect intense personal frustration and underpin individual nurses' decisions to leave, or plan to leave, the workforce.	There is an urgent need for increasing health service management and community awareness about the relationship between providing comprehensive nursing care and nurses' job satisfaction. Addressing nurses' discontents, wider nursing involvement in the international policy arena, and the politicization of nurses worldwide may contribute to alleviating the current global nursing shortage.	
17010739	Medication nonadherence is a significant problem in psoriasis. Although previous research has aimed to quantify the prevalence of nonadherence in topical medication users, patient motivations for intentional nonadherence are not fully understood.Our purpose was to determine the relative importance of factors contributing to nonadherence in topical corticosteroid users with psoriasis.	A survey was distributed to psoriasis patients visiting an outpatient clinic.	Among the 53 persons surveyed, medication nonadherence was 40%. Frustration with medication efficacy, inconvenience, and fear of side effects were the most important reasons patients deviated from usage instructions. Subjects who did not receive instructions on topical treatment duration used corticosteroids longer (>8 weeks) than subjects who were instructed (P < .05).	A relatively small sample size prevented trends in demographic predictors of adherence from reaching statistical significance. The patient self-report format has the potential to introduce recall bias.	Factors contributing to intentional nonadherence, including dissatisfaction with efficacy, inconvenience, and fear of side effects, are the most important patient-identified barriers to appropriate use of topical steroids in psoriasis. Clear patient instructions on the intended steroid treatment duration may reduce adverse effects from overuse.	
17010305	To compare the frequency of nail biting in 4 settings (interventions) designed to elicit the functions of nail biting and to compare the results with a self-report questionnaire about the functions of nail biting.Randomised allocation of participants to order of conditions.	University Psychology Department.	Forty undergraduates who reported biting their nails.	Left alone (boredom), solving maths problems (frustration), reprimanded for nail biting (contingent attention), continuous conversation (noncontingent attention).	Number of times the undergraduates bit their nails.	Nail biting occurred most often in two conditions, boredom and frustration.	Nail biting in young adults occurs as a result of boredom or working on difficult problems, which may reflect a particular emotional state. It occurs least often when people are engaged in social interaction or when they are reprimanded for the behavior.	
17009569	The musculoskeletal injury (MSI) rate in the Richmond Hospital Intensive Care Unit (ICU) increased significantly in 2000 and 2001 by 130%. As part of a quality initiative program, the problem was identified, assessed, and a plan was developed that involved the installation of ceiling-mounted patient lifts (CMPL) and the incorporation of a patient positioning sling. The evaluation process included a survey given to the ICU nursing staff prior to the implementation of the CMPL and repeated three, six, and 18 months after implementation. The survey included questions about discomfort, fatigue, and frustration levels before and after a 12-hour shift, as well as any medical interventions such as use of medications, physician visits, physiotherapy, and massage therapy for work-related issues. The use of the lifts contributed to lower scores in fatigue, pain and frustration in addition to a reduction in medical visits. The results also demonstrated a significant reduction in work-related time loss claims while promoting a positive workplace environment.
16986357	Limited attention has been paid to experiences of individuals with siblings diagnosed with schizophrenia. The purpose of this article is to address this gap by exploring the impact of having a brother or sister with schizophrenia. The lived experience of 6 individuals with a sibling with schizophrenia was explored using van Manen's (1997) Hermeneutic Phenomenology. Four themes were identified: struggling to understand, struggling with the system, caring for the sibling, and seeing beyond the illness. Health care providers need to re-evaluate current approaches for assisting individuals to cope with having a sibling with schizophrenia. Inclusion in the plan of care and recognition of their struggle is essential for individuals having a sibling with schizophrenia.
16981331	To explore the main sources causing stress among Chinese college students and its distribution.A clustered random sampling method was conducted to perform the questionnaire on psychological stress among 2007 students selected from 13 universities.	The main sources of psychological stress on college students regarding learning task, college environment, job-seeking, interpersonal relationship and emotional disorders. 49.3% of the population experienced mild level of psychological stress, 8.4% belonged to critical groups who experienced higher levels of stress,while 0.3% experienced severe level of stress. Sophomores and juniors were under more stressful situation than freshmen and senior students, while female students felt more stressful on learning and job-seeking than males. Male students felt more stressful caused by their families, health status, love affairs, social adaptation and frustration than females. Students from countryside were under more stress than those coming from urbans. Students from ordinary universities felt more stressed than those from famous universities and students from western areas were under more stress than those from the coastal areas.	Stress had become a severe problem influencing the mental health development among college students. The problem needs to be addressed accordingly.	
16974168	This study has used qualitative hermeneutics to explore the patient's experience of treatment for hepatitis C. Hepatitis C treatment may pose numerous physical and emotional challenges. There is a need to understand the experience from a holistic nursing perspective in order to facilitate the patient's well-being. Individuals undergoing combination treatment for hepatitis C participated in a hermeneutic dialogue, which provided the investigators with an emic perspective. Dialogue content, reflection, and preunderstanding were hermeneutically analyzed. Similar treatment experiences elicited four common emotions (sadness, anger, fear, and frustration). Analyzing the similar experiences led to two emerging themes: (1) "That is not who I am," connoted by rejecting the notion of being a "typical" patient, seeing treatment as not so bad, being "different" during treatment, and feeling abandoned because of treatment; and (2) "looking beyond the experience" was noted by looking for faith beyond traditional healthcare and looking for understanding. The hepatitis C treatment experience was seen as a process: having a start, a middle, and an end, without being all-consuming. Implications for holistic nursing care are presented.
16972920	This paper reports a literature review identifying and categorizing client system stressors in Neuman systems model-based studies.To date, literature reviews related to the Neuman systems model have focused broadly on all concepts of the model. The concept of stressors has been selected by the Neuman Systems Model Research Institute as the focus for an initial collaborative research project.	Cooper's five-stage integrative review method was used: problem formulation, data collection, data evaluation, analysis and interpretation, and dissemination. The Neuman systems model research literature from 1983 to February 2005 was searched using Fawcett's Neuman systems model bibliography and a follow-up review of the CINAHL database using the keywords 'Neuman systems model' and 'stressors'. A total of 87 studies published as journal articles or book chapters between 1983 and 2005 were reviewed; 13 of the 87 studies met the definition of 'stressor studies'.	Stressors were identified in five client populations: caregivers, cancer survivors, ICU patients in intensive care units, care receivers, and parents whose children were undergoing day surgery. The most common data collection method was the interview, and investigator-developed interview guides were most often used. Evidence of categorization of intra-, inter- and extra-personal stressors was present. The following overall stressors were identified: burden of responsibility (caregivers); awareness of vulnerability (cancer survivors); being overwhelmed (patients in intensive care units); loss of control (parents); and frustration with role changes (care receivers).	These data could form the basis for nursing practice as well as future research within a collaborative environment. Given the existing body of knowledge concerning Neuman system model-derived middle range theory concepts in the caregiver population, the middle-range theory of caregiver role strain could be tested empirically.	
16967784	To assess the needs, awareness and barriers to diabetes education for self management and to facilitate the initiation of an education programme promoting self care among diabetics and their families.A qualitative study was conducted among adult diabetics attending outpatient clinics in a tertiary care teaching hospital in Karachi, Pakistan. Semi-structured interviews were conducted on 27 subjects (11 men; 16 women) to identify dominant themes and priority issues.	Participants displayed great deal of variation with respect to level of knowledge and motivation for education. Most believed that diabetes was caused by stress. Family was perceived to be a source of positive support. Relative ease of adherence to pharmacological regimens as compared to diet and exercise was reported. Participants expressed frustration at chronicity of disease and fear of developing certain specific complications and inheritance by their children. Barriers to enhancing knowledge included 'No need for further information', distance from training institutions and other priorities.	Knowledge, beliefs and fears about diabetes, family influence and accessibility of healthcare, affects management behaviours and learning. Understanding needs and expectations of people with diabetes is essential in initiating and improving the outcomes of education programme for diabetes self care.	
16965471	Manual restraint techniques are associated with the management of violence in psychiatric settings. Restraint effectiveness and acceptability are under scrutiny, yet the nature and frequency of who or what were involved in restraint episodes have not previously been fully described or understood. The aim of this study was to describe the nature and frequency of manual restraint-related events and their components. This study was carried out using content analyses of nurses' post-incident reports from a psychiatric unit situated within a general hospital, and from its associated medium-secure unit. Requests for restraint occurred at the rate of about once per day, and the majority related to patients' ill-directed frustration, resistance to containment and their desire to leave the ward. Only half of responses to conflicts resulted in restraint implementation. The majority of restraint activities occurred during the afternoon and night. Male patients and detained patients were more frequent participants in restraint interventions. To a lesser extent, police, ambulance, fire services, hospital security, visitors and ex-patients were also involved in restraint episodes. Injuries were rare. In conclusion, training in restraint skills, clinical audit of adverse incidents, and research into psychiatric aggression all need to take into account the association of restraint with the enforcement of detention and treatment of acutely ill patients. The coupling of restraint with medication requires examination of its safety and efficacy. Interagency training may enable the essential services involved to coordinate restraint activities more effectively.
16964774	To investigate the lived experience of the 'support' relationship between students and their personal tutors.The purposive sample comprised 36 personal tutors and 44 pre-registration undergraduate nursing students on diploma and degree-level courses (adult, mental health and child branch) from a London university school of nursing and a northern university school of nursing. Private audiotaped interviews were conducted with the participants. Data analysis was undertaken to identify important themes.	The tutees varied in their readiness to learn, define, discuss and negotiate support. Positive encounters were when the tutees felt supported. Tutors had an overwhelming feeling of frustration when tutees lacked study skills and came unprepared to tutorials. However, some tutors indicated a high level of empathic understanding for tutees and spent much of their personal time supporting them.	The study illuminated the complexity and skill required to be a tutee and a tutor. Tutors' individual support style reflected tutees' expectations and perceptions to varying degrees. A positive experience by tutees and tutors was perceived when each had a shared understanding of the support concept. Mutual trust, engagement, respect and accepting responsibilities were important elements of the personal tutor and tutee relationship.	
16949825	Prehospital care begins when the call is placed to the emergency medical dispatch (EMD) centre and ends when the patient is cared for at the emergency department. The highly technical and specialized character demands advanced medical competence. Communication problems, serious and unpredictable situations can often occur during the emergency calls. A two-year intervention study involved the addition of registered nurses to an EMD-centre team to increase medical competence.To describe registered nurses' and emergency-operators' experiences of working together at an EMD-centre after adding registered nurses to increase medical competence.	Qualitative content analysis was used to analyse the text from interviews with four registered nurses and 15 emergency-operators involved in the intervention.	Initial frustration and scepticism changed to more positive experiences that resulted in improved cooperation and service. The registered nurses had difficulties dealing with the more urgently acute calls, while the emergency-operators had difficulties with the more complicated, somewhat diffuse cases. The two professions complemented each other.	Combining the registered nurses' and emergency-operators' knowledge and experience at an EMD-centre can perhaps improve the prehospital care for those requiring emergency medical care.	
16944832	The purposes of this study were to assess the loneliness of Japanese high school students who own and use a mobile phone, to clarify the relationships between students' loneliness and their social network and frequency of use of e-mail feature, and to demonstrate relationships with a student's social network and recognition of the benefits and drawbacks of mobile phone use.The participants were 227 students from two classes in each grade of a high school in the Kanto region of Japan. Participants answered a questionnaire covering the UCLA Loneliness Scale as well as questions pertaining to the circumstances of use of their mobile phones, their social networks (e.g., number of friends), and their perceptions of the benefits and drawbacks of mobile phone use. The questionnaires of students owning a mobile phone were analyzed. Total scores for the UCLA Loneliness Scale were calculated, and factor analysis was performed for the benefits and drawbacks.	A total of 220 questionnaires were returned, for which 94.1 percent of respondents owned a mobile phone. The percentages of male and female respondents were 58% and 42%. Chronbach's alpha for the UCLA Loneliness Scale (total score) was 0.87, a result similar to previous studies with high school and university students. Factor analysis revealed five factors associated with the benefits and drawbacks of mobile phone use. Multiple-regression analysis showed that 42.9% of the variance in "frequency of e-mail use" was explained by grade level, frequency of mobile phone use, and two of the five factors from the benefits and drawbacks ("difficulty of communication," and "possible sleep loss due to nighttime e-mailing"). Stepwise multiple-regression analysis revealed that 24.4% of the variance in UCLA Loneliness Score was explained by gender, the frequency of e-mail use, the number of friends and the presence/absence of a girlfriend or boyfriend.	Presence of an active social network and frequent e-mailing by mobile phone reduced students' loneliness. The frequency depended on their recognition of the benefits and drawbacks of mobile phone use and by the frequency of mobile phone use. This study established that students appreciate the usefulness of their mobile phone as an immediate communication tool, and are aware of its limitations. Although they experience frustration and lack of sleep (because of nighttime use), students use mobile phones to deepen their friendships.	
16944219	This study examined the relationship between temperament and internalising and externalising problems among children of parents diagnosed with cancer, beyond the effects of socio-demographics, illness-related variables and life events.Three hundred and forty adolescent children and their 212 parents diagnosed with cancer participated. Children and parents completed the Youth Self Report and the Child Behaviour Checklist, respectively. Children completed also the Early Adolescent Temperament Questionnaire.	Daughters of parents with cancer were reported as having more internalising problems than their counterparts did. Prevalence of problems did not depend on children's and parents' age or educational level. Recurrent disease and number of life events experienced by children and parents affected the problems reported. The most important temperament dimensions in the prediction of internalising problems in children were shyness and fear/worry, to a lesser extent, frustration and perceptual sensitivity (children only) and lower scores on pleasure intensity (parents only). Externalising problems were associated with effortful control and in children's reports with frustration. Temperament seemed to be a more important predictor of problems reported by children than parents.	Findings suggest that temperament is useful in determining the relative vulnerability of children of parents who have been diagnosed with cancer. Social workers may help parents to recognise individual differences between children and to support children by using techniques that are compatible with the temperament of children.	
16938790	Recent years have seen a rise in the number of children diagnosed at an early age with bipolar disorder and evidence is increasing that parents are performing most of the caregiving and illness management. This existential phenomenological study describes the personal experience of the parents whose children, age 6-11 years, are diagnosed with Bipolar Disorder. The thematic structure that emerged revealed that the parents in this study, strong advocates for their children, were experiencing unrelenting fear, frustration, loneliness, and hurt. The considerable health implications, affecting both the parent and the child, of lack of respite, loss of self, asynchrony, and chronic fear are discussed. Based on the findings of this study, the psychiatric nurse is in an ideal position to increase interventions that are supportive of parents.
16937774	For people with aphasia, the struggle to communicate creates powerful emotions, such as anger and frustration, and feelings of isolation and depression. The author, who has had aphasia for more than 25 years, calls on health care professionals to relate to people with aphasia with patience, active listening, and motivation for success.
16933460	Sleep bruxism (SB) has been believed to be related to stress and psychosocial factors, however their implicit relationship has remained unclear. This study was conducted on patients visiting our clinic with SB and masticatory muscle disorders (MMD) for the purpose of clarifying personality and behavioral traits. This study was conducted on patients of MMD visiting our clinic. The Rosenzweig Picture-Frustration study was performed on each patient. Twenty-seven (27) patients were divided into two groups: 17 patients with SB and 10 patients without. The SB group showed a significantly lower level of E (extrapunitive) reaction than the nonSB group. SB patients showed a significantly higher level of M (impunitive) reaction than those without SB. Concerning the directions of aggression, the percentage of E-A (extraaggression) was significantly lower in SB patients than in those without. On the other hand, the percentage of I-A (intraaggression) was significantly higher in patients with SB than those without. Our study found a new aspect of the patients with MMD and SB: they are not only intraaggressive, but are also unable to be extrapunitive and extraaggressive. Consequently, they are unable to demonstrate adequate self-assertiveness in stressful situations.
16928572	Applications to cardiothoracic surgery training programs have steadily declined. The application cycle for 2004 marked the first time the number of applicants was lower than the positions offered. This survey reflects on this trend in applications and the perspectives of current and graduating residents.In June 2004, the Thoracic Surgery Residents Association, in conjunction with CTSNet, surveyed residents completing accredited cardiothoracic training or additional subspecialization. Participation was anonymous and voluntary.	Of the 140 graduates, 88 responded. Most were male (92%) and married (72%). Their average age was 35.7 years, and 56% had children. The mean educational debt was less than $50,000. Of the 88 respondents, 69 (78%) had plans to seek jobs whereas 15 (17%) sought additional training. Among job-seeking residents, 12% received no offers. Also, 59% of graduates initially sought a position in academics and 41% in private practice. Nearly one quarter (23%) reported that they would not choose a career in cardiothoracic surgery again, and more than half (52%) would not strongly recommend cardiothoracic surgery to potential trainees. Almost all (90%) of the graduates believed that the number of cardiothoracic training spots should be decreased, and 92% believed that a reduction in training positions should be achieved by closing marginal training programs. Additionally, 91% believed reimbursement for cardiothoracic surgery was inadequate, and 88% thought low reimbursement resulted in restricted patient access and decreased quality of care.	Cardiothoracic training programs are having difficulty in both applicant recruitment and in suitable job placement. This frustration in the job search coupled with reimbursement and lifestyle issues most likely contributes to the general dissatisfaction conveyed by the graduates. If these trends continue, the field will be faced with a crisis of unfilled residency programs and unemployed graduates.	
16926369	Prolonging the living-dying process with inappropriate treatment is a profoundly disturbing ethical issue for nurses in many practice areas, including the intensive care unit. Despite the frequent occurrence of such distressing events, research suggests that critical care nurses assume a limited role in end-of-life decision making and care planning.To explore the practice of expert critical care nurses in end-of-life conflicts and to describe actions taken when the nurses thought continued aggressive medical interventions were not warranted.	A qualitative design was used with narrative analysis of interview data that had a temporal ordering of events. Interviews were conducted with 21 critical care nurses from 7 facilities in the southwestern United States who were nominated as experts by their colleagues.	Three recurrent narrative plots were derived: protecting or speaking for the patient, presenting a realistic picture, and experiencing frustration and resignation. Narratives of protecting or speaking for the patient concerned preventing further technological intrusion and thus permitting a dignified death. Presenting a realistic picture involved helping patients' family members reframe the members' sense of the potential for recovery. Inability to affect a patient's situation was expressed in narratives of frustration and resignation.	The transition from curative to end-of-life care in the intensive care unit is often fraught with ambiguity and anguish. The expert nurses demonstrated the ability and willingness to actively protect and advocate for their vulnerable patients even in situations in which the nurses' actions did not influence the outcomes.	
16900759	The aim of this two-year prospective study was to examine the relationship between multiple aspects of life-event stress and relapse in multiple sclerosis (MS) patients.Few studies have defined the critical features of this life-event stress; for example, stressor duration, frequency, severity, disease-dependency, valency, or stressor constructs, such as the propensity to cause emotional distress/threat or the frustration of life goals.	101 consecutive participants with MS were recruited from two MS clinics in Sydney, Australia. Stressful life events were assessed at study-entry and at three-monthly intervals for two years. Patient-reported relapses were recorded and corroborated by neurologists or evaluated against accepted relapse criteria.	Acute events, but not chronic difficulties (CDs), predicted relapse occurrence: acute stressor frequency counts predicted greater relapse risk, along with low disability score (EDSS) and being male. We also confirmed the bi-directional stress-illness hypothesis: stressors predicted relapse, and relapse separately predicted stressors.	Life-event stress impacts to a small degree on MS relapse. The number and not the severity of acute stressors are most important; chronic stressors do not predict later relapse. Males and those with early stage disease are also at greater risk of relapse. MS patients should be encouraged to reduce acute stressors during times of high stress, and feel reassured that disease-related chronic stressors do not increase their relapse risk.	
16892669	Burnout is becoming increasingly common in the health care profession. Indicators of burnout include feeling overworked, frustrated, emotionally drained, and less productive. Burnout leads to interpersonal conflicts, physical symptoms, compulsive activities, decreased productivity, and negative emotions. Individuals who experience burnout believe they cannot change their situation. Job burnout can be overcome after the cause is pinpointed. To revitalize a career and move away from a burnout state, individuals need to change their thought processes and viewpoints about the people and things that may be contributing to their burnout.

16882001	To describe communication between nurses and physicians during labor within the context of the nurse-managed labor model in community hospitals and its relationship to teamwork and patient safety.Multicenter qualitative study involving focus groups and in-depth interviews.	Labor and birth units in 4 Midwestern community hospitals.	54 labor nurses and 38 obstetricians.	Focus groups and in-depth interviews were conducted using open-ended questions. Data were analyzed using inductive coding methods to gain understanding from the perspective of those directly involved.	Description of interdisciplinary interactions during labor.	Nurses and physicians shared the common goal of a healthy mother and baby but did not always agree on methods to achieve that goal. Two clinical situations critical to patient safety (fetal assessment and oxytocin administration) were frequent areas of disagreement and sources of mutual frustration, often leading to less than optimal teamwork. Minimal communication occurred when the mother and fetus are doing well, and this seemed to be purposeful and considered normal. Physicians and nurses had distinct opinions concerning desirable traits of members of the other discipline.	Interdisciplinary communication and teamwork could be improved to promote a safer care environment during labor and birth.	
16849262	The author, both a nurse and patient, suffered a massive stroke. Included are the internal and external struggles and how to cope. Derived are lessons learned for nurses, to more fully understand a person with a stroke.
16805166	Parents of children with learning disability have been reported to suffer great stress and frustration due to increased burden of care. The manifestation of stigmatization by familial environment and the collective effect of the children with adverse impact on mothers predispose them to mental shock or a variety of neurotic symptoms and other psychiatric conditions including anxiety and depression. The objectives of the study were: to determine the general Health Questionnaire (GHQ) score of mothers of children with learning disability. To identify sociodemographic variables and to assess anxiety and depression in them.Using structured questionnaires between March and May 2002, 106 mothers of children with learning disability in a Mentally Handicapped Home for children in Lagos, Nigeria were assessed and compared with mothers of normal healthy children in Lagos.	The mean age of the subjects was 40.0 +/- 6.6 years. More of the subjects (26.4%) compared with mothers of normal healthy children (9.9%) had a high GHQ score and high levels of anxiety (25.5%) and depression (10.4%). Marital difficulties were associated with learning disability.	Mothers of children with learning disability are prone to emotional and psychological disorders. In order to improve the well-being of children with learning disability, there is need to look into the mental and physical health of mothers. Early and prompt treatment of associated anxiety and depression will no doubt help the children.	
16802901	Children prenatally exposed to cocaine may be at elevated risk for adjustment problems in early development because of greater reactivity and reduced regulation during challenging tasks. Few studies have examined whether cocaine-exposed children show such difficulties during the preschool years, a period marked by increased social and cognitive demands and by rapid changes in reactivity and regulation. The authors addressed this question by examining frustration reactivity and regulation of behavior during a problem-solving task in cocaine-exposed and -unexposed preschoolers. Participants were 174 4.5-year-olds (M age = 4.55 years, SD = 0.09). Frustration reactivity was measured as latency to show frustration and number of disruptive behaviors, whereas regulation was measured as latency to approach and attempt the problem-solving task and number of problem-solving behaviors. Results indicated that cocaine-exposed children took longer to attempt the problem-solving task but that cocaine-exposed boys showed the most difficulties: They were quicker to express frustration and were more disruptive. Effect sizes were relatively small, suggesting both resilience and vulnerabilities.
16796664	This paper presents a literature review whose aim was to provide better understanding of living with early-stage dementia.Even in the early stages, dementia may challenge quality of life. Research on early-stage dementia is mainly in the domain of biomedical aetiology and pathology, providing little understanding of what it means to live with dementia. Knowledge of the lived experience of having dementia is important in order to focus pro-active care towards enhancing quality of life. Qualitative research is fundamentally well suited to obtaining an insider's view of living with early-stage dementia.	We performed a meta-synthesis of qualitative research findings. We searched MEDLINE, CINAHL, and PsycINFO and reviewed the papers cited in the references of pertinent articles, the references cited in a recently published book on the subjective experience of dementia, one thesis, and the journal Dementia. Thirty-three pertinent articles were identified, representing 28 separate studies and 21 different research samples. Findings were coded, grouped, compared and integrated.	Living with dementia is described from the stage a person discovers the memory impairment, through the stage of being diagnosed with dementia, to that of the person's attempts to integrate the impairment into everyday life. Memory loss often threatens perceptions of security, autonomy and being a meaningful member of society. At early stages of memory loss, individuals use self-protecting and self-adjusting strategies to deal with perceived changes and threats. However, the memory impairment itself may make it difficult for an individual to deal with these changes, thereby causing frustration, uncertainty and fear.	Our analysis supports the integration of proactive care into the diagnostic process, because even early-stage dementia may challenge quality of life. Moreover, this care should actively involve both the individual with dementia and their family so that both parties can adjust positively to living with dementia.	
16790003	Depressive symptoms can be triggered by negative social experiences and individuals' processing of these experiences. This study focuses on the interaction between temperament, perceived parenting, and gender in relation to depressive problems in a Dutch population sample of preadolescents.The sample consisted of 2230 ten-to-twelve-year-olds from the North of The Netherlands. Perceived parenting (overprotection, rejection, emotional warmth) was assessed by the EMBU (a Swedish acronym for My Memories of Upbringing) for Children, temperament (fearfulness and frustration) by the parent version of the Early Adolescent Temperament Questionnaire-Revised, and depressive problems by the Child Behavior Checklist (parent report) and the Youth Self-Report (child report).	All parenting and temperament factors were significantly associated with depressive problems. Frustration increased the depressogenic effect of parental overprotection and lack of emotional warmth. Fearfulness increased the effect of rejection in girls, but not in boys. Furthermore, the association between frustration and depression was stronger in boys.	These findings support the hypothesis that the effect of specific parenting behaviors depends on the temperament and gender of the child.	
16781823	The major risk determinants of violence are to be young and male, to have low socioeconomic status and suffering substance abuse. This is true whether it occurs in the context of a concurrent mental illness or not; i.e., mental disorders are neither necessary, nor sufficient causes for violence. Intense motivation is a facilitating factor for violence in clinical and non clinical samples. This explains why 'normal' people, are implicated in planned violence at higher rates than mentally ill (e.g. in criminal acts against property). However mentally ill patients are more easily implicated in impulsive violence or in violence without obvious cause due to veiled motivation fuelled by unidentified symptoms. Subjective or real awareness of competitive disadvantage increases motivation for violence (e.g. paranoid, narcissistic symptoms, etc.). Many psychiatric disorders as antisocial disorder, borderline, schizophrenia, have most of the factors that facilitate the appearance of violence. Antisocial disorder is a good model to study determinants of violence in normal samples as it is present in young males that do not have any psychotic symptom, have stable symptomatology, self control under scrutiny, and their motivations are similar to normal samples. Our evolutionary model suggests that there is a non random association of genetic factors (genes, pseudogenes, promoting areas, etc.), that is, a genetic cluster (cluster DO), whose phylogenetic function is to motivate to be the dominant in social relationships. To be the dominant is a major psychological feature present in many social groups of animals, included primates. DO cluster have sense from an evolutionary viewpoint: when expressed in no pathological way it increases inclusive fitness (transmission of the genes of a person genotype whether by oneself or by relatives reproduction). Features of cluster DO in humans are expressed differently according to sex, age, moral education, level of intelligence, etc. Cluster DO has higher phenotypical expression in males and young people. Primary antisocial personality disorder and other related disorders (cluster B personality disorders, disocial, defiant disorder, etc.), are a pathological manifestation of this cluster DO. Some other genetic clusters that causes the genetic liability to some disorders (e.g. attention deficit disorder) are non random associated with cluster DO, thus explaining clinical comorbidity. According to our model, motivation for dominance usually prevails over motivation for material benefit or antinormative behaviour, this explains some incongruent behaviour in antisocial patients not elucidated by other models. Along with the primary expressed feature of dominance of cluster DO there are other secondary features that have been identified by psychobiological studies: novelty seeking, intolerance for frustration, impulsiveness, fearless, aggressiveness, higher threshold for activation of the sympathetic system, lack of empathy, egoism, non acceptance of rules, defiant and rebellious behaviour, manipulation in social interactions, selfishness and deficits in altruism or in social co-operation.
16780398	Previous research on computer games has tended to concentrate on their more negative effects (e.g., addiction, increased aggression). This study departs from the traditional clinical and social learning explanations for these behavioral phenomena and examines the effect of personality, in-game reinforcement characteristics, gender, and skill on the emotional state of the game-player. Results demonstrated that in-game reinforcement characteristics and skill significantly effect a number of affective measures (most notably excitement and frustration). The implications of the impact of game-play on affect are discussed with reference to the concepts of "addiction" and "aggression."

16768650	This article reviews the literature on the relationship between interpersonal rejection and aggression. Four bodies of research are summarized: laboratory experiments that manipulate rejection, rejection among adults in everyday life, rejection in childhood, and individual differences that may moderate the relationship. The theoretical mechanisms behind the effect are then explored. Possible explanations for why rejection leads to anger and aggression include: rejection as a source of pain, rejection as a source of frustration, rejection as a threat to self-esteem, mood improvement following aggression, aggression as social influence, aggression as a means of reestablishing control, retribution, disinhibition, and loss of self-control.

16766092	This paper reports on the contribution of six nurse educators to embed enquiry-led learning in a pre-registration nursing programme. Their focus was to evaluate student and facilitator perspectives of a hybrid model of problem-based learning, a form of enquiry-based learning and to focus on facilitators' perceptions of its longer-term utility with large student groups. Problem-based learning is an established learning strategy in healthcare internationally; however, insufficient evidence of its effectiveness with large groups of pre-registration students exists. Fourth Generation Evaluation was used, applying the Nominal Group Technique and Focus Group interviews, for data collection. In total, four groups representing different branches of pre-registration students (n = 121) and 15 facilitators participated. Students identified seven strengths and six areas for development related to problem-based learning. Equally, analysis of facilitators' discussions revealed several themes related to strengths and challenges. The consensus was that using enquiry aided the development of independent learning and encouraged deeper exploration of nursing and allied subject material. However, problems and frustrations were identified in relation to large numbers of groups, group dynamics, room and library resources and personal development. The implications of these findings for longer-term utility with large student groups are discussed.
16765018	This study examined postconcussion-like symptoms in a group of university students and explored their relationships to neuropsychological function performance. A sample of 124 students was recruited. All of the participants received the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and completed a comprehensive set of neuropsychological tests. They reported a relatively high base rate of postconcussion-like symptoms. The most frequently endorsed items were "fatigue" (76.9%), "longer time to think" (60.3%), "poor concentration" (58.7%), "sleep disturbance" (50.4%), and "frustration" (46.3%). There were no significant differences between low symptom reporters and high symptom reporters, except for self-reported dysexecutive problems. A comparison of the healthy high symptom reporters and a convenient sample of traumatic brain injury patients revealed that the patients performed significantly worse on neuropsychological functions than the high symptom reporters, despite non-significant differences between symptom endorsement. Our findings demonstrate that: (a) the base rate of postconcussion-like symptoms in a group of healthy university students is relatively high and (b) postconcussion symptom (PCS) is not related to neuropsychological functions in normal people.
16751469	To understand factors influencing patients' decisions to attend for outpatient follow up consultations for asthma and to explore patients' attitudes to telephone and email consultations in facilitating access to asthma care.Exploratory qualitative study using in depth interviews.	Hospital outpatient clinic in West London.	Nineteen patients with moderate to severe asthma (12 "attenders" and 7 "non-attenders").	Patients' main reasons for attending were the wish to improve control over asthma symptoms and a concern not to jeopardise the valued relationship with their doctor. Memory lapses, poor health, and disillusionment with the structure of outpatient care were important factors implicated in non-attendance. The patients were generally sceptical about the suggestion that greater opportunity for telephone consulting might improve access to care. They expressed concerns about the difficulties in effectively communicating through non-face to face media and were worried that clinicians would not be in a position to perform an adequate physical examination over the telephone. Email and text messaging were viewed as potentially useful for sending appointment reminders and sharing clinical information but were not considered to be acceptable alternatives to the face to face clinic encounter.	Memory lapses, impaired mobility due to poor health, and frustration with outpatient clinic organisation resulting in long waiting times and discontinuity of care are factors that deter patients from attending for hospital asthma assessments. The idea of telephone review assessments was viewed with scepticism by most study subjects. Particular attention should be given to explaining to patients the benefits of telephone consultations, and to seeking their views as to whether they would like to try them out before replacing face to face consultations with them. Email and text messaging may have a role in issuing reminders about imminent appointments.	
16741865	Complexity in nursing education has increased as it is challenged to meet the needs of diverse populations in rapidly evolving and highly technical health care settings. To accomplish or meet these societal wants, needs, and demands, nursing educators must prepare students successfully to become active, independent learners and problem solvers. The purpose of this study was to design a nursing course on the basis of scenario discussion, Web-based instruction (WBI), and the assessment of learning outcomes. The design of the study involved two stages. The first, beginning in 2001, developed the scenario discussion with the WBI system. The second evaluated learning outcomes within the context of a scenario discussion. Two instruments were examined in this study: a nursing assessment score and learning effectiveness survey. The target population in this study consisted of students enrolled in a two-year nursing program and registered for the course, Nursing I, during the fall semester of 2002. Using simple random sampling, 43 students were recruited and agreed to participate in the study. Most of the students chose "good" for learning effectiveness. Overall, the students gave higher learning effectiveness survey scores and nursing assessment scores. Due to their lack of previous exposure to scenario discussion, the students here felt frustration and anxiety while taking this course. Faculty should devote more time explaining the advantages of scenario discussion. In addition, in comparison with traditional teaching, Web-based instruction (WBI) imposes a heavier burden on the instructors and institutions involved. Nurse educators must continue to use innovative strategies to enhance student learning. Students registered both positive and negative feedback in open-ended questions on Web- based instruction. However in the future, special attention should be given to the learning software, Internet access speed, synchronous and asynchronous meetings, and the interaction interface.
16724624	Patients with chronic urticaria have a poor quality of life (QOL). Chronic pruritus with variable appearance of urticaria and/or angioedema are typical of the uncertainty that compromise their QOL. Other issues such as fatigue, cost of therapy, and social isolation further contribute to the frustration that patients experience. Various instruments are available to measure the quality of life of patients with urticaria and can be adjunctive in the continued assessment of patients with this variable condition. In comparison with other dermatological and medical conditions, patients with chronic urticaria have a significantly worse QOL.
16722853	This article reviews qualitative and quantitative studies that evaluate health-related quality of life (HRQoL) in lymphoedema. Qualitative studies reveal a number of factors that can affect HRQoL. These include a lack of understanding of lymphoedema by health professionals and poor information provided to patients. Emotional responses include shock, fear, annoyance, frustration and negative body image. Treatment can be costly in terms of time and disruption to lifestyle. Quantitative studies show that patients with lymphoedema experience greater levels of functional impairment, poorer psychological adjustment, anxiety and depression than the general population. Increased limb volume is poorly related to the impact of lymphoedema on the patient. Factors leading to deficits in quality of life include the frequency of acute inflammatory episodes, the presence of pain, skin quality, lymphoedema in the dominant hand and reduced limb mobility. There is some evidence that the adoption of patient-centred guidelines can improve quality of life in patients with breast-cancer-related lymphoedema. HRQoL is an important outcome in the management of patients with lymphoedema. Further studies must examine how lymphoedema impacts on patients other than those with breast-cancer-related lymphoedema and the consequences to patients of different approaches to care.
16720395	It has been reported that capuchin monkeys reject a less preferred food (LPF) when they see a partner capuchin receive a more preferred food (PF) for performing the same task. This behaviour was taken as evidence of 'inequity aversion', but an alternative hypothesis is that capuchins reject the LPF because of the mere presence of the PF. We tested this hypothesis in a paradigm, which consisted of presenting two different foods (one PF and one LPF) on a tray and allowing the capuchin to take only the LPF. Refusals to initiate the trial and refusals to take and eat the LPF were higher when the PF was hidden (hiding condition) and when the PF was accumulated in sight but out of reach of the subject (accumulation condition) compared to when two pieces of LPF were placed on the tray (control condition). Interestingly, the subject behaved as in the control condition when its partner was given and ate the PF (partner condition). We argue that capuchins' refusals were due to the frustration of seeing and not obtaining the PF, and that seeing the partner eating increases the LPF acceptance.
16718538	Evaluating a youth program whose goals are to provide instruction in Cambodian dance, increase awareness and pride in Cambodian culture, promote healthy behaviors, and create linkages within the community has been a challenge. A primary source of conflict was incorporating evaluation methods that were required of all funded programs with our own specifically tailored measures. One of our concerns was that the required tools were not culturally appropriate for our participants. Our experiences reinforce the importance of forming partnerships that embrace principles of respect, equity, and empowerment among all involved before establishing a research agenda. The choices we made and did not make contributed to our struggles and frustration and also to the insight that was gained. Our analysis examines the importance of clear communication, cultural awareness, tailoring evaluation, and meaningful participation. We believe that the lessons we learned will help facilitate the conduct of culturally sensitive community-based research.
16699693	This qualitative study aimed to apprehend the meaning of adolescents' pregnancy for their families, using semistructured interviews and collective subject discourse. Adolescent pregnancy is represented as a problem to be faced with family support. The families worry and are mobilized to solve adversities. Besides the shock about the news, impotence as to pregnancy prevention, conformism, happiness and improvement in family relationships due to the baby's arrival, participants evidenced frustration due to the interruption/change in the family life project in terms of the adolescent being pregnant without a stable relationship with the child's father. In valuing the family perspective on adolescent pregnancy, professional care to pregnant adolescents and their families can be delivered in partnership with the family and social context, making it easier to cope with conflicts and recognizing the family as an active subject in this process.

16675751	The authors describe "collaborative problem solving," a cognitive-behavioral approach for working with aggressive children and adolescents. The model conceptualizes aggressive behavior as the byproduct of lagging cognitive skills in the domains of flexibility, frustration tolerance, and problem solving. The goal is to train staff to assess specific cognitive skills that may be contributing to challenging behavior and to teach children new skills through collaborative problem solving. The authors present results from an inpatient unit that dramatically reduced rates of seclusion and restraint.
16673844	Using 2 field procedures, the authors assessed impacts of cell-phone use on mild forms of driver aggression. Participants were 135 drivers traveling within a city of approximately 17,000 people in an otherwise little-populated region of western North Dakota. The authors videotaped the participants while a confederate driver in a low-status vehicle frustrated them. In Experiment 1, the confederate was traveling well under the posted speed limit. In Experiment 2, the confederate remained motionless at a stoplight that had turned green. When the confederate visibly talked on a hand-held cell phone (n = 67), male drivers exhibited their frustration by honking their horn more quickly and frequently than did drivers in no-cell-phone trials, and female drivers were more angry according to blind judgments of videotaped facial expressions that were compared with those of drivers in no-cell-phone trials (n = 68). The present results suggested that driver cell-phone use contributes to the growing crisis of roadway aggression.

16649514	Many stressful situations, particularly strong and long time lasting, can induce the burnout syndrome. The definition "burnout" refers to emotional and exhausting conditions related to working environment. Since 70'ties, many studies, have focused on this topic, have assessed that this condition is much more frequent in some particular professional categories: teachers, physicians, nurses, social workers, policemen, judges (the so-called helping professions). The main syndrome characteristics are: physical and emotional fatigue, depersonalization, frustration for unsuccessful professional realization and reduced personal accomplishment in competence and productivity with decreasing critical sense towards working field. The Maslach Burnout Inventory (MBI) has been the most popular instrument for measuring burnout in medical research. The coherence of many studies results on helping professions in different countries, leads to the conclusion that basically burnout is a psycho-social phenomenon of international relevance. These studies have also identified personal, relational and environmental risk factors susceptible to prevention.
16647660	Factitious disorders reside under the broad umbrella of dysfunctional syndromes. This article is meant specifically to focus on common patterns of upper extremity factitious illness. It is intended to emphasize recognition, differential diagnosis, and problems related to misdiagnosis. It is not devoted to treatment, which is a separate issue.
16638651	The meaning of life can be defined as a sense of a clear aim in life and a belief that one's daily activities are meaningful. Pregnancy is clearly an important aim of women who undergo in vitro fertilization (IVF) treatment. The purpose of this study was to evaluate the meaning of life and its related factors among women who underwent IVF treatment throughout the first treatment cycle until either pregnancy was achieved or when the attempt was abandoned.This cross-sectional study was performed in a single medical center in Taiwan. A total of 149 subjects were recruited from women receiving IVF (n = 69) and women who had experienced IVF failure within the previous 1 year (n = 80). These women were classified into four subgroups according to their treatment stages: beginning of first IVF (n = 39); pregnancy/delivery (n = 22); continuing treatment (n = 64); and discontinuing treatment (n = 24). The Purpose in Life (PIL) test, a previously developed instrument designed to measure meaning of life, was administered to all patients at their follow-up IVF visit.	The mean PIL score was 99.1 +/- 19.5, which indicated that all subjects had some degree of uncertainty regarding the meaning of life; however, no significant difference in PIL score was found among the four groups. Four factors were extracted from PIL by factor analysis, among which "existential frustration" (factor 4) was highest in the continuing group and those with a lower level of education; whereas "being in control" (factor 2 ) was lowest in women whose infertility had a female etiology.	Treatment stage, educational level, and etiology of infertility were found to be factors influencing the meaning of life in women undergoing IVF.	
16637755	The negative affective priming of aggression was examined across different aversive contexts (general stress exposure and frustration) with a laboratory aggression paradigm that measured the intensity of shocks participants delivered to a putative employee. Participants' emotional responses were gauged via startle eyeblink reactions and self-report mood ratings. Aside from gender differences in overall aggression, men but not women exposed to general stress showed significant increases in aggression across blocks. However, frustration produced increases in aggression in both genders. Although both genders showed robust startle increases during stress, startle activation was related to increases in aggression in men and decreases in aggression in women. These findings suggest that general stress and experiences of negative emotion trigger physical aggressive responses more strongly in men than in women.
16625023	To investigate predictors for externalizing behaviors and minor unintentional injuries in toddlers and to examine whether common risk factors can be identified.Linear regression models were used to investigate the contributions of predictors belonging to the domains of child characteristics and parental characteristics. Participants were 117 boys (M = 16.9 months) and their parents.	Two common risk factors for externalizing behaviors and minor injuries were identified: maternal low conscientiousness and paternal low self-control. In addition, children's inhibitory control and dispositional frustration as well as maternal externalizing symptoms contributed independently to children's externalizing behaviors.	Results supply some evidence for the interrelatedness of negative outcomes and on the existence of common risk factors. Interventions could aim to address these common risk factors in order to pursue a number of goals at the same time, instead of focusing on only one type of negative outcome.	
16621334	Instrumental learning involves both variation and selection: variation of what the animal does, and selection by reward from among the variation. Four experiments with rats suggested a rule about how variation is controlled by recent events. Experiment 1 used the peak procedure. Measurements of bar-press durations showed a sharp increase in mean duration after the time that food was sometimes given. The increase was triggered by the omission of expected food. Our first explanation of the increase was that it was a frustration effect. Experiment 2 tested this explanation with a procedure in which the first response of a trial usually produced food, ending the trial. In Experiment 2, unlike Experiment 1, omission of expected food did not produce a large increase in bar-press duration, which cast doubt on the frustration explanation. Experiments 3 and 4 tested an alternative explanation: a decrease in expectation of reward increases variation. Both used two signals associated with different probabilities of reward. Bar presses were more variable in duration during the signal with the lower probability of reward, supporting this alternative. These experiments show how variation can be studied with ordinary equipment and responses.
16620741	This paper presents an investigation into the relationship between driver stress, coping strategies and aberrant driving of a Greek sample of company employees (N=714). The results supported the main factor structures of the Driver Behavior Inventory (Matthews, G., Tsuda, A., Xin, G., Ozeki, Y., 1999. Individual differences in driver stress vulnerability in a Japanese sample. Ergonomics 42, 401-415) and Driver Behavior Questionnaire (Kontogiannis, T., Kossiavelou, Z., Marmaras, N., 2002. Self-reports of aberrant behavior on the roads: errors and violations in a sample of Greek drivers. Accident Anal. Prev. 34, 391-399). An inventory of coping strategies was also examined in terms of self reports. Confrontive coping was characteristic of drivers high on aggression who also had higher rates of mistakes and violations. Coping in terms of self-criticism was exhibited by drivers high on dislike of driving (i.e., anxiety) who reported a higher incidence of mistakes. Task-focus coping was characteristic of alertness and had a weak correlation with confidence. Drivers high in confidence reported fewer mistakes and violations which, in association with low perception of risk, was a particularly worrying aspect of driving. A contextual model of accident involvement was tested with LISREL in which violations yielded a direct effect whilst aggression yielded an indirect effect mediated by violations. Alertness and confidence were both related to safety orientation but failed to predict accident rates and speeding convictions.
16616269	Treating pain patients is difficult. The usual problems encountered in providing coherent and effective treatment for any chronic medical illness are compounded in painful conditions by time, society's choices, and the cultural role of the patient. Effective treatment of these patients depends on the persistence of the clinician. We must persist in requiring a complete history to understand the patient and his or her problem. We must persist in performing a thorough physical examination to uncover sufficient under-standing of the patient's physiology. We must persist in developing a comprehensive treatment plan to cover all of the intervening concerns. We must persist in following the patient in the clinic to make sure that the plan is completed and that complications that arise are dealt with efficiently. This can lead to considerable satisfaction and frustration. There remain many unanswered questions in the evaluation of pain patients and of pain itself. How accurate is physical examination in providing information about a given patient that is relevant to treating pain? Can physical examination reliably elicit a nociceptive focus for a specific individual's chronic pain experience? Is all long-term pain a smorgasbord of nociceptive, central sensitization, and neuromodulatory mechanisms? Can acute pain be more consistently aborted to minimize the development of chronic pain? Over the next few years, as our expanding knowledge of neuropharmacology, neurophysiology, and pain modulation in the CNS combines with better understanding of pain psychology and sociology, we clinicians will expect to have happier and more productive patients.
16614787	This study improves the knowledge of early autistic symptomatology and research concerning (i) the significant differences in the behaviors of children with autistic disorder (AD) and children with a developmental delay (DD), and (ii) the influence of the cognitive delay on symptomatology.Two groups of 20 young children (7-42 months) were compared: children with AD, and those with DD. The groups were paired by chronological and developmental age. The comparison was extended to four subgroups composed according to age (younger and older children--<24 months, >24 months) and to the global development quotient (GDQ) (the more and less delayed). Each child was evaluated with the Infant Behavior Summarized Evaluation scale (IBSE).	For the younger AD children, significant differences affected social communication and their adaptation to the environment (intolerance to frustration, resistance to change). For the older children (>24 months), this study showed the rapid progression of the number of distinctive signs between AD and DD children according to age and/or developmental level.	Cognitive delay has an important influence on the symptomatology at the moment of initial recognition of an autistic syndrome. This study is a complement for the fuller understanding of the nature and early diagnosis of disorders specific to autism at the earliest phases of development.	
16613600	Corticotropin-releasing factor (CRF) is typically considered to mediate aversive aspects of stress, fear and anxiety. However, CRF release in the brain is also elicited by natural rewards and incentive cues, raising the possibility that some CRF systems in the brain mediate an independent function of positive incentive motivation, such as amplifying incentive salience. Here we asked whether activation of a limbic CRF subsystem magnifies the increase in positive motivation for reward elicited by incentive cues previously associated with that reward, in a way that might exacerbate cue-triggered binge pursuit of food or other incentives? We assessed the impact of CRF microinjections into the medial shell of nucleus accumbens using a pure incentive version of Pavlovian-Instrumental transfer, a measure specifically sensitive to the incentive salience of reward cues (which it separates from influences of aversive stress, stress reduction, frustration and other traditional explanations for stress-increased behavior). Rats were first trained to press one of two levers to obtain sucrose pellets, and then separately conditioned to associate a Pavlovian cue with free sucrose pellets. On test days, rats received microinjections of vehicle, CRF (250 or 500 ng/0.2 microl) or amphetamine (20 microg/0.2 microl). Lever pressing was assessed in the presence or absence of the Pavlovian cues during a half-hour test.Microinjections of the highest dose of CRF (500 ng) or amphetamine (20 microg) selectively enhanced the ability of Pavlovian reward cues to trigger phasic peaks of increased instrumental performance for a sucrose reward, each peak lasting a minute or so before decaying after the cue. Lever pressing was not enhanced by CRF microinjections in the baseline absence of the Pavlovian cue or during the presentation without a cue, showing that the CRF enhancement could not be explained as a result of generalized motor arousal, frustration or stress, or by persistent attempts to ameliorate aversive states.	We conclude that CRF in nucleus accumbens shell amplifies positive motivation for cued rewards, in particular by magnifying incentive salience that is attributed to Pavlovian cues previously associated with those rewards. CRF-induced magnification of incentive salience provides a novel explanation as to why stress may produce cue-triggered bursts of binge eating, drug addiction relapse, or other excessive pursuits of rewards.	
16610298	Home care is a health sector under increasing pressure. Demand is often said to be outstripping capacity, with constant change and retrenchment distinguishing features of the current context. This paper takes a reading of the current conditions of home care using data gathered during a field study of home care case management practices conducted in 2004. As economic discourses become increasingly influential in determining responses to client situations, case managers (and their managers) find themselves with limited capacity to exercise control over their practices. A growing gap between professionally influenced discourses--those presumably intended to guide practice--and organizational priorities creates a dissonance for case managers as the political-ethical dimensions of their practices are displaced by budget "realities." For front-line workers, such displacement cannot be sustained in their face-to-face encounters with clients, leading to a growing sense of frustration and powerlessness among these highly skilled practitioners.
16583399	To describe the health-related quality of life (HRQOL) of adolescents with juvenile idiopathic arthritis (JIA), and to examine the usefulness of the Juvenile Arthritis Quality of Life Questionnaire (JAQQ) in a UK context. It was hypothesized that HRQOL would decrease with worsening disease and disability.Patients with JIA ages 11, 14, and 17 years were recruited from 10 major rheumatology centers. HRQOL was measured using the JAQQ. Other data were core outcome variables including the Childhood Health Assessment Questionnaire, demographic characteristics, arthritis-related knowledge, and satisfaction with health care.	Questionnaires were completed by 308 adolescents. One-fifth had persistent oligoarthritis. Median disease duration was 5.7 years (range <1-16 years). The JAQQ was shown to have good psychometric properties when used in the UK, but was not without limitations. HRQOL of adolescents with JIA was less than optimal, particularly in the domains of gross motor and systemic functioning. Items most frequently rated as adolescents' biggest psychological problems were "felt frustrated" and "felt depressed," rated by 30.2% and 23.4%, respectively. These were particularly problematic for the 17-year-olds, with 39% reporting frustration as one of their biggest problems and 63.6% reporting depression. Variation in the adolescent JAQQ scores was explained by functional disability, pain, and disease activity.	JIA can have a significant adverse effect on the HRQOL of adolescents. The JAQQ is a useful tool to assess the HRQOL of UK adolescents with JIA, but there is need for improved measures that incorporate developmentally appropriate issues.	

16573856	The behavioral syndrome resulting from damage to the ventromedial prefrontal (VM) region presents major challenges for clinical assessment and management, stemming from the absence of reliable neurologic or psychometric markers, coupled with often debilitating impairments of decision-making and behavior regulation. Damage to this region disrupts neural circuitry critical for emotion, which in turn may contribute to impairments in real-world competencies. Here we present findings from patients with focal lesions in the VM region acquired either in childhood or adulthood, and show that there is a relationship between emotional dysfunction and impairments in real-world behavioral competencies. Emotion was rated by participants' relatives on dimensions including frustration tolerance, lability, anxiety, and blunted affect. Real-world competencies were rated by the relatives on dimensions including judgment, planning, and initiation, and were evaluated by clinician ratings in areas including social, financial, and occupational function. VM damage resulted in severe disruption of emotion, and this emotional dysfunction accounted for a significant portion of impaired real-world competencies. The long-term impairments associated with childhood-onset lesions were at least as severe as those resulting from adult-onset damage. Greater focus on the contribution of emotional dysfunction to the real-world competencies of patients with damage in the VM region may sharpen their neuropsychological assessment and facilitate rehabilitation efforts.
16572048	Many persons who survived Nazi concentration camps are now in advanced age, so that rehabilitation centers in Poland are seeing increasing numbers of such patients, especially after strokes. In many cases, the process of rehabilitation is severely hampered by Post-Traumatic Stress Disorder (PTSD), while the neuropsychological consequences of the stroke itself often evoke traumatic memories and simultaneously disorganize or destroy the patient's previous coping mechanisms. The present study describes the program developed by the authors for concentration camp survivors in post-stroke rehabilitation, including the use of art therapy and specially prepared films to help the patients cope with PTSD.The experimental group (KL) consisted of 8 such patients (4 men, 4 women, average age 79.1+/-4.28) with mild post-stroke aphasia who went through the PTSD program, while the comparison group (C) included 8 post-stroke patients, matched for age and gender, who were not concentration camp survivors and showed no premorbid symptoms of PTSD. All subjects were tested at baseline and again 3 months later, using structured interview and observation, self-rating scales for three basic negative emotions (anger, anxiety and sadness) and the Frustration and Aggression Test for the Disabled.	The results showed significant differences between the groups at baseline, while at follow-up the differences between groups had changed in both extent and distribution.	Qualitative analysis of the results allows for some important observations about the etiology and course of PTSD in these persons.	
16563307	The effects of reward schedule (100% and 30%) and extinction on attention (reaction time to auditory stimuli) and frustration levels (pressure exerted on a response key) of 15 adults with attentional disorders and 21 normal adults were examined using a continuous performance task. We predicted, that adults with attentional deficits would (a) perform similar to comparisons when rewarded on a continuous schedule, (b) exhibit higher levels of frustration when that continuous schedule was moved to an extinction schedule, and (c) experience more frustration than comparisons when rewarded on a partial schedule. Overall, adults with attentional deficits were slower to respond and their responses were more variable than typical comparisons across trials, similar to what is observed for children. Continuous reward resulted in poorer performance earlier in the reward phase and continued throughout an extinction phase. The frustration levels of adults with attentional deficits did not differ from comparisons across schedule conditions. Results are discussed in terms of the role of arousal in mediating responding to various schedules of reward.
16553701	This paper reports the perceived barriers to and effective strategies for self-management of adults with type 2 diabetes in a rural setting.Worldwide, diabetes is a major public health concern and financial burden. Research shows that, for people with diabetes, adhering to programs of self-care is often problematic. Despite the potential for improved metabolic control and quality of life, little is published on the barriers and effective strategies that people with diabetes successfully use to incorporate plans of care into their lifestyles.	Twenty-four adults diagnosed with type 2 diabetes were recruited from a rural primary care practice to participate in one of three audiotaped focus groups. Content analysis was conducted on the focus group transcripts and validity was strengthened through independent rankings of barriers and strategies by an expert panel and by the nurse researchers. The data were collected 2002.	The most frequently reported barriers were lack of knowledge of a specific diet plan, lack of understanding of the plan of care and helplessness and frustration from lack of glycaemic control and continued disease progression despite adherence. Effective strategies identified were developing a collaborative relationship with a provider, maintaining a positive attitude that prompts proactive learning and having a support person who provides encouragement and promotes accountability.	These data highlight the importance of barrier and strategy identification in developing and implementing realistic self-management plans and the significance of collaborative alliances between patients and practitioners. Awareness of barriers, identification of strategies to overcome obstacles and the opportunity to problem solve with practitioners assists patients in managing a chronic illness that requires numerous daily decisions.	
16551501	The noise produced by oscillatory movements of secretions in oropharynx, hypopharynx and trachea during inspiration and expiration in unconscious terminal patients is often described as 'the death rattle'. The reported incidence of death rattle in terminally ill patients varied between six and 92%. It is most commonly reported in patients dying from pulmonary malignancies, primary brain tumours or brain metastases, and predicts death within 48 hours in 75% of the patients. Clinical studies demonstrate that hyoscine hydrobromide is effective at improving symptoms. After withdrawal of artificial ventilation on the intensive care unit, excessive respiratory secretions resulting in rattling breathing, during the last hours of life, is not uncommon. Physicians and nurses experience considerable difficulties and frustrations in treating the death rattle. The distressing experience and negative influence in the bereavement process indicates an ethical demand to treat this symptom from the perspective of others merely than that of the patient. This article provides practical and ethical considerations in the management of this near-death symptom. The fact that relatives were relieved in almost all cases, in which a positive effect was obtained, makes treatment in anticipation of death rattle an ethical demand. In practice, injectable scopolamine is the reference drug for symptomatic treatment of death rattle.
16551168	P. G. Roma, A. Silberberg, A. M. Ruggiero, and S. J. Suomi (2006) noted that the results S. F. Brosnan and F. B. M. de Waal (2003) attributed to inequity aversion could also be explained as a frustration effect. Roma et al. redressed this confound by designing a procedure that could have supported either of these interpretations. Nevertheless, they found that only a frustration effect accounted for both their data and those of Brosnan and de Waal (2003). The criticisms Brosnan and de Waal (2006) offered of Roma et al. ignored the fact that Brosnan and de Waal's (2003) research design was not capable of offering an unequivocal demonstration of inequity aversion. This conclusion holds no matter what the claimed inadequacies of Roma et al.'s procedures might have been. Caution is urged in inferring the existence of inequity aversion in nonhuman primates.
16544200	The author traces the history of free association, the "fundamental rule," through the Freud-Ferenczi relationship and controversy. The use of "activity," first proposed by Freud in 1910 with phobic and compulsive patients, was then championed by Ferenczi in the early twenties. The goal of activity was to enhance-or, more accurately, "to force"--the associations into the analysis. Subsequently, Ferenczi reversed himself, concluding that his analysis was re-creating the traumatic parental environment which originally caused the patient's neurosis. The far-reaching results of Ferenczi's change of heart included a redefinition of countertransference and added the techniques of "indulgence" and "relaxation" to soften Freud's emphasis on "abstinence" and "frustration. A vignette from the analysis of a dangerously self-destructive bulimic patient illustrates the value of free association in helping a patient feel understood by the analyst without pressure to give up her symptoms. Constantly monitoring his therapeutic ambition, the analyst demonstrates the value of free association in enhancing the patient's understanding of herself and of the survival value of her symptoms. This vignette highlights the fact that the analyst's therapeutic ambition makes freedom to associate even more difficult for the patient and inevitably intrudes on the analyst's evenly hovering attention. Of course for the analyst to have a therapeutic wish is necessary and desirable but for the analyst to demand change promotes compliance and hidden rebellion which limits the analysis.
16529152	Selected texts derived from the edited diaries of an eighty year old man shed a light on the troubles of old age, declining health and wellbeing in a year prior to death. The author, Hans Warren (1921-2001) is a well known Dutch poet. Despite his poor physical condition and his mental frailty he confides his daily anguish and his lonely sufferings to his diary, resulting in an upsetting story of unhappiness and frustration. Although quite a few doctors are consulted, their advice seems inadequate or futile. The author's relationship with his supporting partner, who is nearly forty years his junior, suffers under the strain of daily conflicts and humiliating dependency. Despite all this they share moments of love and friendship until the end. The author expresses thankfulness for all things of beauty he can still enjoy.
16518946	Many health professionals seem to lack the knowledge and skills required to understand and communicate with the child or young person with an autistic spectrum disorder. Educational materials about this subject for student nurses and healthcare professionals were developed as part of a nursing course and are presented in this article as an introductory reference for those seeking to improve their communication with these children. A short resource list is provided.
16507034	Many people with learning disabilities (LD) show aggressive behaviour, but the extent of the problem and its associated factors and effects are unclear.A cross-sectional analysis was carried out using interview data from 3065 adults with LD on the Leicestershire LD Register. Physical aggression towards others was defined as carers reporting frequent (more than three times per week) and/or severe episodes. Individuals with and without aggression were compared using multiple logistic regression models for potential physical and psychological factors.	Carers reported that 443 (14%) of adults were physically aggressive towards others. Men (P = 0.001), younger individuals (P < 0.001), people with more severe LD (P < 0.001) and those in institutional settings (P < 0.001) had a significantly higher prevalence of physical aggression. People with Down syndrome had a lower prevalence of physical aggression (P < 0.001). After adjustment, we found no relationship between aggression and the presence of epilepsy or autism. Among psychological factors, symptoms of frustration (P < 0.001) and mood swings (P < 0.001) were associated with higher levels of aggression. Failure to cope among carers was reported by 14% overall: 42% of people caring for adults with aggression said they were unable to cope compared with 10% of those caring for adults without aggression.	Physical aggression towards other people presents a significant challenge to carers of adults with LD. Further research is needed to identify aetiological factors with a view to finding effective interventions to reduce, and improve management of, this behaviour.	
16503531	To investigate the coping strategies of the community-based population in Shenzhen.Totally 5,940 subjects from the communities in Shenzhen were sampled and tested with the Simplified Coping Style questionnaire.	The most common coping strategies adopted by the community residents in Shenzhen were "consoling themselves" (33.1%) and "looking at the bright side of things" (31.4%), and the least adopted coping strategy was "relieving distress by smoking, drinking, taking medicine and eating" (57.8%); the strategies left out from their choices were mostly negative strategies. The scores for positive coping strategy factors of community residents in Shenzhen were greater than those of negative ones, with a mean difference of 0.43. The scores of both positive and negative coping strategy factors of these residents were significantly lower than those of general population in other mainland cities (P<0.001), with mean differences of 0.12 and 0.36, respectively.	The community residents in Shenzhen adopt mostly positive strategies for coping with frustration, which benefit their status of self-rated health.	
16502003	To explore the major factors important in decision making for whole-brain radiotherapy (WBRT) for patients with brain metastases and their caregivers.Two parallel qualitative studies, one for patients and one for caregivers of patients with newly diagnosed brain metastases, were conducted. Semistructured interviews were conducted and audiotaped with each participant. Content analysis and theme extraction of the transcripts were undertaken to identify recurring themes and relational patterns.	Twenty patients and 19 caregivers (including eight patient and caregiver pairs) were recruited into the study. Four major factors were identified to influence decision making of whole-brain radiation: hope, knowledge, expectations of radiation therapy, and current symptoms. Analysis reveals that patients generally focus on current informational needs, while caregivers want more information about the future (e.g., life expectancy and anticipated symptoms). Caregivers expressed frustration when unable to explore future needs because patients were unprepared to discuss prognostic issues. Participants expressed substantial relief when offered WBRT after the diagnosis, but WBRT is often considered the only available plan rather than an informed choice.	Given the importance of caregivers in the care of patients with brain metastases, fulfilling their unique informational needs appears to require more attention. The blurred boundary between hopes and expectations for WBRT creates unique challenges in joint treatment decision making for patients with brain metastases and their caregivers.	
16499239	The study used semi-structured interviews in an interpretive research design to explore nurses' perceptions of patients requiring disproportionate amounts of nursing resources, and factors influencing those perceptions. A total of 50 senior nurses from a variety of medical and surgical settings, including a high dependency unit, were interviewed and the data analysed to determine common themes and differences between participants. The four major themes of patient characteristics, family needs, staffing and organisational context defined the factors nurses perceived as influencing their perceptions of patients' dependency. Patient requirements for nursing resources were seen as a continuum rather than a specific point, and were balanced on the combined influences of the four themes. At times, demands imposed on nursing resources lead to nurses' perceptions of delivering less than ideal care, stress and frustration. The latter applied particularly to factors that were outside of the control of nurses such as staffing levels and skill mix.
16493325	This article explores the value of case study methodology as a means of investigating the relationship between people with learning disabilities and self-injury. One life story might appear to be of limited value in this regard; however, it is argued that it might not only be of use in demonstrating the development of an isolated self-injuring career, but there may also be insights into its entrenchment in the lives of others. The telling of one story might serve as a filter, through which the interventions of medication, mechanical restraint and behaviourism can be observed over time. Furthermore, studying one life in some detail might be used to illustrate broader concerns about the context of the transition from institutional to community care. The restrictions of such an approach are acknowledged, particularly in the telling of a story where the main character's words cannot be heard, but maybe that is also the point of undertaking research about those at the margins of society.
16492259	The current review focuses on the construct of psychopathy, conceptualized as a clinical entity that is fundamentally distinct from a heterogeneous collection of syndromes encompassed by the term 'conduct disorder'. We will provide an account of the development of psychopathy at multiple levels: ultimate causal (the genetic or social primary cause), molecular, neural, cognitive and behavioral. The following main claims will be made: (1) that there is a stronger genetic as opposed to social ultimate cause to this disorder. The types of social causes proposed (e.g., childhood sexual/physical abuse) should elevate emotional responsiveness, not lead to the specific form of reduced responsiveness seen in psychopathy; (2) The genetic influence leads to the emotional dysfunction that is the core of psychopathy; (3) The genetic influence at the molecular level remains unknown. However, it appears to impact the functional integrity of the amygdala and orbital/ventrolateral frontal cortex (and possibly additional systems); (4) Disruption within these two neural systems leads to impairment in the ability to form stimulus-reinforcement associations and to alter stimulus-response associations as a function of contingency change. These impairments disrupt the impact of standard socialization techniques and increase the risk for frustration-induced reactive aggression respectively.
16488022	The aim of the study was to identify risk factors in subjects at risk for depressive disorders and controls.In a 6.5 year follow-up study we examined the effects of personality (neuroticism, frustration intolerance, rigidity, melancholic type), adverse life events and chronic difficulties on depressive symptoms in 89 high-risk subjects (HRS, siblings and children of patients suffering from an affective disorder), without any mental illness at wave 1 (T1), and 49 controls without any personal and family history of psychiatric disorder at T1. To this end, regression analysis and path analysis using a structural equation model (only for HRS) were performed.	Risk factors for depressive symptoms at wave 2 (T2) in HRS comprised acute adverse life events, frustration intolerance (T1) and depressive symptoms (T1). Risk factors for depressive symptoms in controls included chronic difficulties, neuroticism and rigidity. HRS had less stressful life events and the same risk for chronic difficulties, but perceived adverse events as more stressful.	The sample size of the control group is too small for identifying slight effects.	Our results indicate that the impact on the emergence of depressive symptoms of various risk factors is different in high-risk subjects and controls. High-risk subjects are more sensitive to the depressogenic effects of acute stress and thus avoid potential stressful changes in their life to a higher extent. On the other hand, the influence of persistent factors such as personality traits (neuroticism, rigidity) and chronic difficulties on subsequent depressive symptoms was less pronounced in HRS as compared to controls.	
16483889	We review here aggression-related human psychopathologies and propose that human aggressiveness is mainly due to three major factors: (i) brain dysfunction affecting aggression-controlling brain centers (e.g. in certain types of brain lesions, epilepsy, Alzheimer disease, etc.); (ii) hypoarousal associated with chronically low plasma glucocorticoids, which foster violence by diminishing emotional barriers that limit such behaviors (e.g. in conduct disorder and antisocial personality disorder); (iii) hyperarousal which leads to irritability and outbursts (e.g. in depression, intermittent explosive disorder, chronic fatigue, etc.). Different disorders are associated with different types of aggressiveness; e.g. hypoarousal is often associated with instrumental aggression, whereas hyperarousal is associated with uncontrollable outbursts. Many psychological disorders have been simulated in laboratory models, which were used to assess aggressiveness. Little effort was invested, however, in assessing the abnormal dimension of such aggressiveness. We present here three models that appear especially suitable to assess abnormal aspects of rodent aggression: (i) abnormal attack targeting (head, throat, and belly) that is induced by hypoarousal in rats and models violence in hypoarousal-driven human aggression (ii) 'escalated' aggression (increased aggressive response due to frustration or instigation), which models irritability and hyperarousal-driven aggressiveness; and (iii) context-independent attacks induced by hypothalamic stimulation or genetic manipulations. These three models address different aspects of abnormal aggressiveness, and can become extremely useful in three areas: in evaluating and assessing models of human psychopathologies, in studying transgenic animals, and in developing new treatment strategies. Research based on these or similar models do not address aggressiveness in quantitative terms, but follows the development of abnormal aspects, and the possibilities of their specific treatment.
16466477	The aim of the study was to reach a more profound understanding, through looking at nurses' working situation, of those factors that influence how nurses are able to work together with family members of older people living in nursing homes or similar facilities.Working with the care of older people as a Registered Nurse provides a varied job with many challenges. Nurses have to co-operate with family members of those in community health care. Co-operation is important and necessary for all involved.	Nurses working in elder care in a geographically defined area received a questionnaire with three open-ended questions, on the difficulties and/or problems involved with working together with family members, and the positive or negative aspects of this co-operation.	Analysis was carried out using the latent content analysis method.	Three themes, problems within the system, interaction with families and caring in nursing work, are presented with categories and their subcategories. The nurses wanted their superior to be a nurse so that their working situation would be better understood. Appreciation from their superior and family members was also a very important part of their work as nurses in community health care. The frequent changes and the lack of time in the work of elder care often put nurses under considerable psychological pressure. For the most part family members are a resource for the elder, but sometimes they will avoid contact, which will make co-operating difficult.	Registered Nurses and family members are dependent on each other in their care of the elder. Relevance to clinical practice. More attention should be paid to the working situation of Registered Nurses in community health care, and their ability to work together with family members of older people.	
16460887	Humans can predict with some accuracy whether or not they know the correct answer to a question before responding. In some cases the capacity to make such predictions depends on memory awareness, the ability to introspectively discriminate between knowing and not knowing. In this unplanned retrospective analysis of video taped behavior we asked whether a rhesus monkey's apparent frustration predicted his accuracy in a matching-to-sample task on a trial-by-trial basis. The monkey was likely to aggressively strike the computer touchscreen when committing errors, whereas he generally touched the screen more gently when selecting the correct stimulus. This difference in behavior, which occurred before the monkey received feedback on the accuracy of his choice, suggests that he knew whether or not he remembered the correct response.
16460417	The purpose of this study was to explore the lived experience of becoming diagnosed with Lyme disease.A qualitative, phenomenological study was conducted to investigate the experience of becoming diagnosed with Lyme disease.	A purposive sample of 10 participants diagnosed with Lyme disease were interviewed and tape-recorded. Data saturation guided the size of the sample.	The interviews were transcribed verbatim. Key words or phrases were extracted and clustered; clusters were interpreted into themes. Analyzed data were confirmed with the participants for trustworthiness and reliability.	Six themes emerged from the interviews. Participants expressed feelings of frustration during the long road to diagnosis. They endured multiple diagnostic tests and were seen by numerous health care providers. Participants voiced financial stress. They expressed the need for self-advocacy and felt validation when a diagnosis was made. Despite the chronicity of their illness, the participants voiced a sense of hopefulness for their future.	A deep understanding of the lived experience of becoming diagnosed with Lyme disease allows for nurses to prioritize health care interventions and strategize ways to implement quality improvement systems as clients enter the health care environment.	
16452986	The vasopressin 1b receptor antagonist, SSR149415, and the corticotropin-releasing factor 1 receptor antagonist, SSR125543, are orally active non-peptidic compounds with anxiolytic- and antidepressant-like activities in animal models. Presently, SSR149415 and SSR125543 were evaluated in a differential reinforcement of low-rate 72 s (DRL-72 s) schedule, a procedure known to respond differentially to antidepressants and anxiolytics. Male Wistar rats were trained to lever-press for food reinforcement, but only lever-presses occurring after a 72 s delay were reinforced; otherwise, presses were not rewarded, and the timer was reset to 0 s. The selective serotonin reuptake inhibitor, fluoxetine, and the benzodiazepine anxiolytic, diazepam, were tested in parallel. SSR149415 (10-30 mg/kg, i.p.) and SSR125543 (30 mg/kg, i.p.) increased the percentage of responses emitted in the inter-response time (IRT) bin (49-96 s), which resulted in a greater number of reinforced presses. Both compounds shifted the frequency distribution of responses toward longer IRT durations, with a preservation of the bell shape of the IRT distribution curve. Fluoxetine (10 mg/kg, i.p.) had an effect on DRL-72 s similar to that of SSR149415 and SSR125543. By contrast, diazepam increased the number of responses in IRT bin (0-12 s), and the IRT distribution curve was shifted toward shorter IRT durations and flattened. In summary, these results show that SSR149415 and SSR125543 displayed antidepressant-like activity in a DRL-72 s schedule in rat, confirming their therapeutic potential for the treatment of pathological states induced by chronic frustration such as depression.
16434220	Biopsychosocial management of non-specific back pain in general practice has been problematical, with frequent inappropriate referral for imaging and secondary care interventions and lack of self-confidence in the ability to provide evidence-based care.To examine GP attitudes to managing back pain as a biopsychosocial problem in order to inform future educational strategies that may improve practice.	Twenty-one GPs from separate practices within the Dorset and Somerset Strategic Health Authority area (UK) participated in telephone interviews leading to the development of vignettes to refine the theoretical framework for subsequent focus group interviews about evidence-based back pain management. Transcripts were analysed thematically.	There were 5 main emergent themes. These were generally negative and dominated by concerns about doctor-patient interaction. They included feelings of frustration, mismatches of perceptions in the doctor-patient relationship, problems in relation to time, challenges and discord between stakeholders in the process (for example, over sickness certification) and a lack of resources for education, awareness and local services to refer to. Psychosocial aspects of the actual care process were rarely raised. Participants favoured education that is multidisciplinary, in small group format and involves the participation of patients.	This study illustrates the difficulties that GPs may have in applying the relevant evidence for the successful management of back pain. A desire to avoid conflict in the relationship with patients explained much of the problem of implementing evidence in general practice. This indicates a need for insightful educational strategies that involve active GP participation.	
16430329	Circumplex models have organized interpersonal behavior along 2 orthogonal dimensions--communion (which emphasizes connection between people) and agency (which emphasizes one person's influence over the other). However, many empirical studies have disconfirmed certain predictions from these models. We therefore revised the model in 4 ways that highlight interpersonal motives. In our revision: (a) the negative pole of communion is indifference, not hostility; (b) a given behavior invites (not evokes) a desired reaction from the partner; (c) the complement of a behavior is a reaction that would satisfy the motive behind that behavior; (d) noncomplementary reactions induce negative affect. If the motive is unclear, the meaning of the behavior is ambiguous. This ambiguity helps explain failures in social support, miscommunications in everyday life, and features of most personality disorders. The model emphasizes measurable individual differences: Reactions that are complementary for one person need not be complementary for another.
16426164	To determine whether therapeutic riding resulted in higher levels of stress or frustration for horses than did recreational riding and whether therapeutic riding with at-risk individuals was more stressful for the horses than was therapeutic riding with individuals with physical or emotional handicaps.Observational study.	14 horses in a therapeutic riding program.	An ethogram of equine behaviors was created, and horses were observed while ridden by 5 groups of riders (recreational riders, physically handicapped riders, psychologically handicapped riders, at risk children, and special education children). Number of stress-related behaviors (ears pinned back, head raised, head turned, head tossed, head shaken, head down, and defecation) was compared among groups.	No significant differences in mean number of stress-related behaviors were found when horses were ridden by recreational riders, physically handicapped riders, psychologically handicapped riders, or special education children. However, mean number of stress-related behaviors was significantly higher when horses were ridden by the at-risk children.	Results suggest that for horses in a therapeutic riding program, being ridden by physically or psychologically handicapped individuals is no more stressful for the horses than is being ridden in the same setting by recreational riders. However, at-risk children caused more stress to the horses, suggesting that the time horses are ridden by at-risk children should be limited both daily and weekly.	
16418608	To understand patterns of decision making among families presenting to a pediatric emergency department (ED) for nonacute care and to understand pediatric ED staff responses.Cross-sectional qualitative study using in-depth interviews, direct observations, and nonidentifying demographic data.	Eleven percent of visits made during the study period were identified as nonacute. All were made by families from low-income areas. Three main themes emerged: (1) most families had been referred by their primary care providers; (2) the complexity of living in low-income areas makes the ED a choice of convenience for these stressed families; and (3) mistrust of primary health services was not identified by our respondents as a motivator for ED utilization, in contrast with other published data. Two themes emerged from ED staff: (1) actual nonurgent visit rates were lower than staff estimates; and (2) these visits produced frustration among staff members, although their degrees of insight and understanding of factors motivating these visits were variable.	In this setting, nonacute visits occurred with lower than perceived frequency and caused disproportionate frustration among staff and families. These visits appear to be driven more by consequences of system design and structure than by family members' decision making. Mistrust of primary care services was not a strong family decision-making factor; the study's setting may have limited its ability to capture such data. Recommended system changes to lower barriers to primary care include expanded office hours, subsidized staffing for offices in medically underserved areas, and lowering barriers to sick care.	
16412444	Peer tutoring involves students helping each other to learn. It places teaching and learning commitments and responsibilities on students. Considerable evidence supports the positive effects of peer tutoring, including cognitive gains, improved communication, self-confidence, and social support among students. Peer tutors are also said to better understand the learning problems of fellow peer learners than teachers do.This study intended to facilitate the development of 'cooperative learning' among nursing students through a peer-tutoring scheme.	Undergraduate nursing students were invited to join a peer-tutoring scheme. Fourteen students studying year 3 were recruited to serve as peer tutors and 16 students from year 2 of the same program participated as tutees. Peer tutors attended a training workshop and received a guideline for peer-tutoring activities. They were to provide a total of '10 weekly tutoring sessions throughout the semester on a one-to-one basis for their tutees. Focus groups and individual interviews were conducted in the middle and at the end of the semester to evaluate the students' experiences in the tutoring process.	Content analysis of the interview scripts identified that students had both positive and negative experiences from the peer tutoring, but that positive experiences predominated. Positive aspects included enhancement of learning skills/intellectual gains and personal growth. Negative experiences stemmed mainly from frustrations in dealing with mismatched learning styles between tutors and tutees, and the required time commitment.	Both tutors and tutees benefited to some extent from this peer-tutoring process. Further studies in an education program for students in all years should be implemented to examine peer-tutoring effects. Implementation of peer tutoring should address the frustrations and difficulties encountered by the students to facilitate better outcomes.	
16405222	Utilization review (UR) is a strategy used by the managed care industry to monitor and control utilization of health care resources. The concurrent UR process requires that hospital staff report clinical information to payers, who either certify or deny reimbursement. Conflicts may arise when hospital staff disagree with denial decisions. The authors analyzed the various responses of a medical center UR staff to payer denials and found that although denials were not frequent, they were perceived negatively by hospital staff. Improving and standardizing communication among providers, payers, and patients is one means of reducing conflict and frustration in the event of reimbursement denial.
16403246	The aim of this study was to identify key aspects of the impact of cognitive impairment on patients with mild cognitive impairment (MCI) and mild probable Alzheimer disease (AD) and their informants, and identify overlap and differences between the groups.Structured focus group discussions were conducted with MCI patients, AD patients, MCI informants, and AD informants. Participants were recruited from memory clinics in the U.K. and the U.S.A. A total of 20 AD and 20 MCI patients and 16 AD and 11 MCI informants participated. Sessions were content reviewed to identify key impacts of cognitive impairment; results were compared across diagnostic groups and for patients and informants.	Seven key themes emerged: uncertainty of diagnosis, skill loss, change in social and family roles, embarrassment and shame, emotionality, insight, and burden. Patients were able to discuss the impact of cognitive impairment on their lives and reported frustration with recognized memory problems, diminished self-confidence, fear of embarrassment, concerns about changing family roles due to cognitive impairment, and anxiety. Informants reported more symptoms and more impairment than did patients and indicated increased dependence on others among patients.	MCI and mild AD exert substantial burden on patients' lives and the lives of those close to them.	
16399686	Execution of higher cortical functions requires inhibitory control to restrain habitual responses and meet changing task demands. We used functional magnetic resonance imaging to show the neural correlates of response inhibition during a stop-signal task. The task has a frequent "go" stimulus to set up a pre-potent response tendency and a less frequent "stop" signal for subjects to withhold their response. We contrasted brain activation between successful and failed inhibition for individual subjects and compared groups of subjects with short and long stop-signal reaction times. The two groups of subjects did not differ in their inhibition failure rates or the extent of signal monitoring, error monitoring, or task-associated frustration ratings. The results showed that short stop-signal reaction time or more efficient response inhibition was associated with greater activation in the superior medial and precentral frontal cortices. Moreover, activation of these inhibitory motor areas correlated negatively with stop-signal reaction time. These brain regions may represent the neural substrata of response inhibition independent of other cognitive and affective functions.
16396438	Women are often faced with the primary role of providing care for individuals with Alzheimer 's disease (AD). This study explored women caregiver's perceptions of caregiving through the use of Cognitive Mapping (CM), a qualitative research method. Volunteers were recruited from caregiver support groups to construct maps of their experience of "caregiving for someone with AD. " Maps were analyzed for commonly identified concepts and relationships. Twelve participants identified 280 concepts, 206 of which were unduplicated. Concepts were collapsed into 17 categories; the largest concepts being "friends and family," "sad," "frustration," and "time." The maps produced by the sample in this study were unique, providing evidence that the experience of AD caregiving varies significantly among caregivers. CM appears to be effective for identifying caregiver stressors and needed support services.
16396075	In three experiments, we studied the consequences of ejaculation upon the frustrative or contrast response of male rats exposed to reward downshift situations (i.e., surprising changes from 32% to 4% sucrose solutions). Similar to what has been found after treatment with anxiolytic agents, consummatory suppression was partially reversed by previous ejaculations in a second postshift trial (Experiments 2 and 3), such a result not having been obtained in a first postshift trial (Experiment 1). Moreover, the effect of ejaculations upon males' behavior during a second postshift trial was transitory, disappearing when assessed during the third and fourth postshift trials (Experiment 3). These results are in accordance with both Amsel's (1958, 1992) frustration theory and Flaherty's (1996) multistage hypothesis of successive negative contrast; the diverse factors that are known to modulate contrast effects are considered, including an interpretation of the present data in terms of the anxiolytic-like effect of the ejaculation.
16395848	Mental health is not considered only as absence of mental disorders, but rather as the achievement of higher standards of available psychical potentials. True devotion and obedience to The God give the one a huge and incredible strength, constant source of spiritual emotional and moral energy, which is of help in resisting destructive and slavery attacks of the environment and its materialistic-consuming tendencies, as well as social and mental disruption. According to the opinion of numerous worldwide recognized mental health experts, humankind of today is confronted with a number of problems, which are the consequence of spiritual and moral-ethical degradation of human being. Therefore, religiosity became the field of interest of mental health researchers. The results of new studies undoubtedly indicate beneficial effects of religion on life and mental health in humans. Religiosity reduces tendencies for risky behaviour, impulsive reactions and aggression; it corrects tendencies towards psychopathic and paranoid behaviour, reduces converse, depressive and schizoid tendency, and provides successful overcome of emotional conflicts. In comparison to low-religious adolescents, the factors such as inner conflicts, frustration, fear, anxiety, psychological trauma, low self-esteem, unbalance of psychical homeostasis, emotional instability, and negative psychical energy are less present in highly religious adolescents and neutralized in a healthier and more efficient way. Beneficial impact of religion on mental health derives from precise cognitive-behavioural patterns, which provide a clear life orientation, solid basis and safe frames for personality development, assuring human to be continually on the way to achieve its own generic essence and reach its own maturity and self-actualization.
16390307	This study tests a model of children's emotion regulation (ER) as a moderator of the link between maternal depression and child internalizing problems. Participants were 78 children (ages 4 to 7), including 45 children of mothers with a history of childhood-onset depression (COD) and 33 children of mothers who had never been depressed. ER was assessed observationally during a laboratory mood induction. ER behaviors were empirically reduced into 3 categories: (a) negative focus on delay, (b) positive reward anticipation, and (c) behavioral distraction. Linear mixed models indicated that positive reward anticipation moderated the effects of maternal COD on children's internalizing problems, particularly if mothers had current depressive symptoms. Findings suggest that generating positive affect in the face of a potential frustration may be a protective ER strategy for children at risk for depression.
16382848	The authors examine the crime of stalking, including the cognitive traits, emotional reactions, attachment pathology, violence patterns and sex differences of samples of stalking offenders. They focus on two common types of stalkers: 1) those who sustain pursuit of a former sexual intimate who has rejected them; and 2) those who pursue a stranger or acquaintance who has failed to return the stalker's romantic overtures. The authors discuss data from neuroimaging (fMRI) studies of romantic love which suggest that these forms of stalking may be associated with heightened activity of subcortical dopaminergic pathways of the "Reward System" of the brain, perhaps in combination with low activity of central serotonin. The authors propose that this set of neural correlates may contribute to the stalker's focused attention, increased energy, following behaviors, obsessive thinking about and impulsivity directed toward the victim. To further explore the neural systems associated with stalking behavior, they also discuss several biopsychological phenomena associated with romantic rejection, including the "protest response," "frustration attraction," "abandonment rage" and "mate guarding." They illustrate the parallels between stalking and addiction. They conclude that stalking may be associated with a specific set of biological components and they offer suggestions for further research into this pathological emotional/motivational state.

16364448	Delay intolerance/aversion is one amongst a number of candidate neuropsychological endophenotypes for ADHD. Pilot data suggest that, because of potential ceiling effects, simple choice measures of delay tolerance used for children are probably not appropriate for adolescents and adults. The Delay Frustration Task (DeFT) is a new measure of delay intolerance, designed to be used in a similar form with adolescents and adults as well as children. In it delay frustration is indexed as the number and duration of responses made on a response key during a series of unpredictable and unsignalled delay periods, which interrupt the completion of a simple computer-based tests. The aim of this study was to provide preliminary data on the applicability of the task in a sample of young adults. The DeFT was administered to 49 male and female undergraduate students selected from a normal population-base. Their mean age was 23.14 (S.D.=1.54). Three measures of delay frustration were recorded across time intervals during the response window; the number of responses, their duration and their combined product (total time button was pressed) was calculated for each second interval bin during the post-response delay period. The AARS and HADS were used as screening questionnaires for ADHD and anxiety behaviour, respectively. The results indicated that young adults with high-ADHD symptoms scores pressed the button more than those with low ADHD scores during the post-response delay condition. While both groups increased responding across time within intervals this was significantly more marked in the high-ADHD symptom group. These effects became more pronounced when anxiety was controlled. Young adults with high-ADHD symptoms appear to be more sensitive to the imposition of unscheduled and unsignalled delay during a simple maths test. DeFT may provide a useful index of delay tolerance in young adults with ADHD. Future research needs to examine DeFT performance in different age groups and in clinical and non-clinical populations.
16350901	Research shows that stable leadership provided by a nursing home's director of nursing (DON) is the foundation of good quality. Conversely, a high DON turnover often results in a quality meltdown at all levels. A recent study, seeking to uncover the root causes of DON turnover, looked at 103 DONs working in Virginia nursing homes. Although DONs overwhelming affirmed their role and agreed that they were overall satisfied, a majority said they would not choose to be a DON again or recommend the role to others. Not surprisingly, low staff retention rates, mounting administrative responsibilities, growing regulatory and legal constraints, and unrealistic time commitments were the leading causes of frustration. Given less time to spend on the responsibilities that lie at the very heart of their mission-direct-care and clinical issues, quality improvement, family relations, staff mentoring and professional development-DONS are likely to experience burnout unless long-term care owners and managers reconfigure their role.
16340105	The aim of this study was to explore the changes in work-related abilities of members after attending the Clubhouse program for 12 weeks. The extent to which the changes would contribute to members' performance on simulated work tasks was also investigated. A total of 39 people with mental illnesses, primarily schizophrenia, attending Phoenix Clubhouse participated in the study. Seventeen were newly recruited members to the Clubhouse. The other 22, who served as the control group, were existing members who had been attending the Clubhouse for more than three months. All the participants were assessed by the McCarron-dial System (Observational Emotional Inventory-Revised, McCarron Assessment of Neuromuscular Development), Cognistat, Chinese Work Personality Profile, WHO Disability Assessment Schedule and WHOQOL-Bref-HK at the baseline and 12 weeks after attending the Clubhouse program. They were required to complete a set of simulated work tasks after 12 weeks. New members showed significant improvement in emotional-coping abilities (impulsive-frustration and depression-withdrawal) and work personality (task orientation, social skills, and team work) after attending the Clubhouse program for 12 weeks. The increase in emotional-coping skills (depression-withdrawal) was found to contribute to better performance on typing tasks, whereas emotional coping (anxiety) contributed to better performance on cleansing tasks. Three months' participation in the Clubhouse program appears to have positive effects on emotional-coping abilities and work personality. The emotional-coping abilities were found to predict good performance in simulated clerical and maintenance jobs. Recommendations and suggestions for further research are discussed.
16340100	Mild to severe cognitive impairment and depression are common among patients with Parkinson's disease (PD) and play a significant role in disability. Effective treatment planning requires a holistic assessment of cognitive and emotional difficulties. A brief neuropsychological protocol was developed to examine the pattern of cognitive and emotional functioning of patients with idiopathic PD. Data was retrospectively analyzed for the first 61 male veterans who were evaluated at an interdisciplinary movement disorders clinic. The most frequently observed cognitive impairments were in the areas of auditory learning, delayed recall memory, and visual motor functioning that required alternating tracking and sequencing. Executive dysfunction was marked by the inability of 60% of the sample to complete the Wisconsin Card Sorting Test, a measure of non-verbal reasoning with a cognitive flexibility component. Clinical interviews revealed that 28% of the sample met DSM-IV Criterion A for a Major Depressive Episode. The findings suggested that this brief neuropsychological protocol established cognitive and emotional profiles of patients with PD, consistent with other samples of patients with Parkinson's Disease. Clinical uses of the brief neuropsychological protocol are detailed. Selection of an alternative executive function measure with a lower "floor" that minimizes patient fatigue and frustration is recommended.
16328077	The author attempts to apply the psychoanalytic concept of "prolonged adolescence" to two literary works, both of which are embedded in England's postwar social and political climate. The discussion of John Wain's Hurry on Down ([1953] 1979) and John Osborne's Look Back in Anger ([1956] 1989), by necessity, involves a look at those factors responsible for shaping the cultural "mood" in those days. However, the author's primary concern lies with how two particular (fictional) individuals, or antiheroes, deal with the frustration, which, although generally felt among contemporary academia, in their cases seems to hide a much deeper layer of mental insecurity and instability. In fact, we come to feel that the characters have not achieved a proper sense of identity ("self") and are, from the point of view of maturity, delayed and, hence, "unfitted" to cope adequately with the external world. Having long achieved formal adulthood, they seem to have gotten "stuck" somewhere along the passage of growing up. Essential papers by Sigmund Freud and his daughter Anna, as well as a very early paper on the topic by Siegfried Bernfeld, are, among others, taken into account, as is the profound research done by Peter Blos on the subject in question.
16310766	This article sets out to provide a general background to the study of aggression in the social sciences, with a particular focus on its link to collective violence. While the study of what happens in the human brain appears to be already highly complex, analysis of violent behavior appears to be even more intricate. A deductive system in the sense of a general and clear system of propositions logically connected to one another is not feasible, principally because contrary to the natural sciences there are no verities but merely "stylized facts." One of these concerns the setting of human aggression in the light of frustration, as argued in the frustration-aggression hypothesis developed by Dollard et al. in 1939. Apart from conceiving of aggression as a pure human instinct, it may also be seen as externally driven, while a third possibility concerns culturally "learned" aggression. Proof of the latter is that the strongest correlation appears to be that between current violence and previous manifestations thereof. Attention is paid to the way in which Gurr has rooted his relative deprivation theory on causes of collective violence among peoples in mechanisms of frustration and aggression. That theory is taken a bit further in terms of "perceived acquirement failure," which appears to be highly connected to the role of the state. Based on certain observations by Hannah Arendt, the argument then proceeds to violence as a manifestation of powerlessness. Finally, this leads to a discussion of justice as a crucial factor in what Durkheim used to call a "right to conflict." In this way, human aggression is placed in a broad socio-economic context.
16310139	The purpose of this study was to identify the comprehensive picture of palliative care in the home, as experienced by the people involved. The study is a secondary analysis of three phenomenological studies including six cancer patients, six next of kin and six district nurses. Data were collected in qualitative interviews using an interview guide. The interviews were tape-recorded and transcribed verbatim. In this secondary analysis, data were analysed by hermeneutic analysis guided by Gadamer. The guiding questions during the reading were: Is there an advantage receiving palliative care at home? Is there a disadvantage receiving palliative care at home? The findings indicate that the advantages of palliative care at home is; striving for normal life, including the care in the home composed of physical care and emotional/mental care. Striving for normal life also includes emotional feelings, safety and resources and policies which regulates this activity. Disadvantages of palliative care at home are commitment, composed of adaptation and extra work, and demands, composed of frustration and uncertainty. If the people involved are to be able to manage the situation and optimize living while dying, there must be support and resources facilitating the situation.
16300695	We investigated the links between familial loading, preadolescent temperament, and internalizing and externalizing problems in adolescence, hereby distinguishing effects on maladjustment in general versus dimension-specific effects on either internalizing or externalizing problems.In a population-based sample of 2230 preadolescents (10-11 years) familial loading (parental lifetime psychopathology) and offspring temperament were assessed at baseline by parent report, and offspring psychopathology at 2.5-years follow-up by self-report, teacher report and parent report. We used purified measures of temperament and psychopathology and partialled out shared variance between internalizing and externalizing problems.	Familial loading of internalizing psychopathology predicted offspring internalizing but not externalizing problems, whereas familial loading of externalizing psychopathology predicted offspring externalizing but not internalizing problems. Both familial loadings were associated with Frustration, low Effortful Control, and Fear. Frustration acted as a general risk factor predicting severity of maladjustment; low Effortful Control and Fear acted as dimension-specific risk factors that predicted a particular type of psychopathology; whereas Shyness, High-Intensity Pleasure, and Affiliation acted as direction markers that steered the conditional probability of internalizing versus externalizing problems, in the event of maladjustment. Temperament traits mediated one-third of the association between familial loading and psychopathology. Findings were robust across different composite measures of psychopathology, and applied to girls as well as boys.	With regard to familial loading and temperament, it is important to distinguish general risk factors (Frustration) from dimension-specific risk factors (familial loadings, Effortful Control, Fear), and direction markers that act as pathoplastic factors (Shyness, High-Intensity Pleasure, Affiliation) from both types of risk factors. About one-third of familial loading effects on psychopathology in early adolescence are mediated by temperament.	
16299874	To describe cognitive and behavioural characteristics in a group of blind children with bilateral optic nerve hypoplasia (ONH).Data from records, parents, teachers, and repeated developmental assessments of 13 blind children with ONH born in 1988-1998 were analysed. All children had neuroimaging and/or hormonal evidence of midline malformations. They were all blind and able to communicate with speech.	Severe mood swings and temper tantrums were common, especially during the first years of life. Later in life, sluggish tempo, low frustration tolerance and a narrow range of interests were common. Autism had been diagnosed in 6/13 children, autistic-like condition (ALC) was found in another three. The behaviour of the remaining four children was not within the autism spectrum. Eight children had cognitive capacities within the normal or near-normal range; five had mental retardation. Autism/ALC was found in all cognitive subgroups. All children exhibited fluent speech and, of these, 12 had started to talk at the expected age, but had clear deficiencies in communicative ability.	These children had a common pattern of behavioural characteristics including autism spectrum disorders independent of intellectual capacities.	
16298132	Patients on intensive care units (ICU) have difficulty with communication [Menzel LK. Factors related to the emotional responses of intubated patients to being unable to speak. Heart Lung 1998; 27(4):245-52]. Feelings of anger and low mood have been reported, which can lead to reduced participation in rehabilitation. For members of the multidisciplinary team breakdown in communication with patients may be frustrating and related to a limited knowledge of strategies and resources to facilitate communication. The NHS Modernisation Agency Critical Care Programme (2002) identified speech and language therapists (SLTs) as having a role in the assessment and management of patients with communication difficulties on ICU. This multi-centre pilot study aimed to investigate staff and patient perceptions and experiences of communication within ICUs. A short questionnaire was devised using semi-structured interviews to collect quantitative and qualitative information. Patterns were identified including insights into SLT service delivery and possible directions for future research and development.
16290063	The Paced Auditory Serial Addition Test (PASAT) was developed to assess the effects of traumatic brain injury (TBI) on cognitive functioning. Subsequent research has shown that the PASAT has clinical utility in detecting impairments in cognitive processing in patients with a wide variety of neuropsychological syndromes. Gronwall and Sampson (1974) originally assumed the PASAT measured speed of information processing. However, the PASAT is now recognized as a measure of multiple functional domains because it requires the successful completion of a variety of cognitive functions, primarily those related to attention. While the PASAT has demonstrated good psychometric properties such as high levels of internal consistency and test-retest reliability, several issues should be considered when administering and interpreting this test. For example, test-retest scores show that the PASAT is extremely susceptible to practice effects. The PASAT is also negatively affected by increasing age, decreasing IQ, and low math ability. Administration of the PASAT creates an undue amount of anxiety and frustration in participants which affects their performance on this and other neuropsychological tests, and may subsequently increase their reluctance to return for follow up testing. Demands for rapid responding place individuals with speech or language impairment at a distinct disadvantage, as it does for those who naturally speak slowly for cultural or geographic reasons. In conclusion, the PASAT represents a reliable test that has legitimate but restricted clinical applications. A low score on the PASAT may not necessarily indicate or confirm the presence of neurological pathology. The PASAT is a highly sensitive, non-specific test and as such, care must be taken to identify the reasons underlying any low score before interpreting it as clinically significant.

16268288	The society's image about the nurses is permeated of stereotypes that include figures like saints, prostitutes, witches, heroines and are related to the function of assisting doctors and to a lack of social life. Moreover, the image that the nurses have of themselves and of their work is negative, causing frustration for the lack of autonomy found on the professional reality. Seeking for a better understanding of this problem, a literature review was proceeded, aiming to characterize and analyze the nurse's image. The national scientific production is considered small on the subject. Conclusions indicate that stereotypes negatively influence nursing practice and that in Nursing history it is found many reasons for the existing distortions.
16265842	Although tics are considered the hallmark of Tourette syndrome, arguably tics may not be the only or primary presenting symptom. For many children diagnosed with Tourette syndrome irritability, frustration intolerance, hyperactivity, inattention, ritual behavior or other difficulties may have been present a number of years before the appearance of tics. Children with Tourette syndrome are often highly co-morbid with attention deficit-hyperactivity disorder, obsessive compulsive symptoms, and other related behavioral problems that should be detected and treated effectively. Therefore tics should not be the sole indicator or receive over emphasis in the detection and treatment of Tourette syndrome.
16263201	This research examined the experience of Amyotrophic Lateral Sclerosis (ALS) patients who depend on an invasive mechanical ventilator in Japan. We investigated their difficulties in expressing their needs, their desires and wishes, and their sources of support and happiness. We examined the relationship between these factors and patient demographics, and hope as an indicator of successful adaptation to the illness experience (assessed by the Herth Hope Index). Interview results guided the formation of an anonymous questionnaire distributed to patients by mail. We interviewed 27 patients and their families and surveyed 157 respondents with a questionnaire. Most patients experienced multiple categories of difficulties, which correlated with reduced hope. More severe physical symptoms correlated with more emotional and social difficulties. Notable findings included a high prevalence of unalleviated pain, fear or experience of ventilator difficulties, and fear of burdening others. Having more sources of psychosocial support and happiness was associated with greater hope. Living at home was associated with fewer social difficulties. No patients claimed additional sources of support without claiming family or professional caregiver support, suggesting their mediation may be crucial in maintaining other social connections. Users of computer communication reported more sources of support and happiness and less frustration from difficulty expressing themselves. The most common reported desires, following a cure for ALS, related to the happiness of the patients' families, and a desire not to burden them. We also found that invasive mechanical ventilation (IMV) had been initiated emergently in 30.1% of patients without patient or family consent. Our results provide an insight into the world of this challenged population, elucidating the difficulties they face, and clarifying the role of support and other factors in maintaining hope. We identify concrete areas to which increased attention should be directed in patient care.
16262988	Empathic concern for others is an essential motive for challenges of self-regulation at all developmental stages. A child who never develops the capacity for empathic concern may become an ineffective parent, such that developmental psychopathology propagates across generations. We draw on evidence and theory by Panksepp and associates that indicates that infant-mother bonding is mediated by opiate mechanisms. We review the neural systems of pain perception and find these are closely aligned with those for attentional and cognitive self-regulation. Analysis of the limbic and neocortical representations for interpersonal reasoning suggests there are important contributions from visceral, affective, and somatic and cognitive levels. We draw on modern learning theory to propose a critical role for frustration training in development to allow the child to achieve the capacity for tolerating psychological pain that allows effective empathic concern in later relationships.
16252800	1. The characteristics of people with developmental disabilities, such as poor judgment, low frustration tolerance, lack of impulse control, and naivete, compounded by the symptoms of a mental illness, contribute to their susceptibility to engage in problematic or criminal behaviors. 2. Nurses should recognize that conducting risk assessments for this population may take time and could involve modifying risk assessments to the individuals' abilities. 3. Providing appropriate care for this vulnerable population requires a long-term, interdisciplinary approach and quality community support services
16245478	The aim of the study was to determine whether physicians in a private sector setting verbally abuse nurses, and to what extent. A review of the literature showed that verbal abuse by physicians accounts for the highest incidence of aggression towards nurses in health care, and that it is strongly related to turnover rates. It has also been reported in recent studies that within the context of verbally abusive episodes, patient care, work productivity, morale and job satisfaction have been negatively affected. Of the 120 questionnaires that were distributed among registered and enrolled nurses, 83 were returned in time to be used, which was a response rate of 69%. This response rate is consistent with previous studies and is exactly the same as for a study that was done in Turkey (Uzun, 2003:81). The questionnaire used was one that has been adapted from the Verbal Abuse Scale developed by Manderino and Berkey (1997:50) and the Revised Conflict Tactics Scale (CTS 2) as described by Little (1999:24), and was in the form of a 4-point Likert-scale with one open ended question. The results showed that 79% of the nurses admitted that verbal abuse was taking place. Forms of direct verbal abuse included 81% that felt they were criticised unjustly, 76% that were screamed at in front of others, and 81% that felt physicians vented their frustration on them. The results obtained in the study were consistent with previous studies done elsewhere and it indicated that nurses still experience high levels of verbal abuse in the workplace.
16244504	Anaemia is the most common haematological abnormality encountered by cancer patients. A large European survey of cancer patients (n = 15,367) reported that 67% had anaemia at some point during the survey, and that over 60% of these patients did not receive any treatment for their anaemia. Two other surveys (the FATIGUE surveys) showed that over 75% of cancer patients experienced fatigue at least monthly, with over 30% reporting this symptom on a daily basis. Significantly, patients regarded fatigue as having a greater negative impact on their daily lives than many other cancer- or treatment-related complications, with important emotional and mental consequences including lack of self-motivation, sadness, frustration, and mental exhaustion. Indeed, fatigue was considered so debilitating, 12% of patients felt their quality of life (QoL) was so reduced that they did not wish to continue living. Anaemia is also recognised as an independent predictor of poor prognosis in cancer patients. A systematic review evaluating survival showed a 65% overall increase in the risk of mortality in cancer patients with anaemia. Increasing physicians' awareness of the importance of effectively treating anaemia in cancer patients therefore has the potential to improve prognosis as well as QoL.
16214146	Although nurses worldwide are confronted with euthanasia requests, how nurses experience their involvement in euthanasia remains unclear.To explore nurses' involvement in the care for patients requesting euthanasia.	A qualitative grounded theory strategy.	Two general hospitals (A, B) and a palliative care setting in Flanders (Belgium).	Nurses who fulfilled the following inclusion criteria: (a) Dutch-speaking; (b) working for at least one year in hospital A or B; (c) working at least part-time (50%); and (d) ever received a euthanasia request. We collected data using purposeful sampling, superseded by theoretical sampling in a palliative care setting. The sample included one intensive care nurse, one oncology nurse, eight palliative care nurses, and five internal medicine nurses. All but five were women. Their age ranged from 24 to 49 years.	We conducted one-on-one semi-structured interviews between November 2001 and September 2002. Grounded theory was applied for guiding data collection and analysis. The trustworthiness of data was ensured by several strategies.	Although euthanasia was still illegal, the nurses unanimously stated that they had an important role in caring for patients requesting euthanasia. Their personal and intense involvement caused them to experience a spectrum of emotions, chief among them being a sense of powerlessness. Several elements contributed to the nurses' conflicted involvement. Nurses became frustrated if the context (e.g., lack of time) hindered their efforts to provide compassionate care. The palliative care setting and its associated culture (group mentality, care philosophy) created the opportunity for nurses to take time to holistically support patients and their relatives.	Hospital nurses are confronted with patients' euthanasia requests. Each stage of this process requires that the nurses possess specific competencies. Their willingness to personally care for these patients, in addition to their specific care expertise, allows them to be skilled companions.	
16210026	The purpose of this descriptive study was to describe the frequency, severity, emotional reactions, and coping behavior of Jordanian nurses working in hospitals in response to verbal abuse. A convenience sample of 138 nurses employed in five hospitals was surveyed using the verbal abuse questionnaire (VAQ), which was developed for this study and received limited testing for reliability (homogeneity) and validity. This instrument measured different aspects of verbal abuse against Jordanian nurses. Findings indicate that the most frequent and most severe forms of verbal abuse reported were judging and criticizing, accusing and blaming, and abusive anger; the most common emotional reactions were anger, followed by shame, humiliation and frustration and most nurses used engaging in negative activities to cope with verbal abuse. Findings of this study highlights the need for hospitals to develop protocols for reporting and dealing with verbal abuse from physicians toward nurses.
16205206	This is the second article of a two-part series about issues encountered in implementing a predictive modeling program. Part I looked at how to effectively implement a program and discussed helpful hints and lessons learned for case managers who are required to change their approach to patients. In Part II, we discuss the readiness to change model, examine the spirit of motivational interviewing and related techniques, and explore how motivational interviewing is different from more traditional interviewing and assessment methods.
16202777	The impact of delayed diagnosis of cystic fibrosis (CF) on families is poorly described, especially in the United States. Studies outside the United States indicate that misdiagnosis leads to increased anxiety, guilt, anger, and mistrust of the medical profession, and late diagnosis leads to more negative feelings about the pre-diagnostic period and less confidence in the medical profession. To describe the impact of delayed diagnosis on US families, diagnostic stories were requested on the CF Research, Inc, e-mail list in September 2003. Twenty diagnostic stories were returned, and 20 additional stories were found on the Cystic-L listserv dating back to 1997. Stories were condensed into that of a single family and a qualitative description of the symptoms, medical and family responses at different life stages provided, along with health and family sequelae if the diagnosis had occurred at various ages. Responses to symptoms differed by age. Families were frustrated and stressed by diagnostic incompetence. Ineffectual care led to long-term anxiety, emotional trauma, and self-doubt. Families suffered economic losses. Relationships with one another and with doctors were seriously affected. CF parents consistently expressed that newborn screening would help others avoid the pain they suffered by not knowing the diagnosis earlier.
16199164	This study used a descriptive qualitative design to explore emergency nurse experiences of decision making about triage in Hong Kong. Seven experienced nurses who were working in three different accident and emergency departments participated in the study. Unstructured interviews were used to provide the nurses with opportunities to describe their experiences. The findings fall into three main categories, including the experience of triage decision making, the use of information in the triage decision-making process, and the factors that influence triage decision making. Although the experience of triage was generally positive, the nurses felt frustrated and uncertain in some circumstances. In addition, triage decision making was influenced by a series of factors that occur in daily practice. The findings of this study have implications for the development of formal triage training and triage decision-making protocols in accident and emergency nursing. They also provide positive reinforcement and support to triage nurses that will enhance their ability to make decisions about triage. Avenues for further research in the area are recommended.

16187665	This is the second paper in a series of two that focus on causational factors that contribute to child physical punishment, injury and child physical abuse. Paper one concentrated on the extent of child physical punishment, injuries sustained and the relationship between macrotheoretical factors. It highlighted a continuum between child physical discipline, injuries and child physical abuse. Paper two introduces the reader to microtheoretical factors that contribute to child physical punishment and its relationship with child physical injuries and abuse. The focus is on parental and child influences, lifestyle factors and socialisation of parents. It will integrate macrotheroretical factors highlighted in paper one and microtheroretical factors presented in this paper into a framework for the prevention of child physical injury and abuse based on an ecological model.
16183062	Critical illness and subsequent hospitalisation of a relative to an intensive care unit (ICU) can result in many physiological and psychosocial problems for patients and their family members. Caring for the anxiety and frustration of these families is an integral part of critical care nursing. The purpose of this study was to examine the effect of a needs-based education programme provided within the first 3 days of patients' hospitalisation, on the anxiety levels and satisfaction of psychosocial needs of their families. This was a quasi-experimental study with pre- and post-test design. A convenience sample was recruited over a period of three months, consisting of one primary family carer of each critically ill patient who had been admitted to an ICU in Hong Kong. Conducted by an ICU nurse specially assigned for the purpose, family carers in the experimental group (n=34) received an individual education programme based on the results of a literature review and an individual family needs assessment carried out at the time of patient admission, using the Critical Care Family Needs Inventory. The subjects in the control group (n=32) received the usual orientation and explanation given by the ICU nurses. Anxiety and need satisfaction were measured in the two groups at pre- and post-test and their mean scores were compared. Of the ten most important statements identified by the family carers in the two groups, the statements regarding the needs for information and assurance were found to predominate. After the needs-based intervention, the experimental group reported significantly lower levels of anxiety and higher levels of satisfaction of family needs than the control group at the post-test. The findings support the effectiveness of providing families of newly admitted critically ill patients, with a needs-based educational intervention to allay anxiety and satisfy immediate psychosocial needs. The formulation of a family education programme should be based on the results of a needs assessment, in order to meet family carers' individual needs.
16182093	This article presents parents' perceptions regarding continuity and coordination of care of children with life-threatening conditions as revealed through qualitative analysis of interviews with 36 bereaved parents of children who died after receiving care at three geographically dispersed teaching hospitals in the United States. Parental concerns about and experience of continuity of care were framed primarily in terms of the quality and continuity of relationships with healthcare providers throughout a child's illness and death and the continuity and consistency of information that they received about their child's condition and care. Continuity in relationships was perceived as key in ensuring that clinicians knew and cared about the child and parents, which in turn contributed to parents' confidence that their child would receive the best possible care. In the absence of continuous, caring relationships with staff, parents reported frustration, hypervigilance, and mistrust about the quality of care that their child received.
16170296	Renal pathologies have an hard impact on ill children's life style, psychic and physical development. In the last years, even if medical cures allowed these children to live longer and to have a better quality of life, today both their families and themselves have to face a lot of difficulties due to the kind of pathology. These children show behaviour troubles, bad sociability, aggressiveness, poor school performance, anxiety and depression, and then the subjects with chronic renal failure show a retard in neurological and cognitive development. In this study we evaluated the impact that the chronic renal illness has on children and adolescents' quality life.For this study, we have used the Impact of Childhood Illness Scale. It includes 30 questions that value 4 aspects of the child and family's life style: illness and its treatment, impact on the child, impact on parents and impact on the family. For every question, it considers the frequency of the problem and the degree of the worry that it causes. We gave the questionnaire to 47 couples of parents' children who are suffering from chronic renal diseases (19 subjects with nephrotic syndrome, 7 with chronic glomerulenephritis, 10 with chronic renal failure, 5 dialysed, 6 with kidney transplant). All parents compiled the questionnaire.	The obtained results showed that developing age subjects, who are affected by chronic renal diseases, can have emotional and behavioural difficulties that have an effect on subject and on his family. Their parents live in a continuous stress state because chronic pain and anxiety cause depression, a sense of inadequacy and frustration.	As in every chronic physical illness, the sick child and his family are obliged to face a series of physical, behavioural and emotional changes. Besides, they are faced by possible collateral effects of the illness and of its treatments on development.	
16166408	The authors sought to determine the effect of kinship status (daughters versus wives) and ethnicity (Hispanic/Latino versus Caucasian) on self-efficacy to perform tasks relevant to caregiving in a sample of family caregivers for people with memory problems.Baseline data were collected from 238 female caregivers who participated in an intervention program. Ethnic and kin relationship groups were compared on measures of caregiver self-efficacy, acculturation within the Hispanic/Latino sample, and the relationship of self-efficacy to key outcome variables.	Hispanics/Latinos reported higher self-efficacy on two of three self-efficacy subscales (Responding to Disruptive Behaviors and Controlling Negative Thoughts About Caregiving). Daughters reported higher self-efficacy on all three self-efficacy scales. Among Hispanics/Latinos, acculturation did not relate strongly to self-efficacy. Caucasian and spousal caregivers appeared to make more generalized appraisals about caregiving.	Higher self-efficacy among Hispanic/Latino caregivers may relate to cultural values about caregiving and/or ethnic differences in appraisal. Wives may be more at risk for low self-efficacy, which may relate to greater role frustration and distress. This study highlights the heterogeneity among caregivers in their experience of caregiving.	
16165259	This long-term study in Sri Lanka explored the complexities behind self-inflicted pesticide poisonings by 166 Sri Lankans. Using or threatening to use pesticides for self-harm has become a response to stressful events and a powerful message towards a specific individual, or to the outside world in general, conveying misgiving, anger, sadness, hopelessness, frustration, or simply a way to manipulate a situation to one's own advantage. The effects of alcohol misuse are especially important in understanding self-harm at the community level in terms of the impact they have on the domestic environment. Also, issues around "love affairs," arranged marriages and domestic physical, sexual or psychological abuse in the domestic environment are referred to by many self-harmers or their relatives as a reason for ingesting poison. Clearly, easy access to lethal pesticides by impulsive individuals often living under economically or psychosocially stressful conditions, combined with insufficient treatment facilities and limited outreach programs, can be a deadly blend. A strategy aimed at reducing the availability of the most toxic pesticides and improving case management should be implemented, as it is likely to reduce death from pesticides although unlikely to impact on the number of episodes. Support to families plagued by domestic violence and male alcohol misuse is essential to improve the quality of life for the most vulnerable and to reduce the number of self-harm episodes in the long-term.
16146184	Intensive Naikan therapy (INT) is used to treat irrational recognition, and to develop awareness of others and self-reflection. Several reports have also shown that INT is effective for treating anxiety disorders. The purpose of the present systematic study was to investigate the factors contributing to the efficacy and clinical outcomes of INT by assessing the background, psychological evolution, and treatment required after such therapy.Twenty-eight anxiety disorder inpatients at Tottori University Hospital, 15 with general anxiety disorders (GAD) and 13 with panic disorders (PD), were treated with INT. Age, sex, duration of the present anxiety episode, and diagnosis were investigated. The Tokyo University Egogram (TEG), Yatabe-Guilford personality inventory (YG test) and Rosenzweig picture frustration (PF) study were conducted before and after INT to investigate psychological changes. The long-term efficacy of INT for PD and GAD was assessed with Global Assessment of Functioning (GAF). Whether the patients achieved awareness of others, awareness of egocentricity, feelings of love, and self reflection after INT were investigated.	1) All patients showed improved GAF; the average GAF score increased from 51 +/- 8 (before Naikan therapy) to 83.2 +/- 15 (after therapy). The clinical outcomes of INT were as follows: 17 patients showed extremely effective results (60.7%), 6 were effective (21.4%), 3 were slightly effective (10.7%), and 2 were unchanged (7.1%). Overall, 23 patients (82.1%) showed remarkable improvements as a result of INT (improved group) and 5 showed no remarkable improvements (not improved group). 2) The improved group included significantly more patients with obsessive tendencies or nervous personalities such as a premorbid personality. In addition, significantly more of the patients in this group underwent daily INT and improved more rapidly in the short-term. 3) According to the STAI (state trait anxiety inventory), both state-(S-anxiety), and trait-anxiety (T-anxiety) significantly decreased after INT. The PD group showed significantly reduced S and T-anxiety, but the GAD group only showed significantly reduced T-anxiety. The adult (A) and free child (FC) TEG scales significantly increased, and according to YG, nervousness (N) and depression (D) significantly decreased while general activity (G) and social extraversion (S) significantly increased. Furthermore, according to the PF study, extraggression (E -A) after INT significantly decreased and imaggression (I-A) significantly increased. In the improved group, significantly more patients became more aware of their partners (Naikan) and achieved an objective outlook, awareness of egocentricity, feelings of love and self-reflection after INT.	Our results suggest that INT for PD and GAD is extremely effective, and a very important form of psychotherapy. Attainment of self-reflection caused psychological changes that motivated the patients to continue Naikan therapy daily. We consider this a key factor in maintaining the efficacy of INT.	
16139240	The present study examined the relations among a depressive ruminative response style, a general propensity to experience negative affectivity, and negative affect induced by a paced serial auditory addition task (PASAT). Ninety nonclinical individuals completed a computerized version of the PASAT, which elicits a generalized negative affect response [Lejuez, C. W., Kahler, C. W., & Brown, R. A. (2003). A modified computer version of the paced auditory serial addition task (PASAT) as a laboratory-based stressor: Implications for behavioral assessment. Behavior Therapist, 26, 290-292]. As hypothesized, there was a moderate correlation between depressive rumination and a propensity to experience negative affect, as indexed both by a significant association with a negative affect personality factor and the prediction of negative affect elicited during the provocation. Findings also suggested that dispositional negative affectivity moderated the effects of a depressive ruminative response style on the valence but not arousal dimensions of emotional responding to the challenge. These findings are discussed in terms of improving our understanding of rumination and its potential role in emotional vulnerability processes.
16138737	There is increasing programme focus on the impact of HIV and AIDS and the advances in biomedical research that are taking central stage even in sub-Saharan Africa. Perhaps out of frustration, communication and behaviour change efforts are receiving lesser attention. But as long as heterosexual intercourse remains the predominant means of transmission of HIV in sub-Saharan Africa, there is the inherent danger of more people getting infected thus mopping up the gains from other approaches. This paper therefore argues for evidence based behaviour change interventions in sub-Saharan Africa, revisits the behaviour change theories and their relevance to the African situation. It proposes an integration of models based on the convergence of three existing theories of social learning, diffusion of innovation and social networks and the author's understanding of some African culture. The beauty of the model is based on the fact that 'social norms are best understood and influenced at the level of social networks'; existing chains of communication and the naturalness of exchange of information. A case is made for application of the 'model' to precipitate sexual behaviour change and HIV reduction in sub-Saharan Africa.
16137266	Hyperactivity, a persistent, severe pattern of inattention or impulsivity, places children at risk for impaired functioning in many developmental areas. This behavior is characterized by short attention span, low frustration tolerance, impulsivity, distractibility, and increased physical activity. Responses from multiple sources in the child's environment must be monitored to manage childhood hyperactivity.Success at school, in peer relationships, and parent-child interactions is frequently affected by hyperactivity. Using a focus group approach, a Nursing Outcomes Classification (NOC) label, definition, and indicators were developed for Hyperactivity Level.	Review of the literature allowed for a content analysis approach and conceptualization of hyperactivity at several levels.	Twenty three (23) measurable indicators were formulated and refined into conceptually and clinically coherent outcomes. Clinical relevance and utility were presented through a case study approach.	

16116774	For many years student nurses were trained in a more disciplined approach with considerable time allocated to working in the hospital environment and specified times allowed for gaining theoretical knowledge throughout their formal training. Nurses therefore gained a tremendous amount of experience and competency in their practical skills. With the introduction of more specialized equipment and technology it was now desirable to improve the professional status of nurses and nursing education. The introduction of university trained nurses has been met with much criticism. Student nurses are now being empowered and informed with theoretical knowledge from many health disciplines that allows them to use a holistic approach to patient care. The changes to nurse education were hoped to improve the professional status of nurses although this transition has not been without problems. Experienced nurses who are already working in stressful conditions with continuous staff shortages and poor recognition of service see the student nurse sometimes as an extra hindrance to their already increasing workload. Student nurses are theoretically competent but lack the clinical expertise and experience to complement this knowledge which can also add to the professional pressure that experience nurses encounter. Most nurses would like to see themselves, as promoters of nursing but are frustrated and disillusioned with their profession. It would seem then that student nurses as a result of this dissatisfaction are often devoured by some nurses instead of being encouraged and nurtured in their enthusiasm for nursing.
16108776	To explore registered nurses' perceptions of standards of nursing practice and factors that affect nursing practice standards.Nursing governance affects nurses' ability to manage nursing practice standards. Lack of nursing professional autonomy has been associated with occupational dissatisfaction, stress, turnover and low morale, which impact upon care quality.	Grounded theory was used. Data, gathered by semistructured interviews with 142 nurses, theoretically sampled from three National Health Service hospitals were analysed using constant comparative analysis.	Nurses were dissatisfied with their governance over factors that they believed had most influence on nursing practice standards. Perceived lack of control over factors that affect practice standards generated dissatisfaction, frustration and demoralization.	Nurses' perceived lack of governance over their practice requires investigation and attention if occupational dissatisfaction, stress, turnover and low morale, which impact on quality care, are to be reduced. Dissatisfaction with nursing governance indicates a need to review nurses' professional involvement in clinical governance.	
16101652	The choice of informant is a critical piece in the identification of psychosocial problems in youth. While many behavioural measures have been adapted to include information from multiple sources, in the case of parents and youth, poor agreement has been found. Our study purpose was to identify youth and parent factors associated with whether the youth agrees with a positive parent-completed screen of youth psychosocial problems.Parents of youth aged 10-15 years who were seen for a medical visit at eight clinics completed the 17-item Pediatric Symptom Checklist (PSC-17). Youth scoring positive on the screen and their parents/guardians were interviewed by telephone after the visit (n = 145). We conducted bivariate and multivariate analyses to identify parent characteristics and child factors associated with whether the youth agrees with the positive parent-completed screen.	Fifty per cent of youth participants agreed with their parent on a positive parent-completed PSC-17 based on their completion of the Y-PSC-17 as a self-report measure. Youth who reported a positive Y-PSC-17 in agreement with their parent were twice as likely to meet diagnostic cut-offs on sub-scales of anxiety/depression and aggression on the Child Behaviour Checklist (P < 0.01 and P < 0.05 respectively), reported lower parent-child connectedness (P < 0.01) and their parents reported more anger/frustration (P < 0.05) than youth who disagreed with the positive parent-completed screen. Most of these associations remained significant when controlling for the other factors and demographic characteristics in multivariate analysis.	Findings indicate that when the youth agrees with a positive parent-completed PSC-17, there is higher parent frustration, lower parent-child connectedness, and the youth is more likely to have a diagnosis of an emotional or behavioural disorder. Thus, when possible, the use of both parent and youth as informants provides necessary information in formulating a comprehensive treatment strategy to address the psychosocial needs of youth.	
16093369	Communication between postoperative head and neck cancer patients with speech impairment and their health care providers is challenging. These challenges emerge during a period when the patient must communicate needs related to symptoms such as pain or concerns of significance in the absence of the traditional communication process. Content analysis methods facilitated understanding of the perspective of the postoperative head and neck cancer patient experiencing pain and a speech impairment, and the examination of the nurses' view in the assessment and management of this population. The authors identified self-report of pain as a critical component of pain assessment regardless of the presence of a speech impairment. Significant levels of frustration were associated with the nurses' goal of addressing the pain management needs of the speech impaired and the patients' pursuit of reporting the uniqueness of their pain experience.
16087553	To demonstrate the efficacy of using differential reinforcement to treat non-compliance in adolescents with spinal cord injury.A case series design was used to examine three adolescents (aged 14-16 years) with tetraplegia who received multi-disciplinary rehabilitation treatment and a behavioural contract programme during an in-patient hospital admission. Assessment included collecting data on each patient's weekly percentage of compliance with all rehabilitation goals, weekly percentage of negative affect observed in therapy sessions and scores on a measure of mobility in physical therapy.	Compliance with rehabilitation demands improved from a baseline of 20-65% to 80% or greater after the patients received differential reinforcement for participating in the rehabilitation regimen. Patients exhibited less anger, sadness and frustration during therapy sessions once contracts were started.	The adolescents demonstrated greater compliance after the implementation of a behavioural contract. Future studies should identify the specific variables that affect psychological adjustment and predict 'readiness' to participate in rehabilitation.	
16083540	To describe the impact of migraine on psychological well-being of young women and to evaluate their communication with physicians about migraine.This cross-sectional telephone survey was conducted in Israel and eight European countries (Finland, Germany, Greece, Italy, Norway, Spain, Sweden, and The Netherlands). Random-digit dialing was used to identify eligible study participants: women 18-35 years of age with migraine, who used medication to treat their migraine, and who were employed or full-time students.	Of 1810 participants, 42% self-reported having a physician diagnosis of migraine. Eighty-six per cent believed that their life would be better if they did not suffer from migraines; and 58% of participants felt frustrated, 46% felt angry, and 44% felt depressed because of their migraines. Negative feelings related to migraine varied substantially from country to country. For example, feelings of frustration caused by migraine ranged from 32% in Italy to 84% in Finland; feelings of anxiety ranged from 21% in Norway to 57% in Italy; and feelings of confusion ranged from 13% in Greece to 61% in Italy. Overall, 81% of participants had visited a physician in the past year but only 50% of them had discussed their severe headaches or migraines with their physician within the year. While 68% of those who had visited a physician stated that they were comfortable speaking with their physician about migraine, 71% reported being the one who initiated the conversation about severe headaches or migraines. Of all participants, 39% did not feel that their physician understood how much severe headaches or migraines interfered with their life.	Migraines and severe headaches impose a substantial burden on the psychological well-being of young women with migraine in Europe and Israel. In general, communication between these women and their physicians about migraine is incomplete.	
16080439	This study presents five cases of completed suicides in which injures were situated in parts of the body changed by illness or in areas related to medical treatment. Following early research, physical illness has been identified as an important risk factor for suicide and for suicidal behavior. It is an unusual and rare problem when opposition to somatic disease is signified by the localization and character of suicidal injures. These cases illustrate such a phenomenon, where the body--in a symbolic way is engaged in expression of human stress and frustration. This is caused by the loss of the possibility to control one's own life. The authors also discussed this problem in the view of the literature.
16075136	Truth telling in medicine is difficult and stressful. Medical training teaches to mitigate pain and suffering, but death and health deterioration causes feelings of frustration among physicians. Physicians tend to conceal bad news to avoid the suffering caused by such adverse information. However, veracity is an integral part of a respectful relationship and is the basis of confidence between patients and health providers. However, confusing truthfulness with a mere exposure of all the available information is an oversimplification of the problem. Therefore the real issue drifts from "how convenient is to communicate the truth" to "how to share the information with my patient" in a setting in which he can express his feeling and thoughts. Communicating the truth is an ethical imperative. The patient has the right to be informed and the physician must provide this information timely and taking into account the capacity, interest and emotional status of the patients. Therefore prudence, warmth and bioethical reasoning are required for a good medical practice.
16055382	Cardiovascular disease accounts for 39% of all deaths in Ireland each year. Many of these deaths are due to acute myocardial infarction (AMI). The diagnosis of AMI has major implications for individuals in terms of health and social gain, health related quality of life and living and adapting to a chronic illness. The diagnosis requires lifestyle changes such as changes to diet, smoking habit, physical activity, and stress management.The aim of this descriptive qualitative study was to explore patients' perspectives of making lifestyle changes following AMI.	Using a descriptive qualitative approach, ten participants were interviewed 6 weeks following discharge about their experiences. Data were collected using in depth interviews and analysed using thematic analysis.	Four themes emerged: lifestyle warning signs, taking responsibility for lifestyle changes, professional support and looking forward to the future. The findings offer insight into the everyday realities, which patients experience regarding lifestyle changes particularly in relation to smoking cessation and stress management. The difficulties encountered by participants 6 weeks following discharge reflect the implementation of too many life style changes at once as well as the lack of professional help in the community to support participants in their endeavours to make lifestyle changes. In addition, overprotection by family members was a source of frustration and aggravation for participants.	The study highlights the need for the development of primary care services and cardiac rehabilitation programmes to support patients as well as providing information to families to reduce anxiety and fear.	
16049396	In many cultures the social and familial issues regarding reproduction are of great importance. Hence it seems only logical to conclude that a couple failing to achieve the expected goal of reproduction will experience feelings of frustration and disappointment. The present review was aimed to sort out the relationship between psychological stress and male infertility. It remains unclear weather stress and infertility are closely related, or that other parameters that affect stress are the important predictors of fertility. The majority of the studies rejected the theory of stress as a lone factor in the etiology of infertility. However, there is growing evidence that stress stands as an additional risk factor for infertility. It seems by the emerging evidence that more intervention studies should be conducted in order to assess weather reducing stress during fertility treatments can alter fertility treatment results. Meanwhile, collecting data regarding the couples stress level seems an appropriate approach, especially since many couples feel that health care systems do little to ease the psychological burden they experience during treatment.
16043533	To determine emergency medicine residents' emotional and behavioral responses to their medical errors and examine associations between residents' responses to medical error and perceptions of their training.In 2003, 55 residents at two U.S. residency programs were asked to complete questionnaires about their errors and responses to their errors in three domains: emotional response, learning behavior, and disclosure. The questions were a mixture of free text, yes/no responses, and some were rated using a five-point Likert scale. Based on a conceptual framework, the authors constructed scales to describe the various domains and associations between the residents' responses to medical error and perceptions of their training were examined using Somers' D.	A total of 43 residents returned questionnaires (80%); 40 of these residents described errors. Thirty-three (83%) residents discussed the error with someone; 27 (71%) with the attending and 10 (28%) with the patient/family. Negative emotions were common: 27 (68%) felt remorse, 21 (53%) guilt, 23 (58%) inadequacy, and 22 (55%) frustration. Residents' negative emotional responses were associated with their personal characteristics [26% (95% CI, 5-47%) association with lack of experience] and residents' perceptions of their training environment: 15% association with job overload (95% CI, -8-38%) and 23% association with lack of institutional support (95% CI, 5-41%). While 32 (81%) residents increased attention to detail, only 2 (5%) increased their use of evidence-based medicine.	Errors committed by emergency medicine residents often resulted in negative emotions, limited constructive system-based improvements, and inadequate disclosure. Negative perceptions of the training environment are associated with negative emotional responses.	
16043391	As the demands on the emergency medicine (EM) system continue to increase, improvements in the organization of work and the access to timely clinical and system information will be required for providers to manage their workload in a safe and efficient manner. Information technology (IT) solutions are beginning to find their place in the emergency department (ED) and it is time to begin understanding how these systems are effecting physician behavior, communication and workload.The study used a time-in-motion, primary task analyses to study faculty and resident physician behavior in the presence of an electronic whiteboard. The NASA-Task Load Index (TLX) was used to measure subjective workload and the underlying dimensions of workload at the end of each physician observation. Work, communication and workload were characterized using descriptive statistics and compared using Mann-Whitney U-tests.	Physicians in our study performed more tasks and were interrupted less than physicians studied previously in conventional EDs. Interruptions interrupted direct patient care tasks less than other clinical activities. Temporary interruptions appear to be a major source of inefficiency in the ED, and likely a major threat to patient safety. Face-to-face interruptions persist even in the presence of advanced IT systems, such as the electronic whiteboard. Faculty physicians exhibited lower workload scores than resident physicians. Frustration was a significant contributing factor to workload in resident physicians. All physicians ranked temporal demands and mental demands as major contributing factors to workload.	The results indicate that the electronic whiteboard improves the efficiency of work and communication in the ED. IT solutions may have great utility in improving provider situational awareness and distributing workload among ED providers. The results also demonstrate that IT solutions alone will not solve all problems in the ED. IT solutions will probably be most effective in improving efficiency and safety outcomes when paired with human-based interventions, such as crew resource management. Future studies must investigate team interaction, workload and situational awareness, and the association of these factors to patient and provider outcomes.	
16040177	Having enjoyed tremendous growth for the past 5 years, the anti-aging medicine movement is redefining aging so that it becomes a target for biomedical intervention. Targeting aging for intervention dislodges popular understandings of aging: for anti-aging practitioners it no longer matters if aging is natural since it can be itself the target of therapy. So-called "age-associated" diseases like cancer are, in this framework, conceived of as symptoms of aging. Anti-aging medicine is a broad term that may comprise groups selling remedies over the Internet, companies touting the "anti-aging"ness of their products, practitioners who work outside of scientific medicine, and practitioners of anti-aging medicine in clinics who believe that their work is strictly scientific. This article, drawing from more than 3 years of ethnographic interviews, participant observation in clinics and conferences, and a review of the literature, considers the last group. It examines the involvement stories of anti-aging medicine practitioners in two Western United States metropolitan cities. These stories reflect the practices of anti-aging medicine practitioners and the accompanying rationale for involvement. Often originally patients themselves, practitioners frame their involvement with the anti-aging movement in three ways. First, they describe aging as it is currently experienced as a time of decline, suffering, and weakness. This anguish is not inevitable, they argue, and their work toward treating aging biomedically is situated as clearly moral. Secondly, intense frustration with the current biomedical environment has motivated practitioners to look for other ways in which to practice: anti-aging medicine is their chosen alternative. Finally, with dramatic expectations of future biotechnologies and disdain for current medical treatments of old age, anti-aging practitioners embrace a scientific revolutionary identity. These stories of migrations from patient to practitioner reveal the values upon which this movement is grounded and how coming to be a part of it is as much about the movement's mission as it is the origins of the migrations.
16037100	To explore patient perceptions of patient-provider communication after an actual adverse medical event because prior patient error studies are rarely based on real situations.We conducted four patient focus groups using a semi-structured guide. We analyzed transcripts using an editing approach to identify themes.	Three sites in Colorado.	participants were recruited from statewide post-injury program. Purposeful sampling began with patients in a geographic location; we contacted every other patient (up to 50). Twenty-two patients initially agreed to participate; 16 adults participated, representing 13 cases.	Complex issues and processes were involved in resolution attempts. Effective communication was an important factor in whether professional relationships continued after an adverse event. The communication nature and quality influenced whether patients defined event as 'honest mistake' or 'error'. Two types of trauma (physical and emotional) were expected and found. A third (financial) uncovered and proved in some cases the most salient factor influencing patients' subsequent actions. Caring, honest, quick, personal, and repeated provider responses were linked to patient satisfaction.	Provider communication timeliness and quality were important influences on patients' responses to adverse events. Confronting an adverse medical event collaboratively helped both patients and providers with patients' emotional, physical, and financial trauma and minimized the anger and frustration commonly experienced. Health organizations, providers, investigators, and policymakers should consider the patient experience when developing provider training or evaluating processes in patient resolution.	


16005913	The inbred RLA (Roman Low-Avoidance) and RHA (Roman High-avoidance) rat strains have been psychogenetically selected for rapid (RHA) vs. extremely poor acquisition (RLA) of two-way active avoidance. As a consequence of this selective breeding, RLA animals exhibit a higher level of emotionality that can be observed in many anxiety models. The present study was conducted in order to analyze the performance of female RLA, RHA and Wistar rats in a behavioral test of anxiety that involves the reduction of the magnitude of an expected reward: the negative contrast effect that is obtained in one-way avoidance learning by reducing the time spent in the safe compartment. To this aim, three groups of animals (30-1/RLA, 30-1/RHA and 30-1/W) were trained to avoid an electric foot-shock administered in a "danger" compartment, by running from this compartment to a "safe" compartment. We observed an impairment of the avoidance response when time spent in the safe compartment was reduced from 30 to 1 s, when 30-1/RLA and 30-1/W groups were compared with control groups that were trained with a constant safe time (1-1/RLA and 1-1/W, respectively). We also obtained significant differences between 30-1/RLA and 30-1/RHA groups in the postshift phase. These results indicate that RLA rats respond more negatively to the frustration triggered by the reduction in time spent in the safe compartment, suggesting that animal models based on negative contrast effects can be useful tools for studying the genetic basis of anxiety.

15992192	The goal of the larger study was to explore physicians' emotional responses to the death of their patients; this study analyzed a subset of physician transcripts to elucidate the construct of questioning care, which emerged from the larger study.To analyzes how physicians question care-expressing concern, unease, or uncertainty about treatment decisions and practices, errors, or adverse events-as they attend dying patients.	Retrospective interview study of physicians caring for randomly selected deaths on the medical service of a major academic teaching hospital, using qualitative and quantitative measures. SETTING, SUBJECTS: 188 attendings, residents, and interns on the internal medical services of two academic medical centers were part of the larger study. A subsample of 75 physician narratives was selected for qualitative data analysis for this study.	Qualitative measures included open-ended questions eliciting physicians' stories of the most recent and a most emotionally powerful patient death they have experienced. Grounded theory was used to analyze physician narratives. Quantitative instruments measured physician attitudes toward end-of-life care and responses to the most recent and most emotional patient death.	Physicians question care more frequently in most emotional deaths (42%) than in most recent deaths (34%). Physicians question communication with patients and families and within medical teams, medical judgment and technique, standards of practice, and high-risk treatments, often assigning responsibility for medical management they perceive as inappropriate, futile, overly aggressive, or mistakes in judgment and technique. Responsibility ranges from the distal (the culture of medicine) to the proximal (personal). Frustration, guilt, and anger are more frequently expressed in these narratives when care is questioned.	A typology of questioning care emerged from these physicians' narratives that parallels and reflects recent and classic research on medical error and the culture of medicine. Physicians' questions about care can contribute to designing training experiences for residents and to improving the quality of systems that affect patients' experiences at life's end and physicians' experiences in caring for dying patients.	
15991730	By far not every fire-raiser suffers from so-called pyromania, i.e. a pathological urge to raise fire. It is indispensable to differentiate between extrinsic and intrinsic motivation, whenever a person is accused of arson. The former aims at external gain, such as the sum insured, while the latter tends towards manipulation of internal states. The leading motive may be frustration, fascination, or in rare cases even sexual arousal. The concept of pyromania, as established by French psychiatrist Esquirol, is not a validated one in all parts; today's diagnostic manuals take "pyromania" rather as a special form of a general disorder of impulse control. The author takes a case report to demonstrate the most important issues in evaluating and prognosticating fire raising behavior.
15991109	The prevalence of obesity is increasing at an alarming rate in African-American children. Fathers influence mealtime behaviors but are often overlooked in nutrition education. A sample of six African-American fathers of toddlers participated in a focus group to describe mealtime behaviors with their toddlers. The focus group was audiotaped and transcribed verbatim. Five thematic categories were identified: mealtime rituals and routines, division of responsibility, family constellation, nutritional knowledge, and tension during mealtimes. Fathers expressed frustration with the toddler's "picky-eater" developmental stage. Fathers need to be included in nutrition education that promotes healthy mealtime habits with their toddlers.
15969874	The version of the Minnesota Nicotine Withdrawal Scale (MNWS) under consideration consists of nine items. No psychometric analyses of this version have been published. The objectives of this investigation were to perform a factor analysis and to further assess the psychometric properties of the MNWS.Data came from three Phase II clinical trials on varenicline, developed for smoking cessation, in a sample of smokers. Exploratory factor analysis was used to examine the structure of the MNWS in the first completed study (n = 626) over various time periods. The postulated factor structure was then tested in a set of confirmatory analyses conducted on two subsequent studies (n = 627, n = 312). The proposed structure was further evaluated through construct validity and reliability analyses.	The nine items of the MNWS included the following: urge to smoke (craving); depressed mood; irritability, frustration, or anger; anxiety; difficulty concentrating; restlessness; increased appetite; difficulty going to sleep; and difficulty staying asleep. Each item was rated by a subject on an ordinal scale from 0 (not at all) to 4 (extreme).	Scree plots and rotated factor patterns from the exploratory factor analyses revealed two multi-item domains--Negative Affect with four items and Insomnia with two items--and three individual items (Craving, Restlessness, Increased Appetite). Confirmatory factor analyses supported the structure with fit indexes exceeding 0.90. The multidimensional framework of the MNWS correlated as expected with health status, depicted an expected course of withdrawal symptoms over time, predicted the sensitivity of withdrawal symptoms on subsequent cessation, and produced internal reliability estimates above 0.70.	Evidence is obtained to support the validity and reliability of the multidimensional structure of the nine-item MNWS. The data suggest that the MNWS has individual constructs on Negative Affect (depressed mood; irritability, frustration, or anger; anxiety; difficulty concentrating), Insomnia (difficulty going to sleep; difficulty staying asleep), Craving, Restlessness, and Increased Appetite. As such, analyzing each construct separately would strengthen the analysis of the popular MNWS.	
15968692	The psychological and social sequelae of secondary lymphedema (SLE) have been an underrecognized and little-researched complication of treatment for breast carcinoma. The reported incidence and prevalence of SLE varied widely (0-48%). Reported reasons for the differences are related to the lack of standard diagnostic and universal assessment criteria.A comprehensive, computerized search was performed. All combinations of the following keywords were used: arm lymphedema, arm swelling, breast cancer, psychological and social, and quality of life (QOL). Eighteen studies were identified.	The literature supported the view that SLE leads to psychological and social sequelae. Psychological sequelae included frustration, distress, depression and anxiety. Social sequelae comprised changes in role function, lack of social support and pain and disability. Pain was a significant predictor of psychological and social morbidity. These experiences resulted in diminution of QOL, particularly psychological and social health. This was particularly worrisome because women must attend daily to the precautions and treatments for SLE.	Researchers should use psychological and social measures along with physiologic parameters when evaluating the impacts of SLE. Clinicians should work to develop standardized primary prevention programs and limb circumference should be measured at the time of breast carcinoma diagnosis. Gaps in knowledge related to intra/interethnic diversity, poverty, and comorbidities of women with breast carcinoma-related SLE need to be explored. The combined efforts of researchers and clinicians would reinforce awareness and knowledge for women at risk and provide important baseline data for research and practice.	
15964672	Narrative interviews were conducted with hospital nurses participating in a research study designed to provide support and assistance to hospitals as they addressed work life issues for nurses in an attempt to create quality work environments. The eight interviews were conducted in a sample of Canadian hospitals and generated themes relating to an imbalance between the effort that nurses put into their work and rewards attained from it. Seigrist's ((1996) Journal of Occupational Health Psychology, 1, 27-41, (2002) In: P.L. Perrewe & D.G. Ganster (Eds.), Historical perspectives on stress and health. Research in Occupational Stress and Well Being (vol. 2). Boston, MA: Jai Press) effort-reward imbalance model was used to frame this study. The nurses' narratives suggest that multiple factors constitute the nurses' work environment and their experiences and perceptions of it. Issues which surfaced repeatedly in the interviews related to changing needs of hospitalized patients in today's health care system and the associated workload, the widespread shortage of nurses, and the imbalance this creates for nursing work. A crucial finding is the extent to which the nurse is impacted by the adequacy of care they are able to provide. These narratives outline the tremendous burden of guilt and the overcommitment that nurses bear when factors in the work environment prevent them from providing complete, quality care. Nurses are experiencing frustration and stress that is impacting their worklife, family and home life, personal health, and possibly patient outcomes.
15960029	It is hardly possible to go through a day without "stepping on someone's toes." By practicing the steps described in this article, you can strengthen your ability to engage in an apology process that is powerful and healing. Being truthful and courageous about your own part of a situation opens the door for others around you to do likewise. People will experience you as a person who has integrity. Receiving an apology from another person allows you to complete the process by forgiving.
15960009	Communication between parents and professionals in the NICU is a necessary part of collaborative decision making in the provision of family-centered care. Decisions with ethical components, those regarding treatment plans or neonatal research enrollment, need to be made conjointly with parents and health care professionals. This article reviews the present state of knowledge of how parents' input can be facilitated in regard to decisions made about their children. Research studies involving decisions made with ethical components in the NICU since the advent of the Baby Doe regulations reveal parents' frustration with communication practices, their need for control of information, and the trust in their children's health care providers that is required to best facilitate their input into ethical decisions made about their children.

15953589	Theories in affective neuroscience suggest that mood disorders involve perturbations in attention-emotion interactions. We tested the hypothesis that frustration adversely impacts attention and behavior in children with bipolar disorder (BPD).Thirty-five children with BPD and 26 normal control subjects completed: 1) a Posner attention task with feedback but no contingencies; 2) an affective Posner with contingencies; and 3) an affective Posner that used rigged feedback to induce frustration. Reaction time (RT) and event-related potential (ERP) data were collected.	At baseline (task 1), there were no between-group differences in behavior or ERPs. Children with BPD exhibited reduced parietal P3 amplitude on task 3 only. On trials occurring after negative feedback, control subjects showed decreased RT when contingencies were introduced (task 2), whereas BPD subjects did not.	The introduction of contingencies was associated with impaired performance of children with BPD, suggesting deficits in their ability to adapt to changing contingencies. In addition, frustration was associated with disrupted attention allocation in children with BPD. We hypothesize that children with BPD inappropriately deployed attention to their internal frustration rather than to the task, causing impaired performance.	
15948882	Accessing services for children with developmental co-ordination disorder (DCD) is frequently difficult for parents who have to navigate both health and education systems to find a diagnosis and appropriate interventions.A qualitative study design incorporating a phenomenological perspective was utilized to understand the nature of the experiences of these parents in attempting to access support for their children with DCD. Twelve parents, whose children attended the Kids Skills Clinic at the University of Western Ontario and were identified as having DCD, were interviewed by the second author. Interviews were transcribed verbatim and analysed using constant comparative method. Member checking, peer checking and code-recoding were carried out to enhance rigour in data analysis.	A number of themes emerged focusing on the common problems experienced leading to occupational therapy referral. Parents' journeys to seek and access services for their children with DCD were characterized by a sense of maternal knowing, experience of frustration, trivialization of the problem, a sense of 'going it alone', and 'getting the run around'.	Implications for health and educational professionals working with children, in terms of recognition of DCD and referral for services, are described.	
15948363	Psoriasis, a T-cell-mediated disorder, affects 1% to 3% of the world's population. The characteristic lesions occur in many different forms, can cause significant discomfort and social distress, and in some instances, lead to dehydration and metabolic derangement. A chronic, unpredictable course and the necessity of periodically switching drugs or classes of drugs make psoriasis frustrating to treat. However, topical and systemic drug therapies and phototherapy can help minimize the exacerbations and prolong remissions. In this article, Dr Shenenberger outlines treatment approaches and discusses research into the use of immunomodulatory agents.
15948050	Medical decision-making models focus on doctor-patient relationship. The impact of the family, specifically the involvement of the relatives in the information- and decision-making process have rarely been evaluated yet. Within the project "Patient as partners - cancer patients and their involvement in medical decision making" progressive disease cancer patients, their relatives and doctors as well as Thuringian general practitioners have been interviewed with regard to their attitudes (among others) towards the medical system and information and decision making processes.From the patient's point of view, the family is highly important in decision-making (very important/important 80.3 %). 73 % of the patients, but only 58 % of the relatives feel very good/good informed about the treatment. With regard to prognosis, 30 % of the patients and 27 % of the relatives feel less/poorly informed. 83.7 % of the relatives believe they cannot influence treatment decisions. According to this, Thuringian general practitioners judge the influence of family members on treatment decisions quite low (very high/high 12.9 %, partly 37.4 %, low/not possible 49.7 %), though the relatives' wish for involvement is seen quite realistic (89 % of the GP's believe that the family wants to be involved).	From the patients point of view, the family has got a high status with regard to medical decision-making. In palliative cancer patients doctors should offer an early and continuous involvement of relatives in information and decision-making processes in order to reduce misjudgements and frustration within the families.	
15943210	Application of computer vision to track changes in human facial expressions during long-duration spaceflight may be a useful way to unobtrusively detect the presence of stress during critical operations. To develop such an approach, we applied optical computer recognition (OCR) algorithms for detecting facial changes during performance while people experienced both low- and high-stressor performance demands. Workload and social feedback were used to vary performance stress in 60 healthy adults (29 men, 31 women; mean age 30 yr). High-stressor scenarios involved more difficult performance tasks, negative social feedback, and greater time pressure relative to low workload scenarios. Stress reactions were tracked using self-report ratings, salivary cortisol, and heart rate. Subjects also completed personality, mood, and alexithymia questionnaires. To bootstrap development of the OCR algorithm, we had a human observer, blind to stressor condition, identify the expressive elements of the face of people undergoing high- vs. low-stressor performance. Different sets of videos of subjects' faces during performance conditions were used for OCR algorithm training. Subjective ratings of stress, task difficulty, effort required, frustration, and negative mood were significantly increased during high-stressor performance bouts relative to low-stressor bouts (all p < 0.01). The OCR algorithm was refined to provide robust 3-d tracking of facial expressions during head movement. Movements of eyebrows and asymmetries in the mouth were extracted. These parameters are being used in a Hidden Markov model to identify high- and low-stressor conditions. Preliminary results suggest that an OCR algorithm using mouth and eyebrow regions has the potential to discriminate high- from low-stressor performance bouts in 75-88% of subjects. The validity of the workload paradigm to induce differential levels of stress in facial expressions was established. The paradigm also provided the basic stress-related facial expressions required to establish a prototypical OCR algorithm to detect such changes. Efforts are underway to further improve the OCR algorithm by adding facial touching and automating application of the deformable masks and OCR algorithms to video footage of the moving faces as a prelude to blind validation of the automated approach.
15941457	The purpose of this article is to report a study of the perceptions and experiences of nurses caring for people living with HIV/AIDS in the public health sector in South Africa.The number of people living with HIV/AIDS in South Africa has escalated at an alarming rate. Many people being hospitalized are HIV positive, and hence nurses are in more regular and prolonged contact with people suffering from HIV/AIDS than is the case in other working environments. Although studies focusing on nurses' experiences of caring for patients with HIV/AIDS have been done in numerous countries, little is known about nurses' views in Africa, and South Africa in particular. To ensure quality care for patients with HIV/AIDS, it is important to understand nurses' experiences of nursing HIV-positive patients and how they may influence their attitudes towards these patients.	A qualitative approach was used, the primary method of data collection being in-depth interviews. These interviews were conducted with 35 nurses at a public hospital in the Gauteng province of South Africa in 2002-2003.	Seven themes were identified: helplessness, emotional stress and fatigue, fear, anger and frustration, occupational-related concerns, empathy, and self-fulfilment.	Increased understanding of the stresses and rewards experienced by these nurses can contribute to policy development in this area. It is also important to provide appropriate preregistration and continuing education and support for nurses working in this field, and to ensure that the working environment is adequate in terms of resources.	
15921985	This interpretive-phenomenological study examined the lived experience of being on the waiting list for arthroplastic surgery of the knee or hip. Interviews reveal that respondents experience suffering in different ways: illness-, caring- and life-suffering. Suffering leads to a struggle in order to have their caring needs met and the struggle is often fruitless-against a faceless enemy-"the system". No one is there to answer their plea or the frustration they experience. This in combination with their present life situation may lead to a disrupted self-image. Finding or creating meaning in suffering appears to be a crucial issue in the struggling process. Respondents who are able to preserve or create meaning in life are able to reformulate their life-world and live a full life, in spite of severe pain and disability.

15918661	Our knowledge of juvenile delinquency has progressed considerably since the early 1980s, thanks to self-reported delinquency surveys. They teach us that the determinants of delinquent behaviors among teenagers are dependent on the facility with which the offense is committed, the internal motivation (frustration in the family and school, observational learning of the use of violence in the media) and the weakness of social reactions.
15910399	Recent advancements in immunosuppression and surgical techniques have significantly improved the outcome of kidney transplantation in the pediatric population. Adolescents enjoy the best 1-year graft survival of any age group. However, the long-term transplant outcome in adolescents is disappointing. Non-adherence with immunosuppressive medications is one of the most important contributing factors for graft rejection and loss in teenagers. The impact of non-adherence is perceived to be far more powerful in adolescent transplant recipients than in the transplant population as a whole. To better understand adolescent non-adherence, the process of transplantation must be placed in the context of adolescent development. Adolescents try to establish their identity and autonomy separately from the parents; however at the same time, adolescents with chronic illness require help, support and guidance from adults, including parents and medical personnel. Adolescents have limited ability to anticipate abstractly the long-term consequences of their immediate actions. This inconsistency can create frustration in both adolescents and in the supporting systems around them. Despite the significant consequences of adolescent non-adherence, research in this area is scarce. There are still no established definitions, standardized diagnostic methods and effective interventions to treat and prevent this problem. We propose the recommendations to approach the problems of adolescent transplant non-adherence from the transplant clinician's viewpoint. With early identification and appropriate interventions, significant improvement in adolescent graft survival is possible.
15908273	In this article, findings are presented from a study that aimed to explore the perceptions and experiences of a sample of nurses in addressing sexuality as an aspect of care for women receiving chemotherapy for breast cancer. A sample of 10 oncology nurses was selected from oncology units at three hospitals in Ireland, and each participant was interviewed in depth. A qualitative strategy was employed to analyse data. Findings indicated that participants tended to construct sexuality in broad terms, and were well aware of the effects of chemotherapy on a person's sexuality. In addition, they considered sexuality education to be a legitimate and important aspect of their role. However, they also revealed that they avoided addressing sexuality with patients, or encountered structural obstacles in doing so. Some participants expressed anger and frustration when discussing barriers to incorporating sexuality into their practice. A strong theme in data was participants' perceptions that they were not adequately prepared in either pre- or post-registration programmes to incorporate sexuality as a dimension of patient care, although post-registration programmes were more likely to furnish them with knowledge about sexuality. Finally, participants' views on sexuality care are considered in the context of Irish culture which until recently was dominated by Catholic Church teachings.
15897211	Somatising patients frequently present in primary care but GPs often express frustration in dealing with them. A negative attitude may result in missed diagnoses and ineffective treatment.This study aimed to evaluate the effect of a novel, multifaceted training programme on GPs' attitudes towards somatisation.	The study was performed as a cluster randomised controlled trial with practices as randomisation unit and with a follow-up period of 12 months. Forty-three GPs from 27 practices in Vejle County, Denmark participated. The intervention consisted of a cognitive-oriented educational programme on assessment, treatment and management of somatisation (The Extended Reattribution and Management Model). Outcome measures were GPs' attitudes toward somatoform disorder and somatisation in general measured by the means of questionnaires at baseline and follow-up. The primary outcome was a change in response.	Baseline values confirmed previous findings that GPs find it difficult to deal with somatising patients. Compared with the control doctors, intervention doctors' attitudes towards patients with somatoform disorders had changed significantly 12 months after training on the parameters enjoyment (P = 0.008) and anxiety (P = 0.002). Doctors also felt more comfortable in dealing with somatising patients in general (P = 0.002). Attitudes about other parameters related to the doctors feelings, aetiology and course of somatisation changed in the expected direction, but these changes were not statistically significant.	A brief multifaceted training programme focussing on somatisation was accompanied by a significant change in GPs' attitude towards patients with somatoform disorders.	
15890071	The problem of poor compliance/adherence to prescribed treatments is very complex. Health professionals are rarely being asked how they handle the patient's (poor) therapy compliance/adherence. In this study, we examine explicitly the physicians' expectations of their diabetes patients' compliance/adherence. The objectives of our study were: (1) to elicit problems physicians encounter with type 2 diabetes patients' adherence to treatment recommendations; (2) to search for solutions and (3) to discover escape mechanisms in case of frustration.In a descriptive qualitative study, we explored the thoughts and feelings of general practitioners (GPs) on patients' compliance/adherence. Forty interested GPs could be recruited for focus group participation. Five open ended questions were derived on the one hand from a similar qualitative study on compliance/adherence in patients living with type 2 diabetes and on the other hand from the results of a comprehensive review of recent literature on compliance/adherence. A well-trained diabetes nurse guided the GPs through the focus group sessions while an observer was attentive for non-verbal communication and interactions between participants. All focus groups were audio taped and transcribed for content analysis. Two researchers independently performed the initial coding. A first draft with results was sent to all participants for agreement on content and comprehensiveness.	General practitioners experience problems with the patient's deficient knowledge and the fact they minimize the consequences of having and living with diabetes. It appears that great confidence in modern medical science does not stimulate many changes in life style. Doctors tend to be frustrated because their patients do not achieve the common Evidence Based Medicine (EBM) objectives, i.e. on health behavior and metabolic control. Relevant solutions, derived from qualitative studies, for better compliance/adherence seem to be communication, tailored and shared care. GPs felt that a structured consultation and follow-up in a multidisciplinary team might help to increase compliance/adherence. It was recognized that the GP's efforts do not always meet the patients' health expectations. This initiates GPs' frustration and leads to a paternalistic attitude, which may induce anxiety in the patient. GPs often assume that the best methods to increase compliance/adherence are shocking the patients, putting pressure on them and threatening to refer them to hospital.	GPs identified a number of problems with compliance/adherence and suggested solutions to improve it. GPs need communication skills to cope with patients' expectations and evidence based goals in a tailored approach to diabetes care.	
15886547	Most women are unaware that that they may experience atypical coronary heart disease (CHD) symptoms. Women's atypical presentation often results in women having difficulty being diagnosed with CHD or myocardial infarction. Investigating women's CHD diagnostic experiences may reveal vital areas amenable to intervention. This secondary analysis explored women's CHD diagnostic experiences. Forty women completed in-depth interviews in their homes that were audiotaped and lasted 2-3 hours. Using content analysis and constant comparison, five themes emerged: awareness, seeking treatment, frustration, treatment decisions, and anger. Despite numerous symptoms and visits with clinicians, most women were not diagnosed with CHD before myocardial infarction. During the infarction, women with typical symptoms were easily diagnosed while those with atypical symptoms received a delayed diagnosis. Those who repeatedly sought treatment were angry about not being diagnosed earlier. Further research is needed to promote early symptom recognition, timely diagnosis, and efficacious treatment-keys to improving women's CHD outcomes and to preventing similar negative diagnostic experiences.
15882365	This paper reports a study elucidating the meaning of caring for girls of the street, as experienced by female staff members working with street children in Eastern Africa.The phenomenon of children living on the streets is a global and escalating problem, and girls are presumed to be especially vulnerable. In East Africa, the traditional extended family system is rapidly breaking down and traditional gender values seem to remain. This was the context for investigating female carers' experience of caring for girls.	Interviews were conducted with 37 project staff members working with children living on the streets in the framework of non-governmental organizations in Kenya, Uganda and Tanzania between 1997 and 1998. Transcribed text from female interviewees (n = 13) working with girls of the street was analysed using a phenomenological-hermeneutic approach.	The meaning of caring for girls of the street for female professional carers in East Africa was comprehensively understood as counselling the girls to integrate the past of their adverse life stories with their present identity. Counselling meant conveying visions for a possible re-direction of the life stories, from being a girl of the street into being an accepted family girl. Caring in this context meant being squeezed between ethical demands and gender values. Experiencing frustration and powerlessness was related to gender structures in society, having to fight the grip of street culture, and a lack of professional tools. Hope and satisfaction were related to success in changing the course of life stories of girls and to seeing possibilities for contributing to empowerment of girls and community members.	Gender issues are critical to care provided to girls of the street. Carers felt that they lacked relevant knowledge and support. Ethical aspects and gender issues in relation to professional care for vulnerable girls ought to be addressed in nursing education and practice, not only for developing countries, but also as a matter of global interest.	
15881302	Chronic orofacial pain is a biopsychosocial problem. Pain description and intensity have been previously reported by the authors. This follow up study reports on the presence and severity of psychological morbidity presence and alseverity changes associated with chronic and personality changes associated with chronic orofacial pain.A total of 415 questionnaires for psychological morbidity (238 chronic orofacial pain patients and 175 controls) and 205 responses for personality changes (105 pain patients and 100 controls) were analyzed. Demographic and status, level of education include and current work status. status, level of education and current work status. Psychological variables tested were depression, anger, fear, distress, frustration and anxiety. Pain patients indicated descriptors of their personalities 'pre-pain' and 'with pain'.	The chronic pain group reported higher levels of 'feeling sad or miserable' p < 0.001 'feeling frustrated' p = 0.001 and 'feeling anxious, worried' p = 0.022 than the control group. Within the chronic pain group, patients unemployed due to pain or other reasons reported higher levels of 'feeling sad or miserable' and 'feeling frustrated' (p < 0.05) compared with patients engaged in full or part-time work. Negative personality changes due to pain were clearly evident with 'irritable' and 'sad' being frequently chosen words (p < 0.001).	Patients with chronic orofacial pain suffer from negative psychological and personality changes.	
15875758	Excessive computer and video game playing among children is being critically discussed from a pedagogic and public health point of view. To date, no reliable data for this phenomenon in Germany exists. In the present study, the excessive usage of computer and video games is seen as a rewarding behavior which can, due to learning mechanisms, become a prominent and inadequate strategy for children to cope with negative emotions like frustration, uneasiness and fears. In the survey, 323 children ranging in age from 11 to 14 years were asked about their video game playing behavior. Criteria for excessive computer and video game playing were developed in accordance with the criteria for dependency and pathological gambling (DSM-IV, ICD-10). Data show that 9.3% (N = 30) of the children fulfill all criteria for excessive computer and video game playing. Furthermore, these children differ from their class mates with respect to watching television, communication patterns, the ability to concentrate in school lectures and the preferred strategies coping with negative emotions. In accordance with findings in studies about substance-related addiction, data suggest that excessive computer and video game players use their excessive rewarding behavior specifically as an inadequate stress coping strategy.
15862936	Psychosocial variables play a substantial role in the IBS condition of many patients. Evaluating and addressing adverse psychosocial factors is important to achieve satisfactory clinical outcomes with those patients. This can be achieved efficiently through psychosocial interviewing, establishing a solid therapeutic relationship, and judicious and tactful application of psychotropic medications and psychological treatments. Success in address-ing psychosocial factors in clinical encounters benefits not only patients, but also the gastroenterologist through increased work satisfaction because of reduced difficulty and frustration in working with IBS patients.
15855863	End-of-life care involves not only the care of patients but also the care of those providing care for patients. The routine demands of providing care for patients in end-of-life situations often prevent nurses from working through the grief associated with the death of a patient, resulting in frustration, depression, stress, and eventually, burnout. It is important to recognize that grief and mourning are necessary steps in adjusting to the loss associated with the death of a patient or a loved one. The process of mourning can be likened to the process of healing, with predictable stages or tasks. As nurses providing quality end-of-life care, we can provide an opportunity for a patient's family to begin the process of grieving through appropriate interventions while the patient is still in the hospital or care facility. Recognizing and respecting the appropriateness of individual differences in grief responses creates a means of support for both patients and professionals in healthcare settings. By understanding grief as a predictable, yet individual, response to the loss of a patient or a loved one, we, as nurses, can take care of ourselves while providing quality end-of-life care for our patients.
15848357	A surgeon's level of frustration when performing an operation and level of satisfaction at completion may be correlated with patients' outcomes. We evaluated the relationship between the attending surgeons' frustration and satisfaction and recurrence and complications of open and laparoscopic inguinal hernia repair.Men with detectable inguinal hernias were randomized to undergo open or laparoscopic herniorrhaphy at 14 Veterans Affairs hospitals. After completion of the procedure, surgeons were asked to assess their level of frustration during the operation and their overall satisfaction with the operative result. Two subjective scales ranging from 1 (not frustrated/not satisfied) to 5 (very frustrated/very satisfied) were used to independently assess both parameters. Reasons for surgeon frustration were evaluated. Patients were followed for 2 years for recurrence and complications.	Of 1,983 patients who underwent hernia repair, 1,622 were available for analysis; 808 had open repair and 813 had laparoscopic repair. Surgeons reported less frustration and more satisfaction with open than with laparoscopic repair (p = 0.0001 and 0.0001, respectively). Frustration was associated with a higher rate of hernia recurrence at 2 years (adjusted odds ratio, 2.01, 95% CI, 1.15-3.51) in open repair, and a higher overall rate of postoperative complications (adjusted odds ratio, 1.27, 95% CI, 1.03-1.56) in both open and laparoscopic hernia repair. Satisfaction was not correlated with recurrence or complications.	The level of a surgeon's frustration during performance of an inguinal herniorrhaphy was a better predictor of outcomes of the operation than was satisfaction with the procedure. Sources of intraoperative frustration should be controlled to improve outcomes.	
15826344	To investigate residential care staff beliefs and feelings about the challenging behaviour of adults with learning disabilities in their care, and how they perceive these beliefs and feelings to have developed over time.A qualitative study using thematic analysis.	A group of 18 staff from 10 different residential services participated in indepth semi-structured interviews. Transcripts were analysed according to thematic analysis techniques drawn from interpretative phenomenological analysis (IPA) and grounded theory. The analysis was then subjected to scrutiny by participants using a respondent validation survey.	Staff talked of dilemmas about whether challenging behaviour should be seen as a 'communication' of need or as a 'behaviour problem', how to balance a 'firm' response with 'kindness', and how to deal with unpleasant feelings evoked by the work, especially fear and frustration. Over time, staff reported overcoming initial fears of the client by 'getting to know them', or alternatively, avoiding the client, 'cutting off' emotionally, or protecting themselves with safety procedures.	The analysis suggests that staffs are troubled by the limitations of a narrow behavioural discourse. Staff development and training based on richer approaches that integrate behavioural ideas with a value-based philosophy, might allow staff to respond to needs expressed by behaviour without fear of reinforcing it. Services should attend to staff emotional reactions to their work, to help them maintain nonavoidant coping strategies.	

15808697	Transplantation is a process with several psychosocial challenges. Regarding the case of xenotransplantation, the perceived similarity between humans and pigs may be stressful. Adjustment disorders have been reported among transplantation recipients. We sought to assess the psychosocial aspects of xenotransplantation among porcine islet-cell recipients and their efforts to adapt themselves to this condition.Ten insulin-dependent diabetes mellitus patients aged 14.58 +/- 7.93 who received porcine islet-cells were included. The bioartificial steel/fibrous tissue chamber method was used. All patients and their relatives were interviewed about their expectations, overall functioning, and experiences. The quality of life, enjoyment, and satisfaction scale and the hospital anxiety and depression scales were used. A 1-year follow-up was done.	Their motivation was centered on autonomy; there were no troubles regarding the graft origin. Xenotransplantation was perceived with pragmatism, seeing pigs as an unlimited resource. The patients with best outcomes also had the greatest improvements in several quality of life areas (QOL) while the medium responders had fewer QOL improvements. The nonresponders experienced mainly frustration. Parents' concerns were not related to their children's health but to their recently gained autonomy.	In addition to enthusiasm, the perception of animals as an unlimited source of organs may affect patient compliance; in this group, xenotransplantation was seen as using as a long-lasting drug, with chamber walls considered as a physical, immunologic, and, in certain manner, a psychological barrier.	
15807759	To explore in depth the experiences of nurses' caring for SARS patients in Hong Kong.Severe Acute Respiratory Syndrome (SARS) dramatically demonstrates the global havoc that can be wreaked by a newly emerging infectious disease. The current literature either has a predominantly biomedical focus or deals with the psychological impact on healthcare workers. Published studies on the lived experience of nurses caring for SARS patients are currently lacking.	A phenomenological design.	Using methods consistent with Husserl's philosophy, eight Registered Nurses working in three regional hospitals in Hong Kong were invited to participate in sharing their lived experience of caring for SARS patients and data were analysed using Colaizzi's approach.	The three major themes explicated were: the various emotions experienced in caring for SARS patients, the concept of uncertainty and revisiting the 'taken for granted' features of nursing.	These themes, when taken together, describe the essence of the voyage undertaken by nurses who cared for SARS patients during the outbreak. The findings of this study indicate that extensive and ongoing support is needed to prepare and enable nurses to care for SARS patients during a crisis and make it easier for nurses to deal with the various uncertainties.	The essence of caring for SARS patients is highlighted in this study. The experience of caring for SARS patients prompts nurses to find meaning in their experience(s), and to develop knowledge and attitudes on how best to care for patients and prepare for a new crisis in the future. This paper considers a more in-depth understanding of the lived experience of nurses during the crisis and the relevance of this perspective for education and support of nurses.	
15807749	This paper reports the views of teaching staff and clinical assessors on their experience of programme delivery and assessment.In 2001, the Irish Department of Health and Children developed a vocational training programme for healthcare assistants. This programme was piloted nationally across 14 hospital and community sites. Teaching staff and clinical assessors at each site delivered the programme.	One-to-one semi-structured interviews were undertaken with 16 clinical staff and 26 teaching staff. With consent, all interviews were tape-recorded, from which the transcripts were subject to content analysis.	A lack of experience and preparation among teaching staff and clinical assessors was evident. The staff's commitment to their role on the programme while maintaining their normal duties caused frustration and uncertainty. Not withstanding, the value of the programme in terms of increased motivation, satisfaction and knowledge of healthcare assistants and the impact on care delivery, was recognized by respondents.	This programme represents the provision of a national standard training programme for healthcare assistants. It provides an insight into the delivery of such a programme and the educational and training needs of healthcare assistants through the views of staff that taught and assessed on it.	Findings suggest that the development and implementation of a national training programme for healthcare assistants is achievable.	
15799208	A series of case reports in the early 1980s and prevalence studies in the 1990s highlighted the serious medical consequences of coexisting eating disorders and diabetes mellitus. Diabetes-specific treatment issues, such as the need to carefully monitor diet, exercise, and blood glucose, may contribute to the development of eating disorder symptoms among women with diabetes mellitus. The attention to food portions and bodyweight that is part of routine diabetes mellitus management parallels the rigid thinking about food and body image found in women with eating disorders who do not have diabetes mellitus. Additionally, intensive insulin management of diabetes mellitus, the current standard of care, has been shown to be associated with bodyweight gain. Following from this, it may be that the very goals of state-of-the-art diabetes mellitus care increase the risk for developing an eating disorder. Once an eating disorder and recurrent insulin omission becomes entrenched, a pattern develops which is hard to break - one of chronic hyperglycemia, depressed mood, fear of bodyweight gain, and frustration with diabetes management. Eating disorders predispose women with diabetes mellitus to many complex medical risks. For example, insulin omission and reduction, eating disorder symptoms unique to diabetes mellitus, are strongly associated with an increased risk of diabetic ketoacidosis and with microvascular complications of diabetes mellitus such as retinopathy. For this reason, it is critical that diabetes mellitus clinicians understand more about eating disorders so as to improve the likelihood of early detection, appropriate treatment, and prevention of acute and long-term medical complications within this high-risk group of women.
15780152	Chronic malnutrition and growth failure are frequent consequences of feeding difficulties in neurodevelopmentally disabled children. Gastrostomy feeding has been used successfully to alleviate chronic malnutrition as well as distress and frustration associated with feeding. Unfortunately, caregivers are often resistant to gastrostomy placement. In order to determine the impact of gastrostomies in 20 children with neurodevelopmental disability (NDD), a questionnaire was used to collect caregivers' perceptions both before and after gastrostomy. The questionnaire assessed caregivers' retrospective perceptions of quality of life, feeding difficulties, and the burdens and benefits of gastrostomies. To determine impact on growth, height and weight were measured once before and three times after gastrostomy (at six, 12, and 24 months). The number of times a child was fed and the amount of time spent feeding decreased significantly following gastrostomy (p<0.001 and p<0.05, respectively). Growth for all children improved following gastrostomy (p<0.001). Pre-gastrostomy problems improved significantly following gastrostomy, as did caregivers' perceptions of quality of life for both themselves and their child (p<0.001). These results indicate that gastrostomy has a positive impact on growth for neurodevelopmentally disabled children, and on quality of life for both children and caregivers. Caregivers may find these results encouraging if they are faced with a decision about gastrostomy placement for their child.
15768781	A state-level survey of registered nurses confirmed national findings and raised new issues. Findings revealed that while nurses love the intrinsic reward of nursing, they report workplace, relationship, and stress issues which contribute to frustration and exhaustion. These issues may prevent registered nurses from giving the nursing care they desire to deliver, hastening preventable retirement and costly turnover decisions.
15765641	To explore and describe what it means to be a GP meeting patients with non-specific symptoms.Focus group interviews analysed in a phenomenological approach.	GPs at two urban healthcare centres from a big city, a low socioeconomic area with mostly immigrants and a high socioeconomic area, and from a smaller town.	14 GPs in 3 focus groups.	The essence of the study was the GPs' feeling of being a "helpless helpoholic". All GPs specified the patient with non-specific symptoms as a female patient with muscular pain. The key constituents were: inconsistent patient, insufficient tools, frustration, helplessness, and devotion to help. The tools were described as communication skills, biomedical education, and holistic perspective. Even if most informants were trained in communication skills, this did not help to avoid the feeling of helplessness.	To be a "helpless helpoholic" may make the GPs less patient-centred and may create even more feelings of frustration and helplessness. This can be an important reason why consultations with female patients with non-specific muscular pain often fail.	
15765460	Pain patients can be difficult. They can provoke negative feelings of frustration and anger among clinicians and damage the doctor-patient relationship. This article helps practitioners to identify those pain patients who would be prone to difficult behavior and sheds light on some of the reasons behind the behavior that give rise to difficult feelings. Issues of comorbid psychopathology, hostility, suicidality, aberrant drug behavior, and chronic noncompliance are discussed. Specific recommendations are also given of the best ways to manage patients with difficult behavior.
15764637	The purpose of this study was to explore nurses' experiences and perspectives regarding child abuse in Taiwan. Semistructured interviews with Taiwanese nurses were audiotaped and transcribed verbatim for this descriptive study. The method of category development proposed by the grounded theory method was used to develop categorical themes that reflected the nurses' experiences and perspectives. From the 18 registered nurses interviewed, four major categorical themes emerged that were integral to nurses' experiences working with abused children: the meaning of child abuse, conflict, feeling frustrated, and nurses' roles. Findings provide a base for understanding child abuse from the perspectives of nurses and a beginning understanding of interventions needed to improve identification and reporting of child abuse in Taiwan. Although nurses have considerable awareness and concern about child abuse, additional education related to this issue is needed.
15760957	Many patients prefer to donate unused embryos when surveyed. However, it is a source of frustration and curiosity that clinical audits of embryo outcomes show the majority changed their minds. In many clinics, the number of recipients continues to outweigh the number of donors. To plan effective counselling practices, it is important to understand the dynamics of decision-making for patients when determining outcomes for unused embryos.Twelve couples and nine women (n = 33) who had discarded unused embryos were interviewed using a narrative structure and various interview techniques. Interview transcripts underwent qualitative analysis through which data were grouped thematically according to similarities. Differences were also examined.	Participants described their initial choice to donate embryos as an idealistic plan rather than a purposeful decision. Their change of mind was due to two factors: (i) a change in their standpoint from a childless couple to parents; and (ii) a change in the symbolism of the embryo from representing a chance to become pregnant to representing a 'virtual' child in cryo-storage. The meaning of embryo donation was likened to child relinquishment.	Counselling and social policy need to take account of the symbolism of the embryo and reform current practices.	

15746657	This study was undertaken to ask mothers who had children with Down syndrome after receiving a prenatal diagnosis: How was the process and what, if anything, could be improved?An 11-page survey was mailed to 2945 persons on the membership lists of 5 Down syndrome parent organizations. The survey gathered both quantitative and qualitative data from yes/no questions, open-ended questions, and a series of statements asking the mothers to rate their level of agreement on a 1-to-7 Likert scale. Qualitative data were analyzed using the Constant Comparative Method of Qualitative Analysis, and quantitative data were summarized using linear regressions, mixed stepwise multiple regressions, and grouped means, 1-way analysis of variance analyses.	Of 1126 surveys received, 141 (12.5%) were from mothers who had received a prenatal diagnosis. Though satisfied with the care that they had received, the majority of respondents expressed frustration with the process. The most common suggestions were that the diagnosis be conveyed in person, that up-to-date printed materials on Down syndrome (DS) be provided, and that mothers be referred to local DS support groups.	Receiving a prenatal diagnosis of DS need not be a negative experience. By implementing suggestions proposed herein by the mothers, health care providers can even make the situation a positive one.	
15727406	Black, Hispanic, and White American mothers (n = 739) and adolescents (n = 806) completed the Parent Success Indicator to rate maternal performance on subscales of Communication, Use of Time, Teaching, Frustration, Satisfaction, and Information Needs. A weighted method corresponding to ethnic proportions in the American population was applied to construct a national standard for comparative reference. In general, both generations perceived mother performance as favorable. Teaching received the highest rating followed by Satisfaction levels. Mothers felt that Information Needs were their greatest limitation while adolescents reported that their mothers were prone to frustration. The amount of time mothers and adolescents spent together was the most significant independent variable influencing parent performance. Other variables such as income and marital status had limited impact.
15686089	Psychoanalytic psychotherapy in clinical practice is traditionally a long-term treatment conducted by well-trained psychotherapists. However, very few studies have been published that evaluate the effects of such treatment. To redress this lack of studies, 55 individuals selected for long-term psychoanalytic psychotherapy (average, 3 years) were invited to participate in a naturalistic study. The psychotherapists had a mean of 15 years of professional experience. The 36 patients who completed psychotherapy manifested a substantial reduction in symptomatic suffering and decreased levels of character pathology, as measured by the Karolinska Psychodynamic Profile (KAPP) and the Karolinska Scales of Personality. Generally, such changes were not found in the individuals who did not engage in treatment. In the therapy group, improvements were found on eight KAPP subscales defining different aspects of character: Intimacy and Reciprocity, Frustration Tolerance, Regression in the Service of the Ego, Coping with Aggressive Affects, Conceptions of Bodily Appearance and their Significance for Self-esteem, Sexual Function, Sexual Satisfaction, and Personality Organization. The results indicate that individuals who engaged in psychotherapy improved their capacity to handle crucial aspects of life and reduced their symptomatic suffering.
15678026	Let me make this clear. I do not look for "mission impossible" cases, but they always find me! A nurse case manager on a busy pediatric floor, I was trying to think through a challenging case one day when a new nurse working with me said in frustration, "Stephanie, how do you keep from giving up on cases like this?"My mind flashed back to three situations that stand out as mission impossible. I have seen so many struggles and disappointments in the quest to solve the impossible. However, I have painfully learned a fundamental truth in the past 20 years. In my practice, some of the most hopeless cases stand out as pivotal in drawing from that truth, which gives me strength.
15673636	Hot flashes are among the most frequently reported menopausal symptoms. However, little is known about factors associated with their occurrence. Moreover, despite the wide use of self-report hot flash measures, little is known about their concordance with physiological flashes. This study evaluated emotional and behavioral antecedents of subjectively and objectively measured hot flashes during daily life. It also examined individual differences predicting concordance between objective and subjective hot flashes.Forty-two perimenopausal or postmenopausal women (mean age = 50.5 +/- 4.8 years) reporting daily hot flashes completed 2 days of ambulatory sternal skin conductance monitoring, behavioral diaries 3 times an hour, and psychometric questionnaires. Hot flashes meeting objective physiological criteria and subjectively reported flashes not meeting physiological criteria were assessed. Likelihood of hot flashes following emotions and activities were examined in a case-crossover analysis.	Relative to nonflash control times, objective hot flashes were more likely after increased happiness, relaxation, and feelings of control, and less likely after increased frustration, sadness, and stress. Conversely, subjective hot flashes not meeting physiological criteria were more likely after increased frustration and decreased feelings of control. Questionnaires revealed increased negative mood and negative attitudes were associated with fewer objective flashes and higher false-positive reporting rates.	Increased positive and decreased negative emotions were associated with objective hot flashes, whereas increased negative and decreased positive emotions were associated with subjective flashes not meeting physiological criteria. The anecdotal association between negative emotions and hot flashes may be the result of self-reported flashes lacking physiological corroboration.	
15671326	Caring for patients with chronic health conditions is an important component of health care in the 21st century. This study uses qualitative research methods to take an in-depth look at the attitudes of first-year medical students toward chronic illness and the care of chronically ill patients.In Spring 2000, 26 first-year medical students at the College of Human Medicine, Michigan State University, were invited to participate in interviews focused on their attitudes toward caring for patients with chronic illness. Transcripts of the interviews were analyzed to identify iterative themes. Concurrently, all 105 first-year students were given a questionnaire that asked about their attitudes toward various aspects of patient care.	Nineteen students participated in the interviews. Students viewed chronic illness as incurable, long running, life altering, and often terminal. Most students had firsthand experience with chronic illness in family members; many had premedical work experience with chronically ill patients. Most students described themselves as comfortable with a partnership relationship with patients. Students acknowledged responsibility for caring for those with chronic illness but anticipated sadness and frustration in this work. One hundred and four students completed the questionnaire. Respondents' attitudes were consistent with those expressed in the interviews, suggesting that the interview findings represent the class as a whole.	Students enter medical school with complex attitudes toward chronic illness, many of which are more negative than previously reported. Qualitative instruments constitute important methods for studying the intricacies of students' attitudes and outlooks.	
15669951	Ethnic disparities in pain have recently gained increasing attention; however, relatively few studies have examined ethnic differences in pain prevalence, and even fewer have addressed whether ethnic groups differ in their pain-reducing behaviors. Thus, this study investigated ethnic differences in pain prevalence and impact among healthy young African Americans, Hispanics, and non-Hispanic whites.(1) Also, ethnic differences in pain-reducing behaviors were explored. Undergraduate students (N = 1,037) from three ethnic groups completed a telephone survey of recent pain experiences. Groups did not differ in overall pain frequency or severity; however, more African Americans reported chest and stomach region pain, whereas more Hispanics reported pain in the legs/feet. Significant group differences regarding pain-reducing behaviors emerged. More whites utilized self-care behaviors, compared to Hispanics and African Americans. Conversely, greater numbers of African Americans and Hispanics than whites reported having prayed to relieve pain. The predictors of the total number of pain-reducing behaviors used differed across ethnic groups. For whites, pain intensity and interference were the strongest predictors of pain-reducing behaviors. For African Americans, total pain sites, as well as interference and frustration, were significantly associated with pain-reducing behaviors, while among Hispanics, worry and frustration were the strongest predictors for total pain-reducing behaviors. These results suggest potentially important ethnic differences in patterns and predictors of pain-reducing actions, and their emergence in a healthy sample suggest that ethnic differences in pain-related responses predate the development of chronic pain. These findings may have important implications for understanding ethnic differences in responses to clinical pain and for tailoring treatment approaches to eliminate disparities.
15661670	Evil actions are defined as repeated or persistent, not commensurate with provocation and causing extreme harm, at times due to repetition. Evil develops or evolves. As individuals and groups harm others, they tend to develop characteristics that make further and more intense harmdoing probable. In this article, I explore instigating conditions (difficult life conditions in a society, group conflict); cultural characteristics; the nature of evolution, with its psychological and social processes in individuals and groups; and the passivity and complicity of bystanders that lead to genocide and other collective violence. I consider the question of whether bystanders can be regarded as evil, focusing on the genocide in Rwanda as an example. I examine the socialization and experience of children and youth that lead to aggression and the subsequent evolution of aggression toward greater violence and evil. I explore the way personal characteristics and a system of relationships can lead to sexual abuse by fathers. One organizing concept in understanding the generation of violence that causes extreme harm is the frustration of basic human needs and their subsequent destructive fulfillment.
15659998	Providing safe, error-free care is the number-one priority of all health care professionals. Excellent outcomes have been associated with procedural efficiency, the implementation of evidence-based standards, and the use of tools designed to reduce the likelihood of medical error (such as computerized medication orders and bar-coded patient identification). But the impact of work relationships on clinical outcomes isn't as well documented. The current survey was designed as a follow-up to a previous VHA West Coast survey that examined the prevalence and impact of physicians' disruptive behavior on the job satisfaction and retention of nurses (see "Nurse-Physician Relationships: Impact on Nurse Satisfaction and Retention," June 2002). Based on the findings of that survey and subsequent comments on it, the follow-up survey examined the disruptive behavior of both physicians and nurses, as well as both groups' and administrators' perceptions of its effects on providers and its impact on clinical outcomes. Surveys were distributed to 50 VHA hospitals across the country, and results from more than 1,500 survey participants were evaluated. Nurses were reported to have behaved disruptively almost as frequently as physicians. Most respondents perceived disruptive behavior as having negative or worsening effects, in both nurses and physicians, on stress, frustration, concentration, communication, collaboration, information transfer, and workplace relationships. Even more disturbing was the respondents' perceptions of negative or worsening effects of disruptive behavior on adverse events, medical errors, patient safety, patient mortality, the quality of care, and patient satisfaction. These findings suggest that the consequences of disruptive behavior go far beyond nurses' job satisfaction and morale, affecting communication and collaboration among clinicians, which may well, in turn, have a negative impact on clinical outcomes. Strategies aimed at reducing the incidence and impact of disruptive behavior are recommended.
15652694	The aim of this study is to explore identity change in medical students over their first year of medical training, particularly in relation to their experience of human dissection. Each of our four participants completed two repertory grids at the end of term one and, again, towards the end of term three. One grid tapped their identity construction, and the other, their experience of human dissection. Our participants were optimistic about becoming similar to a doctor they admired and, towards the end of term three, began to develop a stable identity as a medical student. Their identity constructs involved three common themes: dedication, competence, and responsibility. However, the data also revealed negative reactions to the demands of training, such as feeling driven and stressed. Three major themes were apparent in their experience of human dissection: involvement, emotional coping, and ability. Our participants' dedication to their studies was reflected in their appreciation of the need to become involved actively in the process of dissection but some experienced an erosion of their self-confidence and perceived some of their colleagues to have lost much of their enthusiasm for learning. Emotional coping could be an additional challenge within this context and their reaction tended to reflect distancing processes previously identified in the literature. In all, we see a development of a vulnerable sense of professionalism alongside a frustration of losing out potentially on wider aspects of personal development due to the high work demands.
15629209	In the last decade, the Iowa Gambling Task (IGT) has become a widely employed neuropsychological research instrument for the investigation of executive function. The task has been employed in a wide range of formats, from 'manual' procedures to more recently introduced computerised versions. Computer-based formats often require that responses on the task should be artificially delayed by a number of seconds between trials to collect skin-conductance data. Participants, however, may become frustrated when they want to select from a particular deck in the time-limited versions--so that an unintended emotional experience of frustration might well disrupt a task presumed to be reliant on emotion-based learning. We investigated the effect of the various types of Iowa Gambling Task format on performance, using three types of task: the classic manual administration, with no time limitations; a computerised administration with a 6-s enforced delay; and a control computerised version which had no time constraints. We also evaluated the subjective experience of participants on each task. There were no significant differences in performance, between formats, in behavioural terms. Subjective experience measures on the task also showed consistent effects across all three formats-with substantial, and rapidly developing, awareness of which decks were 'good' and 'bad.'
15614671	This article describes the experience of nursing an outpatient primipara in the 26th week of pregnancy who was not conscious of fetal movement and whose fetus was confirmed by sonography as having suffered intrauterine fetal death to adapt to labor induction as a hospital inpatient. The nursing care lasted between March 21 and March 28, 2002. I (the researcher) tried to use the well established Roy Adaptation Model of Nursing to collect information through observation, interview, and physical assessment. The subject's nursing problems included: 1.The sadness of losing child. 2. The frustration of not being able to take on the mother's role. 3. Feeling evil and sorry when facing her husband. 4. Doubting her course of medication. 5. Pain due to labor induction. In accordance with the situation, the main nursing strategies were: 1. To reduce the shock and pressure for the subject case and her family due to the loss of a child. 2. To help the subject accept the fact of loosing her child. 3. To help the subject and her husband to communicate well and establish support systems. 4. To help the patient to be receptive to medical treatment. 5. To reduce discomfort from labor induction. During the hospitalization, the researcher helped the subject case to face stress and adapt to physiological accommodation, develop a concept of herself, her functional role and interdependence and then accept the fact of losing child and maintain a healthy body image.
15610382	This paper reports a study to illuminate the complex interaction between person and their life world during the burnout development period.Burnout is a construct describing the psychological state resulting from ineffective strategies for coping with enduring stress in both client and non-client work. Role conflict and role ambiguity, or long-term stress and frustration caused by strain in daily life, promote or exacerbate burnout, indicating that the person's entire life world is involved. There is still a lack of description of lived experiences of the time preceding manifest burnout.	Data were collected from interviews with eight people suffering from burnout and analysed using a phenomenological method.	The essential meaning of the phenomenon of burnout is understood as being trapped with stimulating challenges as a self-nourishing drive on one side and with responsibilities and demands on the other. This essence can be illuminated by its eight constituents: inner incentive, feeling responsible, threatened self-image, cutting off, bodily manifestations, psychological manifestations, fatigue and reaching the bottom line.	The lived experiences of the time preceding manifest burnout are an ambiguous struggle. Cutting off is understood as a mean to shelter the threatened self-image in a state of vulnerability and weakened strength. Accordingly, a better understanding of how to reach behind the defence of 'cutting off' and thus help to open up for consolation and self-acceptance is an essential skill for nurses, health care professionals and others encountering the burnout sufferers. Furthermore this study illuminates early signs of burnout and an important issue is how to strengthen the individuals' ability to shelter their need for recovery and restitution.	
15604633	Patients and practitioners may believe that clinically validated laboratory tests provide definitive information. Genetic counselors know this is not always so, and the possibility of inconclusive genetic test results is often discussed in the pretest counseling session. This added discussion topic prolongs the process of genetic counseling, but if there is inadequate patient understanding, patient frustration may be high when receiving a result of uncertain significance, and patients may make decisions about subsequent medical management based on incorrect assumptions. For patients/participants in a research setting, where the clinical validity of testing may be unclear, some patients/participants may still want to use test results to influence their medical management. This paper presents findings from a qualitative study wherein 15 women from the High Risk Breast Cancer Clinic at Utah's Huntsman Cancer Institute discussed how uncertainty regarding results affected their decision making. The women were randomly selected from 3 categories--women with test results of uncertain significance; women without cancer who have a mutation; and women who are members of high-risk families, but for whom no mutation was found. Study findings will be used in future studies to better understand how to improve communication regarding uncertain results, especially in a research environment.
15590230	When a physician believes that the troubles of caring for a patient outweigh the rewards, he or she can move--"turf", the unwanted patient from his or her own to another physician's territory. Physicians receiving such patients can feel burdened by, and resentful about, caring for those who are "turfed" to them by other physicians, yet little is known about the effects such "turf battles" have on patient care. This study aims to discover if "turfed" patients (TPs) experience their hospitalizations differently from patients whose admissions are perceived more favorably by their physicians.Semi-structured, in-depth interviews.	Twenty Six English-speaking patients on a medical service in a tertiary care university hospital.	Hospitalization experiences based on qualitative thematic analysis of interview audiotapes and transcripts.	The experience of patients perceived as "turfs" differed from patients deemed more appropriately admitted in two areas: mode of admission and tone of interview themes. TPs were admitted via the emergency department or intra-hospital transfer; unlike the "appropriate" patients (APs), none came from outside hospitals. Although patients in both groups voiced many similar themes, nearly all TP interview themes were unfavorable. AP interviewees, by comparison expressed both favorable and unfavorable themes. TPs were direct and explicit about their anger and frustration, while APs mixed humor with complaints.	"Turfed" patients may have different care experiences from those of patients deemed appropriate for a medical service. Inter-specialty barriers to collegiality and relationship-centered care shape physicians' perceptions of patient appropriateness and desirability and merit further large-scale exploration.	
15589184	People can learn to control mu (8-12 Hz) or beta (18-25 Hz) rhythm amplitude in the electroencephalogram (EEG) recorded over sensorimotor cortex and use it to move a cursor to a target on a video screen. The recorded signal may also contain electromyogram (EMG) and other non-EEG artifacts. This study examines the presence and characteristics of EMG contamination during new users' initial brain-computer interface (BCI) training sessions, as they first attempt to acquire control over mu or beta rhythm amplitude and to use that control to move a cursor to a target.In the standard one-dimensional format, a target appears along the right edge of the screen and 1s later the cursor appears in the middle of the left edge and moves across the screen at a fixed rate with its vertical movement controlled by a linear function of mu or beta rhythm amplitude. In the basic two-choice version, the target occupies the upper or lower half of the right edge. The user's task is to move the cursor vertically so that it hits the target when it reaches the right edge. The present data comprise the first 10 sessions of BCI training from each of 7 users. Their data were selected to illustrate the variations seen in EMG contamination across users.	Five of the 7 users learned to change rhythm amplitude appropriately, so that the cursor hit the target. Three of these 5 showed no evidence of EMG contamination. In the other two of these 5, EMG was prominent in early sessions, and tended to be associated with errors rather than with hits. As EEG control improved over the 10 sessions, this EMG contamination disappeared. In the remaining two users, who never acquired actual EEG control, EMG was prominent in initial sessions and tended to move the cursor to the target. This EMG contamination was still detectable by Session 10.	EMG contamination arising from cranial muscles is often present early in BCI training and gradually wanes. In those users who eventually acquire EEG control, early target-related EMG contamination may be most prominent for unsuccessful trials, and may reflect user frustration. In those users who never acquire EEG control, EMG may initially serve to move the cursor toward the target. Careful and comprehensive topographical and spectral analyses throughout user training are essential for detecting EMG contamination and differentiating between cursor control provided by EEG control and cursor control provided by EMG contamination.	Artifacts such as EMG are common in EEG recordings. Comprehensive spectral and topographical analyses are necessary to detect them and ensure that they do not masquerade as, or interfere with acquisition of, actual EEG-based cursor control.	
15576500	The interdependencies of Pharmacy and Therapeutics Committee members in 222 teaching hospitals were studied by use of the social relations model. Cooperation, influence, frustration and enjoyment were studied among four-person subgroups chosen from the five roles recommended for hospitals by the American Society of Hospital Pharmacists: physician-chair, physician-nonchair, pharmacist, nurse and administrator. The results show that the elicitation and reception of cooperation, influence, frustration and enjoyment vary considerably by role (as manifest in actor and partner effects); small amounts of individual reciprocity (i.e. the association between actor and partner effects) were found for some measures of interdependence across roles, while small amounts of dyadic reciprocity (i.e. the association between reciprocal relationship effects) were found for many relationships. Significant group level (i.e. committee) effects were found as well.
15556958	We conducted a postal survey of parents whose child had been diagnosed with an autistic spectrum disorder by a district diagnostic service. The service was regarded as having improved significantly following recent changes, but there were still shortcomings. Parents had obtained useful information from a range of other sources, including a parents' support group, school teachers, speech and language therapists, educational psychologists, the Internet, books and academic journals. Special units and schools were rated as the most useful source of support and treatment, but many other interventions were rated highly. Parents reported a diverse range of both negative and positive consequences of diagnosis, and many reported a change in their attitudes to diagnosis over time. Many expressed frustration with trying to get an early diagnosis, with the social, educational and health services, and with the way that autistic spectrum disorders are regarded by lay people and other parents.
15556250	Little is known about the perspectives that patients with advanced cancer and their family members have concerning nutritional problems and nutritional support. The aim of this study was to investigate their experiences of the nutritional situation prior to introduction of home parenteral nutrition (HPN) in order to understand factors contributing to the decision to accept HPN.Semi-structured interviews were conducted with 13 patients with advanced cancer who had received HPN and 11 family members. The constant comparative method was used for data analysis.	Patients and family members described the nutritional situation prior to HPN as a source of worry and often desperation. Patients reported wanting and trying to eat, but being unable to do so. Family members experienced powerlessness and frustration, as they could not enable the patient to eat. A lack of attention to nutritional problems by the hospital staff was described. The offer of HPN came when patients and family no longer felt able to solve the nutritional problems within the family.	The desperate and chaotic nutritional situation in the family led to willingness to accept HPN. Because of the severity of the problems, HPN was viewed as a positive alternative.	
15548488	To describe changes in personality after stroke and effects on carers.A consecutive series of patients was recruited from hospital admissions with stroke. A novel questionnaire was administered to the patients' main carer at nine months after the stroke to determine their perception of the patients' pre-stroke and post-stroke personality. Personality change was identified by changes in these ratings, and associations between personality change and the following variables explored: emotional disorder in patients and carers (measured using the hospital anxiety and depression scale and a structured psychiatric interview), stroke classification (Oxford community stroke classification), residual disability (Barthel index and Nottingham extended activities of daily living scale), and lesion characteristics on computed tomography (CT).	Carers of 35 patients with stroke took part. Reported changes in personality after stroke included: reduced patience and increased frustration (both p<0.0001, t test of difference), reduced confidence, more dissatisfaction, and a less easy going nature (all p<0.005). Occasionally, aspects of personality change were seen as positive by carers. There were relations between greater personality change and interviewer rated patient depression or anxiety (p<0.001) but not when this was self rated; and between personality change and both emotional disorder in carers (p<0.005) and greater disability (p<0.01) but not CT lesion characteristics.	Carers commonly perceive personality change in stroke patients. This is associated with self rated emotional distress in the carer. More research is needed to understand what carers mean by "personality change" and what factors contribute to the perceived change.	
15545072	Road rage has generated increasing public concern. Research has shown that victimization and perpetration of road rage is more common among males and younger drivers. We aimed to extend the understanding of determinants of road rage to driving exposure and vehicle factors, based on a 20022003 population survey of 1,631 regular drivers in Ontario, Canada. Regression analyses revealed that number of times drivers reported experiencing road rage in the previous 12 months was significantly greater for males, younger respondents, and those residing in Toronto. Also, victimization was significantly greater for drivers who did all their driving on busy roads and increased with number of kilometers driven on a typical week; however, type of vehicle driven was not significant. Number of times road rage perpetration was reported in the past 12 months was significantly greater for males, younger respondents, and those residing in Toronto, and lower for those in the Eastern and Northern region. Road rage perpetration increased significantly with number of weekly kilometers driven and was significantly greater for drivers who are always on busy roads and lower for those who never drive on busy roads, and higher for high-performance vehicle drivers. Even after controlling for driving exposure, road rage victimization and perpetration were highest for drivers in Toronto, where the pace of life may be more demanding. As expected, high-performance vehicle drivers reported more road rage perpetration. These individuals may experience more frustration when they are prevented from using the full performance capacities of their vehicles by crowded urban roadways.
15541845	Despite the fact that various studies have demonstrated the importance of the mind-body connection and fertility, the psychosocial aspects of infertility have not been adequately addressed. Fertility treatments, ranging from medical monitoring, to hormonal remedies and in vitro fertilization (IVF), are both a physical and emotional burden on women and their partners. Psychological factors such as depression, state-anxiety, and stress-induced changes in heart rate and cortisol are predictive of a decreased probability of achieving a viable pregnancy. A couple that is trying to conceive will undoubtedly experience feelings of frustration and disappointment if a pregnancy is not easily achieved. However, if the difficulties progress and the man and or woman are labelled as having fertility problems, then this may result in a severe insult to self-esteem, body image, and self-assessed masculinity or femininity. Three types of relationships have been hypothesized between psychological factors and infertility. These include: (1) psychological factors are risk factors of subsequent infertility; (2) the experience of the diagnosis and treatment of infertility causes subsequent psychological distress; (3) a reciprocal relationship exists between psychological factors and infertility. The evidence for these three relationships is reviewed and an alternative approach to the treatment of infertility including stress evaluation that precedes or is concurrent to fertility treatment is suggested.
15535540	Care of the resident with dementia can be both challenging and unpredictable. Activities provided for nursing home residents often have rules and may be a source of frustration for residents with advancing dementia. Snoezelen, or multisensory therapy, offers a failure-free activity in an enabling environment that can both stimulate and relax the resident with dementia. Good Shepherd Nursing Home in Versailles, Mo, undertook a 1-year outcome-based quality improvement project to find if use of Snoezelen therapy could reduce the number of behavioral symptoms that residents were suffering from. While there are still barriers to the use Snoezelen therapy, employees at Good Shepherd Nursing Home believe that the use of Snoezelen therapy has been a successful and rewarding experience for both residents and staff members.
15535386	In an effort to examine early negative emotional response patterns, infant responses to frustration were studied with specific regard to anger.Forty infants, 7-9 months (n = 20) and 12-14 months (n = 20) old, were observed in laboratory play situations. Infant affective response as well as maternal behavior were observed. Maternal interviews assessed maternal impressions of infant behavior and affect.	Findings revealed increased displays of anger in older infants, evidence of cognitive-affective linkages in response, and individual differences in emotional response style and maternal-infant processes.	Findings relate to the emergence and interplay of negative emotional response, maternal-infant patterns, and socioemotional risk.	
15533107	The experiences of how patients live with an implantable cardioverter defibrillator are still poorly understood. Only a few qualitative studies have investigated this phenomenon. This paper was undertaken as part of a larger project to evaluate quality of life and psychological well-being in those survivors of cardiac arrest who have received an implantable cardioverter defibrillator.The aim of this qualitative study was to explore how implantable cardioverter defibrillator recipients perceive their lives during the first year after implantation of the device.	A sample of 21 patients who received an implantable cardioverter defibrillator was interviewed during three consecutive periods: one, six and 12 months postdischarge from the hospital. The semi-structured interviews were based on insights gained from a literature review. The transcripts were subjected to content analysis.	Analysis of the data revealed seven major categories: physical deterioration, cognitive changes, perceived social support, dependency, contact with the doctor, confrontation with mortality and uncertainty surrounding having a shock. Anxiety, uncertainty, disappointment, frustration, unexpected barriers, acceptance of and dependency on the implantable cardioverter defibrillator played a major role in the lives of implantable cardioverter defibrillator recipients. Well-being improved throughout the year. During the first months after discharge from the hospital the focus was on regaining physical health. During the early postimplantation period both the implantable cardioverter defibrillator recipient and family members had adapted to the situation. Reflection on the impact and consequences of the cardiac arrest was reported more often in the late postimplantation period.	Content analysis is a resourceful approach giving answers to questions that have hardly been addressed within the domain of cardiology. Implantable cardioverter defibrillator recipients face a complex first year, especially the first 6 months. Cognitive deterioration and confrontation with mortality are problems that need to be researched further.	Caregivers are able to explain to future patients what they can expect in the first year after implantation. Caregivers may become more receptive to physical, psychological and social limitations and to emotional and social problems that occur in implantable cardioverter defibrillator recipients, enabling them to act upon them.	
15505947	This study used a community sample of 494 twins with a reading disability (223 girls, 271 boys) and 373 twins without a reading disability (189 girls, 184 boys) to assess the relation between reading disability (RD) and attention-deficit/hyperactivity disorder (ADHD). Symptoms of DSM-III and DSM-IV ADHD were classified into symptoms of inattention and symptoms of hyperactivity-impulsivity (H/I). Results indicated that individuals with RD were more likely than individuals without RD to meet criteria for ADHD and that the association between RD and ADHD was stronger for symptoms of inattention than for symptoms of H/I. Parents and teachers reported similar rates of ADHD, suggesting that ADHD symptoms were pervasive across settings and were not solely attributable to academic frustration. Analyses of possible gender differences revealed that RD was significantly associated with inattention in both girls and boys but associated with H/I only in boys. This difference may provide a partial explanation for the discrepancy between the gender ratio obtained in referred (approximately 4 boys to 1 girl) and nonreferred (1.2 to 1.5 boys to 1 girl) samples of individuals with RD. Specifically, the hyperactive and impulsive behaviors exhibited by boys with RD may be more disruptive than the inattentive behaviors exhibited by girls and may therefore precipitate more frequent referrals for clinical attention.
15496345	The purpose of this study is to test our hypothesis that muscle relaxation is effective on the psychological well-being of juvenile delinquents. Subjects were 16 juvenile delinquents who had entered a reform school. Subjects were divided into two groups. The muscle relaxation group received muscle relaxation therapy once a week for a total of 4 times. The control group spent an ordinary daily life in the reformatory. Psychological questionnaires used were the Rosenzweig Picture Frustration Study (P-F study), the Psychological Stress Response Scale (PSRS), and the Eysenck Personality Questionnaire (EPQ). There was a significant Group Time interaction of the Group Conformity Rating (GCR) of the P-F study (F [1,14] =10.1, P=0.007). There were no significant interactions in the other psychological subscales. Thus, muscle relaxation therapy may improve frustration tolerance among juvenile delinquents.
15494967	The purpose of this study was to understand from baccalaureate-degree nursing students the experience of virtual learning in nursing and to understand how online education enhanced and detracted from learning. Three in-depth, focus-group interviews were conducted with a total of 27 baccalaureate nursing students. Hermeneutic phenomenology was employed to analyze the narrative data. Seven themes were identified from the data. The first theme was "making the framework": (1) providing flexibility; (2) enabling students through observing, guiding, and modeling; (3) faculty as facilitators; and (4) questioning as method. The second theme was "building incredible dialogue": (1) having great discussions, (2) sharing ideas/knowledge, and (3) not being inhibited. The third theme was "critical thinking--the 3-D effect": (1) sitting with the words, (2) using references/research, (3) seeing a variety of perspectives, (4) critiquing self and others, and (5) using selective language. The fourth theme was "personal and professional growth": (1) being connected, (2) feeling valued and respected, and (3) having intimate relationships. The fifth theme, representing the outcomes for online courses, was "more comprehensive learning": (1) deeper understanding and (2) better retention of knowledge. The sixth theme was "being overwhelmed", and the seventh theme was "being frustrated". As a result of this study, an understanding of the phenomenon of online learning was developed. The findings provide direction for future development of the pedagogy of distance learning.
15492956	The outpatient dialysis industry is experiencing a dramatic growth in new patients. A shortage of professional nephrology staff, coupled with increasing frustration with the system on the part of a number of dialysis patients, contributes to an environment of frustration and negative behaviors. The dialysis industry lacks concise or practical definitions to describe these behaviors and respond with appropriate interventions. Patients may be labeled improperly and then discharged inappropriately and involuntarily. The TransPacific Renal Network, a nonprofit agency supported with funds from the Centers for Medicare and Medicaid Services, convened a volunteer multidisciplinary work group to address this issue. The group's tasks were to develop behavioral definitions specific to dialysis therapy that could be understood easily by any dialysis staff member, classify these definitions into at-risk categories, examine the parameters of a zero-tolerance policy, and provide objective pathways to guide staff interventions.
15489576	Irritable bowel syndrome (IBS) is defined by specific validated symptom criteria and encompasses several different underlying pathophysiological mechanisms that express a common set of symptoms. However, IBS is poorly understood by patients. We aimed to explore how a diagnosis of IBS affects the interaction between patients and their physicians.A comprehensive literature search for studies in the English language addressing this issue was conducted using Medline, PubMed, Cochrane Database, Psychinfo, Cinahl, Embase, Web of Science and manual recursive search of reference lists. Investigators reviewed and abstracted data from articles fulfilling our inclusion criteria: primary care patients, all ages, gender and ethnic groups diagnosed with IBS by a general practitioner (GP).	Retrieval of 121 articles generated only four that met inclusion criteria. Research methods of three studies relied solely on qualitative subjective, anecdotal patient narratives, a bias in favor of patients' negative opinion, absence of objective physician diagnostic criteria, pre-testing questions for two studies, follow-up and patient verification of accounts for accuracy. The fourth study included objective physician diagnostic criteria, quantitative measures, a pre-testing questionnaire, and both patient and doctor perspectives. There was a disparity between patient and GP perception regarding the nature, severity and consequences of IBS in primary care, leading patients to perceive this interaction as one of dissatisfaction. The fourth study revealed GP management of IBS mostly meets patient's expectations areas of concern centered on etiology, diagnostic criteria and dietary advice. Disparity seems to lie with the physician, who needs to provide more trust, knowledge, and sympathy, create rapport and be forthcoming with information, while keeping information simple and understandable. Patient dissatisfaction stems from the actual information provided and how this is communicated.	There is evidence that some IBS patients in primary care experience dissatisfaction and negative attitudes in GP interactions. Future research should take into account personality attributes and cross-situational stability in addition to methodological implications of studies. GPs may be the first avenue for IBS patients to vent their frustration, and appropriate education programs for optimal management of patients with IBS are needed in primary care.	
15487604	This study investigates how temperament factors are linked to internalizing and externalizing problems in a Dutch population sample of preadolescents (N = 2230). Internalizing and externalizing problems were assessed by the Child Behavior Checklist and the Youth Self-Report and temperament was evaluated by the parent-version of the Revised Early Adolescent Temperament Questionnaire. Temperament profiles were examined in children with (a) neither internalizing nor externalizing problems, (b) only internalizing problems, (c) only externalizing problems, and (d) both internalizing and externalizing problems. The results suggest clearly diverging temperament profiles for these groups of children, with High-Intensity Pleasure and Shyness (representing the broad dimension of Surgency) steering the conditional probability of internalizing and externalizing problems (direction markers), Frustration mainly being related to maladaptation in general (severity marker), and Fear and Effortful Control being associated with both the severity and the direction of internalizing and externalizing problems, respectively. Girls and boys differed in the distribution across the problem groups, but the associations between temperament and psychopathology were comparable for both genders.
15475796	The authors previously reported that selective serotonin reuptake inhibitors (SSRIs) reduce chronic subjective dizziness in patients with and without psychiatric illnesses. To extend those preliminary findings and test the hypothesis that SSRIs may offer a novel treatment for chronic subjective dizziness, the authors conducted a prospective study of sertraline in patients with dizziness for more than 6 months, in the absence of active physical neurotologic illness.Sixteen-week, prospective, open-label, flexible-dose clinical trial.	Twenty-four patients with subjective dizziness for more than 6 months and no active physical neurotologic illness were studied. Eighteen patients had major anxiety disorders. Six had minor frustration or worry that did not warrant a psychiatric diagnosis. Sertraline was administered at a daily dose of 25 mg, which was increased to a maximum daily dose of 200 mg. Dizziness, functional impairment, and psychological distress were measured using the Dizziness Handicap Inventory (DHI) and Brief Symptom Inventory-53 (BSI-53). Treatment outcomes were analyzed using repeated-measures multivariate analyses of variance, with last observations carried forward.	Three patients were excluded from data analysis for disqualifying medical conditions, one for protocol violations. Fifteen (75%) patients completed treatment. Five (25%) withdrew for adverse effects or lack of efficacy. The median daily dose of sertraline was 100 mg. Sertraline significantly reduced scores on all three DHI subscales and the BSI-53. Eleven of 15 (73%) patients who completed treatment had a positive response, including 8 of 11 (73%) with major anxiety disorders and 3 of 4 (75%) with no psychopathological conditions. Six patients enjoyed a full remission of symptoms.	Sertraline significantly reduced chronic subjective dizziness in patients without active physical neurotologic illness, including those with and without psychiatric comorbidity.	
15474785	DV encompasses a wide variety of actions that coerce, control, or demean the victim. Victims of DV suffer many physical and mental health consequences that cause emergency physicians to encounter them knowingly or unknowingly in the medical setting. Physicians who are aware of the prevalent problem of DV are able to help victims the most. A physician should be educated to recognize the physical and emotional presentations of victims, but, more importantly, the physician should be knowledgeable about the need for screening of all patients to reach the greatest number of victims. Victims often are not ready or able to disclose DV because of patient and physician barriers. Clinicians should work to overcome these barriers by initiating screening, ensuring patient comfort and safety, and understanding the many stages involved in behavioral change that a victim must traverse. The emergency physician would experience less frustration and more success if he or she would change their role from problem solver to listener and empowerer. This approach allows the survivor to make informed choices. Patients who are ready to make changes must be provided with protection,treatment, resources, and support. Informed, active physicians have great potential for improving DV victims' lives, reducing the effects of violence,and facilitating the patient's progression from victim to survivor.
15458759	This article presents a case study of a 39-year-old European American married woman with a history of child and adolescent incest,marital rape, and physical abuse from her husband for more than 10 years. She was referred to a pain clinic for treatment of headaches and Tourette's syndrome. The client was evaluated with the Ackerman-Banks Neuropsychological Rehabilitation Battery to identify neuropsychological strengths and weaknesses. The Vulnerability to Stress Audit was used to identify life events that were positively and negatively influencing her life. The client was treated for mild traumatic brain injury, post-traumatic stress disorder,cognitive difficulties, impulsivity, confabulation, low frustration tolerance, and inability to evaluate and make decisions about socially appropriate behaviors. Treatment involved traditional psychotherapy, hypnosis, cognitive rehabilitation, biofeedback training, electromyography, finger temperature, and blood pressure.
15449751	During surgery, anesthetists take extra care to prevent patient awareness done mainly under general anesthesia either by using inhalational or intravenous medications. However, patients in the ICU mainly those on ventilatory support with intubation and sedation, pass through lot of psychological stress and frustration. Most of the times this stress phenomenon is not documented in the general intensive care. This is the first report in our general ICU.Assessment of this stress phenomenon in order to avoid it in future, and to elicit proper consensus regarding its existence and offer methods of re-solution.	Seventy patients aged (20-60) years were interviewed one day after discharge from the ICU, about their memory of events during their stay. Patients with head injury, CNS infection and those who were disoriented at the time of interview were excluded from the study. The remaining 55 patients were oriented as to place and time. Intravenous morphine was used for analgesia as required, while sedation was achieved using midazolam and morphine infusions in appropriate doses as decided by the attending doctors and nurses, to achieve appropriate Ramsay sedation score. Questions asked were patient's memory of events and their distressing experiences regarding pain, anxiety, dreams, fear, noises, and other discomforts. The same questions were repeated 5 days later.	The sample of patients were representative of our regular ICU admissions in their age group, APACHE II score and duration of stay. The most distressing experiences recalled were: Anxiety (68%), discomfort from endotracheal tube (60%), fear (54%), pain (52%), discomfort from N/G tube (48%), difficulty in communicating (33%), dreams and hallucinations (31%), discomfort from physiotherapy (24%), noise (15%), insomnia (13%), thirst (10%), muscle paralysis (100%), some of these like anxiety, fear, dreams, hallucinations and insomnia had continued since discharge in 6% of patients. None of the studied experiences correlated with age, sex or with the APACHE II score. On interviewing the patient 5 days later, there were no significant change in their responses.	Our sedation and analgesia in the ICU is not enough to prevent unpleasant experiences, mainly those related to patient awareness. More work is still needed i.e. using sedation measuring systems, to improve our sedation and analgesia in the ICU.	
15448624	Health personnel volunteering for humanitarian assistance assignments work in increasingly dangerous situations and increasingly complex roles. A qualitative analysis of interviews with returning Swedish aid workers, who collectively had been on 74 missions in 32 different countries, revealed that they felt positive about their contribution, but experienced high levels of stress and frustration. They were also surprised and inadequately prepared for tasks that fell outside their professional health care training, including ones demanding pedagogic and management skills. The volunteers perceived their success on humanitarian assistance assignments as being affected not only by their own professional competence and special preparatory training, but also by many other factors. In particular, recruiting organizations could improve volunteer performance by accepting only experienced professionals, requiring special preparatory training, clarifying the exact nature of the work, and providing better support during the assignment. Further analysis of humanitarian assistance as a complex and dynamic system involving multiple 'actors' could lead to improved understanding and better performance.
15375414	To explore how dental undergraduates with different levels of emotional intelligence (EI) cope with stress.Qualitative unstructured depth interviews.	A dental teaching hospital in the UK, 2002.	Subjects selected from the undergraduate population of a 5-year dental degree course. A questionnaire survey was carried out to determine the EI scores of the subjects. In each year of study, subjects were divided into low and high EI groups at the median score. From each EI group in each year, one male and one female subject were recruited.	Unstructured face-to-face interviews.	Transcribing, sifting, indexing and charting data according to key themes.	10 males and 10 females with low and high EI, representing all 5 years of study were interviewed. The experience of stress, expressed in emotional terms, ranged from anger and frustration to hatred. Four sets of coping strategies, adopted at varying degrees according to EI, were identified. High EI students were more likely to adopt reflection and appraisal, social and interpersonal, and organisation and time-management skills. Low EI students were more likely to engage in health-damaging behaviours.	Future research needs to establish whether the enhancement of EI in dental students would lead to improved stress-coping, and better physical and psychological health.	
15365501	Severe lung disease is known to affect the lives of not only the sufferer but also his/her family. This qualitative phenomenological study identified seven patients with severe lung disease and studied the quality of life of their carers (five female, two male) who were not fully employed, living in the same house or nearby. In a semi-structured interview, the carers were asked about looking after their spouse or relative, whether they had support and the effect of caring on their health and finances. The findings showed the carers' lives to be severely restricted, all carrying a heavy emotional burden of frustration, depression and isolation: part-time jobs were important both financially and to reduce isolation. Family support was vital to their coping, but few had received professional help. All were affected by reduction in income, but claiming allowances was confusing; unpredictability of the disease complicated much-needed recreation and holidays. Findings were similar to previously published data.
15359681	An engagement mode involves a subject (e.g., a user of information technology, or IT) who is engaged in an activity with an object in a certain manner (the mode). The purpose of this study is to develop a general model of engagement modes that may be used for understanding how IT-related activities are shaped by properties of the user and the IT object. A questionnaire involving items on IT engagement and the experience of flow was administered to 300 participants. The results supported an engagement mode (EM) model involving 5 different engagement modes (enjoying/acceptance, ambition/curiosity, avoidance/hesitation, frustration/ anxiety, and efficiency/productivity) characterized on 3 dimensions (evaluation of object, locus of control between subject and object, and intrinsic or extrinsic focus of motivation). The flow experience follows from a balance between enjoying/ acceptance and efficiency/productivity propelled by ambition/curiosity. The EM model could provide a platform for considering how IT users, IT applications, and IT environments should work together to yield both enjoyment and efficiency. Actual or potential applications of this research include designing IT training programs on different levels of specificity.
15359672	The workload and stress associated with a 40-min vigilance task were examined under conditions wherein observers monitored an auditory or a visual display for changes in signal duration. Global workload scores fell in the midrange of the NASA Task Load Index, with scores on the Frustration subscale increasing linearly over time. These effects were unrelated to the sensory modality of signals. However, sensory modality was a significant moderator variable for stress. Observers became more stressed over time as indexed by responses to the Dundee Stress State Questionnaire, with evidence of recovery in the auditory but not the visual condition toward the end of the watch. This result and the finding that signal detection accuracy - although equated for difficulty under alerted conditions - favored the auditory mode, indicate that display modality and time on task should be considered carefully in the design of operations requiring sustained attention in order to enhance performance and reduce stress. Actual or potential applications of this research include domains in which monitoring is a crucial part, such as baggage screening, security operations, medical monitoring, and power plant operations.
15355946	Intimate partner violence (IPV) is common in primary care; 11% to 22% of women experienced physical abuse in the past year. Older women experience IPV as well, but it is often undetected. This study examined primary care providers' awareness about IPV in older women, including their screening practices and management.Interviews and focus groups were conducted with 44 primary care providers. Thematic analysis was used to identify common themes.	Providers fell along a continuum of thoroughness for identifying and managing IPV in older women, ranging from suboptimal to thorough identification of IPV and suboptimal to thorough management of the patient. In addition to the barriers commonly reported about IPV screening in younger women, providers described limited understanding of the diagnoses commonly associated with IPV, frustration with older women's unwillingness to disclose problems and ask for help, and limited community services that accommodate older women with IPV. Providers recommended that communities sponsor public awareness campaigns about IPV as a problem for all women and that aging and IPV agencies work together.	Continued provider training about IPV should include information on identifying older victims and appropriate management options. Participants stressed the importance of community efforts to raise awareness and improve resources available for older women who are victims of IPV.	
15340585	Previously, the subjective dimension of suffering from chronic pain has only infrequently been reported in the literature. However, in recent years qualitative psychosocial research has added new perspectives that describe how suffering from chronic pain affects life. The present paper refers to a qualitative study on the subjective experience of women diagnosed with chronic musculoskeletal pain. In a model for life adjustment, turning points and passages are described in three stages. In Stage I, there was increasing pain, disability, and physical and mental exhaustion. Alongside frustration and chaos there was a struggle to restore daily life; therefore, the picture of a healthy future was still intact. Acknowledging that pain may not be temporary marked the transition into Stage II, which was characterized by sorrow and loss, and the picture of the future faded. Once given an explanation of pain (a 'pain diagnosis'), a new understanding developed, with gradual improvement of coping skills. Adjustment eventually progressed into Stage III with the constructive use of past experiences, and competence and control increased. A new picture of the future emerged that could be handled. However, living with pain still required regular maintenance work. The outcome of qualitative investigations, including the one presented here, is discussed along with certain clinical implications. The following clinical implications are reviewed in the present study: distrust from health professionals may obstruct the adjustment process, prolong sick leave and hinder rehabilitation; providing the patient with a diagnosis (eg, an explanation of pain mechanisms) will facilitate life adjustment; acknowledging the individual experience of suffering from chronic pain will make concepts related to pain behaviour, secondary gain and sick role liable to question; and vocational rehabilitation measures should be harmonized with the actual stage of life adjustment.
15335132	Despite recent attention given to medical errors, little is known about the kinds and importance of medical errors in primary care. The principal aims of this study were to develop patient-focused typologies of medical errors and harms in primary care settings and to discern which medical errors and harms seem to be the most important.Thirty-eight in-depth anonymous interviews of adults from rural, suburban, and urban locales in Virginia and Ohio were conducted to solicit stories of preventable problems with primary health care that led to physical or psychological harm. Transcriptions were analyzed to identify, name, and organize the stories of errors and harms.	The 38 narratives described 221 problematic incidents that predominantly involved breakdowns in the clinician-patient relationship (n = 82, 37%) and access to clinicians (n = 63, 29%). There were several reports of perceived racism. The incidents were linked to 170 reported harms, 70% of which were psychological, including anger, frustration, belittlement, and loss of relationship and trust in one's clinician. Physical harms accounted for 23% of the total and included pain, bruising, worsening medical condition, and adverse drug reactions.	The errors reported by interviewed patients suggest that breakdowns in access to and relationships with clinicians may be more prominent medical errors than are technical errors in diagnosis and treatment. Patients were more likely to report being harmed psychologically and emotionally, suggesting that the current preoccupation of the patient safety movement with adverse drug events and surgical mishaps could overlook other patient priorities.	
15326993	Nurses who are sexually harassed at work face frustration and emotional and economic consequences. Historically before the 1970s, nurses had little legal recourse and tolerated sexual harassment as a necessary "evil" associated with working. The Civil Rights Act of 1964 created the option for legal remedies for sexual harassment/discrimination cases. Successful court cases established the legal criteria for sexual harassment. This article discusses the history, definition, high profile cases, research, consequences, and prevention of sexual harassment. Although research is scant and little is known of how nurses respond to harassing behavior, prevention requires coordinated activities of employers, individual employees, and the healthcare profession. Sexual harassment at work increases anxiety and undermines the nurse's ability to focus on the delivery of safe and competent care.
15323119	By the age of 1 year toddlers demonstrate distinct coping habits for dealing with frustration. However, these habits may be open to change and reorganization at subsequent developmental junctures. We investigated change in coping habits at 18-20 months, a normative age for major advances in social cognition, focusing on the dynamic systems principles of fluctuation and novelty at transitions. Specifically, we asked whether month-to-month fluctuation, novel behavioral habits and real-time variability increased at the age of a normative transition, despite individual differences in the content of behavior. Infants were given frustrating toys while their mothers sat nearby without helping, on monthly visits at 14-25 months (before, during and after the hypothesized transition). State space grids representing patterns of behavioral durations were constructed for each episode and compared over age. As predicted, month-to-month fluctuation in grid patterns increased temporarily between 17 and 20 months, partly independently of a concurrent peak in distress, and new behavioral habits replaced old ones at the same age. Coping habits changed differently for high-and low-distressed toddlers. However, changes in real-time variability did not generally meet our expectations.
15300289	This study aims to detect the influence of deeply rooted traditions on physicians' discursive constructions concerning children with genetic diseases involving malformations and mental retardation. It also aims to capture the reflections resulting from the professional care for (and contact with) these children. All the physicians work at the Fernandes Figueira Institute, Oswaldo Cruz Foundation, in Rio de Janeiro, Brazil. Data were collected using oral interviews (in the form of conversational narratives) and were submitted to semiotic analysis. Four traditions were found in the medical discourse: norm, reason, family, and religion. This article focuses exclusively on norm and reason, highlighting how dismorphism, congenital malformations, and mental retardation associated with genetic diseases defy the established norms of perfection, beauty, and productivity. Therefore, feelings of uneasiness, powerlessness, and frustration are increased. The article also discusses how reason, one of the most important cultural traditions organizing modern thought, shapes medical discourse on genetic syndromes associated with mental retardation.
15288800	This study evaluated content validity, internal consistency and construct validity of the Strain of Care for Delirium Index (SCDI), a newly constructed instrument to measure the strain nurses experience in caring for patients with delirium. Content validity, evaluated by eight experts, reduced the initial pool of items from 38 to 28. Using a convenience sample of 190 nurses, Cronbach's alpha for the 28-item version was 0.88. Using non-linear principal components analysis another eight items were eliminated and a four-factor structure was identified. The proportion of variance explained by the remaining 20 items was 61.51%. Preliminary psychometric evaluation of the SCDI supported content validity, internal consistency and construct validity; however additional psychometric evaluation is warranted.
15287280	Clinicians and researchers have become increasingly interested in the impact of chronic pain (CP) on quality of life (QoL). This report describes the qualitative stages of developing a pain and discomfort module for persons with CP to be used with the UK World Health Organisation generic measure of quality of life (WHOQOL). The aims were to investigate patients' perceptions of CP and its effect on QoL, and to generate items to be used in the development of a module appended to the UK WHOQOL-100. At the first stage (study 1), six focus groups of patients were invited to discuss how living with pain and discomfort affected QoL. At the second stage (study 2), an international web survey was conducted with English-speaking respondents. Ten new facets of QoL were identified by the focus groups: flare-ups, pain relief, anger and frustration, vulnerability/fear/worry, uncertainty, loss/loneliness/feeling alone, positive strategies, communication, guilt and burdening others, and relationship with health care providers. The web-survey confirmed and validated these new facets. Although the WHOQOL-100 is a reliable and valid measure of QoL for use in CP, this study shows that additional areas must be assessed when measuring the impact of CP on QoL.
15283537	To examine the psychosocial effects on health care workers of being quarantined because of exposure to severe acute respiratory syndrome (SARS).We used semistructured qualitative interviews.	We identified 3 major themes concerning psychosocial effects: loss, duty, and conflict.	Quarantined workers experienced stigma, fear, and frustration. We highlight the need for clear and easily accessible information on dealing with infectious diseases. Practical advice on coping and stress management techniques for health care workers are needed in preparation for potential future outbreaks of infectious diseases.	
15265326	For certain complex motor tasks, humans may experience the frustration of a lack of improvement despite repeated practice. We investigate a computational basis for failure of motor learning when there is no prior information about the system to be controlled and when it is not practical to perform a thorough random exploration of the set of possible commands. In this case, if the desired movement has never yet been performed, then it may not be possible to learn the correct motor commands since there will be no appropriate training examples. We derive the mathematical basis for this phenomenon when the controller can be modeled as a linear combination of nonlinear basis functions trained using a gradient descent learning rule on the observed commands and their results. We show that there are two failure modes for which continued training examples will never lead to improvement in performance. We suggest that this may provide a model for the lack of improvement in human skills that can occur despite repeated practice of a complex task.
15260843	Reducing and eliminating racial and ethnic health disparities has become a national research priority. This research agenda requires new research frameworks that encompass the social determinants of health and the translation pathways of these social contexts into physiological morbidity. Within these sociobiological research frameworks, identity and emotions are seen as crucial links in the causal pathways from stressors to biological responses. In this country, the lived social reality of African American individuals is experienced through the color of their skin. Their identity is bound with the racial inequities of our society. It has been suggested that the emotions of anger and frustration resulting from this institutionalized racial discrimination are an emotional causative pathway to the pathophysiology contributing to the health disparities experienced by African Americans. However, as much as we espouse the concept of cultural competency in health care, until recently, there has been very little honest dialogue about how race and racism influences health. This article will explore the Black-White cultural perception gap and attempt to provide insight on the relationship to African American health and implications for health disparities research.
15248364	The health care system is often unsuccessful in the treatment of the patient experiencing chronic pain. Chronic pain is often complicated by a variety of psychiatric conditions that make it difficult to engage and treat patients. This generates frustration and pessimism in the physician. The patient may be afflicted by the syndrome of an affective disorder, demoralized by the unintended circumstances of their life, unable to meet the demands of stressors because of a lack of inherent capacities, or helplessly trapped by poor choices and repeated unproductive actions. The physician's interest and the patient's optimism can be restored and sustained by utilizing a systematic interdisciplinary approach utilizing the four perspectives of diseases, life stories, dimensions, and behaviors to evaluate the patient who is disabled by depression and chronic pain. The design of a comprehensive treatment plan involves the determination of each perspective's contribution to the patient's suffering. The process of formulation recognizes that the perspectives are distinct from one another but complementary in illuminating the various reasons for a patient's suffering. The perspectives offer a recipe for designing a rational treatment plan rather than trying to reduce the individual patient's complexity into a one-dimensional construct. This approach increases the probability of a successful outcome for both patient and physician.
15225968	Extinction following positively reinforced operant conditioning reduces response frequency, at least in part through the aversive or frustrative effects of non-reinforcement. According to J.A. Gray's theory, non-reinforcement activates the behavioural inhibition system which in turn causes anxiety. As predicted, anxiolytic drugs including benzodiazepines affect the operant extinction process. Recent studies have shown that reducing GABA-mediated neurotransmission retards extinction of aversive conditioning. We have shown in a series of studies that anxiolytic compounds that potentiate GABA facilitate extinction of positively reinforced fixed-ratio operant behaviour in C57B1/6 male mice. This effect does not occur in the early stages of extinction, nor is it dependent on cumulative effects of the compound administered. Potentiation of GABA at later stages has the effect of increasing sensitivity to the extinction contingency and facilitates the inhibition of the behaviour that is no longer required. The GABAergic hypnotic, zolpidem, has the same selective effects on operant extinction in this procedure. The effects of zolpidem are not due to sedative action. There is evidence across our series of experiments that different GABA-A subtype receptors are involved in extinction facilitation and anxiolysis. Consequently, this procedure may not be an appropriate model for anxiolytic drug action, but it may be a useful technique for analysing the neural bases of extinction and designing therapeutic interventions in humans where failure to extinguish inappropriate behaviours can lead to pathological conditions such as post-traumatic stress disorder.
15222965	The effect of rearing conditions on feather pecking and reaction to frustration was studied in two lines of laying hens. From commercial rearing conditions (large group, no mother hen), seven birds from a high feather pecking line (HC birds) and eight birds from a low feather pecking line (LC birds) were used. From semi-natural rearing conditions (small group, mother hen present) seven birds from the high feather pecking line (HN birds) were used. Feather pecking behaviour of HC, LC, and HN groups was recorded for 30 min. After that, each bird was food deprived and trained to peck a key for a food reward in a Skinnerbox. After training, each bird was subjected to a frustration session in a Skinnerbox, where the feeder was covered with Perspex. Three HC birds showed severe feather pecking, compared with one HN bird and zero LC birds. Differences in reaction to frustration were found between birds from different lines, but not in birds from different rearing conditions. LC birds tended to put their head in the feeder more frequently than HC birds over all sessions. Although limited, this study indicates that rearing conditions influence feather pecking, but not reaction to frustration.
15222850	Does simple displeasure cause anger without appraisals or agency attributions? The authors offer 8 observations: (a) Appraisal theory also predicts that displeasure promotes anger, (b) An emotion of frustration can be usefully distinguished from anger, (c) Aggressive reactions to norm violations among animals suggest that they too distinguish bad behavior from bad outcomes, (d) Attributions to agency are perceptual and automatic in social situations, (e) It is tenuous to argue that agency attributions are enacted in angry aggression, but absent in anger elicitation. (f) The contextualized meanings of expressive movements, rather than movements themselves, elicit emotion, (g) Expressions may be better seen as constituents than as causes of emotions, (h) Cognitive components of emotion generally come before, not after, eliciting events.
15222848	The review of the literature on anger by L. Berkowitz and E. Harmon-Jones (2004) evaluates leading theories of anger for which they offer their own theory of aggression as an integration. Their article leads to a number of empirical questions.
15217064	The ABC model underlying Ellis's Rational-Emotive Behavior Therapy predicts that people who think more irrationally should display greater trait anger than do people who think less irrationally. This study tested this prediction regarding the ABC model. 186 college students were administered the Survey of Personal Beliefs and the State-Trait Anger Expression Inventory-Second Edition to measure irrational thinking and trait anger, respectively. Students who scored higher on Overall Irrational Thinking and Low Frustration Tolerance scored significantly higher on Trait Anger than did those who scored lower on Overall Irrational Thinking and Low Frustration Tolerance. This indicates support for the ABC model, especially Ellis's construct of irrational beliefs which is central to the model.
15209451	This study aimed to describe and analyse how participants with fibromyalgia or chronic, widespread, musculoskeletal pain, 1 year after completion, experienced a rehabilitation programme; and what knowledge and strategies they had gained. DESIGN, METHODS AND SUBJECTS: Semi-structured interviews with 16 female patients were analysed using the grounded theory method of constant comparison.One core category, from shame to respect, and 4 categories, developing body awareness/knowledge, setting limits, changing self-image and negative counterbalancing factors, and hopelessness and frustration over one's employment situation emerged from the data. The core category represents a process where the informants changed emotionally. Three categories were identified as important for starting and maintaining the process, one category affected the process negatively.	The rehabilitation programme started the process of change, from shame to respect. The informants learned new strategies for handling their pain and other symptoms; they improved their self-image and communication in their social environment.	
15207434	Techniques of reality orientation in dementia are widely used around the world and indifferent settings. Nevertheless, after the controversies for adverse effects and frustration,by the new millennium "a new era" is coming on where cognitive rehabilitation "has come of age" and a series of positive results appeared until the fulfillment in the global and person-centered approach. This renewed technique may no more be based only on cognitive psychology but it is necessary to apply a more complete psychosocial approach taking into account also emotional, behavioral and functional domains of the globally considered person. The aims of our study are: (1) To assess the global efficacy on cognitive and affective functions. (2) To detect cognitive subsystems more sensible to our three-phase stimulation program. We studied 34 outpatients, 13 men and 21 women, age range 67-88 years, referred to our Expertise Center, all but one affected by mild cognitive impairment(MCI), suffering from mild dementia (clinical dementia rating, CDR <1). After 20 sessions of formal and complementary activities, a comprehensive improvement of cognition, language,memory and affective functions was observed. Semantic fluency improved with high statistically significant difference. The immediate recall, free or cued, appeared more sensible to stimulation than the delayed one. A correlation between a mini mental state examination (MMSE) low basal score and higher performance after the program was also obtained.
15196174	The borderline syndrome is one of the most severe disturbances of psychosomatic dermatology. Patients with borderline syndrome are situated 'on the border' of psychosis, neurosis and personality disorders. The skin as a borderline organ carries a symbolic role. The clinical picture includes artefactual skin diseases due to self-mutilation by conscious or unconscious cutting, and rubbing, scratching or para-artefactual manipulations of pre-existing dermatoses. Leading symptoms of the borderline syndrome are poor impulse control, emotional instability and poor ego strength with low frustration tolerance and unstable personal relationships. We present the case of a 38-year-old female patient with borderline syndrome suffering from para-artefactual skin diseases of the face and a massive hyperhidrosis of the hands and feet. Within 9 months she was treated in four acute psychiatric hospitals and by 12 psychiatrists and psychotherapists. Early and accurate diagnosis and high-quality, sophisticated long-term therapy are necessary.
15195454	Onchocerciasis (river blindness) is a serious public health problem with important socioeconomic consequences. The presence of onchocercal skin lesions is unsightly and has a psychosocial effect on the affected. This cross-sectional study was undertaken to assess the perception and social implication of onchocerciasis in the village of Apana in Nigeria. Apana is a rural community, hyper-endemic for onchocerciasis and currently receiving ivermectin treatment. The village is one of the ten communities of Uzairue district of Etsako West Local Government Area (LGA), Edo State, Nigeria. There are many water streams in the community which serve the domestic needs of the inhabitants but also provide the breeding sites for the vector flies of onchocerciasis. Multi-stage sampling methods were used to select the 385 respondents that participated after informed consent was obtained. A structured researcher-administered questionnaire was the tool for data collection. Of the 385 respondents that participated in the survey, 240 (62.3%) were male while 145 (37.7%) were female. The awareness of the disease among the respondents was fair. They were aware of the nuisance value of blackflies ('Uja-ini') and associated the bite with itching. The signs and symptoms of onchocerciasis were recognised as specific diseases with specific local names. They called itching and rashes 'Erhue', nodules and leopard skin 'Evbiomu-Ogui', worm in the eye 'Okogho-Ikpalo' and blindness 'Orunalo'. The attitude of the non-affected towards the affected was partially discriminatory and suspicious. The affected were socially withdrawn, probably due to the frustration of their health condition. There is a need to improve people's attitude towards the disease and improve disease awareness through appropriate health education, which will encourage the acceptance of ivermectin as adequate treatment and compliance to the treatment regimen to reduce morbidity and promote self-esteem.
15189644	This study describes the experiences of a group of nursing students from Sweden in a hospital in Tanzania. Students were interviewed on their return after the trip. Although students experienced considerable upheaval and frustration working in a different context, they learned valuable lessons as to how nursing can be conducted in conditions entirely different from those familiar to them. They attempted to understand the value and behavioral divergences they encountered, yet values of their home culture remained their frame of reference. This project reflected the importance of working through students' experience if knowledge and understanding of self and others are to be enhanced or developed.
15183506	In rodents, aggressive behavior can be altered by experimental manipulations of emotional responsiveness. The goal of this study was to identify characteristics of emotional reactivity associated with individual differences in aggressive behavior and their integration within a common neural network. Male golden hamsters were first screened for offensive aggression. Then, the animals were trained through immediate reinforcement and tested for their adaptation to a delayed reward. Similar protocols have been used to test behaviors associated with frustration. At first, all hamsters showed increased frequency of bar pressing per reward during delayed reinforcement. However, Low-Aggression animals were able to adapt to the delay and showed a decreased rate of bar pressing per reward within 5 days. In contrast, High-Aggression animals maintained a high rate of bar pressing per reward. In addition, brains were collected after immediate reward training or delayed reward testing, and labeled for pCREB-immunoreactivity as a marker of trans-synaptic activity. In High-Aggression individuals, elevated density of cyclic AMP response element binding protein, phosphorylated (pCREB) immunostaining was found within the anterior hypothalamus, an area critical to the control of aggression. Delayed reinforcement was associated with enhanced pCREB immunostaining within the central amygdala, medial amygdala and preoptic area/hypothalamus continuum. Further analysis of the data also showed a positive correlation in labeling density between the lateral septum and the anterior hypothalamus, specifically in Low-Aggression animals exposed to delayed reward. Therefore, as High-Aggression individuals lack control of their emotional reactivity, they are also characterized by a de-synchronization between the inhibitory output of the septum and the aggression areas of the hypothalamus. Finally, our data also show that frustration is associated with an extensive activation of the preoptic area/hypothalamus continuum and amygdala.
15182475	The following report is a case study example of how problematic information can invade and percolate through the literature on forensic human factors and ergonomics. Initially, a highly doubtful assertion was used to bolster an argument made in a legal case of wrongful death. The assertion was supported through reference to a number of cited works. When the trail of evidence was pursued, however, it became clear that diverse citations had all branched from one, single, original and doubtful source. The fundamental issue, whether children have one third less peripheral vision than adults turns out to be much more complex than the original, simplistic spatial conception suggested. The case study illustrates the importance of ascertaining original citations and is yet another example of the frustration that often accompanies forensic activity where financial and legal concerns frequently over-ride the fundamental search for knowledge.
15173466	To examine the use and predictors of different discipline practices by parents of very young children using data from the 2000 National Survey of Early Childhood Health (NSECH).NSECH is a nationally representative telephone survey of 2068 parents of young children between the ages of 4 and 35 months conducted by the National Center for Health Statistics. The survey includes questions about parents' use of 5 discipline practices: yelling, spanking, time out, toy removal, and explanations. chi2 analyses and logistic multivariate regression were used to examine associations between discipline practices and child, parent, and demographic factors.	Among young children aged 19 to 35 months, frequent parental use of discipline strategies ranged from 26% (spanking) to 65% (taking away toy or treat), 67% (yelling), 70% (using time out), and 90% (providing explanations). In multivariate analyses, child age predicts reports of more frequent spanking and yelling, and child developmental risk is associated with increased reports of yelling. Parent frustration predicts frequent use of every discipline practice, including a greater inclination to use aversive practices. Lower parental emotional well-being is associated with reports of frequent yelling and spanking. Black ethnicity and maternal age predict more frequent spanking, and Spanish-speaking parents reported less frequent use of time out and taking away a toy.	Child age and developmental risk and parents' ethnicity, emotions, and mental health are closely associated with discipline practices in the first 3 years of life. These factors are important for pediatricians to recognize in providing anticipatory guidance about discipline.	
15155439	The case is reported of a 40 year old male high risk sport athlete who had seriously injured himself several times and as a result was partially physically disabled and had trouble with mental tasks requiring concentration such as spelling, reading numbers, and writing. The athlete was referred to a sports psychologist. In consultations, it became clear that he was having difficulty reconciling the difference between his life as it used to be and as it would be in the future. Part of his difficulty was dealing with the frustration and anger "outbursts" which resulted from not being able to perform straightforward everyday motor skills. In spite of his injuries and disability, the patient badly wanted to continue participating in extreme sports. Reversal theory is used in the discussion to provide theoretical explanations of the motivation for his extreme risk taking behaviour.
15142919	To describe the experiences of patients with type 2 diabetes in a web based disease management programme based on an interactive electronic medical record.Qualitative analysis of semistructured interviews with patients enrolled in a diabetes care module that included access to their electronic medical record, secure email, ability to upload blood glucose readings, an education site with endorsed content, and an interactive online diary for entering exercise, diet, and medication.	Patients' homes in Washington state, United States.	Nine participants aged 45-65 completed interviews before and after they used the programme.	Six themes emerged: feeling that non-acute concerns are uniquely valued; enhanced sense of security about health and health care; frustration with unmet expectations; feeling more able to manage; valuing feedback; and difficulty fitting the programme into activities of daily life. Three themes--valuing non-acute concerns, feeling secure, and unmet expectations--have particular relevance to the design and use of web based tools for care of patients with diabetes and chronic medical conditions.	Participants' experiences support further study of open access to the electronic medical record and online communication between patients and their care providers. The development of web based disease management programmes should take into account the specific needs and expectations of patients, and patients and providers should have candid discussions about what web based care can and cannot provide.	

15132195	The role of women in the Middle Ages was vilification, veneration, and exclusion. Due to the high rates of maternal and infant mortality bonding shifted from the mother-child dyad to one in which the Church, Holy Family, and king acted as pseudo-parents. In art this is suggested by the virtual absence of eye contact between the Virgin and Christ-child. Frustration of early oral needs consequent to lack of adequate mother-child bonding prompted a reactive emphasis on orality in art and legend. A decrease in infant mortality and a reciprocal improvement in mother child bonding contributed to cultural shifts in how self-realization would be accomplished during the Renaissance and in the later emergence of secular humanism.
15129047	First-person reports of individuals' experiences of problematic "sleep sex" were collected in an Internet-based study. Qualitative analysis of 121 reports yielded 6 distinct themes: (1) fear and a lack of emotional intimacy; (2) guilt and confusion; (3) a sense of repulsion and feelings of sexual abandonment; (4) shame, disappointment, and frustration; (5) annoyance and suspicion; (6) embarrassment and a sense of "self-incrimination." Results suggest that sleep sex can elicit negative emotions and cognitions that may become a source of personal and relational distress. Clinician familiarity with problematic sleep sex may foster more effective communication with individuals presenting with such complaints.
15127776	The healing role of nurses has been undervalued and undeveloped for a long time. A literature review of nurses and healing reveals the fears and frustration generations of women healers and nurses experienced as they strived to practice their art. The current nursing shortage reflects the toxicity of the nursing work environment. The satisfaction and liberation of nurses who have found ways to practice their calling also emerges, giving hope to those in the field as well as their patients. The first in a series, this literature review served as the foundation for a qualitative study entitled, "Medical-Surgical Nurses' Self-Perceptions as Healers," which will appear in the next issue of Holistic Nursing Practice.
15122962	Relations among authoritative and authoritarian parenting styles, children's effortful control and dispositional anger/frustration, and children's social functioning were examined for 425 first and second graders (7-10 years old) in Beijing, China. Parents reported on parenting styles; parents and teachers rated children's effortful control, anger/frustration, externalizing problems, and socially appropriate behaviors: and peers rated aggression and leadership/sociability. High effortful control and low dispositional anger/frustration uniquely predicted Chinese children's high social functioning, and the relation of anger/frustration to social functioning was moderated by effortful control. Authoritarian parenting was associated with children's low effortful control and high dispositional anger/frustration, which (especially effortful control) mediated the negative relation between authoritarian parenting and children's social functioning. Effortful control weakly mediated the positive relation of authoritative parenting to social functioning.
15106487	Conditions affecting the musculoskeletal system are the cause of approximately 25% of absenteeism from work. Fibromyalgia syndrome is an exemplary condition of chronic widespread pain which most physicians consider difficult to manage. The physician-patient relationship is burdened with resignation and frustration on both sides. Initial agreement regarding the aims of treatment is rare. The patient's active involvement in the decision making process is expected to improve the physician-patient relationship. One aspect of this shared decision making process is the evaluation and possibly modification of treatment decisions. In the present study 39 consultations of physicians who had undergone special communication training were examined as to whether these physicians actually exercised the option of revising their treatment decisions. In 87.2% of the consultations the therapy decisions were modified within three months after the first encounter. Patients considered to be "difficult" were less likely to modify their decisions. The shared decision making process usually takes more than one consultation.
15105785	The Anglo-Saxons were the first to evoke the "burn out syndrome" although the Canadians prefer to use "burning" in order to emphasize these situations in which the person is as it were literally "consumed by his/her work". The burn-out syndrome more specifically involves all those who have chosen to devote their lives to others. This is the case notably with health care workers because they are in direct contact with suffering, poverty, hardship, disease and death.There is no particular pre-morbid personality. Nevertheless, various factors can be at the origin of a burn out syndrome: subconscious motivations in the choice of the profession, capacity to adapt to hardship at work, excessive idealization of the profession, lack of recognition and the absence of any possibility of promotion. INSTALLATION IN 4 STAGES: The onset of an occupational burn out syndrome is usually insidious. Schematically, the first stage is idealistic enthusiasm. Then a helpless stagnation period follows with progressive disinterest, followed by a phase of frustration, before the onset of an apathetic disenchantment with search for a form of security.	A range of effects exist: sleep and digestive disorders, reduced performance, progressive feeling of exhaustion with impact on friends and relatives, irritability towards others, absence of dialogue, and a feeling of "emptiness".	The first consists in improving work conditions by changing the environment; the second consists in improving communications and enhancing the end to isolation and the third consists in changing the employee's private life. Such as reorganizing the person's life so that they can disconnect and develop other interest than through their work.	
15054728	The relationship between coping responses and psychological adjustment to a breast cancer diagnosis is well documented for time periods close to diagnosis. The purpose of the present study was to assess the long term association between these two variables. Fifty-five women completed measures of coping response, decisional control, frustration expression, and psychological adjustment within six months of receiving their breast cancer diagnosis. These women were contacted three years later and their psychological adjustment-as measured by the profile of mood states (POMS)-was reassessed. Univariate and multivariate analyses were performed. The results showed that women who were depressed at time of treatment planning, and who responded to their cancer diagnosis with cognitive avoidance, i.e. acceptance/resignation, had significantly worse psychological adjustment three years later. Poor adjustment was significantly associated with cognitive avoidance and minimal use of approach-based coping responses. The findings suggest that women who respond to their breast cancer diagnosis with passive acceptance and resignation are at significant risk for poor long term psychological adjustment. Psychological interventions for these women should address cognitive avoidance, with the aim of fostering approach-based coping and positive well-being.
15053723	Does the behavioral approach system (BAS) relate to the experience of any negative affects, or are all negative affects tied to the behavioral inhibition system (BIS)? In Study 1, self-reported Fun Seeking predicted reports of greater frustration and sadness after frustrative nonreward. In Study 2, self-reported Reward Responsiveness predicted reports of greater anger in response to scenarios. In Study 3, self-reported Drive predicted reports of greater anger after the terrorist attacks of September 11, 2001. In no case did BIS sensitivity contribute uniquely to these affects, though BIS predicted nervousness in Study 2 and fear in Study 3. Discussion focuses on the role of frustration and anger in effortful pursuit of goals and depressed affect in disengagement from goals.
15050091	This study evaluated the effectiveness of distance education for training behavioral health professionals. Five live video workshops that covered key elements of Motivational Interviewing (MI) were delivered. The programs occurred a month apart, each 3 hours long. The programs used compressed video, transmitting the video signal through telephone lines. The audience was staff at substance abuse treatment organizations throughout the state of Arizona. Participants completed assessments regarding their training experiences, knowledge and self-efficacy in MI, and their satisfaction with the training, prior to, during, and subsequent to the workshops. Participation in the five workshops varied; the first workshop had the largest attendance of 351, the fourth the lowest of 92; 145 participants attended all five workshops. Participants expressed moderate levels of satisfaction with most aspects of the training, although some expressed frustration with interrupted audio or video signals during the programs. The handouts and videotaped examples of MI were identified as the more helpful aspects of the training. Participants reported statistically significant improvements in their self-perceived knowledge and skills. They demonstrated a statistically significant but clinically insignificant increase in knowledge. A small group of participants provided audiotapes of actual counseling sessions. These participants demonstrated minimal improvement in skills across the study that were not statistically significant. These results are discussed in terms of their implications for future research in the use of distance education as a technology transfer tool in the addiction treatment profession.
15033847	To determine key themes from parents' comments on paths to diagnosis and intervention for their children with hearing loss, following introduction of at-risk neonatal hearing screening and modification of distraction test screening for infants not at-risk.Parents of children born in 1993 in Victoria, Australia, who were eligible for screening via the Victorian Infant Hearing Screening Program and who were subsequently diagnosed with a permanent congenital hearing loss and fitted with hearing aids prior to the year 2000 were asked to complete a semi-structured questionnaire shortly after aid fitting. Two researchers independently analysed parent comments using the constant comparative method.	Parents of 82 children (61%) replied to the questionnaire. Themes analysis revealed a generally positive response to neonatal ABR screening, with a mixed response to the distraction test; powerful emotions experienced by parents at diagnosis including denial and shock; frustration arising from delays in diagnosis, and communication difficulties with providers. Special difficulties testing children with other medical and developmental problems, confusion about tympanostomy tube insertion, and difficulty with wearing hearing aids were also reported. Some children had experienced problems in the school setting. Experience of post-diagnostic services was generally positive.	Parents need greater support both during the testing of screen failures and at the time of diagnosis. Providers need more training in how to communicate findings to parents, particularly at times when parents are experiencing strong emotions. Parents need more strategies to enable hearing aid wearing in very young children. Some children with additional medical, developmental, and behavioural problems need specialised approaches to testing.	
15029082	Adverse effects of benzodiazepines are well known since the first one was used in 1958 (chlordiazepoxide). The literature collects study-cases or rarely controlled studies concerning side effects or paradoxical reactions to benzodiazepines. They mostly described drowsiness and behavioral disinhibition, including increased well-being feeling but also hostility, rage access with feeling of invulnerability, serious crimes and sometimes homicides. Delusional, manic, confusional or depressive states are also pointed out. Rate for aggressive behaviour is 0.3 to 0.7% but distinction should be done between accidental or "idiosyncratic" reaction and voluntary sought disinhibition, clearly more frequent. No benzodiazepine has any specificity for these adverse effects but pharmacology, doses, associated drugs (or alcohol) and psychopathology interact to produce hazardous psychic states. Pharmacology: GABA induces a decrease in serotonin compound and vigilance. Pharmacokinetic: first dose effect or over-dose effect, short half-life, lipophily, affinity, digestive absorption, active metabolites interact. Psychopathology: age, alcohol association, psychological status (high initial level of hostility, impulsivity, frustration, personality disorder and depressive status). External conditions: chronic illness, affective and professional frustrations, physical or psychic exhaustion contribute also. Some benzodiazepines (flunitrazepam, diazepam, clorazepate, triazolam, alprazolam, lorazepam, for example) are more often concerned for pharmacokinetics characteristics but also prescription habits. Forensic aspects should be considered in case of homicide. Especially, reality of benzodiazepines consumption and awareness of the potential paradoxical reaction should be precisely evaluated. Special focus on voluntary induced disinhibition has to be done for forensic considerations. Relationship but also crime facilitations are sometimes consciously sought. Some benzodiazepines have already been identified for this use: flunitrazepam, clorazepate but also triazolam and temazepam in UK, alprazolam in USA. Flunitrazepam is prohibited in USA and considered as narcotics in France. A Swedish study showed that violent acts were more frequent and serious in juvenile offenders taking flunitrazepam/alcohol than other young offenders staying in the same correctional institution. They recommended classification of flunitrazepam as narcotic. A study from Belgium with drug addicts concluded in the same way and asked for an increased information of professionals and a more efficient control of the delivery. Before concluding to idiosyncratic effect, and then possibly to penal irresponsibility, the forensic approach should consider: firstly the reality of the benzodiazepines absorption and implication in committing violence (urine test, chronology, amnesia); secondly, the association of unusual behaviour and converging circumstances (pharmacological, pharmacokinetic, psychopathology, external conditions); thirdly the consumer's knowledge of the disinhibition effect. In our prison practice, we have to be particularly cautious as population frequently associates personality disorder, drug addiction and high level of frustration related to penitential context. Special information should be given to inmates when benzodiazepines are prescribed, but more extensively, a preventive strategy should be adopted in general population.
15018677	Research has found that individuals who are lower in self-control strength because of previous self-control exertions perform more poorly on subsequent tests of self-control. The present studies suggest that this effect may be moderated by motivation. In particular, depletion and motivation jointly determine self-control performance. Individuals who were depleted and believed that the task would help others (Experiment 1) or believed that their efforts could benefit them (Experiment 2) performed better on a subsequent test of self-control than individuals who were depleted and lower in motivation. The results of Experiment 3 replicated these findings and suggested that depletion only affects performance on tasks that require self-control; tasks that are difficult but do not require self-control are immune to the effects of depletion. Hence, depleted individuals may compensate for their lack of self-control resources when sufficiently motivated. The results may help explain the nature of self-control strength.
15002314	Neurological and psychiatric examination of 334 children, aged 7-15 years, 87 (23%) of them suffering from chronic tension-type headache (CTTH) is presented. All the patients had mental (mostly depressive and anxiety) disorders and 95.3% of them--psychosomatic ones. Clinical heterogeneity of CTTH was revealed: in the cases of daily continuous headache there were depressive disorders, in daily intermittent headache--depressive and anxiety-phobic disorders and in frequent headache pattern neurasthenia was predominantly detected. Personality features of CTTH patients were as follows: high anxiety, aggressiveness, asthenia, low "Ego" power, high frustration, sensitivity, hypochondriac, depressive and hysterical tendencies, affective rigidity. Patients realized mostly non-adaptive coping styles both for high and low pain intensiveness. Combination of psychopharmacology, psychotherapy and biofeedback for the CTTH treatment is recommended.
14998886	Irritability is an important symptom in childhood psychopathology that has received relatively little research attention. Recent controversy concerning the diagnosis of mania in children has focused attention on how little is known about how to assess irritability in a systematic way, and about its diagnostic associations. For example, subtyping irritability according to course (chronic vs. episodic), precipitants, and family history may facilitate the identification of psychopathology and the study of pathophysiology. While normative and pathologic irritability can be differentiated reliably, the validity of the distinction is unclear. In addition, there is a need for scales designed to measure the severity of irritability in children with mood and anxiety disorders. In order to facilitate research, we propose a definition of irritability from the perspective of affective neuroscience. Because reactive aggression may be a helpful animal model for irritability, we review the neural circuitry mediating this behavior. Behavioral paradigms that evoke frustration, as well as those that assess the ability to inhibit a prepotent motor response, maintain attentional focus, execute response reversal, recognize angry faces, and regulate emotional responses, may be useful in the study of irritability. Examples of such paradigms are described, and the pharmacology of irritability is reviewed briefly.
14994893	In recent years there has been broad discussion on the nature of stressors experienced by members of "high risk" occupations and professions, for instance nursing and emergency workers, whose role is to support others through traumatic scenarios (Lam et al, 1999:23). Perioperative nursing is a major specialization in nursing practice in which there is an increased risk of exposure to traumatic events (Schwann, 1998:645). Moreover, the cumulative nature of critical events, if left undealt with that will potentiate attrition among nurses in the perioperative environment (Michael and Jenkins, 2001:39). This triangulated study using self-administered questionaires focused on how theatre nurses coped with contextual stressors in the work milieu. A purposive sample of 46 registered and enrolled nurses who worked at a major Brisbane hospital were asked to describe a recent stressful workplace event, and rate it using Horowitz's (1993) Impact of Event Scale (IES). Results indicated that nurses with the least general theatre experience, demonstrated the highest negative impacts. 25% of females demonstrated avoidance tendencies when stressed, while 83% of males used problem-solving strategies. Reactions following trauma among the nurses were predominantly negative, and included feelings of frustration and self-doubt. These findings support the eminent need for hospital organizations to take a more person-centered approach when dealing with workplace stress.
19777723	The goal of this study was to determine the perspectives of healthcare professionals (HPs) from community and hospital settings involved in a paediatric home chemotherapy programme. Using a prospective descriptive study design, HPs including paediatricians, community nurses, hospital clinic nurses, administrators and pharmacists were interviewed using a moderately structured open-ended approach. Through inductive content analysis, data were categorised under three themes reflecting HPs' perspectives on the programme: (1) perceived family benefits, (2) human resources and service delivery considerations and (3) impact on the role of the HP. All HPs reported that home chemotherapy helped reduce both disruption to family life and psychological stress. Community-based HPs reported increased job satisfaction, increased workload and increased frustration related to scheduling challenges. Hospital-based HPs reported decreased patient interaction and discrepancies in workload changes. Both groups emphasised the need for consistency in care and for specific chemotherapy training. Service delivery issues included the need for more clarity in the programme process, improved eligibility criteria, a focus on community laboratory coordination and development of centralised communications.
14982716	Passive behavior (PB) in persons with Alzheimer's disease (PWAD) has been overlooked despite recognition that it occurs on a daily basis and is often resistant to interventions. The purpose of this study was to describe how the experience of passivity was for the caregiver and the PWAD, factors that precipitated PB, caregiver responses that promoted engagement, and caregiver responses that intensified PB, as well as activities initiated by caregivers over the past month that reduced passivity in the person with dementia (PWD). Fifty caregivers of community-dwelling persons with mild (n = 15), moderate (n = 16), and severe (n = 19) Alzheimer's disease participated in a semi-structured interview. Data were analyzed using Colaizzi's Phenomenological Thematic Extraction and descriptive statistics. Caregivers identified decreased levels of activity, decreased verbalization, withdrawal, less socialization, and decreased interest in activities as examples of PBs. For caregivers, the experience of coping with PBs engendered frustration with their loved ones' cognitive deterioration, difficulty in watching and accepting loss of function, fatigue, sadness, and using coping skills. Paradoxically, both being alone and increased environmental stimuli precipitated PB. Feelings of helplessness and loss of control by the person also caused PB. The most successful interventions to promote engagement were: giving cues and assistance, initiating the task, giving guidance, and providing enjoyable activities. Responses that hindered engagement included: 'correcting' or putting stress on the person, rushing activities, and repeating directions. Faith, humor, patience, and contact with friends and family were identified as positive approaches. Caregiver interventions demonstrated synchrony with selected background and proximal variables in the Need-driven Dementia-compromised Behavior (NDB) model.

14971802	The aim of the study was to investigate the frequency of breastfeeding among children with Down syndrome.The mothers of 560 children with Down syndrome attending four university hospitals in Italy were interviewed and the neonatal clinical records retrieved. Information was collected on the type of infant feeding and on why some mothers had not breastfed their children. Two groups of healthy children whose feeding habits had been previously investigated were recruited as control subjects (1601 and 714, respectively). A paediatrician in each hospital was interviewed about the neonatal admission policy of children with Down syndrome.	Among the 560 Down children, 246 (44%) were admitted to the neonatal unit. Compared with the two control groups, children with Down syndrome were significantly more frequently bottle-fed (57% vs 15% and 24%, respectively, odds ratio 7.5, 95% CI 6.0-9.4 and 4.2, 95% CI 3.3-5.4. respectively). Only 30% of infants admitted to the neonatal unit were breastfed. The main reasons reported by the mothers for not having breastfed were infants' illness in infants who had been admitted to the neonatal unit and frustration or depression, perceived milk insufficiency and difficulty with suckling for those babies who had not been admitted to the unit. The paediatricians reported that the admission of a baby with Down syndrome to the neonatal unit could sometimes take place not for medical reasons, but for diagnostic work-up or for a more appropriate diagnosis and to maintain communication with the family.	Down syndrome babies are less frequently breastfed compared with healthy children. Support in breastfeeding should become a relevant point of health supervision for children with Down syndrome.	
14971552	To describe the experience of mothers whose pregnancies were complicated with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) and to determine if such experiences could be clustered by common themes from which a model could emerge.Retrospective, descriptive, qualitative study utilizing grounded theory analysis.	Participants were interviewed in their homes via telephone. Participants were from Kansas, Maine, Maryland, Michigan, Minnesota, Mississippi, South Carolina, Utah, and Wyoming, representing both urban and rural settings.	Nine self-selected survivors of HELLP syndrome.	The essential structure of the experience of HELLP syndrome can be expressed as a circle of no control and not knowing, which included the five themes of premonition, symptoms, betrayal, whirlwind, and loss. The pervading emotions expressed were fear (of death), frustration, anger, and guilt. HELLP syndrome represents a unique maternal experience that can be expressed in a model.	
14961780	This paper examines the relationship between medical professionals and parents of young adults who are being treated by them for cancer. This study aims to discover what practices and procedures make the cancer journey easier or more difficult to manage for parents in the medical setting. Many studies of carers focus on spouses, little attention has been paid to parents of young adults in this context. Self-selected parents responded to an appeal for narratives about their adult son or daughter's cancer experience. A narrative correspondence method was used relying on contributions of a qualitative nature submitted in written form and analysed through the identification of emerging themes. Interactions with health professionals have a far-reaching effect on parents' experience. A clear understanding needs to be established at an early stage with agreement by all parties on how information and decision making should be shared. If parents feel excluded or uninformed about procedures, or believe that their son or daughter is receiving less than optimum care, this results in feelings of helplessness and frustration. While many of the issues identified in this paper might apply to relatives of cancer patients in other age groups, the effect of life stage during young adulthood exacerbates the complexities of the medical setting.
14754946	To develop and evaluate a parent-completed questionnaire for use by clinicians as part of routine care to assess the burden of diurnal and nocturnal enuresis on children and their families.The questionnaire consisted of items that measure the impact on the child and his/her parent, the child's coping ability and commitment to treatment, previous treatment success, family frustration and overall cohesion, and parental attitudes about enuresis and its treatment. Questionnaires (n = 208) were completed by parents during the child's scheduled office visit for enuresis at 5 specialty clinics across the United States. Traditional criteria were used to assess reliability and validity of the questionnaire, including analysis of variance.	Success rates provide evidence that many of the items in the child scale (79%) and all items in the parent scale (100%) met stringent criteria. alpha values were.62 and.77, respectively. Statistically significant differences were observed for the scales across responses on all but 1 global item, the majority of parental attitude items, whether the child urinated at bedtime, and the number of pads used. These findings suggest that the child's coping ability and commitment and the family's overall cohesion and frustration with the problem influence parental perceptions about the impact of enuresis on the child and the family.	Findings about the performance of the new measure were satisfactory and suggest that, after further refinement, it should prove as a useful tool for clinicians treating enuresis in children.	
14735337	Somatization refers to patients who transform distress and global suffering into pain and symptom expression. We have observed the opposite phenomenon in some outpatients seen for palliative care: patients who transform pain nociception into global suffering or other symptoms. The goal of this study is to describe the meaning of these patients' experiences that are not expressed as pain but seem to masquerade as other symptoms.Hermeneutic phenomenological research methods guided this study with ten patients with advanced cancer. Interviews continued until data were saturated.	Results included that all patients described frustration that they had outlived their usefulness. All expressed an awareness that they were dying, some very directly with sadness but appreciation for the support they received from family and friends, some with anger, and some who were actively fighting death awareness because they were not "ready" to die. Patients described themselves as strong and healthy and reluctant to take medications, both because this was a new and unacceptable behavior for them, and because they were averse to the side effects.	In conclusion, careful evaluation of symptom experiences can ensure appropriate treatment. Patients with advanced cancer may not report pain even though pain medications often improve their other symptoms and well-being. Patients valued selection of medication that allowed them to remain alert and functional. The meaning of symptoms clearly altered patients' reports and limited treatments they found acceptable. Understanding these meanings is important to ensure that patients are treated in the most appropriate ways possible.	
14733455	To determine whether individual and family characteristics of children with anxiety disorders who take psychotropic medications differ from those that are unmedicated and whether there is a differential response to cognitive-behavioural therapy (CBT).Children ages 8 to 12 years (n = 102: 18 medicated, 84 unmedicated) were recruited in a specialized outpatient clinic over a 3-year period. All had a primary diagnosis of an anxiety disorder. Comparisons were done using t-tests for continuous measures and chi-square tests for discrete measures. Treatment-related changes were assessed using repeated measures analyses of variance.	Medicated and unmedicated groups did not differ by age, sex, socioeconomic status, or diagnostic profile. Initial ratings of anxiety symptoms, depressive symptoms, and global functioning were comparable. Greater family dysfunction and family frustration were reported in medicated children. With treatment, both groups improved symptomatically and showed improved family functioning. Families of medicated children showed a greater reduction in frustration than families of unmedicated children, whereas unmedicated children showed greater gains in global functioning.	Initial family functioning of medicated children seems to show more disturbances. Both medicated and unmedicated children can benefit from CBT. Further studies of differential treatment effects for medicated and unmedicated children are indicated.	
14727470	Inappropriate sexual comments and behaviors from clients with brain injuries can be frustrating, awkward, and time consuming for the nurses who are caring for them. Understanding the meaning of these comments and behaviors, as well as receiving direction concerning ways to handle the situation can help nurses overcome their frustration and improve the quality of nursing care. This article examines potential underlying causes of inappropriate sexual behavior, explains the behaviors from client, family, staff, and organizational perspectives, and begins to look at ways to respectfully and sensitively address the behaviors using a model and framework developed by the Sexual Health Service (SHS) at Vancouver Hospital and Health Sciences Centre (VHHSC), in British Columbia, Canada.
14714634	This paper describes the psychoanalytically informed treatment of a schizophrenic patient. The author discusses elements of a comprehensive treatment and illustrates how psychodynamic understanding can help avert impasses in therapy. In this case, for example, psychodynamic understanding helped the hospital staff overcome a sense of frustration and impotence in dealing with a patient who needed to isolate herself in order to overcome feelings of panic. Rehabilitative work was important, not only to recover lost or lessened capacities, but also to modify the patient's feelings towards external and internal objects.
14685987	To examine the relationship between nurse practitioner (NP) perceived self-confidence in performing managed care tasks and NP attitudes toward managed care.A random sample of NPs--members of the Massachusetts Coalition of Nurse Practitioners--completed a demographic survey, responded to questions measuring self-confidence in performing managed care tasks and attitudes toward managed care, and wrote about their managed care experiences.	NPs were only moderately confident in performing managed care tasks and had mostly negative attitudes toward managed care. They reported intense frustration related to prescriptive coverage and referrals to specialty services, potential trust issues between providers and patients, and ethical and legal dilemmas in tailoring plans of care to fit the patient's insurance. The NPs' written comments indicate a need for more in-depth exploration of NP attitudes toward managed care. IMPLICATIONS FOR PRACTICE AND EDUCATION: Continuing education in selected managed care competencies, better education of NP students, and promotion of organizational cultures that support interdisciplinary teamwork as well as population- and evidence-based practice may help NPs to embrace the promise of managed care and to offer solutions to its problems.	
14670189	To explore women's experiences of the relatively uncommon postnatal illness of puerperal psychosis, and to gain understanding into living through and past the illness.An interview-based study using grounded theory principles to analyse the qualitative data.	Interviews were conducted with 10 women who had been diagnosed and treated for puerperal psychosis (defined according to DSM-IV criteria, with onset within six weeks of childbirth) during the last 10 years.	Three main categories were identified from the interviews: puerperal psychosis as a separate form of mental illness, loss, and relationships and social rules. Further, two higher order concepts were identified, termed 'living with emotions' and 'regaining and changing self'. These concepts emerged across, and linked, the categories previously identified.	Women felt that the illness took away the ability to experience normal emotions, as affective responses were viewed as potentially pathogenic. Although puerperal psychosis was described as a life-changing experience, the women used feeling like their 'old sense of self' as a marker for recovery. Anger and frustration were directed towards health services because of their lack of provision of adequate information and support for the women and their families. More support may have alleviated the stresses placed on relationships and informed families about the nature of the illness. Further work is needed to establish the long-term effects of suffering from puerperal psychosis.	
14662557	Despite the robust and widely replicated finding of elevated hypothalamic-pituitary-adrenal (HPA) axis reactivity in depressed adults, studies of depressed children have yielded ambiguous findings. Animal models of early depression and studies of children experiencing early psychosocial deprivation have suggested that alterations in HPA axis reactivity are evident in early "depressive-like" conditions. The current study is, to our knowledge, the first investigation of HPA axis reactivity in very young children with a clinical depressive syndrome for which content validity has been established.Depressed, psychiatric, and no-disorder comparison children aged 3 through 5.6 years were studied for HPA axis reactivity in response to experimental psychosocial stressors. The children were diagnosed using a developmentally appropriate, structured psychiatric interview. Salivary cortisol was obtained at 3 time points during a laboratory assessment before and after stressors involving separation from the parent and frustrating tasks.	Repeated measures of multivariate analysis of variance revealed a significant interaction between the diagnostic group and 2 cortisol percent change scores. Depressed preschoolers displayed a pattern of increasing cortisol levels throughout the assessment in response to both separation and frustration stressors. In contrast, both comparison groups showed decreasing cortisol levels in response to the separation stressor. All groups displayed increasing cortisol levels in response to frustrating tasks. Preschoolers with a presumptive melancholic depressive subtype displayed these alterations at a greater magnitude relative to comparison groups.	To our knowledge, these findings are the first to demonstrate altered HPA axis reactivity in depressed preschoolers. These alterations are consistent with those described in depressed adults and in animal models of early depression. These findings provide evidence for possible continuity of HPA axis alterations in depressive disorders across the lifespan and are discussed in the context of prior studies of HPA axis reactivity in clinically depressed children and adolescents, suggesting that younger age and inpatient status are features associated with altered HPA axis reactivity.	
14660194	Service providers working with people who have complex health problems like chronic pain are considered at particular risk from the heavy emotional content of these interactions (frustration, guilt, hostility). For the good of service users and in the interests of healthcare workers' own health it is important for them to employ reflective practice acknowledging these issues. Service providers are inculcated to negate the affective domain of their practice despite the growing awareness that wellbeing can no longer be envisioned as a linear (cause and effect) process divorced from socio-cultural influences and attendant values and beliefs. The aim of this report is to examine to what degree service users (SU) and service providers (SP) believe their decisions about treatment importance are influenced by self-image and emotion.These results are extrapolated from a larger study based on a postal questionnaire that went to members of the Pain Society (UK Chapter of IASP) and service users belonging to chronic pain support groups in the North-West of England. The question of interest in this report asked participants to identify their level of agreement with statements about how four themes influence their decision-making about whether a treatment is important. The themes (coherence, purposiveness, self-image and affect) arise from Chapman's model of consciousness and pain.	Only 20.5% of service providers rated the influence of self-image (what someone like me would think) as 3 (mostly) or 4 (completely). Service provider rating for the influence of affect (how this treatment makes me feel) were similarly low with only 19.4% of respondents selecting a rating of 3 or 4. In marked contrast, 73.3% of the service users selected self-image and 92.9% selected affect as a strong influence.	Service providers felt that affect and self-image had little influence on their decision-making. However, there is growing evidence in the literature to suggest that it is not possible, nor preferable, to divorce emotion from the clinical encounter.	
14650781	Fatigue is a common presentation in general practice and its diagnosis and management can be a source of frustration to both doctor and patient. Although it may exist independently of other diagnoses, and in conjunction with physical disorders, fatigue is strongly associated with psychological disorders.We propose an approach to the diagnosis and management of the psychological and psychiatric causes of fatigue, and present two clinical cases to highlight some of the discriminating features.	Psychological causes should be considered in all patients with fatigue. Awareness of the range of causes of fatigue, experience in using readily available screening tests to detect psychological disorders, and knowledge of the recommended management regimens will facilitate the delivery of quality care to patients and the reduction of the morbidity associated with the underlying conditions.	
14639561	To describe the patterns of depression in patients with traumatic brain injury (TBI), to evaluate the psychometric properties of the Neurobehavioral Functioning Inventory (NFI) Depression Scale, and to classify empirically NFI Depression Scale scores.Depressive symptoms were characterized by using the NFI Depression Scale, the Beck Depression Inventory (BDI), and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Depression Scale.	An outpatient clinic within a Traumatic Brain Injury Model Systems center.	A demographically diverse sample of 172 outpatients with TBI, evaluated between 1996 and 2000.	Not applicable.	The NFI, BDI, and MMPI-2 Depression Scale. The Cronbach alpha, analysis of variance, Pearson correlations, and canonical discriminant function analysis were used to examine the psychometric properties of the NFI Depression Scale.	Patients with TBI most frequently reported problems with frustration (81%), restlessness (73%), rumination (69%), boredom (66%), and sadness (66%) with the NFI Depression Scale. The percentages of patients classified as depressed with the BDI and the NFI Depression Scale were 37% and 30%, respectively. The Cronbach alpha for the NFI Depression Scale was.93, indicating a high degree of internal consistency. As hypothesized, NFI Depression Scale scores correlated highly with BDI (r=.765) and MMPI-2 Depression Scale T scores (r=.752). The NFI Depression Scale did not correlate significantly with the MMPI-2 Hypomania Scale, thus showing discriminant validity. Normal and clinically depressed BDI scores were most likely to be accurately predicted by the NFI Depression Scale, with 81% and 87% of grouped cases, respectively, correctly classified. Normal and depressed MMPI-2 Depression Scale scores were accurately predicted by the NFI Depression Scale, with 75% and 83% of grouped cases correctly classified, respectively. Patients' NFI Depression Scale scores were mapped to the corresponding BDI categories, and 3 NFI score classifications emerged: minimally depressed (13-28), borderline depressed (29-42), and clinically depressed (43-65).	Our study provided further evidence that screening for depression should be a standard component of TBI assessment protocols. Between 30% and 38% of patients with TBI were classified as depressed with the NFI Depression Scale and the BDI, respectively. Our findings also provided empirical evidence that the NFI Depression Scale is a useful tool for classifying postinjury depression.	
14619678	Different models of mental pain (emotional pain, psychological pain, psychache) are described: (A) the literary model that is based on a content analysis of Styron's book Darkness visible: A memoir of madness, describes mental pain as an inner turmoil of hostile forces; (B) the narrative model based on a qualitative analysis of pain narratives by patients defines pain as a sense of brokenness (Bolger); (C) the phenomenological-psychache model focuses on psychache as a frustration of the most important needs (Shneidman); (D) the theoretical model and (E) the empirical model view mental pain as a perception of negative changes in the self and its function (Baumeister) (Orbach & Mikulincer). The common aspects in all models include intense negative emotions, loss of self, surfeit of the negative. Other aspects appear in some of the models, but not in others (e.g., incompleteness, emptiness). The relevance of mental pain to treatment of suicidal people is discussed.
14613071	This study was conducted to understand students' perceptions of the usefulness of on-line discussion for a nursing seminar. The interpretative approach was selected to explore the students' perceptions of the effectiveness of the on-line discussion. The participants were recruited from maternity nursing courses on two rural campuses in Nebraska. A convenience sample of 31 participated in the study with a purposive sample of 10 representing extreme views selected for in-depth interviews. Eight patterns emerged as a plausible interpretation of the on-line experience. These patterns were exemplified by the themes of engagement theory (relate, create, and donate). The pattern that was identified as relational was learner-to-learner learning without face-to-face communication. However, isolation was found to inhibit relating. Creating, the second theme, was exemplified by multiperspective opinions, however, frustration with the technology and anxiety/information overload inhibited the creative aspects. Finally, the third theme, donate, was represented by having time for critical thinking/reflection while participating in the on-line discussions. The findings of this research support the need for more studies to explore students' perception of the usefulness of on-line discussion.
14609546	Aggressive behavior can serve important adaptive functions in social species. However, if it exceeds the species-typical pattern, it may become maladaptive. Very high or escalated levels of aggressive behavior can be induced in laboratory rodents by pharmacological (alcohol-heightened aggression), environmental (social instigation), or behavioral (frustration-induced aggression) means. These various forms of escalated aggressive behavior may be useful in further elucidating the neurochemical control over aggression and violence. One neurochemical system most consistently linked with escalated aggression is the GABAergic system, in conjunction with other amines and peptides. Although direct stimulation of GABA receptors generally suppresses aggression, a number of studies have found that positive allosteric modulators of GABAA receptors can cause increases in aggressive behavior. For example, alcohol, benzodiazepines, and many neurosteroids are all positive modulators of the GABAA receptor and all can cause increased levels of aggressive behavior. These effects are dose-dependent and higher doses of these compounds generally shift from heightening aggressive behavior to being sedative and anti-aggressive. In addition, these modulators interact with each other and can have additive effects on the GABAA receptor and on behavior, including aggression. The GABAA receptor is a heteropentameric protein that can be constituted from various subunits. It has been shown that subunit composition can affect sensitivity of the receptor to some modulators and that subunit composition differentially affects the sedative vs anxiolytic actions of benzodiazepines. Initial studies targeting alpha subunits of the GABAA receptor point to their significant role in the aggression-heightening effects of alcohol, benzodiazepines, and neurosteroids.

14593937	Idiopathic intracranial hypertension (IIH) is an unusual disease, seen most often in women of childbearing age who are obese. If left untreated, IIH can cause chronic pain and blindness. Although IIH has been recognized by healthcare providers since the late 1880s, the cause is still not known and risk factors remain unclear. Treatment has not changed over the years. While professionals struggle to define, describe, and successfully treat IIH, persons with the disease are struggling to cope. Internet support group communications relate numerous personal stories of frustration, depression, pain, anxiety, and disability. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) model provides an appropriate framework through which to view what is known and what is yet to be discovered about IIH. The ICF model was designed to complement the International Statistical Classification of Diseases and Related Health Problems, looking beyond mortality and disease by describing how people live with their health conditions. Applying this framework to IIH reveals many opportunities for nursing research within the ICF domains of health condition, body function and structure, ability and participation, and environmental and personal factors.
14592284	The current study attempts to define the psychological features of patients with delayed sleep-phase syndrome (DSPS).We administered the Yatabe-Guilford test (Y-G test), Minnesota Multiphasic Personality Inventory (MMPI), Picture-Frustration study (P-F study) and Rorschach test to two groups, one of patients with DSPS (case group) and the other of people without psychiatric symptoms or insomnia (control group).	Overall, the results of the tests indicate that patients with DSPS showed emotional features such as nervousness, depression and lack of control of emotional expression. Specific personality traits included introspection, defensiveness, aspiration for intellectual attainment with compulsivity, overly abstract thinking, unawareness of impulsivity to immediate gratification, perseverance and reduced cognitive ability. In addition, the patients with DSPS showed psychopathological features similar to those of neurosis, hypochondriasis, depression, conversion hysteria and psychopathic deviate.	There seems to exist a definite psychological profile for patients with DSPS. (1) an excessive defense mechanism that increases nervousness and develops neurosis; (2) a high level of intellectual aspiration with compulsivity that makes the patients feel self-defeated, powerless and disappointed; (3) a tendency to egocentric emotion, inhibition and perseverance. These characteristics may worsen social withdrawal, causing a loss of social cues in synchronizing their circadian rhythm. Thus, the phase shift becomes more difficult and a vicious circle is constituted.	
14574069	We test whether or not labor market frustration is associated with clinical alcohol abuse/dependence diagnoses among labor migrants living in California. Our sample consists of 1576 Mexican labor migrants in Fresno, CA, who migrated for the purpose of seeking employment. Using clinical criterion (DSM-III-R), we find that frustrating experiences resulting from labor market exclusion and discrimination are significantly related to past-year alcohol abuse/dependence. Similarly, although high levels of social support are salutary, they are not protective among those who experience moderate/high levels of employment frustration. Since Mexican-origin immigrants have low rates of health insurance coverage and lower propensities for formal help-seeking, community outreach programs that target labor migrants are essential to this population's mental health maintenance.
14571634	To identify the socio-demographic, clinical, psycho-behavioural and therapeutic factors explaining uncontrolled blood pressure in a population of hypertensives in ambulatory practice.The DUO-HTA survey is a national, cross-sectional, mirrored, observational study, from a representative sample of 347 general practitioners (MG) and 210 cardiologists, and a population of 2022 hypertensive patients followed by these doctors. The data were collected by means of questionnaires completed by the hypertensives and their doctors.	The factors significantly discriminating patients for whom BP was controlled (C) from those patients whose BP was not controlled (NC) were an age less than 65 years, smoking, obesity, alcohol consumption, sedentary lifestyle and multiple anti-hypertensive treatment. On the psycho-behavioural front, the NC patients were more often anxious and irritable, claiming to lead a stressful life and for whom hypertension was often perceived as a "foreign entity" and a source of frustration and multiple deprivations. The factors discriminating the NC doctors from the C doctors were essentially psycho-behavioural, with the NC doctors considering the management of hypertension as being less gratifying, and hypertension as a condition with fluctuating progression, poorly understood and dramatized by patients.	The DUO-HTA survey underlines the weight of reciprocal representation systems in hypertension for patients and their doctors, as well as the quality of the doctor-patient relationship in blood pressure control. It prompts the development of sensitisation actions for practitioners centered on improving the doctor-patient relationship.	
14563022	The expression of anger in Japanese people is different from that of other races. We developed a new brief inventory, the Overt-Covert Aggression Inventory, to assess aggressive behavior ofJapanese people by focusing on their uniqueness and examined its reliability and validity. This inventory, the Center for Epidemiological Studies Depression scale, the Japanese version of the Buss-Perry Aggression Questionnaire, and the Picture-Frustration Study were administered to 3,104 men and 316 women in a factory. Internal consistency, test-retest reliability, concurrent validity, and construct validity of the scale were examined. We confirmed that the Overt-Covert Aggression Inventory has adequate reliability and sufficient concurrent validity, however, further studies of the construct validity and discriminant validity are required.
14550937	Although previous studies have discussed age-related changes in the presentation of early onset bipolar illness, the developmental progression of early symptoms remains unclear. The current study sought to trace parents' retrospective report of yearly occurrence of symptoms in a sample of children with and without a diagnosis of bipolar disorder in the community.Parents retrospectively rated the occurrence of 37 activated and withdrawn symptoms causing dysfunction for each year of their child's life (mean age 12.6 +/- 6.9). Children were divided into three groups based on parent report of diagnosis by a community clinician: bipolar (n=78); non-bipolar diagnosis (n=38); and well (no psychiatric diagnosis) (n=82). Principal components analysis was performed to understand the relationship among the symptom variables and their potential differences among the three groups as a function of age.	Four symptom components were derived and these began to distinguish children with bipolar disorder from the other groups at different ages. Component II (irritability/dyscontrol), which included temper tantrums, poor frustration tolerance, impulsivity, increased aggression, decreased attention span, hyperactivity and irritability, began to distinguish bipolar children from the others the earliest (i.e., from ages 1 to 6). The other components (I, III, and IV) which included symptoms more typical of adult depression (I), mania (III), and psychosis (IV), distinguished the children with a bipolar diagnosis from the others much later (between ages 7 and 12).	The data were derived from retrospective reports by parents of their children's symptoms on a yearly symptom check list instrument which has not been previously utilized. Parents' ratings were not validated by an outside rater. Moreover, the children were diagnosed in the community and a formal diagnostic interview was not given.	By parental report, the cluster of symptoms in the irritability/dyscontrol component may characterize the earliest precursors to an illness eventually associated with more classic manic and depressive components that are diagnosed and treated as bipolar disorder in the community. These retrospective survey data suggesting a longitudinal evolution of symptom clusters in childhood bipolar-like illness identify a number of areas for prospective research and validation.	
14533393	This speculative paper concerns certain fundamentals of healing and psychotherapy which we mistakenly tend to take for granted. I discuss our need for the feeling of harmony, wholeness, and oneness. I call this archetypal need our 'normal autistic expectation'. When met, we experience well-being and 'healing'. If not sufficiently and reliably met, this expectation becomes an omnipotent demand ('autistic demand'). Frustration then brings about angry destructiveness, either outwardly directed or inwardly directed, with bodily changes which must be processed if bodily damage is to be minimized. Bereavement, the loss of a person necessary for one's feeling of wholeness (a 'self-object'), is an extreme and well-researched example of such damage. Our selfobjects are 'healing' when they help us to complete our sense of self. Our patients-, our profession, our colleagues, our place of work and our financial security are normally all part of our self-object structure. I give examples where patients' own needs for survival or intactness mean that they have to externalize their own hurt and anger for long periods of their therapy. This often means that the therapist's own wholeness and health are under attack, and even damaged permanently, or at least until the damage can be processed. The nature of 'processing' in this sense is therefore in need of energetic research.
14528541	The presence of a painful, disabling chronic disease may have implications for perceived ability to fulfill a parenting role. The purpose of this research was to examine the realities of parenting from the perspectives of mothers, fathers and grandparents with arthritis using a combination of methods: a cross sectional survey and in-depth focus group discussions. There was consensus that pain, fatigue and restricted physical functioning combined to interfere with the parenting role. Overall, approximately 35% of the sample had experienced difficulties attributed to arthritis. A gender difference emerged with women reporting more difficulties in relation to caring for babies and toddlers, whereas men reported more problems as children grew older. Key themes concerned: physical limitations; practical and caring issues; social factors; emotional response; hereditary risks and safety issues. Perceived inability to fulfill parenting roles resulted in feelings of frustration, guilt, anger and depression. A number of positive outcomes were mentioned including children's increased awareness of the needs of others. Limitations of the methodological approach adopted are discussed.
14510868	A qualitative research approach was adopted in order to explore the views and health beliefs of patients with Type 2 diabetes who had experienced a new structured diabetes shared care service.Patients from 15 general practices were randomly selected and invited to attend three focus groups. Two independent researchers adopted the "Framework" technique to analyse the transcribed data and identify key themes expressed by patients.	Themes relating to diabetes included frustration, victimization and powerlessness in relation to living with diabetes, controlling blood sugar, medication and economic barriers to care. Differences in emphases between patients and healthcare providers emerged. Patients were generally positive about shared care and largely identified it with the nurses involved.	This research highlights the importance of an in-depth exploration of patients' views during changes in diabetes care delivery to identify service delivery failures and gaps in patient knowledge such as lack of awareness of the extent of macrovascular risk.	
12973276	Return to work remains a central issue for many traumatic brain injury (TBI) patients. The present literature generally ignores the complex work issues involved for high-functioning individuals, in whose hands may lie the fate of many other workers. This case discusses return-to-work challenges facing a 64-year-old high-technology company founder and president. Following a bicycling accident, he sustained intracerebral hemorrhage with an initial Glasgow Coma Scale of score 12. Although postmorbidly he still maintained a relatively high level of cognitive functioning, his case highlights special challenges during workplace rehabilitation of patients with cognitively demanding jobs, including (a) a higher potential for patient frustration given the gap between function and job expectations and (b) confidentiality issues regarding business employees and competitors. Rehabilitation health care providers can benefit from lessons learned here, including tapping into these patients' strong motivation for return to work, accessing the likely higher remaining cognitive level, and drawing upon the likely strong social and professional networks available. Finally, the importance of the role of stress-management techniques in order to cope with high frustration levels is highlighted.
12968427	To describe powerlessness on postoperative cardiac surgery patients according to frequency, intensity, defining characteristics and to compare powerlessness between valvular surgery patients (VAL) and coronary artery bypass surgery patients (CAB).Powerlessness was defined through the analyses of interviews of 75 patients (60% VAL and 40% CAB).	58.7% patients presented powerlessness. There were not differences according to powerlessness frequency (p = 0.84) and intensity (p = 0.73) between VAL and CAB patients. The defining characteristics most frequent on powerless patients were: "verbal expressions of having no control or influence over situation" (77.3%), "doubts regarding planning future and stating objectives" (75%), "expressions of doubt regarding role performance" (63.6%), and "expressions of dissatisfaction and frustration over inability to perform previous tasks and/or activities" (56.8%).	
12964495	While the overall consumption of psychotropic medicines such as tranquillisers and hypnotics has declined, the consumption of the newer antidepressants--selective serotonin reuptake inhibitors (SSRIs) has increased drastically since their introduction. In order to understand the mechanisms underlying the use, it is important to gain insight into the users' perceptions about their medicine and use.To analyse younger women's perceived functions of SSRIs in their everyday lives.	12 in-depth interviews and 6 re-interviews were conducted with a community-based sample of 21- to 34-year-old women taking SSRIs. The women were recruited through Danish pharmacies.	Prior to taking SSRIs the women struggled with their emotional problems, often in great frustration and distress. While taking SSRIs the women experienced that the medicine functioned both at a psychological and a social level. They believed that the medicine gave them resources to behave actively in a way that was not previously possible. They felt that the medicine use enabled them to concentrate on daily life activities other than dealing solely with their emotional problems. The women found that the medicine gave them back a sense of 'normality'.	The main finding in this paper is that the perceived functions of SSRIs were related to social meanings and goals in everyday life.	
12962072	The investigation of 198 servicemen suffered from peptic ulcer has revealed the clinical specific features of disease course and specific character of relapse season. The multiple correlation between such parameters of psychological status as personal anxiety, neurotism, emotional non-stability and frustration tension were established. The leading type of attitude to one's own disease (ergopatic) conditioned by high level of realizing the social needs and by the aspiration for maintaining the professional status.
12948570	As medical treatment for AIDS has become more complex, the need for good palliative and end-of-life care has also increased for patients with advanced disease. Such care is often inadequate, especially among low-income, ethnic minority patients. The current study investigated physicians' experiences with caring for dying HIV patients in an underserved, inner city community in the Bronx, NY. The goals of the study included: (1) to investigate the barriers to effective end-of-life care for HIV patients; and (2) to examine physicians' experiences of role hindrance and frustration in caring for dying patients in the era of HAART. Qualitative, open-ended interviews were conducted with 16 physicians. Physicians identified two core, prescriptive myths shaping their care for patients with HIV. The 'Good Doctor Myth' equates good medical care with the delivery of efficacious biomedical care. The role of the physician is defined as technical curer, while the patient's role is limited to consultation and compliance. The 'Good Death Myth' envisions an ideal death which is acknowledged, organized, and pain free: the role of the physician is defined as that of comforter and supporter in the dying process. Role expectations associated with these myths were often disappointed. First, late-stage patients refused to adhere to treatment and were thus dying "unnecessarily." Second, patients often refused to acknowledge, accept, or plan for the end of life and as a result died painful, chaotic deaths. These realities presented intense psychological and practical challenges for providers. Adaptive coping included both behavioral and cognitive strategies. Successful adaptation resulted in "positive engagement," experienced by participants as a continuing sense of fascination, gratification, and joy. Less successful adaptation could result in detachment or anger. Participants believed that engagement had a powerful impact on patient care. Working with dying HIV patients in the post-HAART era of efficacious treatment challenges physician's cherished roles and values. Physicians adapt to the challenge through a variety of cognitive and behavioral strategies. The failure to adapt successfully has psychological consequences for providers that may impact patient care.
12946970	To increase understanding of how the prison environment influences the mental health of prisoners and prison staff.Qualitative study with focus groups.	A local prison in southern England.	Prisoners and prison staff.	Prisoners reported that long periods of isolation with little mental stimulus contributed to poor mental health and led to intense feelings of anger, frustration, and anxiety. Prisoners said they misused drugs to relieve the long hours of tedium. Most focus groups identified negative relationships between staff and prisoners as an important issue affecting stress levels of staff and prisoners. Staff groups described a "circle of stress," whereby the prison culture, organisation, and staff shortages caused high staff stress levels, resulting in staff sickness, which in turn caused greater stress for remaining staff. Staff shortages also affected prisoners, who would be locked up for longer periods of time, the ensuing frustration would then be released on staff, aggravating the situation still further. Insufficient staff also affected control and monitoring of bullying and reduced the amount of time in which prisoners were able to maintain contact with their families.	Greater consideration should be given to understanding the wider environmental and organisational factors that contribute to poor mental health in prisons. This information can be used to inform prison policy makers and managers, and the primary care trusts who are beginning to work in partnership with prisons to improve the mental health of prisoners.	
12945065	Very few studies have examined the relationship between personality traits and long-term postoperative psychosocial adjustment. In a sample of 46 patients, we examined the relation between personality traits before pelvic pouch surgery for ulcerative colitis and psychosocial adjustment seven years postoperatively, controlling for the effects of surgical functional outcome. The Karolinska Psychodynamic Profile (KAPP) was used for personality assessment. Surgical functional outcome scales and the Psychosocial Adjustment to Illness Scale were also used. As assessed by the KAPP, poor frustration tolerance, long-standing preoperative problems in sexual functioning, perfectionistic body ideals, and lack of alexithymia predicted poorer postoperative long-term psychosocial adjustment in the areas of health concerns, sexuality, family relations, and psychological distress. Surgical functional outcome itself was a poor predictor of long-term adjustment. The results indicate that it may be beneficial to take personality factors into account in preoperative assessment.
12937347	The surprising or unexpected omission of an appetitive reinforcer has at least two effects: An allocentric effect according to which the organism updates knowledge about the environment, and an egocentric effect that allows the organism to learn about its own emotional reaction to the change. This egocentric effect (traditionally called frustration) is correlated to activation of the hypothalamic-pituitary-adrenal axis, can be modulated by treatment with anxiolytics, and is expressed in terms of behavioral changes that have an emotional component (e.g., agonistic behavior). It is hypothesized that all vertebrates share the mechanisms underlying the allocentric effect, but only mammals possess the mechanisms underlying the egocentric effect. It is further argued that frustrative mechanisms evolved in early mammals from those underlying fear conditioning.
12930542	It has become clear that nursing is a high-risk occupation with regards to stress-related diseases. In this study, we were interested in nurses' experiences of stress and the emotions arising from stress at work. Results showed that nurses experienced negative stress which was apparently related to the social environment in which they worked. Four nurses were interviewed. The method used was grounded theory. Analysis of the interviews singled out absence of response as the core category. Recurring stressful situations obviously caused problems for the nurses in their daily work. Not only did they lack responses from their supervisors, they also experienced emotions of frustration, powerlessness, hopelessness and inadequacy, which increased the general stress experienced at work. Our conclusion is that the experience of absence of response leads to negative stress in nurses.
12930536	This paper reports the findings of a survey undertaken in Queensland, Australia in October 2001. The participants were registered and enrolled nurses and assistants in nursing who were members of the industrial body - the Queensland Nursing Union (QNU), and who were in paid employment in nursing in Queensland. Participants were selected by random sampling from each of the three major employment groups - the aged care, public and private acute sectors. Of the 2800 invited participants, 1477 responded resulting in an overall response rate of 53%. The findings indicate that over 50% of nurses in the aged-care sector, 32% of nurses in the public and 30% of nurses in the private acute sector experience difficulties in meeting patient needs because of insufficient staffing levels. The nurses in this study also believed that there was poor skills-mix, mostly caused by lack of funding, too few experienced staff or too many inexperienced staff. Many nurses in this study expressed their anger and frustration about their inability to complete their work to their professional satisfaction in the paid time available. Further, many nurses also expressed the view that because of this inability they were planning to leave the nursing profession. These findings are consistent with other research into the nursing workforce both within Australia and internationally.
12916539	Autointoxications are among the most common medical emergencies. Patterns of toxicosyndromes show regional variation, and they change over time. Intoxications are usually multiple. Although autointoxication is often self-limiting and a fatal outcome is unusual, suicide attempts may kill. Toxicity screening, emergency room first aid, decision rules for admission to the Ward or the ICU, or prolonged observation in the Emergency Department, and measures to prevent gastrointestinal substance resorption are based on expert opinion rather than scientific evidence. Toxicity screening needs regular adjustment and should be individually tailored, based on local patterns as well as on clinical syndromes. A team approach and efforts to study safe management strategies should turn caregiver frustration into a more enthusiastic and inquisitive attitude towards the challenges to meet the medical needs of these patients.
12899467	Comparative studies of the health, well-being, and social functioning of adolescents and youths have, in the past two decades, been focused on young people in developing countries where rapid social, cultural, and economic changes have been associated with dramatic increases in the rates of social problems indicative of poorer mental health. Young people in many Pacific Island societies suffer from some of the highest rates of social problems like suicide and substance abuse in the world. It is generally agreed that the increases in rates of social problems among youths in this region result from increases in psychosocial stress, anger, and frustration surrounding intergenerational conflict within the family. Much less is known about the aspects of everyday experiences of young people in the Pacific that can lead to psychosocial stress and the angry episodes of interpersonal conflict that often precede suicide attempts and binge drinking. This paper examines 40 cases of interpersonal conflict in young men's and women's experiences in the islands of Chuuk of the Federated States of Micronesia to better understand what can lead to elevated levels of psychosocial stress for youths in the Pacific. This study shows that the emotional crises of young people in Chuuk often emerge from the incongruence in their pursuit of valued personal and social identities within the family, the community, and the peer group. Thus youths who experience more incongruity in their engagements across the multiple activity settings of everyday life are at greater risk for stressful experiences.
12899419	This study investigated J. M. G. Williams's (1996) affect-regulation hypothesis that level of specificity of autobiographical memory (AM) is used to minimize negative affect. It was found that a negative event leads to more reports of subjective stress in high- as compared with low-specific participants. Also, afterward, high-specific participants rated their unprompted memories for the event as more unpleasant. The results indicate that, relative to high specificity, being less specific in the retrieval of AMs is associated with less affective impact of a negative event. Results are discussed within the affect-regulation model. It is suggested that future research take a more functional perspective on AM specificity.

12877233	Psychosocial issues permeate the field of cosmetic surgery: 1. The preoperative psychological profile of cosmetic surgery patients is likely to differ from that of people who don't come for surgery. Despite several decades of research, this difference is not well understood. 2. Cosmetic surgery patients often look for more than changes in their physical appearance. If these procedures do not lead to improvements in body satisfaction, self-esteem, or quality of life, then what is their purpose? 3. Patient-surgeon rapport is not simply a nice plus if it happens. Patient satisfaction, reduced legal liability, and improved surgical outcome can all be direct reflections of the surgeon's mastery of relationship-building techniques. 4. Identifying and screening out patients who should not have cosmetic surgery can prevent both patient and surgeon frustration and more extreme adverse outcomes. 5. A wide range of studies document the use of psychological techniques to improve surgical outcome.
12868294	CHRONIC BOREDOM and the conditions that induce boredom are associated with a host of undesirable outcomes. It is proposed that the course and treatment of schizophrenia and other severe mental illnesses (SMI) that require extended care in community-based treatment facilities are often complicated by such outcomes. Brief case studies are used to illustrate how sustained boredom can contribute to (1) postpsychotic mood disturbances, (2) increased risk-taking and substance-seeking behaviors in the residual phases of the illness, (3) the exacerbation of positive symptoms such as paranoia and hallucinations, (4) changes in distractibility and overall cognitive efficiency, and (5) a hypohedonic state of highly generalized uninterest. The observation is made that despite the potential value of boredom as a prodomal marker, few, if any, of the instruments commonly used to assess clinical change include a measure of boredom. It is suggested that training in covert boredom coping skills should be integrated into the social skills training and rehabilitation strategies currently employed with individuals with severe and persistent mental disorders.
12859123	Two experiments examined how different frustration contexts affect the instrumental and emotional responses of 4- to 5-month-old infants. Three different frustrating contexts were investigated: loss of stimulation (extinction), reduction in contingent stimulation (partial reinforcement), and loss of stimulus control (noncontingency). In both experiments, changes in arm activity and facial expressions of anger and sadness coded according to the Maximally Discriminative Facial Movement Coding System (MAX) were the measures of frustration. Both experiments showed that (a) arm responses increased when the contingent stimulus was lost or reduced but decreased when control of the stimulus was lost under noncontingency, (b) MAX-coded anger, but not MAX-coded sad or blends of anger and sad, was associated with frustration, and (c) the pattern of anger and arm responses varied with the frustration context. When contingent stimulation was lost or reduced, both anger and arm responses increased, but when expected control was lost under noncontingency, arm responses decreased while anger increased.
12857581	In the context of welfare pluralism where government in the UK has been contracting a number of public services out to a range of private and voluntary sector organisations, the aim of this study is to explore the extent to which decisions to become involved in employment support programmes are affected by the users' perceptions of those delivering the service.A qualitative design involving two focus groups of fourteen participants was employed to examine the attitudes and perceptions of participants in the government's New Deal for Disabled Persons. The study sample was purposefully selected from client records of Shaw Trust a national charity for disabled persons, one of the organisations who have been contracted by the government to provide this service.	Two distinct but related themes of disillusionment with the government and the importance of trust emerged from the focus groups. Overall, the data suggests that the identity of those delivering the service significantly influences the decision to participate. As Shaw Trust is a voluntary organisation promoting the rights of disabled persons they were deemed to be trustworthy. The users were sceptical about the government's commitment to improving the lives of disabled people and were reluctant to engage with the state.	Making the transition from dependency on disability benefits to paid employment is a quantum leap. For many the decision to put themselves forward for voluntary support schemes is affected by the extent to which they believe they can trust the agency delivering the service. It is imperative that the government listen to the service users who have been involved in these projects and learn from their experiences.	
12856368	If scientific knowledge can be acquired through a series of learning strategies that are made easier by the tutorial system, personal and relational training is a more complex task. In fact, it means acquiring a particular mental structure that one only reaches with personal development. The emotional management of patients and of their relatives also requires a set of psychological and communicative abilities that are inborn predispositions, but have to be nurtured: learning from experience, sympathetic listening, self insight and understanding, attention towards transference and counter-transference, cannot be acquired from theory, but have to be experienced and verified hands-on. Living other people's emotional experience is not easy; sympathizing means being able to identify with them, but at the same time, to perceive oneself as separate. Moreover, the contact with suffering and sickness amplifies problems of the self, activating a set of emotions and defence mechanisms. One may get caught into other people's suffering, and be influenced by fear and anguish. Approaching illness, pain and death already represents a border-line experience. Students have to overcome the reassuring reality of theoretical study to carry out a strong and complex relational experience: that of a never-ending alternation of taking care and separation, of fulfilment and frustration, of continuous professional and personal testing. The emotional urge is varied and uninterrupted: managing patients cannot be reduced to a protocol of interventions technically defined.
12851552	To evaluate outcomes and issues pertaining to cochlear implantation in a group of subjects affected by Cogan syndrome.Prospective cohort.	Department of Ophthalmology and Otorhinolaryngology, University of Parma.	Five postlingually deafened adults suffering from a typical form of Cogan syndrome who underwent cochlear implantation.	Benefit from cochlear implantation as measured by word and everyday sentence recognition tests. Surgical issues and postoperative complications were also evaluated.	In two cases, intracochlear electrodes were inserted into the scala vestibuli because of the ossification of the scala tympani. Two patients experienced a recurrence of keratitis the day after surgery. To date, with a follow-up of 1 to 4 years, no patient has experienced flap complications or other local or systemic complications. At the 12-month postoperative evaluation, all patients had gained useful open-set speech perception, achieving a mean score of 91% and 95% on word and everyday sentence recognition tests, respectively.	Patients deafened by Cogan syndrome demonstrated high levels of speech understanding after undergoing cochlear implantation. Obliteration of the cochlea may complicate electrode implantation, requiring modifications of the surgical technique. Stress consequent to the surgical procedure may instigate an acute phase of the basic illness.	
12851097	This study aimed to get knowledge of the younger stroke patient's viewpoint and to describe how young stroke patients experience the rehabilitation process. The purpose was also to develop hypotheses about the relationship between young stroke patients and the rehabilitation process.Thematised in-depth interviews were performed with two women and three men who suffered from stroke (37 - 54 years). The analysis used was the Grounded Theory method of constant comparison.	The analyses resulted in the core category 'Frustration' which was derived from the categories labelled 'The paralysed everyday' and 'Outside and invisible'. 'The paralysed everyday' category involved different aspects of everyday life after a stroke. Because of their fatigue they were unable to work and their family and social life were negatively affected. They found it difficult to engage in daily life activities and felt indifferent. The three women expressed frustration over the demands they experienced as being mothers and housekeepers, whereas the two men emphasised economic responsibility of the family as problematic. The category 'Outside and invisible' describes the lack of participation the informants experienced regarding the rehabilitation process. The informants felt they lacked information and age-adapted interventions. Their needs were not provided for and they felt distant from the other patients. Their remaining symptoms were probably on a cognitive basis and therefore invisible. This was a source of frustration.	The hypotheses generated indicated that young stroke patients are frustrated and invisible due to the fact that the rehabilitation setting does not acknowledge the different needs of young stroke patients compared with older patients.	
12848432	Mutual regulation of anger plays a role in both healthy adjustment and mental health problems. This study of 85 preschooler boys and girls examined mother-preschooler anger regulation during a frustration in relation to the child's preschool and school age problem status. Less mutual positive emotion, more mutual anger, and more emotional mismatches than other dyads characterized dyads with a stable conduct problem child. Maternal emotion predicted school age conduct problems, particularly for boys. Maternal emotion also predicted stability versus improvement of symptoms. The emotional dynamics of mother-preschooler angry exchanges may redirect girls' conduct problems and may contribute to the stability of boys' conduct problems.

12834924	Over the past 25 years, suicidal behaviour in young people has continued to be a major concern for health services around the world. Self-harm in individuals aged 13-18 is common and represents a significant reason for admission to accident and emergency departments, paediatric medical services and child and adolescent mental health services. Nurses' and doctors' working in these areas are the first point of contact for young people following an episode of self-harm. This paper presents a study exploring nurses and doctors perceptions of young people who engage in suicidal behaviour. The data presented form part of larger project conducted using both quantitative and qualitative methods, and a contemporary grounded theory approach to analysis. The findings revealed two main categories and associated subcategories: Experiences of frustration in practice (subcategories: non-therapeutic situations, insubstantiality of interventions and value of life) and strategies for relating to young people (sub-categories: specialist skills in care and reflections on own experience). The meanings of these categories highlight barriers in the relationship nurses and doctors have with young people who engage in suicidal behaviour. If suicide prevention policies around the world are to succeed the phenomena impacting on the communication between these professionals and young people needs to be addressed in research, education and in the development of practice.
12819575	Studies of patients on coronary artery bypass graft (CABG) waiting lists have revealed emotional disturbances (Underwood et al, 1993; Fitzsimons et al, 2000a). Patients may wait up to several months, following angiography, before being accepted on to the waiting list. To date, their needs, at this time, have been largely overlooked. A qualitative research design, using in-depth interviews, was used to identity the main concerns of six such patients. Thematic content analysis affirmed the existence of anxiety/fear, uncertainty and frustration among patients awaiting CABG surgery. These themes have been identified previously among patients on the CABG waiting list (Fitzsimons et al, 2000a). Other themes identified, unique to patients who had been referred for CABG surgery but not yet accepted on to the CABG waiting list, were confusion related to treatment plans, guilt, shock, avoidance and acceptance related to the need for surgery or their diagnosis. Consideration should therefore be given not only to providing additional support to patients actually on the waiting list but also to those patients who are in the process of being referred for CABG surgery.
12803458	Six hundred Israeli students responded to a questionnaire dealing with five motives for participating in vandalism: anger/frustration, boredom, erosion, aesthetics, and catharsis (Cohen, 1984). As we did not find a coherent pattern, we created a variable comprising all five motives: general motivation. Four factors accounted for motivation to participate in destructive behavior: perceived level of vandalism at school, attitude toward school, attitude toward teacher, and school anxiety. Punishment, father's level of education, sense of hope, and class level did not have an effect on motivation to participate in vandalism. It was concluded that the social context is a crucial element in school vandalism.
12801375	This article examines the role of nurse managers in delivering the NHS modernization agenda by supporting the development of new and innovative nursing roles as proposed in recent health care policy. A study by Ewens (1998) indicates that nurses will respond positively to new short-term developments because of the ability to re-conceptualize work roles before actually undertaking them, but that long-term success will depend upon whether the workplace provides the scope and flexibility for integration of new identities into the self-concept. It is argued that when nurses find a gap between what they believe their role could be and what in reality it is allowed to be they separate their self-concept from their work role. In this situation the nurse experiences frustration and disappointment and the work role becomes 'untenable', resulting in them either leaving or retreating back into traditional professional identities. A discussion is provided on the role of nurse managers in the prevention of this negative response by supporting innovative work environments that can accommodate the new roles envisaged in the current policy. The paper concludes with consideration of the current direction of nursing and questions whether this move towards the nurse as 'assistant physician' will, in the longer term, be a good thing for patients.
12800708	This paper explores the processes of policy-making, budgeting and service implementation in three provinces of South Africa, drawing on interviews with health managers at different levels of government. It illustrates how the process of decentralisation creates disjunctures between the policy-making authority of higher levels of government and the implementation capacity of service provision levels. It also explores the complex dynamics between those responsible for specific policies, such as reproductive health policies, and those responsible for managing the integrated delivery of all policies, with their resultant contestations over authority and resources. The pace of change in South Africa and the enormous capacity it requires, both in relation to financial management and the technical skills needed for specific programmes, has created a sense of frustration and demoralisation. Whilst shortage of financial resources, particularly as reflected in shortage of staff, is frequently assumed to be the biggest constraint in this context, most managers identified other issues, particularly staff morale, as greater barriers to the delivery of high quality health services. The paper concludes that it is the complexity of experience and feelings described by health managers that may determine the extent and quality of service delivery. For this reason, both practice and research need to give greater attention to issues of power relations and personal experience of change.
12800702	Universal access to comprehensive reproductive health services, integrated into a well-functioning health system, remains an unfulfilled objective in many countries. In 2000-2001, in Tanzania, in-depth interviews were conducted with central level stakeholders and focus group discussions held with health management staff in three regional and nine district health offices, to assess progress in the integration of reproductive health services. Respondents at all levels reported stalled integration and lack of synchronisation in the planning and management of key services. This was attributed to fear of loss of power and resources among national level managers, uncertainty as to continuation of donor support and lack of linkages with the Health Sector Reform Secretariat. Among reproductive health programmes, sexually transmitted infection (STI) control alone retained its vertical planning, management and implementation structures. District-level respondents expressed frustration in their efforts to coordinate STI service delivery with other, more integrated programmes. They reported contradictory directives and poor communication channels with higher levels of the Ministry of Health; lack of technical skills at district level to undertake supervision of integrated services; low morale due to low salaries; and lack of district autonomy in decision-making. Integration requires a coherent policy environment. The uncoordinated and conflicting agendas of donors, on whom Tanzania is too heavily reliant, is a major obstacle.
12799606	Families of individuals with mental illness face a range of practical and emotional stresses. Studies that have addressed the sources of these burdens are limited. Literature suggests that burdens could come from the stigmatizing attitudes towards individuals with mental illness and inadequate public resources. Nevertheless, how public attitudes and availability of public resources have affected the burden on patients' families remains to be studied. This study set out to explore the relationship between stigma, accessibility of mental health facilities and family burden through individual interviews of patients' relatives in order to understand the burden on mentally ill patients' relatives from their perspectives. Ten interviewees from two out-patient psychiatric clinics were recruited and interviewed. Each interviewee had at least one family member receiving out-patient psychiatric services. Altogether 11 mentally ill patients were involved. Data analyses showed that much of the burden was related to stigma and to lack of mental health and rehabilitation services. Consequences included social isolation of the families, difficulties experienced by the mentally ill patients when trying to obtain competitive employment and financial difficulties. Subjective burden resulting from social stigma included frustration, anxiety, low self-esteem and helplessness. Implications of the findings to social policy and development of mental health services were discussed.

12789022	The welfare of agricultural research animals relies not only on measures of good health but also on the presence of positive emotional states and the absence of aversive or unpleasant subjective states such as fear, frustration, or association with pain. Although subjective states are not inherently observable, their interaction with motivational states can be measured through assessment of motivated behavior, which indicates the priority animals place on obtaining or avoiding specific environmental stimuli and thus allows conclusions regarding the impact of housing, husbandry, and experimental procedures on animal welfare. Preference tests and consumer demand models demonstrate that animal choices are particularly valuable when integrated with other behavioral and physiological measurements. Although descriptive assessments of apparently abnormal behavior such as stereotypies and "vacuum behaviors" provide indications of potentially impoverished environments, they should be used with some caution in drawing welfare conclusions. The development of stereotypies may in some cases be linked to psychiatric dysfunction and reflect underlying neurophysiological impairments, which have implications for the ability to perform flexible behavior and thus the quality of research data provided by this kind of behavioral measurement (e.g., in pharmaceutical research). Environmental modifications, commonly termed "enrichment," can have diverse consequences for cognitive function, physiological responses, health, psychological welfare, and research data. Simple practical modifications of housing, husbandry, and experimental design are suggested to improve the psychological welfare of agricultural research animals in accordance with the principles of refining, reducing, and replacing (the "3Rs"), which underlie US Public Health Service Policy, and prevailing public ethics.
12776977	Currently, many patients undergo surgery when they and their families are not prepared or resilient enough to recover fully, predisposing them to poor outcomes. These poor outcomes lead to missed work, patient depression, chronic pain, litigation, and surgeon frustration. Sometimes these individuals require the surgeon's oversight and are more likely to improve with rapid vocational therapy, physical therapy, and aggressive, continuous chronic-pain management. The foot and ankle surgeon who takes a biopsychosocial multidisciplinary perspective will prescreen his or her patients for positive risk factors and expand his or her intervention long before and after surgery. This strategy of triaging medical cases to differential treatment is not a new concept in medicine. What is novel is the necessity of triaging and prioritizing patients on the basis of the most significant factors that determine successful surgical outcome: psychologic, social, environmental, and historical medical factors . Robert Sternberg of Yale University suggested that three psychologic problem-solving strategies are available: (1) I can try to change myself, (2) I can try to change others, or (3) I can try to change the situation. Naturally, the authors of this article encourage applying all three: (1) the caring surgeon is attentive to these issues; (2) the medical community prepares the patient, themselves, and the patient's family; and (3) the environment into which the patient is released is altered to support their rehabilitation. The ABLE Presurgical Assessment Tool and related treatment strategies provide foot and ankle surgeons with an easy-to-use, research-based application to better screen and manage their surgical patients. The goal of this review and assessment tool is not to determine a quantitative level of risk. Instead, the authors hope to facilitate a surgeon's awareness of critical preoperative risk factors and provide a tool to efficiently identify these factors and arrange appropriate treatment as needed.
12774877	To describe the lived experience of nurses who care for newborns with sepsis.Phenomenology, a qualitative study using open-ended, tape-recorded interviews, followed by a focus group discussion. The data were analyzed using Colaizzi's step-by-step procedure, resulting in an essential structure of the experience.	The nursery and neonatal intensive-care unit of a large community hospital in the southwestern United States.	Eleven registered nurses who cared for newborns in both a transitional nursery and the neonatal intensive-care unit were interviewed individually or in a focus group.	Three major themes were generated from the data: (a) "Dealing With Death and the Blessings of Life," (b) "Sepsis: The Cancer in the NICU," and (c) "Losing the Dream: Parents' Reactions." The nurses had feelings of helplessness and frustration while caring for these sick newborns. Nurses described the changes in newborns' condition as sepsis developed, the actions taken to reverse the downhill course, and the experiencing of the outcome. Nurses perceived that parents responded with overwhelming fear, guilt, and loss of control.	The nurse caring for the infant with sepsis experiences many different emotions, reactions, and perceptions. These findings can assist nurses to have a better understanding of the role of the nurse and the emotional burden of working in the NICU.	
12765314	To assess the prevalence of asthma symptoms, their impact on daily activities, and perceptions of disease severity among people with asthma.A telephone survey of 699 people with asthma was conducted in 1999 in metropolitan and nonmetropolitan New South Wales, Victoria, and Queensland, Australia.	Forty-two percent of adults and 26% of children reported experiencing asthma symptoms at least every 2-3 days. Thirty-seven percent of adults and 26% of children reported using a reliever more than four times in the previous week. Of those for whom preventer therapy had been prescribed (61% of respondents), 30% of children and 45% of adults did not use their preventer as instructed. A high proportion of respondents reported avoiding physical and social activities because of their asthma, while 75% said asthma generally made them feel tired. Many respondents attributed frustration (61%), irritability (57%), fear (38%), and worry (43%) to their asthma. Only 50% of respondents had been reviewed by a general practitioner for asthma in the past year. Respondents generally underestimated the severity of their asthma, compared with symptom frequencies reported.	The Living with Asthma Survey suggests that national asthma management goals are not being achieved in a high proportion of patients, with evidence for both underprescribing and underusage of preventer medication. Achieving closer alignment between medical and patient perspectives is an important goal of asthma education and management in order to help bridge the gap between current concepts of best practice and the reality of persistently poor asthma outcomes.	
12751841	One of the more controversial issues related to maternal employment in the United States concerns the timing of entry into the workforce and its effect on children, particularly during the first year of the child's life. Some studies show deleterious effects on children, such as increases in aggression and noncompliance, while others document few negative and even positive effects of early employment.This study examined the long-term effects of maternal employment during the child's first year of life on the social behavior of 171 third- and fourth-grade children in two-parent families. The moderating effects of child gender and social class were investigated. The extent to which stability in alternative care arrangements statistically explained links between early maternal employment and child outcomes was tested.	After controlling for child gender, and maternal ethnicity, social class, and current employment status, third- and fourth-grade children whose mothers were employed during their first year of life evinced more acting out and less frustration tolerance and were nominated more often by peers for 'hitting' and 'being mean' than children whose mothers were not employed. There was some evidence that these associations were moderated by child gender and social class: boys, but not girls, whose mothers were employed during the first year were subsequently rated by teachers as acting out more than other children, and were also more likely to be nominated by peers for hitting. Higher nominations for hitting were only found in the working class. Finally, there was partial evidence that the number of alternative child-care arrangements during the first year accounted for the links between early maternal employment and subsequent child outcomes.	These results are congruent with extant research that posits a risk of early employment on socioemotional development, but show that this risk is partially attributable to child-care instability.	
12746626	Though the importance of self-monitoring blood glucose (SMBG) for type 1 diabetes is widely acknowledged, it is still questioned in type 2 diabetes, at last when it is not treated with insulin. Indeed, SMBG appears to be efficient only when it is integrated into a strategy of self-treatment, which leads the patient to adapt his treatment to his blood sugar tests. Passive self-control is useless, and can even favour increasing anxiety or frustration. Numerous problems are still to be solved, be it concerning the adaptation of the treatment - the number of tests per day or per week, the kind of therapeutic adaptation, etc - or concerning the therapeutic education, which should correspond to the patient's personality and to his strategy of treatment. Evaluating the locus of control of the patients could help to single out those who could benefit from SMBG. The development of SMBG, whose cost is financed by social Security in France, is a good mirror of the patients' increasing wish to be informed about their treatment and to take an active part in it. Yet prospective randomised studies are still needed to confirm the efficiency of SMBG in type 2 diabetes.
12745389	This study aims to characterize the factors determining the retention or loss of insight in dementia through: (i). a comparison of assessment procedures previously used to quantify loss of insight and (ii). a qualitative analysis of interviews with patients and carers. Semi-structured interviews were carried out with thirty-two people with dementia and their carers, which incorporated assessments via clinical interview, discrepancy ratings between patient and carer on an Activities of Daily Living scale, and prediction of performance on a memory task. The results of these were compared and supplemented with themes arising from qualitative analysis of the interviews. Significant differences were found between insight as measured by a prediction of performance paradigm and other methods of assessment. This may reflect a distinction between implicit and explicit knowledge. Analysis of interviews identified the following factors as contributing to people's awareness of their difficulties: (1). short-term frustration or distress; (2). continuous discontent; (3). lack of concern; (4). normalization of problems; (5). worry and anxiety; (6). defensiveness; (7). explicit denial; and (8). priority given to other problems. We conclude that insight in dementia is a complex, multi-dimensional, and value-laden concept. Emotional and behavioural aspects need to be considered as well as the cognitive, which is emphasized by traditional methods of assessment based on quantitative ratings. Implicit awareness may be accessible through subjects' predictions of performance on cognitive tasks and should be further investigated. An adequate account of insight in dementia should incorporate both objective and subjective measures in order to determine the interrelationships between organic changes, personality factors, and psychological mechanisms. A generally accepted, reliable protocol for the assessment of insight needs to be developed.
12744596	This is a personal account of the experience of a bariatric patient with a typical story of frustration with weight loss options who eventually sought bariatric surgery in desperation. Her story traces the steps of her journey to an ideal bariatric center where she derived the many benefits of competent medical care and personal support. She has been married for 7 years is an active mother of 5-year-old twin boys and is expecting her third child in May 2003.
12742794	Narrative and problem-solving versions of the same virtual patient's case were created for teaching communication skills to medical students. This qualitative study explored how students experienced the virtual patient.In 1998-1999 in-depth, free-form interviews and follow-ups were conducted with 12 third-year medical students at Monash University in Australia. Students were asked about their experiences with the virtual patient. The interviews were qualitatively analyzed using psychological phenomenology.	Results were in the form of a description of the students' lived experiences with the virtual patient. Findings indicated that students responded to the virtual patient as if she were real but they felt a simultaneous sense of prefabrication, which often led to frustration. Students' experiences of both versions were similar, but the narrative version permitted better rapport with the virtual patient.	This phenomenological study indicated that a constructed, computer-based virtual patient can have substantial emotional effects on medical students.	
12729809	The effect of three types of cell phones (hand held, hands free with an external speaker and personal hands free) on total subjective workload (including its constituent components; mental demand, physical demand, temporal demand, performance, effort and frustration) and intelligibility was measured using the NASA-task load index (TLX) and the modified rhyme test (MRT), respectively in 13 experienced drivers (nine male, four female, age range 28-65 years), whilst driving on a rural highway. The drivers rated all components of workload for each type of cell phone to be significantly higher than for a control condition in which no cell phone was used. The mean (standard deviation) total workload was lowest for the personal hands free cell phone (7.1(3.65)) and highest for the hands free speaker phone (10.8 (3.63)) (P<0.001). The mean (standard deviation) intelligibility score was highest for the personal hands free cell phone (74.1 (7.9)) and lowest for the hands free speaker phone (55.0 (10.4)) (P<0.001). Frustration was significantly correlated with total workload (0.60, P<0.001) and intelligibility was significantly correlated with frustration (-0.35, P<0.05). Physical demand was not a high contributor to total workload. It is concluded that a personal hands free cell phone would interfere least with the cognitive demands of driving.
12728696	The present study examined the effects of hypnosis on aggression and depression in depressed undergraduate students. Six frustrating situations were presented to 13 mildly depressed subjects as well as to 13 non-depressed subjects. All subjects were studied both in light trance and in the waking state. Their emotions were measured by numeric rating scales and open-ended questions. On scores using with numeric rating scales, depressed subjects were less depressive under trance as compared to the waking state. Responses to open-ended questions, which were scored by four raters, indicated that depressed subjects were less aggressive during trance than during the waking state, while non-depressed subjects were more aggressive under trance. Furthermore, the depression score was lower during trance than during the waking state. These findings suggested that depressed subjects were not repressive, while non-depressed subjects were repressive and exhibited controlled anger in the waking state.
12718944	To investigate the lived experience of violence of nurses in one A&E department.Following an extensive literature review, it was elicited that there was very little evidence of the psychological impact of violence in A&E.	Violence in the health service has increased over the last decade associated with a corresponding increase in the published literature on this topic. While violence in A&E departments would appear common, little evidence exists on the psychosocial impact of these incidents on A&E nurses.	A qualitative domain using a phenomenological philosophy was utilised. Sampling was of a volunteer nature and data were collected using interview. Nurses were sampled from one major acute hospital in Northern Ireland.	Participants expressed feelings of frustration, anger, and fear. Support from colleagues was greatly valued and lack of feedback from management was cited as being common.	Frustration and anger were synthesised into the "why me" principle with nurses not knowing why they were the focus for attack. Violent incidents were associated with a sense of isolation but colleague support developed a sense of belonging.	Whilst a useful insight was provided, more research is essential into this emotive topic.	
12699136	To study the associations of patient-related and perceived healthcare-related factors with the control of blood pressure.Physicians identified all of the hypertensive patients they saw during I week in 26 health centres. Out of 2,219 patients, 80% agreed to participate, 88% of which took antihypertensive medication.	In this cross-sectional questionnaire study, based on 82 opinion statements, 14 problem indices were formed using factor analysis. Logistic regression models were used to study the associations with blood pressure control.	Eighty per cent of the men and 79% of the women had poor blood pressure control (BP > or = 140/90 mmHg). High levels of hopelessness towards hypertension (adjusted OR 2.16; 95% confidence interval (CI) 1.20-3.88) as well as medium and high levels of frustration with treatment (adjusted OR 1.50; 95% CI 1.04-2.18 and OR 1.83; 95% CI 0.98-3.44) were associated with poor control. The perceived tension with blood pressure measurement (adjusted OR 1.60; 95% CI 1.08-2.36) was similarly associated with poor control. Non-compliance in men, old age and monotherapy were also associated with poor blood pressure control.	Hopelessness, frustration with treatment, and perceived tension with blood pressure measurement are associated with poor blood pressure control.	
12681159	To identify difficult (heartsink) patients (DP), describe their profile, and report the opinions and experiences they evoke in physicians who see them.Descriptive, cross-sectional study based on quantitative and qualitative methods.	Urban health care center.	Difficult patients were selected daily from among all patients seen in six primary care practices during the period from March to May 2001. Patients were identified according to the diagnostic criteria of Ellis (patients who cause a knot in the stomach when their name appears on the list of patients with an appointment that day) and O'Dowd (patients who cause distress or discomfort).	Information was obtained on the number of DP seen, number of visits made by DP, age, sex, type of DP, level of education, occupation, family structure and comorbidity. Type of DP was determined with a modification of the Groves classification (dependent clinger, entitled demander, manipulative help-rejecter, self-destructive denier, somatizer, emotive seducer). We analyzed the opinions DP generated by examining the discourse produced during a discussion group session with 9 physicians from the participating health center and a moderator.	A total of 82 DP were identified (prevalence.7%, i.e., 2.3% of all visits). Most (67.1%) were women. Mean age was 57.8 years (standard deviation 15.2 years). Dependent clinger patients predominated (41%). Most patients had primary-level education (62%), about one-third were retired (35%), and about one-third were married and had children (35%). Most had two or more medical diagnoses (74.4%), and many had at least one psychiatric diagnosis (40.2%).The feelings these patients evoked most often in physicians were irritability and frustration. Most physicians agreed that these patients are rare but have a severe emotional impact. Physicians believe that the skills and strategies they have to help them manage these patients are limited, and consider specific training necessary to improve them.	Although DP are not a relevant problem in quantitative terms, they cause considerable emotional distress. Specific training in clinical interviewing is felt to be necessary given the difficulties in managing these patients.	
12674289	The ABC model underlying Ellis's Rational Emotive Behavior Therapy predicts that people who think more irrationally should respond to daily stressors or hassles differently than do people who think less irrationally. This study tested this aspect of the ABC model. 192 college students were administered the Survey of Personal Beliefs and the Hassles Scale to measure irrational thinking and daily hassles, respectively. Students who scored higher on overall irrational thinking reported a significantly higher frequency of hassles than did those who scored lower on overall irrational thinking, while students who scored higher on awfulizing and low frustration tolerance reported a significantly greater intensity of hassles than did those who scored lower on awfulizing and low frustration tolerance. This indicates support for the ABC model, especially Ellis's construct of irrational beliefs central to this model.
12664735	To examine general practitioners' (GPs) and practice nurses' (PNs) perceptions of obesity, their strategies and attitudes towards weight management, and their views on the major obstacles to (and need for) better weight management in primary care.A qualitative study was carried out using semi-structured interviews with GPs and PNS within the Greater Glasgow Healthboard area.	GPs and PNs understood the problem of obesity but generally had little enthusiasm for weight management. Most of the GPs felt it was an inappropriate use of their time and passed obese patients onto the PNs; the PNs felt that obese patients were "off-loaded" onto them. Stated management objectives were aimed at "healthy lifestyle" rather than "unrealistic" weight loss, yet frustration at "lack of success" was a major theme. Lack of motivation on the part of the patient was seen as the major problem. GPs were keener to be directly involved when a concomitant disease was present. Suggested requirements to improve weight management at the level of primary care included more time, better facilities, community dieticians and more training courses. However, many felt that Government, media and public health had to take a leading role in order to deal with the problem effectively.	A comprehensive and integrative primary care-led approach to weight management may be possible but will need substantial shifts of resources, organisation, training and attitudes in order to maximise its potential impact.	
12647573	Caregiving by relatives to a person with mental illness is demanding and overwhelming. This paper describes how to use guided imagery, role-playing, humor, and paradoxical intervention to help the wife of a man with mental illness in easing her worry, anxiety, and frustration engendered by caregiving. The intervention made the wife feel normal and relaxed in facing the "symptoms" of her husband's mental illness. It also revived the wife's patience, hope, and strength in the process of rehabilitation.
12625097	The purpose of this study was to investigate the psychosocial issues facing young people living with a chronic medical condition.Subjects were young people with a range of medical conditions who were on a waiting list to participate in the Chronic Illness Peer Support programme at the Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia. Young people agreed to in-depth interviews which were taped and transcribed. Thematic analysis was undertaken by two researchers working independently.	Thirty-five young people were interviewed. Thematic analysis revealed five broad themes: control (in control, under control, out of control); emotional reactions (happiness, frustration, anger, sadness, anxiety); acceptance (of illness, of others, of self); coping strategies, and; a search for meaning. The importance of social connections was emphasised. While illustrating the difficulties of managing a chronic medical condition during adolescence, a generally positive message emerges about these young people.	Many young people with chronic illness appear relatively resilient in the face of the adjustment challenges presented by their illness. Interventions that allow a young person to explore meaning, build self-esteem, and acceptance through positive social connections are likely to improve adjustment outcomes in this group.	
12617337	Today questionnaires developed to assess important outcome measures such as health-related quality of life are widely used. In this study we evaluated the construct validity of the Nottingham Health Profile (NHP) and the reliability of its Turkish version in hemodialysis patients.In a sample of patients on renal dialysis (n = 94) the quality of life is measured by the NHP. The validity of this questionnaire is evaluated by using the Kidney Disease Questionnaire (KDQ) in the same patient group. The NHP is administered twice to each patient, at dialysis intervals two weeks apart.	NHP scores at both administrations are similar in both assessments. Pearson's correlation coefficients range from 0.61 to 0.84. Cronbach's alpha coefficients for the NHP sections range between 0.64 and 0.79. The alpha coefficients for three of the NHP scales (energy, sleep and social isolation) are well below 0.7. In the KDQ the mean values obtained for the five dimensions are: 4.2 +/- 1.5 for physical symptoms, 4.8 +/- 1.7 for fatigue, 4.9 +/- 1.9 for depression, 4.2 +/- 1.2 for relationship with others, and 4.8 +/- 1.5 for frustration. In general the correlation between the dimensions of the NHP and KDQ is good and the correlation coefficients varies from 0.18 to 0.73. Clinical validity is assessed by examining the correlation between the results obtained for the two questionnaires (components of the NHP and KDQ) and hemoglobin level, number of the co-morbid conditions and educational level.	The NHP is shown to have construct validity when used in patients with end-stage renal disease (ESRD) in Turkey. The application of the NHP in patients with ESRD is easy, fast and the questions are not difficult to understand. The multiple-degree scoring in the KDQ causes a complexity in answering. The correlation between the dimensions of the NHP and KDQ is good. Our results show better correlations between disease specific questionnaires and clinical parameters.	
12609224	The goals of this study were to understand patient attitudes about the treatment of medically intractable epilepsy and to document potential barriers limiting patient access to the surgical treatment of epilepsy, highlighting the attitudes of adolescents and minorities.Focus groups of adults with intractable epilepsy (n=10), adolescents with intractable epilepsy (n=4), parents of adolescents with intractable epilepsy (n=4), and African-Americans with intractable epilepsy (n=6) were conducted at UCLA, Los Angeles, California.	Patients with intractable epilepsy communicated frustration with their continued disability despite trials of new medications. Their perceptions of the risks of the surgical treatment of epilepsy were exaggerated. Patients felt that their health care providers did not provide adequate information about epilepsy and portrayed epilepsy surgery negatively.	This study illuminated several factors that could change patient attitudes and help improve patient access to the surgical treatment of epilepsy, especially among minorities and adolescents.	
12603556	The aim of this study was to elucidate the meaning of being a female partner living with a man with fibromyalgic pain. Fourteen partners were interviewed about the meaning of their experiences, using a narrative approach. A phenomenological hermeneutic method, inspired by the French philosopher Ricoeur, was used to interpret the interview text. The structural analysis is presented in three major themes: struggling to give support and comfort, struggling to keep going on, and experiencing lack of understanding and support. The findings elucidate that the meaning of living with a man with fibromyalgic pain meant living a life strongly influenced by the man's illness and in the shadow of the man's pain. Taking daily life for granted was interrupted and restricted family and social life. Prominent in this study was the frustration partners felt as a result of men's reluctance to communicate. This led to feelings of being excluded from men's emotions. The responsibility day in and day out meant that women's own caring and tenderness were replaced, which brought about an almost constant sense of fatigue. Women became drained by the long duration of men's illness. This gave them a feeling of being alone, although they were a couple. Gaining comfort outside the family helped partners to reach a new insight and appreciation for life, which was viewed from a renewed perspective. This involved feelings of both togetherness and separateness in the relationship. The findings also consider the lack of support from the health care system for female partners living with men with fibromyalgic pain.
12602146	To understand how the social construction and expression of masculinity among male adolescents and young adults are related to sexual health and reproductive risks.The study was carried out in an underserved and a popular area of Mexico City. Eighteen focal groups and 18 individual interviews were applied to a sample of males from three age groups: 10 to 14, 15 to 19, and 20 to 24 years. Data analysis was performed inductively through open codification of the verbal transcriptions. These were used to create more abstract concepts and search for relationships among them.	This paper centers on interpretations of masculinity as expressed by the youngsters themselves. Our research sheds light on what youngsters do and say to "be men". Their ideas and practices produce different forms of masculinity through which risk behavior is manifested, as well as specific speech and dressing styles, and ways of courting and "going steady". These behaviors and their meanings are associated with sexual and reproductive health risk taking.	The traditional model of masculinity characteristic of both social settings involves poor communication about sexuality in couple relationships, which results in infrequent protection and exposure to Sexually Transmitted Infections and unwanted pregnancies. On the other hand, their economic living conditions prevent them from fully practicing central elements of their own concept of masculinity, such as being a hard worker, a provider, and a responsible person. These unmet needs may cause frustration, aggression, and domestic violence.	
12597701	Examined emotional competence in 87 children, aged 7-10 years, who varied with respect to reports of aggressive behavior to determine whether individual differences in emotional competence characterize children with higher levels of aggressive behavior. Emotional competence was assessed during a 1-hr lab visit that included (a) an observational period consisting of a modified disappointment paradigm, (b) assessment of cognitive and language abilities, and (c) 2 structured emotion interviews. Children with higher levels of aggressive behavior exhibited more intense and frequent expressions of anger, both as reported by mothers and as observed during the disappointment paradigm. Less sophisticated ability to identify the causes of emotion also characterized children with higher levels of aggressive behavior. Gender moderated the relation between aggressive behavior and type of emotion identified such that reports of happiness (in response to receiving a disappointing prize) were associated with lower levels of reported aggressive behavior for boys. The value of assessing children's emotional competence in the context of an emotionally arousing situation is suggested by these findings.
12594973	Two important aspects of psychological well-being are positive mood state and a positive outlook with respect to the future. This study investigates the use of lavender baths to improve these aspects of psychological well-being.A single blind, randomised control trial.	The participants' home and interview rooms at the University of Wolverhampton.	Eighty women not receiving treatment for psychological disorders who were staff or students at the University of Wolverhampton. Forty participated in Study 1 and 40 in Study 2.	Participants were randomly allocated to use either grapeseed oil or 80% grapeseed oil and 20% lavender oil in their bath for 14 days.	In Study 1, the UWIST mood adjective checklist. In Study 2, the MacLeod and Byrne Future Events procedure.	In Study 1 psychologically positive mood changes were found after the bathing regimen for energetic arousal, tense arousal, hedonic tone and anger-frustration. Only anger-frustration showed a selective effect for lavender oil. In the second study negative responses about the future were selectively reduced after lavender oil baths.	These results are encouraging and suggest further investigation using potential patients may result in the development of a useful procedure for improving psychological well-being.	
12585772	Latinos represent nearly 13% of the U.S. population, surpassing African-Americans as the nation's largest racial/ethnic group. Many rural midwestern communities are seeing unprecedented growth in their Latino populations, creating new challenges and pressures for health and social service providers. This study is based on four focus groups conducted in three rural communities to examine concerns with health care services and access to care. Focus group analysis found several key barriers to health care access, including cost of health care services and frustration with the complexity of the U.S. health care system, as well as language and cultural issues that adversely affect patient-provider relationships. In addition, a number of impediments related to employer-sponsored health coverage were identified, including prohibitive premium costs as well as concerns about occupational injuries and access to care during work hours. The growth of the Latino population in the rural Midwest will require changes in existing health and social service systems to serve as a bridge to new systems in this country. We recommend several policy options including premium subsidies for low-wage jobs, community-based enrollment specialists for public programs, and continued research and data collection to monitor change and progress.
12584575	Twenty-five per cent of the North American population smoke cigarettes regularly. Twelve smokers (aged 19 to 55 years, Fagerström test score 3 to 10) participated in a double-blind, placebo controlled, counterbalanced study to determine the extent to which subjective effects of smoking are altered by nicotine delivered by transdermal patches. Subjects wore a placebo or 21 mg nicotine patch while abstaining from smoking for 48 h. Nicotine-mediated objective and subjective effects were measured at baseline, and after smoking a regular and a low yield cigarette at four different study sessions. Subjective effects were assessed using validated computerized questionnaires such as the Profile of Mood States and Visual Analogue Scales. Nonsmoking compliance was determined by measuring expired air carbon monoxide and saliva cotinine concentrations. Significant within-session differences were found in subjective effects at baseline and after smoking. No differences in subjective effects were found between patch treatments before smoking. Nicotine withdrawal symptoms such as craving, irritability, tension, frustration, anxiety and restlessness were significantly increased in both patch conditions after 48 h of smoking abstinence. Smoking markedly ameliorated nicotine withdrawal symptoms. Systolic blood pressure increased after smoking in both patch conditions (P=0.01). Visual Analogue Scale scores for cravings, nicotine effects, good effects and 'high' consistently increased after smoking during either patch condition. Thus, wearing a nicotine patch did not seem to modify the subjective effects of smoking compared with placebo in this preliminary study.
12572970	The purpose of this study was to describe the experiences and perceptions of hospice nurses caring for residents in long-term care facilities. The study used a fax-back survey to gather data from 69 hospice nursing and nurse managers in 24 hospices across one Midwestern state. Respondents reported negative experiences with pain management and care coordination in the nursing home setting. Although hospice is thought to be a benefit to residents, hospice staff report frustration in caring for nursing home patients, especially in trying to control pain. The study identifies opportunities for improvement in hospice and nursing home staff relationships.
12571342	General practitioner (GP) prescribing accounts for about 10% of NHS expenditure. GPs at the top of the range have annual prescribing costs that are almost twice as much as those at the bottom of the range. This variation cannot be accounted for purely in terms of differences in underlying need for health care.To describe the relationship between GPs' prescribing costs and their attitudes towards prescribing decisions and prescribing information sources, and to identify potentially modifiable attitudinal and behavioural factors associated with high cost prescribing.	A postal questionnaire was designed on the basis of hypotheses developed from a literature search and an earlier qualitative survey. This questionnaire was sent to a national sample of GPs with equal numbers of practices in the upper, middle, and lowest quintile of prescribing costs.	GP practices in England.	1714 GPs in NHS practice.	GPs' self-reported practices, attitudes and personal characteristics.	There was a 64% response rate. Responders were more likely to be from larger practices, in less deprived areas, and with lower prescribing costs than were non-responders. Multivariable analysis showed that GPs with high prescribing costs were significantly more likely to work in dispensing practices, in practices with low income populations, in single handed practices, and in practices without a GP trainer. They were also significantly more likely to see drug company representatives more frequently, to prescribe newly available drugs more freely, to prescribe more readily to patients who expect a prescription, to report high levels of frustration from lack of time in the consultation, to find unsatisfactory those consultations which ended in advice only, and to express dissatisfaction with their review methods for repeat prescribing. They were significantly less likely to find useful criticism of prescribing habits by colleagues, and to check the BNF rather than other sources when uncertain about an aspect of drug treatment.	While they cannot be held to have a causal relationship, the pattern of attitudes towards prescribing of GPs in the highest quintile of prescribing costs provide the basis for developing an educational intervention which may be an acceptable method of modifying the attitudes of GPs and consequently reducing their prescribing costs.	
12563071	We used surveys from 274 families who had at least 1 child with fragile X syndrome (FXS) to determine their experiences in discovering FXS, factors associated with the timeliness of discovery, and the perceived consequences of obtaining this information. For families of male children who were born in the last decade, someone first became concerned about the child's development at an average age of 13 months. Professional confirmation of a developmental delay did not occur until an average age of 21 months, and a FXS diagnosis occurred at an average age of nearly 32 months. Families reported several barriers to discovering FXS and frustration with the process. Many families had additional children with FXS without knowing reproductive risk. A range of perceived benefits and challenges associated with the discovery were reported. We conclude that selected pediatric practices could promote earlier identification but in only a limited way and predict that disorders such as FXS will continue to challenge current criteria for determining viable candidate disorders for newborn screening.
12546283	To test five hypotheses that non-Hispanic African Americans (AAs) and non-Hispanic whites (NHWs) differ in responsiveness to new dental symptoms by seeking dental care, and differ in certain predictors of dental care utilization.Florida Dental Care Study, comprising AAs and NHWs 45 years old or older, who had at least one tooth, and who lived in north Florida.	We used a prospective cohort design. The key outcome of interest was whether dental care was received in a given six-month period, after adjusting for the presence of certain time-varying and fixed characteristics.	In-person interviews were conducted at baseline and 24 months after baseline, with six-monthly telephone interviews in between.	African Americans were less likely to seek dental care during follow-up, with or without adjusting for key predisposing, enabling, and oral health need characteristics. African Americans were more likely to be problem-oriented dental attenders, to be unable to pay an unexpected $500 dental bill, and to report postbaseline dental problems. However, the effect of certain postbaseline dental signs and symptoms on postbaseline dental care use differed between AAs and NHWs. Although financial circumstance was predictive for both groups, it was more salient for NHWs in separate NHW and AA regressions. Frustration with past dental care, propensity to use a homemade remedy, and dental insurance were significant predictors among AAs, but not among NHWs. The NHWs were much more likely to have sought care for preventive reasons.	Racial differences in responsiveness to new dental symptoms by seeking dental care were evident, as were differences in other predictors of dental care utilization. These differences may contribute to racial disparities in oral health.	
12536055	Anxiety may be a hypothetical factor responsible for psychogenic pseudoepileptic seizures. The purpose of this study was to analyse anxiety indexes manifested in the Minnesota Multiphasic Personality Inventory. Patients were divided into three groups on the basis of a neurological examination and long-term video-monitoring. Group One (N=70; 58 F, 12 M) had only psychogenic pseudoepileptic seizures. Group Two (N=40; 31 F, 9 M) had both epileptic seizures and psychogenic pseudoepileptic seizures. Group Three (N=42; 30 F, 12 M) had only epileptic seizures and served as the control group. Patients with psychogenic pseudoepileptic seizures, alone or in combination with epileptic seizures scored significantly higher than the epileptic group on the following anxiety measures: Anxiety Sign (Gough) - AxS - (P<0.001), Expressive-repressive Index (Sandford, Webster and Freedman) - ERI (P<0.001), and the Neurotic score (Ruesch and Bowman) - NS (P<0.001). Difference between all three groups were found for the Triad Elevation Index (Lovell)-TI (P<0.001) and the Frustration Tolerance Index (Beall and Panton) - FT (P<0.005). These findings suggest that the existence of psychogenic pseudoepileptic seizures or the predisposition to such seizures is reflected in the anxiety dimensions of the personality profile. Psychological evaluation of anxiety may help us to gain a better understanding of, and discrimination between, patients with psychogenic pseudoepileptic seizures, mixed seizures and epileptic seizures.
12536014	The aim of the experiment was to assess the effects of either maternal deprivation or prevented suckling on lambs. Thirty Comisana lambs were assigned to a control dam-suckled group (DS) and two test groups of 10 each. Test lambs were maintained with their mothers 24 to 30 h after parturition and subsequently offered ewe milk from buckets: EM lambs were separated from their mothers, while EM+D animals were reared with their dams but suckling was denied by covering ewe udders with juta bags. Behavioral, immune and cortisol responses of lambs were assessed throughout the experiment. EM+D lambs spent less time (P<.001) on investigative behavior compared to the two other groups. When isolated in a novel environment, EM+D lambs exhibited a shorter duration of movement (P<.01) and a longer latency time compared to DS and EM lambs (P<.001 and P<.05, respectively) as well as a higher number of bleats (P<.01) than EM lambs. EM+D lambs also displayed higher (P<.001) plasma cortisol levels than the other two groups when isolated at 4 days of age. When subjected to discrimination tests, EM+D lambs spent less time near their companions (P<.01) than EM lambs and took a longer time to reach their pen mates (P<.01) than DS and EM lambs. EM+D lambs displayed reduced growth (P<.001) compared to DS animals during the 0-7 and 8-14-day periods. We conclude that frustration arising from maternal feeding deprivation results in altered endocrine and behavioral responses and reduced growth suggesting emotional disturbances of lambs.
12514352	To describe women's experiences of miscarriage after infertility treatments. Published studies in which fertile women were interviewed after miscarriage have found that the women universally look to another pregnancy as the solution to their grief. However, for women undergoing infertility treatments, the possibility of another pregnancy is not a certainty. Despite this, little is known about the unique experience of this group of women. Appropriate interventions based on evidence require research to discover these women's needs.Phenomenology.	Eight women who had experienced miscarriage after infertility were interviewed. Interviews were audiotaped and transcribed verbatim. Data saturation guided the sample size. Colaizzi's methods for phenomenologic analysis were used. Analyzed data were brought back to the women for fact checking and to ensure trustworthiness and reliability of the data.	Themes included : going back to "square one," an inner struggle between hope and hopelessness for future fertility, running out of time, anger/frustration, lack of understanding by others, guilty feelings, feeling alone/numb with their grief, and gaining strength from adversity.	This study provides a first glimpse of women who miscarry after infertility treatments, and demonstrates that they feel profoundly alone, and grieve intensely. They worry that they caused the miscarriage, and find it difficult to hope that they will ever become pregnant again. Several women described being hospitalized for their miscarriage on postpartum units. This was unbearable for them, and should remind all of us in healthcare that this type of unthinking treatment of women who miscarry after infertility is not acceptable.	
12496298	More positivity than negativity is demonstrated in this analysis of discrete emotions among 353 community-dwelling individuals from 72 to 99 years old. A complexity in positive emotions was displayed, with more happiness, contentment, and gratitude reported than frustration, sadness, and anger. Our results also imply that another individual's presence may elicit negative emotions such as anger and guilt, whereas perceptions of support may elicit various positive emotions. As expected, certain negative emotions were associated with poor health, with a link between sadness and sickness being most prominent. Of note, poor health did not undermine positive emotions. These findings provide an optimistic view of emotions in later life, even among individuals who are poor, not well educated, and/or physically unwell.
12474662	The aim of the work was to evaluate the changes brought by time in the psychoemotional state of neglected and abandoned children (exhibiting disturbed social relations), which were displayed in childrens' behavior. The longitudinal research has been carried out by the epidemiological case-control scheme. Two groups of children were examined. During the first test the study group was formed by 70 (44 boys and 26 girls) neglected and abandoned children drew up from foster care institutions. The control group was adequate in age and sex to the study group. It included 70 (44 boys and 26 girls) children from traditional families. The second test was carried out two was years later. It was applied to the same groups of children, only this time 50 (32 boys and 18 girls) children from the study and from the control group were tested. Mixed psychoemotional and behavioral disorders were evaluated by experts (teachers from foster care institutions, nurseries and schools) who applied the scale of indicators. The results gave evidence of psychoemotional problems in the neglected and abandoned children growing up in foster care institutions: they were nervous, exhibited aggression, difficulties in their education emerge. The behavior and emotions shape themselves in frustration and depression. These disorders tend to grow and become more serious in the course of time, social behavior deviations and social health development disorders emerged. The psychoemotional health development of neglected and abandoned children evoked difficulties in their psychological adaptation.
12450001	The total value set of a working individual consists of three components: personal, professional and organizational values. In the light of the changing health care environment, the individual nurse manager's values may no longer be applicable for coping with the needs of the work environment. For many nurses who developed their values in keeping with the humanistic tradition, the 'new' organizational values may create confusion, frustration and conflict. The purpose of this study was to determine if the organizational domain in the value sets of Israeli middle nursing managers in acute care hospitals reflect the process of shifting values needed in today's management roles. Analysis of the results revealed that head nurses did not yet fully internalize the 'new' organizational values. Implications of the results for planning undergraduate and graduate programmes are detailed.
12442973	Palliative care describes a caring philosophy. Originally, palliative care referred exclusively to the care of dying cancer patients, but over time has expanded to include mitigating care of all dying people whatever the diagnosis. The purpose of this paper is to explore the meaning of palliative care according to the experience of district nurses in Sweden. Six district nurses were interviewed, and the transcripts were analyzed using Giorgi's phenomenology. The essence of the caring philosophy for the nurses in the study was identified as commitment, underscored by four themes: challenge, control, frustration, and relationships. These findings indicate that district nurses must be offered resources and education in order to be able to fulfill their commitment, i.e., to supply good palliative care.
12406266	Medicine has traditionally been considered a masculine pursuit and its undergraduate curriculum criticised as being inherently sexist. Overt sexism, though diminished, still occurs and students report offensive sexual remarks, unwanted sexual advances and unequal learning opportunities. Sexual discrimination also colludes with attitudes that promote the stereotyping of the roles of women both in medicine and in society itself. This study aimed to ascertain medical students' own experience of sexism during undergraduate training, their understanding of these events, what effects the events had on them and, specifically, how they coped.Twelve in-depth interviews, each focusing on a critical incident, with individual self-selecting Year 5 medical students took place. Initial qualitative analysis of transcripts produced themes that were further subsetted.	Students described situations where they felt their learning had been jeopardised. Male students reported frequent difficulties whilst attached to obstetric and gynaecology firms. Students commented that their gender did sometimes affect their relationships with teaching staff and that affirmation from their teachers was important. Female students coped well with their experiences of sexism, often supporting each other. Male students often felt resigned to being excluded from certain learning opportunities and this sometimes resulted in unresolved frustration.	Developing a non-sexist undergraduate curriculum should be prioritised. Encouraging teaching staff to reflect on their attitudes to gender, approaches to teaching and providing support, such as mentoring, especially for female students frequently lacking appropriate role models, is advised.	
12399341	To compare the illness trajectories, needs, and service use of patients with cancer and those with advanced non-malignant disease.Qualitative interviews every three months for up to one year with patients, their carers, and key professional carers. Two multidisciplinary focus groups.	Community based.	20 patients with inoperable lung cancer and 20 patients with advanced cardiac failure and their main informal and professional carers.	Perspectives of patients and carers about their needs and available services.	219 qualitative interviews were carried out. Patients with cardiac failure had a different illness trajectory from the more linear and predictable course of patients with lung cancer. Patients with cardiac failure also had less information about and poorer understanding of their condition and prognosis and were less involved in decision making. The prime concern of patients with lung cancer and their carers was facing death. Frustration, progressive losses, social isolation, and the stress of balancing and monitoring a complex medication regimen dominated the lives of patients with cardiac failure. More health and social services including financial benefits were available to those with lung cancer, although they were not always used effectively. Cardiac patients received less health, social, and palliative care services, and care was often poorly coordinated.	Care for people with advanced progressive illnesses is currently prioritised by diagnosis rather than need. End of life care for patients with advanced cardiac failure and other non-malignant diseases should be proactive and designed to meet their specific needs.	
12389269	Feeling overwhelmed or overloaded and frequently experiencing anxiety, anger, guilt, and/or frustration is preventable and amenable to personal control. It takes self-awareness and lots of practice to modify long established ways of thinking about one's self and others. It is often helpful to have someone who will support identified goals to improve stress-reducing resources; to help with developing a sensitivity to self-generated stress-inducing demands; and/or to rehearse cognitive stress-reducing, self-care skills. The cognitive self-care skills outlined herein are powerful stress-reducing resources that can prevent psychological stress and that can promote a sense of wellness.
12382378	The development of the power therapies, behavioral medicine, and short term interventions have reported such success even with trauma cases that it is relevant to question the justification for lengthy psychotherapy. Yet some patients with complex mind/body conditions impervious to medical treatment/hypnosis may require extended, multi-modal, integrative therapy. This paper details a single complex case of paruresis as a prototype for illustrating a holographic treatment model for recalcitrant conditions: Component features of the proposed model presented include: 1) the sequential utilization of hypnobehavioral and analytic approaches; 2) uncovering work providing access to the somatic ego state associated with the illness condition; 3) the extended treatment time frame required for deep psycho-physiological change; and 4) the stages of counter-transference expectably evoked by such patients (e.g. urgency, exuberant optimism, frustration, discouragement), and the transformation of such reactions to achieve maximum therapeutic efficacy.
12349870	Self-regulatory processes are believed to be critical to early personality and behavioral adjustment. Such processes can be observed on multiple levels, including the physiological, attentional, emotional, cognitive, and interpersonal domains of functioning. Data from several longitudinal studies suggest links between early temperamental tendencies such as behavioral inhibition and frustration tolerance, and regulatory developments at the levels of physiological, attentional, and emotional regulation. Deficits in these particular levels of self-regulation may underlie childhood social withdrawal and aggression. Significant gaps remain in our knowledge of the pathways to disordered behavior and the role that self-regulation plays in such pathways. Suggestions are made for the ways in which future longitudinal studies might address these gaps.
12348731	"This article describes the migration context of three sets of Western democracies and then explores plausible linkages between the scale, timing, and characteristics of migration, and the substance and process of migration policies, on the one hand, and support for government, on the other. Trying to move beyond plausibility, I discuss indirect indicators of the impact of immigration on Western publics: attitudes toward immigration policy and immigrants, support for extremist parties, and acts of violence and disorder linked to anti-immigrant or racist motives."
12234161	Acne is the most common problem that presents to dermatologists. Because it causes visible disfiguring of the face, it produces a great deal of embarrassment, frustration, anger, and depression in patients. In addition, acne is most common in adolescence and young adulthood, a time when patients are least capable of coping with additional stress. As a result, it is virtually impossible to separate acne from psychiatric disturbances. Some patients are severely affected and require more than just acne therapy. Dermatologists need to become more adept at diagnosing and treating causative, concomitant, and resultant psychiatric disturbances in patients with acne. This article is intended to highlight the scope of the problem, identify at-risk patients, and help dermatologists assist patients with both their acne and their psychologic response to it.
12217159	Since 1998, over 1300 telemedicine consultations have been provided to 12 schools in Kansas City. Despite the success of the programme, effective utilization of services has not occurred at all sites. We used a focus group and survey methods to investigate barriers to and catalysts for service adoption. The results showed that the school nurses strongly supported the programme. They valued its ability to provide health-care for the children and they welcomed their enhanced role. However, technical complexities and difficulties in obtaining parental consent were found to impede adoption. The nurses also expressed frustration with school personnel who had a poor understanding of their role in general as well as that of the telemedicine service. A new state reimbursement policy may promote greater understanding and provide a financial incentive for schools to adopt the telemedicine service.
12197034	This may be one anniversity best marked by staying at home, not out of fear of terror ro frustration over security hassels, but to stand in pride and solidarity among those we love.
12164907	This study focuses on the reported problem of psychiatric patients who are 'bed-blocking' mental health rehabilitation units. It explores the concept of individualized care within psychiatric nursing and argues that this 'received view' is counterproductive for some client groups. Individualized care assumes a number of mainstream social values and beliefs that may conflict radically with the attitudes to life (ideologies) of some service users. These clients may resist normalisation, independence and individualism, preferring instead a more collective, pastoral and spiritual lifestyle. Clients and nurses may reject culture-biased care policy, using various strategies to neutralize individualized care in practice. In the absence of a coherent alternative, such action may lead to frustration, alienation and bed blocking. The study uses structured and unstructured interviews in two psychiatric units to examine this hypothesis.

12136701	The reinforcement-omission effect (ROE), also known as frustration effect, refers to greater response strength immediately after nonreinforcement (N) than reinforcement (R). The ROE was traditionally interpreted as transient invigoration after N induced by primary frustration. Pigeons demonstrate similar ROEs whether outcomes are surprising (partial R) or expected (discrimination training) in runway (Experiment 1) and Skinner box situations (Experiments 2-3). Variations in the interval between N and the opportunity to respond indicate that the ROE results from an aftereffect of food consumption (Experiment 4). Increasing reinforcer magnitude increased the after-R effect, without modifying the after-N function (Experiment 5). These results are reviewed in the context of comparative research on spaced-trial successive negative contrast and related phenomena that have failed to appear in experiments involving nonmammalian vertebrates.
12131824	Palliative care for those who need it should be an integral part of National Health Service (NHS) practice in all settings in the UK. This study used a focus group and individual structured questionnaires, completed during a semi-structured interview, to gain an insight into how different professionals in the hospital view palliative care. An assessment was made of their understanding of it, previous training and current knowledge. The respondents also discussed training needs and personal experiences. The findings show that previous training was variable but, in general, relatively young and inexperienced staff were working in the hospital under enormous pressures of workload, staff shortages and without experienced role models from whom to learn the complexities of palliative care. Communication difficulties focused around the lack of support and the inherent problems of multidisciplinary team working resulting in frustration and less than optimum care being given. Rapid staff turnover compounded the problems. Although staff were keen to learn, clinical workload always took priority over training. The following recommendations arose from the study: undergraduate training should be standardized, and postgraduate training and support should be ongoing and flexible to accommodate the diversities of knowledge and difficulties encountered in attending set sessions.
12131606	The aim of this study was to assess the effect of infliximab on quality of life in patients with active Crohn's disease (CD) inadequately responsive to concomitant therapies.We examined responses to the Inflammatory Bowel Disease Questionnaire (IBDQ) from patients enrolled in a previously reported, randomized, placebo-controlled study. Patients with active CD received a single intravenous infusion of either placebo or infliximab 5, 10, or 20 mg/kg. Most patients received stable doses of mesalamine, corticosteroids, azathioprine, or 6-mercaptopurine throughout the study. Changes from baseline in overall IBDQ score and individual dimensions at 4 weeks postinfusion were compared.	Patients treated with infliximab had a significantly larger improvement in overall IBDQ score than those treated with placebo at 4 weeks (p < 0.001). Infliximab-treated patients also had larger improvements in all IBDQ dimensions: bowel (p = 0.007), social (p = 0.002), emotional (p < 0.001), and systemic (p < 0.001). A significantly larger proportion of infliximab-treated patients reported having normal or near-normal frequency of bowel movements in the past week (p < 0.001), full or a lot of energy (p = 0.019), and no or hardly any difficulty doing leisure or sports activities (p = 0.011), and being extremely or very satisfied with their personal life (p = 0.046). They also significantly differed in responses regarding fatigue, frustration, ability to work, general well-being, depression, anxiety, and anger resulting from bowel problems.	These results indicate that infliximab significantly improved quality of life in patients with active CD, increasing their ability to work and participate in leisure activities, and decreasing feelings of fatigue, depression, and anger.	
12125295	The treatment of hypochondriasis continues to be challenging because of the nature of hypochondriasis and reactions that it often elicits in therapists. In this paper, it is argued that due to complex interactions between hypochondriacal patients and their therapists, there should be a radically different approach to treating hypochondriacal patients. Within such a framework, it is crucial to determine whether therapists are "eligible" to treat hypochondriacal patients, rather than whether hypochondriacal patients fulfill criteria for particular types of treatment. Regardless of the specific treatment modality used, it is suggested that treatment of hypochondriasis should always entail empathy, acceptance, understanding, and explanation and education. In addition, good therapeutic results can be achieved and therapeutic pessimism about hypochondriasis overcome if therapists are accessible, reliable, and flexible, if their behavior is consistent and predictable, and if they express themselves clearly and in unequivocal terms.
12124724	Wives giving care to spouses with dementia are a particularly vulnerable segment of the caregiving population. In this article a grounded theory study of 20 such wives is described, with their experiences explained as a process of interpretive caring. Wives began the process by either seeing changes in their husbands or recognizing changes in their work. Following this, the wives moved on to a phase of drawing inferences about what they observed and then took over their husbands' roles and responsibilities. These changes prompted the wives to rewrite identities for their husbands that incorporated the dementia and to rewrite identities for themselves to reflect their new roles, abilities, and strengths. Finally, the wives set about constructing a new daily life to sustain both partners. This process is neutral and allows for positive aspects of caring to be considered along with grief and frustration.
12109955	We reviewed all patients with dissociative disorders (nine patients with dissociative amnesia or dissociative fugue) and conversion disorders (10 patients) who were admitted and treated during the past 15 years. Needs frustrated at the appearance of the symptoms and those fulfilled at discharge were studied in both groups using Maslow's hierarchy of needs. The patients of both groups who encountered troubles in their life events were found to have frustrated needs. These symptoms tended to be accompanied more often by frustrations regarding a 'need for love' in the dissociative disorders group and by frustration in the need for 'self-esteem and self-actualization' in the conversion disorders group. In addition, needs of lower orders were already threatened at onset in many patients. The symptoms disappeared in patients in whom the situation completely improved (needs were fulfilled), but the symptoms were alleviated or unchanged in those in whom the problems remained unresolved.
12093591	Experiments with social instigation or the omission of scheduled reinforcement show that serotonergic mechanisms may be involved in escalated aggression in animals. 5-HT1B receptor agonists have anti-aggressive effects in individuals who show moderate as well as high levels of aggression. The present study compared the effects of the 5-HT1B agonist anpirtoline (0.125-1.5 mg/kg) on (1) species-typical aggressive behavior in male mice, (2) aggression "instigated" or primed by prior exposure to the opponent, and (3) aggression heightened by "frustration" caused by omission of scheduled reinforcement. The effects of anpirtoline on species-typical behavior were also assessed after pretreatment with the 5-HT1B/1D receptor antagonist GR127935 (10 mg/kg). Anpirtoline, like other 5-HT1B agonists (CP-94,253, zolmitriptan), decreased both instigated and frustration-heightened aggression, while motor behavior was unaffected. The aggression-inhibiting effects of anpirtoline were blocked by pretreatment with GR127935. The current results indicate that the 5-HT(1B) receptor is critically involved in the modulation of escalated aggression.
12079249	Individuals whose self-control strength is depleted through the prior exertion of self-control may consume more alcohol in situations that demand restraint. Male social drinkers either exerted self-control by suppressing their thoughts or did not exert self-control while doing arithmetic. They then sampled beer. Participants expected a driving test after drinking and therefore were motivated to limit their intake. Individuals who suppressed their thoughts consumed more and achieved a higher blood alcohol content than those who did arithmetic. The groups did not differ in mood, arousal, or frustration. Individuals higher in trait temptation to drink consumed more after suppressing their thoughts relative to those lower in trait temptation. Alcohol intake may be a function of temptation to drink and self-control strength.
12074755	Approximately 1% of the population over 65 years of age is afflicted with Parkinson's disease (PD). The number of patients with the disease will most probably increase in the future because of the increased longevity of the population. There is no curative therapy for the disease.To explore women's experiences of living with symptoms related to PD, and to analyse how the symptoms influence their quality of life.	A phenomenological-hermeneutic method, inspired by the philosophy of Ricoeur was used. The study focuses on eight women between 63 and 80 years of age who have been diagnosed with PD for 5-15 years. The women all lived at home, were moderately to severely disabled and cognitively intact.	In the analysis, four themes emerged: (1) wish for a stable body image; (2) wish to keep traditional female competence; (3) need to feel accepted for the person she is; and (4) perceived stigmatization. All themes showed that trying to adapt to unpredictable fluctuations in physical and psychosocial competence has a great impact on the females' lives. It became clear that fluctuations in competence and not knowing when to expect impaired mobility are connected with frustration and social withdrawal.	The experience of PD from eight disabled female patients has revealed that the disease affects quality of life not only for the person who has it, but also for her family. Thus, it is equally urgent that patients, relatives, nurses and caregivers gain better knowledge and more understanding of PD, so as to ease the impact of the disease on the patient's daily life.	
12069366	Exposure to uncontrollable, unpredictable appetitive events produces a variety of cognitive debilitations and vegetative changes, as does exposure to uncontrollable, unpredictable aversive events. Similarities include impaired escape from aversive events, impaired discrimination, finicky consumption, analgesia, and body weight loss. However, in stark contrast, uncontrollable aversive stress causes reduced motor activity where as similar appetitive treatment does not; aversively induced debilitation is causally related to energy regulation, whereas the appetitively induced effects are not. Parallel mechanisms are suggested to explain these effects in terms of a revised anxiety account of the aversive effects, and a frustration account of the appetitive effects. Finally, factors likely to limit important research to resolve the many remaining issues are identified: negative presentation of animal research, political decision making, and ignorance and fear in committees which review the ethics of research.
12066261	Fathers are important to the stability of the family and to the coping of mothers and their children when there is a child in treatment with cancer. The vulnerability they experience is stupefying and causes self-doubt, general worry, and frustration with the medical care they receive. Fathers' experiences are relatively unreported in the literature, and even less so, the experiences of fathers with children who have cancer. This research is based on two focus groups of five men each who spoke unabashedly for more than 2 hours about their grief, their struggle to come to terms with the diagnosis and the role strain, and role confusion they experienced as fathers and husbands. The findings could be described as reflecting the following themes: (1) impact on the provider role, (2) the emotional impact: I cry privately, (3) it's the fight of our lives, (4) tag-team parenting, (5) hypervigilance, (6) that place is scary!, and (7) what happens next--coping and moving on. The group format was powerful in terms of what these men were willing to share of themselves and their experience. These groups could be characterized as the coming together of strangers, bound by the common experience of "cancer," who actively supported each other and each other's process. Implications for holistic nursing practice are provided.
12056103	Identified children and young adolescents who engaged in parent-directed physical aggression from a sample of youths referred for outpatient therapy (N = 606, 151 girls, 455 boys); examined the frequency, severity, and characteristics of such behavior; and compared aggressive youths with nonaggressive youths across several domains of functioning. Twelve percent of the children and young adolescents in this clinical sample engaged in parent-directed aggression. Aggressive, compared to nonaggressive, youths had significantly increased oppositional behavior, lower frustration tolerance, less adaptability to stressful situations, and were more demanding of their parents. Aggressive children had families characterized by significantly greater parental stress, poorer interpersonal relationships, and were more likely to be 2-parent, European American families of higher socioeconomic status. Moreover, lower frustration tolerance and adaptability were significant predictors of parent-directed aggression after controlling for demographic differences and overall level of oppositionality and aggressiveness, suggesting a more specific functional impairment in such children. Parent-directed aggression warrants additional study given the limitations in our understanding of these events and the potential for such behaviors to continue into adolescence and adulthood.

12040233	The purpose of the study is to describe what it like to live with a highly malignant brain tumor from a family perspective. It is a qualitative study in which 3 families, 3 patients, and 5 next of kin have described their experiences in 15 interviews. The study is prospective, with interviews occurring 2-3 weeks after surgery and 3 and 6 months after the onset of the illness. Inductive content analysis has been employed. The results indicate that when a highly malignant brain tumor is diagnosed, the effect on the family is devastating and there is a state of crisis. Characteristically, there is distancing and a sense of helplessness. The members of the family live from day to day in a state of constant anxiety and fear of losing the patient. The affliction limits the patient's capacity regarding activities of daily life, which increases the burden of the next of kin. The next of kin attempt to cope with their grief by occupying themselves with practical tasks and activities that they believe are meaningful. The family members have only good words to say about their encounter with healthcare staff and about the information given. Negative information that the family have not asked for can cause a long period of frustration and anxiety, and they believe that their hope has been taken away from them.
12035215	Caregivers' experiences and beliefs of working with borderline personality disorder (BPD) in a psychiatric organization were investigated using a qualitative analysis of 29 in-depth interviews. The analysis identified eight characteristics, which were organized in two core concepts. The first of these core concepts, professional skills of mental health work, comprised the categories of empathy for persons with BPD, interest in treating the disorder, feelings of professional frustration and need for a common outlook. The second core concept, frame of work organization, that is categories common to the organization, included ambivalence between the professions of the caregivers, the need for structure in organizing the work, forms of emotional support to the caregivers and the need for a shared philosophy of care. A tentative model was proposed to illustrate the effects of these factors on the type and outcome of work that interact with the care of the patient. It is concluded that ambivalence in the division of labour may be a critical hindrance to the development of cooperation in the care of BPD patients. It is suggested that a shared common philosophy will support corresponding ethical standards by individual practitioners for the benefit of patient outcome.
11985753	Nurses caring for patients with dementia in acute care settings often lack specialized education in geriatric nursing. The acute care settings do not have an environment made for dementia care. The staff often had a high workload, which makes the situation stressful and the nurses who take care of these patients might end up in difficult situations. The aim of this study was to describe nurses' experiences of difficulties related to caring for patients with dementia in acute care settings. Interviews were performed with 12 nurses. Qualitative thematic content analyses were carried out in several steps. The results show that the nurses experienced various difficulties in meeting patients with dementia in acute care settings. This gave rise to for example frustration. Most commonly reported was lack of time to treat these patients satisfactorily. The difficulties were mostly related to the often disorderly conduct of these patients, the ethical problems that appeared in the care of these patients, and the medical care organization. The problematic situations described sometimes led to abuse and neglect of these patients.
11983737	The social consequences of appealing to age to excuse memory failure were examined in 2 vignette-based studies. In Study 1, 75 older (M = 72 years) and 78 young (M = 22 years) adults evaluated forgetful older targets in their 70s who used their age, lack of ability, lack of effort, or the situation to explain forgetting. In Study 2, 105 older (M = 72 years) and 105 young participants (M = 19 years) evaluated forgetful targets with no specific age given in 4 excuse conditions (age, ability, situation, and no excuse). In support of the prediction of positive consequences, age excuses were rated as more believable than situation in both studies and more believable and socially fluent than effort in Study 1. In support of predictions of negative consequences, both groups in Study 2 rated target persons who used an age excuse to be much older than their peers and, along with ability excuse users, as eliciting more worry and frustration than the others. Moreover, young adults showed additional sensitivity to the negative aspects of age excuses in terms of worry and frustration in Study 1 and anticipated repeat forgetting in Study 2. These results suggest that although age excuses may relieve socially awkward situations, this strategy reinforces negative age stereotyping of the older forgetter.

11973519	This paper presents a synthesis about the psychological consequences of twinship based on a review of the literature and on our clinical experience. During pregnancy, delivery and the immediate post-partum, mothers experience physical and psychological difficulties linked with increased medical risks for themselves and for the children. The twins mortality is high before and after delivery. Grieving for one twin creates particular problems for parents. During first months after hospital discharge mothers encounter material and emotional stress. They are caused by overload of mothering tasks and the specificity of mother-twins relationship. The impossibility to establish a dyadic relationship with each child creates feelings of frustration and guilt. The risk of child abuse is increased in twins. The balanced psychoemotional development of twins requires parental attitudes enhancing their individualization as opposed to their "collectivization". The risk of prematurity is ten times increased in twins which increases the risks of developmental disabilities. Considering that the number of twin deliveries is rising in our country it is important to be aware of the problems experienced by the families and to improve the way material and psychological help is provided to them.
11966983	In the UK, someone dies by suicide every 2 hours. An increasing number are also harming themselves. Many of these people are admitted to Medical Admissions Units of General Hospitals. Department of Health guidelines now recommend that anyone who harms him or herself should have a psychosocial and risk assessment. This means that they have to stay in hospital until they are assessed and this renders them 'different' from other patients. This study uses an ethnographic approach to search for the meaning to nurses of having this group of patients on the ward, using participant observation and semistructured interviews with four nurses. Three themes were isolated through analysis of the data: the busy quality of such wards (busyness) how this group of clients impede the busy quality and the strategies which nurses use to cope with the difficulties. Analysis of the data revealed that the research participants found difficulty in understanding why people harm themselves and that they felt that they did not have the requisite skills to deal with this group of people. This appears to leave them with a sense of frustration and helplessness which perhaps mirrors that of this client group.

11940125	The need to integrate information technology into nursing education has been recognized and well documented. In spite of this, information technology remains a neglected subject in many nursing programmes. Strategies have been considered for increasing the integration of information technology in nursing education. One of the key issues identified is the need for research into the factors that contribute to optimal learning with information technology, specifically the need to explore issues that contribute to student frustration and satisfaction with learning. Within Australia, the incorporation of information technology as a core subject in nursing education is still relatively new. This article describes how one university used 'online' learning to expose students to conceptual and experiential opportunities that enabled them to develop skills in the management of information technology.Twenty-one students participated in this qualitative study. Individual interviews were used to develop insights into student perceptions. Thematic analysis enabled refined themes to emerge. These themes formed the basis of focus group discussions. Focus groups were used to enhance and validate the information from one-to-one interviews by using group dynamics to add experiential richness to the data.	Four major themes emerged: computer confidence, flexibility, active learning and practicalities of teaching.	The integration of information technology into nursing education requires a dramatic change in thinking. The 'learning curve' is steep for both student and educator and there are many issues that need to be considered. This research does not aim to provide solutions to the issues highlighted but rather offers recommendations for enhancing the teaching and learning experience.	
11933464	The purpose of this phenomenological study was to describe the experiences of adolescent children living with a parent who has a mood disorder. Three female adolescents each participated in two unstructured, tape-recorded interviews. Interviews were analysed using the Giorgi (1985) method. Three themes emerged. First, participants experienced a serious disruption in family life due to the unavailability of the ill parent, which evoked feelings of an intense sense of responsibility, fear and loss. This disruption led to the adolescent taking on parental roles and tasks. Second, participants perceived themselves to lack knowledge and understanding, leading to frustration and fears that their parents may not get better, and that they themselves may become ill like their parents. They sought information in order to better adjust to and understand the illness. Third, participants struggled to come to terms with the burden of having a psychiatrically ill parent. The effort of trying to cope and make sense of the experience involved a variety of cognitive and affective responses. Implications for nursing practice and research are discussed.
11930861	Accident victims often experience difficulty finding meaning and logic in their accident. Confusion and depression are frequently emotions that will be felt until resolution occurs. In many cases other individuals assist in this struggle for resolution. The nurse often has opportunity to provide suggestions and support as the client struggles to find meaning.
11923997	Role transition is never easy, but is complicated by the experienced neonatal nurse's frustration with reverting to a student role and becoming a novice practitioner, sometimes after years of developing a reputation as an expert nurse. This article discusses this transition, focusing on the skills needed to move successfully from nurse to nurse practitioner. Common to all advanced practice transitions are stages similar to those Benner identifies in her novice-to-expert theory of nursing practice. Feelings of frustration and inadequacy are common during the first year as an NNP. Studies focusing on role transition and role development suggest that a strong nursing identity is important for success in the NNP practice environment. Strategies to enhance the transition are discussed.
11905591	To investigate attitudes to clinical research amongst cancer trial participants and nonparticipants, and to compare results with those from previous studies amongst participants in noncancer trials.Trial participating respondents were given three questionnaires during the clinical trials. Respondents amongst patients declining randomization answered a single questionnaire.	Participants and nonparticipants in randomized clinical cancer trials.	Forty-one participants and 47 nonparticipants in cancer trials.	Altruistic motives of physicians to conduct medical research were highly rated. Attitudes towards clinical research were positive in all groups, with nonparticipant respondents being the least positive. Eight to nine tenths found scientific testing necessary before general health service implementation. Trial participants were, as compared with nonparticipating respondents, more positive towards both participation of self and others. Both personal and altruistic motives for participation were highly rated. Primary reasons for nonparticipation were fear of 'the unknown' and/or unease with randomization. Only a minority felt a moral problem created by declining trial participation. Respondents amongst noncancer participants were more satisfied with the information given than both cancer participants and cancer nonparticipants. Negative experiences in cancer participants generally dealt with frustration related to seeing too many physicians at check-up appointments.	Attitudes towards clinical research are generally positive even in cancer nonparticipants. Both personal and altruistic motives for participation were highly rated. A fear of 'the unknown' and resentments towards randomization were primary reasons to renounce participation. Seeing too many physicians at check-up appointments seems to be an important factor for negative experiences in cancer trial participants.	
11901968	To evaluate the effects of peripheral artery disease (PAD) on health-related quality of life (HRQoL) from the patient's perspective to establish a foundation for systematic PAD-specific HRQoL assessment in this population.Grounded theory methodology.	Open-ended, tape-recorded interviews were conducted with 38 patients (24 men, 14 women) 44 to 83 years old (mean 65) from two US medical centers to report patient experience of PAD and its perceived effects on HRQoL. Tapes were transcribed and analyzed to identify themes and conceptual domains pertinent to the experience of PAD in this population.	Seven major themes were identified: (a) delay in diagnosis and frustration with management of disease; (b) pain; (c) limitation in physical functioning; (d) limitation in social and role functioning; (e) compromise of self; (f) uncertainty and fear; and (g) adaptation to the effects of the disease and demonstration of resiliency.	These findings indicate important psychosocial and emotional consequences of PAD that existing HRQoL questionnaires do not indicate. More complete data might lead to greater understanding of the effects of PAD, serving as the foundation for a more sensitive instrument to assess HRQoL as a basis for more effective interventions.	
11898631	The influence of emotional stress on behaviour and industrial activity of man as well as on the development of posttraumatic stressful frustration and other disorders is considered in connection with real or possible action of ionizing radiation, and on the course of radiation injuries. It is shown that a problem of emotional stress and radiation safety are closely connected. The study is important for solving problems facing emergency medicine.
11888431	The schooling of 1 of every 8 children is influenced by the Individuals with Disabilities Education Act (IDEA). The IDEA also governs, to a degree, the relationship between interdisciplinary hospital clinics that evaluate many of these children and the schools that provide educational services. Little is known about how this relationship functions or how educational personnel perceive reports from hospital settings.To describe special education administrator and hospital evaluator perspectives on hospital assessments of children with learning problems.	A survey of attendees at a 1998 meeting of the Massachusetts Association of Special Education Administrators was conducted by use of a questionnaire using closed and open-ended questions. Subsequently, focus groups were held with hospital evaluators.	Special education administrators describe a high level of frustration with hospital-school relations. They state that hospital reports do not meet the needs of children in the educational setting. They seek closer collaboration with medical evaluators. Evaluators working in hospital settings acknowledge frustration perceived by school personnel. They state that communication with educational personnel improves the quality of their reports and outcomes for the child.	Hospital assessments of children with learning problems are associated with high levels of frustration among special education administrators. These assessments might be made more useful if careful attention were paid to the needs of educators. Greater communication between hospital evaluators and school personnel may increase the usefulness of hospital clinic assessments of children with learning problems.	
11882114	This paper explores the emotional support needs and coping strategies of family carers derived from two focus group interviews, each group comprising seven family carers. The interviews were carried out in Northern Ireland as part of phase one of the ACTION (Assisting Carers using Telematics Interventions to meet Older persons Needs) project. The purpose of the interviews was to investigate family carers' needs and experiences, but this paper focuses specifically on the emotional support needs and coping strategies identified by group members. The issues discussed included information and social support needs, the emotional impact of caring, and coping with and adaptation to the caring role. The findings reveal that for the majority of family carers their experience was one of constant searching for support and information. The anxiety and frustration associated with inconsistent and irregular support and lack of information was a major source of concern for the carers in the study. However, the carers employed a number of positive and negative coping strategies to deal with the stress associated with their caregiving role. The study concluded with the recommendation for nurses and other health care professionals to become more proactive in assessing and meeting carers' emotional support needs.
11881758	Emotion regulation strategies observed during an age 3 1/2 frustration task were examined in relation to (a) angry affect during the frustration task, (b) child and maternal characteristics at age 1 1/2, and (c) indices of self-control at age 6 in a sample of low-income boys (Ns varied between 189 and 310, depending on the assessment). Shifting attention away from sources of frustration and seeking information about situational constraints were associated with decreased anger. Secure attachment and positive maternal control correlated positively with effective regulatory strategy use. Individual differences in strategy use predicted self-control at school entry, but in specific rather than general ways: Reliance on attention-shifting strategies corresponded with low externalizing problems and high cooperation; reliance on information gathering corresponded with high assertiveness.
11878497	According to a recent Australian Institute of Criminology report (1999) the health industry is the most violent industry in Australia. In this paper the authors aim to highlight violence as an important professional issue for Australian nurses that is currently concealed as 'part of the job'. National and international studies bring attention to the severity of the problem for nurses with a particular focus on emergency nurses. Some of the issues identified and discussed include increased waiting times and frustration; increasing use of weapons; inadequate systems of security; culture of silence; inadequate support for emergent mental health needs; lack of reporting; lack of institutional concern and systems of support, and; demands of triage nursing. The nature of workplace violence in emergency departments in New South Wales and South Australia will be explored based on the authors' research. A research pathway to explore national impact and implications of violence for nurses and nursing practice in general will be outlined.
11875592	This paper reports the results of a systematic survey of members of a clinical gastroenterology service to determine their perceptions of patients with inflammatory bowel disease (IBD) who were deemed to function poorly and were difficult to manage clinically.To assess objectively the defining characteristics of this perceived subgroup of patients who are encountered in virtually all gastroenterology services.	A sample of gastroenterologists and gastrointestinal surgeons (n=10), as well as gastrointestinal nurses (n=19), was surveyed regarding their beliefs about the characteristics of patients with IBD who they judged to be extremely "difficult to manage". A survey was developed to assess patient characteristics (eg, symptom presentation, narcotic over-reliance, interpersonal behaviour and illness behaviour) and the emotional impact that this perceived patient group has on individual staff members as well as on the functioning of the gastrointestinal team.	The data indicated that patients with IBD who were perceived to be poorly functioning were viewed to have high levels of dysfunctional behaviour. In particular, negative behaviours (eg, manipulative interpersonal behaviours and excessive illness behaviours) were noted. Not only were these categories of behaviours high in frequency, but survey participants also rated these categories of behaviour to be highly distinct from those of typical patients with IBD. Moreover, this perceived patient group was reported to have a negative impact on individual staff and on the gastrointestinal team, and participants confirmed that they experience significant frustration and hostility when they work with these patients.	These data, if replicated, confirm the general clinical opinion that a small subgroup of "difficult to manage" and poorly functioning patients with IBD exists. These patients appear to differ from typical patients with IBD in interpersonal characteristics more than in medical characteristics. If follow-up research, which is currently underway by the authors' group, shows that groups of poorly functioning gastrointestinal patients and typical gastrointestinal patients actually differ in measures of illness behaviour, then novel treatment approaches to improve the clinical services that are provided to these patients can be developed.	
11873029	Usable real-time displays of intravenous anesthetic concentrations and effects could significantly enhance intraoperative clinical decision-making. Pharmacokinetic models are available to estimate past, present, and future drug effect-site concentrations, and pharmacodynamic models are available to predict the drug's associated physiologic effects.An interdisciplinary research team (bioengineering, architecture, anesthesiology, computer engineering, and cognitive psychology) developed a graphic display that presents the real-time effect-site concentrations, normalized to the drugs' EC(95), of intravenous drugs. Graphical metaphors were created to show the drugs' pharmacodynamics. To evaluate the effect of the display on the management of total intravenous anesthesia, 15 anesthesiologists participated in a computer-based simulation study. The participants cared for patients during two experimental conditions: with and without the drug display.	With the drug display, clinicians administered more bolus doses of remifentanil during anesthesia maintenance. There was a significantly lower variation in the predicted effect-site concentrations for remifentanil and propofol, and effect-site concentrations were maintained closer to the drugs' EC(95). There was no significant difference in the simulated patient heart rate and blood pressure with respect to experimental condition. The perceived performance for the participants was increased with the drug display, whereas mental demand, effort, and frustration level were reduced. In a post-simulation questionnaire, participants rated the display to be a useful addition to anesthesia monitoring.	The drug display altered simulated clinical practice. These results, which will inform the next iteration of designs and evaluations, suggest promise for this approach to drug data visualization.	
11872105	To identify parents' views, both positive and negative on: how inflammatory bowel disease (IBD) affects people in their parenting role; effects parents with IBD have noticed in their children; ways of dealing with any difficulties in parenting; and support needed by parents with IBD.This was a small-scale exploratory study, adopting a qualitative research design. A purposive sample of 19 mothers and five fathers with IBD was recruited through two hospitals and a voluntary group in the north of England.	Data were collected through a combination of focus groups and interviews, and analysed using the 'framework approach'.	The main positive effect for parents was developing a closer relationship with their children. When parents were experiencing symptoms there were difficulties in caring for young children; problems taking children to and from school, and attending school events; restrictions in social life; irritability and reduced tolerance of children. When in hospital, it was sometimes difficult to arrange for care of young children. These difficulties caused worry and guilt for parents, and a few spoke of periods of depression. Parents noticed that their children seemed caring and understanding of illness, but were also anxious when the parent was ill or in hospital, and reacted with anger or frustration to restrictions in social activities. Strategies commonly used to deal with difficulties were turning to family for support and trying to control symptoms. Support from health professionals was variable. Parents wanted more practical assistance, information for families on the effects of IBD, and support in coping with the condition. Awareness-raising about IBD was considered important within health, social services, education and housing departments.	As a group in regular contact with parents with IBD, health professionals have an important role to play in providing support. Staff should be particularly vigilant towards parents with severe symptoms, mothers of younger children, and those receiving limited help from their families.	
11858018	The aim of this study was to determine the frustrations that prevent soldier's successful adaptation to the military environment in the first three months of military duty. The sample consisted of 200 adapted (group A) and 400 maladapted (group NA) soldiers. The applied instrument was the Adjustment questionnaire. It was concluded that the most important cause of frustration was the problem of establishing the interpersonal relationship of soldier and his comrades in the unit. The presence of the actual factor of decompensation was also important, in the sense that it could disqualify for military duty, temporarily or permanently, even a well adapted soldier. Commanding officers and comrades could positively influence the socialization of a personality, by helping the less sociably adaptable soldiers in their adaption to the military environment.
11847996	The purpose of this phenomenological analysis was to describe perceptions of women with irritable bowel syndrome regarding the relationship of diet to their symptoms. Thirty-five women ages 18-45 with a medical diagnosis of irritable bowel syndrome or symptoms compatible with a diagnosis of irritable bowel syndrome were interviewed and completed questionnaires as part of a larger study. During the interview, the women were asked what they thought caused their symptoms. Overall, women tried to adjust their diet to achieve a "Range of Comfort" so their symptoms were tolerable or manageable. To do this, women used a process of "Trial and Error." If a link could be made to diet, then women developed "Self-care Strategies" to maintain a "Healthy Diet." Women who failed to find a relationship during the "Trial and Error" process either felt the frustration of "Uncertainty" or, for a few women, decided that adjusting their diet was not worth the bother. This study suggests diet and eating behaviors are an important starting point for many women as they try to manage their irritable bowel syndrome symptoms.
11847836	Adolescent violence is a major public health problem. Because of their roles in community and hospital settings, nurses have an opportunity to limit the epidemic of violence. The purpose of this study was to examine the perceived levels of knowledge, the value of further education, resource utilization, and attitudes of nurses caring for adolescent victims of violence. Data were collected from 60 nurses employed at an urban public hospital. Results of the study indicate that 50% of the respondents had high scores on the perceived knowledge section of the survey. However, the majority of nurses (82.5%) felt inadequately educated about violence. The attitudes reported with the most frequency were frustration (78%), anger (59%), and powerlessness (58%). The results of this study indicate a need for additional violence education for nurses, particularly in the areas of available resources and intervention for adolescent victims of violence.
11835590	The present study was designed to explore the extent to which advanced cancer pain is explicable in terms of both physical pain intensity and affect. Most notably, it expanded on previous findings by more clearly elucidating the relationship between several discrete emotional states and the total experience of cancer pain. One hundred and eleven patients with cancer pain attending a Pain and Symptom Control Clinic were studied. Visual Analogue Scales (VASs) were used to quantify overall pain intensity and the accompanying affect. Then, correlations were calculated to evaluate the relationships both between and within these two variables. Overall, the participants rated both the pain intensity and the negative affect associated with that pain as high. Of the examined affective components of pain, frustration and exhaustion were found to be the most significant. In addition, some gender differences were identified in terms of frustration, anger, fear, exhaustion, helplessness, and hopelessness.
11820534	This study examines the feelings of nurse caregivers of patients with Alzheimer's disease (AD) who are agitated. Methods included participant observation, examination of medical records, and ethnographic interviews of 17 nurse caregivers from one inpatient setting. Two patterns of feelings emerged from the data. One pattern was associated with caregiver expressions of personal identification with and vulnerability to AD. These nurses endorsed feelings of helplessness, men hopelessness, and frustration when providing care to agitated AD patients. A second pattern situated nursing interactions within the realistic context of the patient's response to the illness. Caregiver feelings of confidence, competence, and satisfaction were associated with the second pattern. The relationship between the feeling states of nurse caregivers and their reported management of agitation in AD is discussed. Recognition and awareness of distressing feelings is a necessary first step for nurses to learn less personalized reactions to patients and respond more objectively to agitated behaviors.
11820044	Bizarre-appearing gingival recessions that do not correspond to any known gingival disease or oral manifestation of any known systemic disease are called factitial (self-induced) gingival disease. Psychological factors are very important in their etiology. Generally, the lesions occur during the time the child is experiencing stress associated with the frustration of his or her dependency needs. Four cases of self-induced gingival recessions involving children aged 4 to 6 years are presented and investigated from the pedodontic, periodontologic, and psychiatric viewpoints.
11794447	Evaluating and treating dementia is intellectually demanding and enormously satisfying. However, physicians providing dementia care also confront unique challenges that cause discomfort and overwhelming frustration unless they are recognized and overcome. Physicians must care for individuals who do not adopt the "sick role." They must establish and maintain rapport with patients while also approaching collateral sources to obtain a complete history. They must develop a complex alliance with the patient, caregivers, community agencies, and other health professionals to provide effective treatment. Physicians must relate "bad news" to several people at once who are unequally prepared for it, while dealing with their own diagnostic uncertainty. Furthermore, physicians must honor patient autonomy and balance it with the needs of caregivers. Since the demands of providing dementia care are not typical of most medical practice, the special attributes needed are often not taught to students or adequately reimbursed by health insurance. The quality of dementia care will improve when strategies that address these aspects of care for patients with dementia are widely adopted.
11793147	Back problems are common, expensive, and the few patients who are the crux of the problem are uncomfortable but also an uncomfortable frustration for clinicians and employers alike. We now know that clinicians can greatly improve the patient's response to back symptoms by admitting our diagnostic limitations, demedicalizing the issue, providing assurance, and encouraging a more reasonable approach to improving comfortable activity tolerance.
11783666	Many physicians report feelings of frustration and anger resulting from encounters with patients during which there is disagreement over the use of narcotics to treat pain. In this article, investigators report a relational control analysis of transcripts of three encounters of this type in order to explore the control dimension of these interactions. Similar analyses in the literature have reported that patients in general attempt to gain control of the interaction more often than previously thought. Results of this analysis, however, were remarkable in that nearly half of the transactions were characterized by competition for control. In addition, a descriptive analysis of the control-gaining strategies revealed physician strategies of giving instructions and orders, explicitly rejecting or disagreeing, providing reasons, and attempting to negotiate; patient strategies included explicitly rejecting or disagreeing and providing reasons. Communication skills training may enhance physicians' ability to understand their feelings of discomfort in this type of interaction as well as train them to be more effective communicators during interactions in which there is a struggle for control.
11760857	In Munchausen by proxy (MBP) abuse, a caretaker fabricates or induces illness in another person to obtain emotional gratification. In representative cases, a mother is the perpetrator and her child is the victim. In view of the limits of current explanatory models, we use personal accounts of MBP perpetrators, physicians, and family members as a window into understanding this counterintuitive behavior.As subspecialty clinicians and consultants, we supplemented our extensive direct experience with MBP with a review of published reports of MBP located via MEDLINE and PsycINFO (1980 onward). We also examined the books devoted to the subject and incorporated personal accounts of MBP perpetrators and of family members and professionals involved with them.	Factors contributing to the onset and continuation of MBP are the perpetrator's experiencing a particular drive (e.g., intense anger or frustration); lacking or overcoming internal inhibitions against abusive actions; and overcoming external inhibitions, such as the potential intercession of a spouse or pediatrician. As a result, the MBP parent experiences release from unpleasant emotions and a sense of renewed control. MBP behavior gains "habit strength" each time it occurs.	Psychodynamic explanations of MBP, while favored by some authors, are inherently speculative and tend to be low in predictive value. We suggest broadening these traditional explanations by emphasizing observable behaviors and verifiable background factors. The behavioral perspective we outline helps explain how MBP behavior is learned, why it is more prevalent among mothers, and why it is so difficult for perpetrators to stop.	
11743845	Seriously ill persons are emotionally vulnerable during the typically protracted course of an illness. Physicians respond to such patients' needs and emotions with emotions of their own, which may reflect a need to rescue the patient, a sense of failure and frustration when the patient's illness progresses, feelings of powerlessness against illness and its associated losses, grief, fear of becoming ill oneself, or a desire to separate from and avoid patients to escape these feelings. These emotions can affect both the quality of medical care and the physician's own sense of well-being, since unexamined emotions may also lead to physician distress, disengagement, burnout, and poor judgment. In this article, which is intended for the practicing, nonpsychiatric clinician, we describe a model for increasing physician self-awareness, which includes identifying and working with emotions that may affect patient care. Our approach is based on the standard medical model of risk factors, signs and symptoms, differential diagnosis, and intervention. Although it is normal to have feelings arising from the care of patients, physicians should take an active role in identifying and controlling those emotions.
11742967	In contrast to primarily deductive quantitative research, qualitative research aims to interpret data to develop theoretical insights that describe and explain phenomena such as interactions, experiences, roles, perspectives, and organizations. In this review, we summarize qualitative studies that used primarily in-depth personal interviews as a data collection method and a grounded theory analytic approach. The liberal use of illustrative excerpts and interpretive descriptions offer clinicians vicarious accounts of patient experiences of weaning from mechanical ventilation. Important experiences of patients during their weaning from mechanical ventilation included frustration, uncertainty, hopelessness, fear, and lack of mastery. The extent to which, in at least some patients, these experiences were determinants of weaning failure, consequences of weaning failure, or both, was difficult to establish. An assumption of this genre of research is that if clinicians understand the lived experiences of patients, they can better appreciate patient needs during the weaning process, and by inference, their role as clinicians during weaning from mechanical ventilation.
11739340	It is generally considered that a significant proportion of 'inappropriate' demand for GP services is generated by consultations for minor ailments. How GPs manage minor ailments is likely to affect how patients perceive and handle similar illnesses in the future. Whilst this potentially has significant implications for general practice workload, research investigating GP' attitudes towards minor ailments and their management is sparse.Our aim was to describe GP' experiences and perceptions of minor ailment consultations and their attitudes towards minor ailment management.	A questionnaire survey was conducted in 1999, derived from a series of 20 qualitative interviews with practising GPs. The survey was sent to one GP randomly selected from each practice (n = 759) in eight English health authorities. Attitudinal statements were analysed using factor analysis.	Four hundred and fourteen GPs (54.5%) completed and returned the questionnaire. Respondents were consulted regularly about minor illness or symptoms, with almost all (95.6%) having experienced a minor ailment consultation in the previous week. Factor analysis suggested four issues to be of importance in determining GP' attitudes to minor ailment management. These were attitudes towards pharmacists, attitudes towards patient empowerment, frustration with minor ailment consultations and attitudes towards caution/risk.	Although GPs are clearly frustrated by the level of minor ailment consultations, this study suggests that there may be complex factors which influence their attitudes. For the optimal management of minor ailments, inter-professional relationships potentially are of great importance. With increasing patient demand, it is essential that finite health care resources are accessible, appropriate and used in an optimal way.	
11732464	AN EXPLANATION OF DISAPPOINTING RESULTS: Handling obesity and moderate overweight with dietary prescriptions or cognitive and behavioral therapies gives unsatisfying results. For some, such treatments even have the drawback of aggravating eating behavioral patterns, not to mention other psychopathological disorders. We believe, on the contrary, that such disappointing results and troubles may be explained by the cognitive restraint theory. COGNITIVE RESTRAINT THEORY: After the radical questioning of a psycho-genic origin to obesity, the efforts made to lose weight have gradually been held responsible for the psychopathological troubles observed in the cases of overweight patients. Herman and Polivy thus consider that slimming diets bring about a state of cognitive restraint, i.e. a way of eating ruled by beliefs of all kinds in the various consequences on the patients' weight of alimentary habits and choices, as opposed to inner criteria of hunger and satiety. DIFFERENT STATES: A person in a state of cognitive restraint can either experience inhibition without loss of control, or a loss both of inhibition and of control. In the former case, one can distinguish: a) a voluntarist stage in which the individual deliberately chooses not to heed his hunger and satiety sensations in order to privilege rules that are supposed to allow him/her to control his/her weight; b) an unconscious stage during which physiological sensations are blurred, and eating habits ruled by unconscious cognitive processes and emotions. The individual thus ends up organising his eating behaviour around his/her fear of lacking, the frustration/guilt doublet and troubles in the comforting pattern. Such a state of inhibition is frequently interspersed with losses of control, described as hyperphagic or bulimic bouts and compulsive eating.Certain authors, facing the necessity to bring down their patients' weight, tend nevertheless to advocate restrictive methods, or seem to consider that in spite of the above-mentioned drawbacks, cognitive restraint remains the only extant method to lose weight. An alternative therapeutic strategy is definitely worth exploring: one that consists precisely in helping the overweight patient to deliver him/herself from cognitive restraint. The first target could thus be to restore eating habits in conformity with personal tastes and with the patient's own personal hunger and satiety physiological regulation systems. This implies a questioning of dysfunctioning cognitive processes, and a thorough investigation of upholding factors such as self-esteem or emotional and relational troubles.	
11732135	Epidemiological studies show that one out of four Dutch individuals suffers from a mental disorder. Consequently, dentists are confronted with noticeable deviant or problematic behaviour. In this paper an overview is presented of several of psychological problems and their relevance to dental treatment. This is illustrated by a case description. For a proper diagnosis and adequate treatment planning it is important that dentists have some general knowledge of psychological functioning of patients, and the possible psychological determinants of illness and well-being. This would prevent unnecessary damage of dental tissues and needless suffering but also frustration, both for the patient and the dentist.
11727173	Typical failure rates for oral contraceptives remain much higher than ideal failure rates. Patients can cite the pill's perceived risks more readily than its benefits, and many women use oral contraceptives inconsistently or discontinue them entirely without a medical reason. Successful use of oral contraceptives mandates that we rethink our roles as providers. Medical barriers, such as mandatory pelvic examinations, impede clients' access to services and require reevaluation. Efforts must also focus on thorough, individualized counseling. Because compliance poses difficulties for many women and noncompliance results in reduced efficacy, counseling must address content points relevant to proper, consistent use. Additionally, as unexpected side effects often cause frustration and method discontinuation, counseling should anticipate their occurrence. Adolescents present additional challenges. However, with careful attention to concerns relevant to teenage women and consideration of obstacles to compliance, oral contraceptives can indeed be used successfully in this group. Regardless of age, all clients should receive information regarding emergency contraception, and instructions for pill use should be individualized to meet the needs of each patient.
11723987	This article presents the results from a longitudinal study of retirement. Data were collected through interviews with 12 Swedish participants over a 7-year period, beginning when they were still working and continuing through their early years of retirement. The findings show that the participants' narrative anticipations of retirement interacted with the events of ongoing life. Sometimes these events influenced the outcomes of the retirement process unpredictably. Consequently, retirement was often full of surprises and temporary periods of turbulence. Although some participants managed a transition into a satisfying pattern of retirement, others found it an ongoing process of frustration and dissatisfaction. Evidence from this longitudinal study indicates that a special type of occupation--engaging occupation with six constituents--was an important determinant of retirement satisfaction. This key finding is discussed with regard to its implications for theory development as well as its practical implications related to the importance of differentiating occupations and attending to the interaction between internal motivation and external expectations in the occupational pattern.
11723287	Twelve patients with a catastrophic reaction (CR) (an outburst of frustration, depression, and anger when confronted with a task) were identified in a prospective cohort population (n = 326) with first-ever stroke admitted within 48 hours from onset. The authors' findings suggest that CR is a rare though not exceptional phenomenon in acute stroke and is associated with nonfluent aphasias and left opercular lesions. CR, poststroke depression, and emotionalism are distinct but related disorders.
11723191	This paper considers neurocognitive models of aggression and relates them to explanations of the antisocial personality disorders. Two forms of aggression are distinguished: reactive aggression elicited in response to frustration/threat and goal directed, instrumental aggression. It is argued that different forms of neurocognitive model are necessary to explain the emergence of these different forms of aggression. Impairments in executive emotional systems (the somatic marker system or the social response reversal system) are related to reactive aggression shown by patients with "acquired sociopathy" due to orbitofrontal cortex lesions. Impairment in the capacity to form associations between emotional unconditioned stimuli, particularly distress cues, and conditioned stimuli (the violence inhibition mechanism model) is related to the instrumental aggression shown by persons with developmental psychopathy.
11718317	The characteristics of coca products use in São Paulo, Brazil during the years of 1994 and 1999 were investigated through interviews with 26 key informants (KIs; persons with knowledge of coca product users) in each of these years. The following information was yielded by the KIs: (1) there has been a large increase in coca products use in São Paulo from 1994 to 1999; concomitantly, there has been a decrease of hydrochloride use; (2) the increase has occurred due to the dissemination of crack which became cheap and easily available; (3) reasons for crack use changed greatly: in 1994, use was attributed mostly to pleasurable sensations produced by smoking; in 1999, use was intended to overcome compulsion/dependence or to put up with frustration/family conflicts; (4) crack users in 1999 came from practically all social classes of São Paulo; (5) use of alcohol and/or marijuana to cut down the anxiety and excitement produced by crack increased from 1994 to 1999; (6) even when police repression of traffic was effective, which rarely occurred, it affected only the price of coca products; (7) treatment services available were considered insufficient both in number and quality, and were run by ill-trained health professionals (this situation deteriorated even more in 1999); (8) many KIs heavily criticized the prevention programs because of the use of "scare techniques"; and (9) all KIs in 1999 believed that, unless the government changes its policy toward the drug problem, the situation would become worse in the next few years.
11703554	This study investigated the views of parents and nurses about the involvement of parents in the management of their child's pain during the first 48 hours after surgery.Children's pain management has been found to be problematic and in need of improvement. Nurses are the key health care professionals with responsibility for managing children's pain. Parents can make important contributions to assessment and management of their child's pain.	Using a phenomenological approach, nurses and parents were interviewed about their perceptions of parent involvement in pain management.	The findings indicated that parental involvement in their child's pain management is superficial and limited in nature. Parents described a passive role in relation to their child's pain care and conveyed feelings of frustration. Only a minority of parents expressed satisfaction with their child's pain care. Nurses perceived that there was adequate involvement of parents and adequate pain management for children.	These findings may be somewhat explained by differing views and a lack of effective communication between parents and nurses. There is a clear need for nurses to discuss parent involvement with parents and negotiate roles in relation to pain management.	
11702807	The purpose of this study was to test a model of substance use in adolescent males. The model is based on the premise that cognitive distortions and poor constructive thinking represent weaknesses in the ability to adaptively cope with everyday problems. It is postulated that failures in adaptive coping result in increased negative affectivity (e.g., frustration, anger, and anxiety), which fosters substance use as a means of alleviating unpleasant feelings.Subjects (N = 276) were 15- to 17-year-old males with a positive (FHP; n = 118) or a negative (FHN; n = 158) family history of a substance use disorder (SUD). Subjects completed self-report measures of constructive thinking, cognitive distortions, negative affectivity, substance use frequency and substance use problems.	Negative affectivity mediated the relations between constructive thinking and both substance use variables, in separate analyses, for the FNP and FHN groups. Negative affectivity also moderated the relation between constructive thinking and substance use frequency, such that constructive thinking was negatively related to substance use frequency but only for individuals high in negative affectivity.	Poor constructive thinking skills are related to increased substance use in adolescent males, in part through an association with greater negative affectivity. SUD treatment and prevention efforts may benefit from strategies aimed at improving constructive thinking abilities and reducing negative affectivity.	
11699677	This article reviews evidence on the reliability and validity of the Children's Behavior Questionnaire (CBQ), and presents CBQ data on the structure of temperament in childhood. The CBQ is a caregiver report measure designed to provide a detailed assessment of temperament in children 3 to 7 years of age. Individual differences are assessed on 15 primary temperament characteristics: Positive Anticipation, Smiling/Laughter, High Intensity Pleasure, Activity Level, Impulsivity, Shyness, Discomfort, Fear, Anger/Frustration, Sadness, Soothability, Inhibitory Control, Attentional Focusing, Low Intensity Pleasure, and Perceptual Sensitivity. Factor analyses of CBQ scales reliably recover a three-factor solution indicating three broad dimensions of temperament: Extraversion/Surgency, Negative Affectivity, and Effortful Control. This three-factor solution also appears to be reliably recovered in ratings of children in other cultures (e.g., China and Japan). Evidence for convergent validity derives from confirmation of hypothesized relations between temperament and socialization-relevant traits. In addition, parental agreement on CBQ ratings is substantial. The CBQ scales demonstrate adequate internal consistency, and may be used in studies requiring a highly differentiated yet integrated measure of temperament for children in this age range.
11696795	We hypothesized in this descriptive investigation that children with daytime wetting demonstrate unique emotional/behavioral patterns, independent of gender and age, compared to children with nocturnal wetting.Two groups of children 5 to 17 years old with day wetting and urinary tract infections in the absence of organic etiology were recruited for study. There were 488 children in group 1 and 418 in group 2. Group 1 was given a short set of behavioral questions and group 2 was evaluated for behavioral characteristics with a revised and longer set of questions. Also in group 2 children with nocturnal wetting only were recruited as a comparison group. A subgroup of 58 children was randomly selected from group 2 and administered 2 standardized questionnaires.	Children with day wetting and urinary tract infection had a significantly higher rate of constipation (35%) than those with day wetting and no infection (25%, p <0.02). Parents of group 1 children reported the level of frustration and anger to be similar whether the children had urinary tract infection or not. Parents also reported that only 3.8% of children had significant learning or school problems. Parents of group 2 did not report any differences between nighttime and daytime wetting with respect to positive outlook, organizational skills or willingness to talk. Differences were noted, with daytime wetters perceived as more stubborn (p <0.0001), secretive (p <0.0001), refusing to follow parental requests (p <0.002) and constipation (p <0.0003). Of the subsample group the incidence of verified attention deficit/hyperactivity disorder was highest in children with daytime wetting and no infection (21%), and nighttime wetting (22%) compared to 0% in daytime wetting and infection. The Child Behavioral Checklist results on this sample suggested that 35% of the children with daytime wetting and no infection earned significant T scores of mixed or externalizing symptoms, while the nocturnal enuresis group demonstrated 16% significant T scores, primarily externalizing. All females with the daytime wetting and infection showed significant T scores within the internalizing domain. The Child Behavioral Checklist defines externalizing behaviors as aggressive and acting out behaviors, while internalizing behaviors include withdrawn and anxious/depressed behaviors. Mixed behaviors on this questionnaire include social, attention and thought problems.	These data suggest that a minority of children with daytime wetting and infection tend to show an internalizing style of problems (11%) and constipation, while those with daytime wetting and no infection show a more mixed style of psychological problem (35%). In contrast, the nighttime wetting group tends to show externalizing problems (16%). Based on a subsample of the data children with daytime wetting and no infection, and nighttime wetting showed a significantly incidence of verified attention deficit/hyperactivity disorder compared to the general population. According to parent perceptions, stubbornness and secretiveness seem to describe a style that the children with daytime wetting exhibit that is not present in those with nighttime wetting. There is a possible role of uncontrol and over control psychological styles to the development and treatment of daytime wetting as well as the relationship of these styles to treatment outcome. Further research is needed to clarify the psychological style of children with daytime wetting to customized treatment protocols.	
11674886	Our purpose was to develop a typology of outpatient visits between family physicians and adult "frequent attender" patients.This was a cross-sectional observational study using qualitative analysis of family physician visits. Three family physician researchers reviewed detailed field notes for each patient based on direct observation of a single office visit to determine major themes and characteristics of physician-patient encounters.	Non-pregnant adults in the top 5% for visit frequency, and age-and sex-mated non-frequent attenders were identified from among 1194 adult patients in 18 Midwestern family practice offices as part of The Prevention and Competing Demands in Primary Care Study.	Visits by 62 patients who had made at least 25 visits in the previous 2 years were selected (frequent attender visits). Three major dimensions emerged to distinguish different encounter types: (1) biomedical complexity, (2) psychosocial complexity, and (3) the degree of dissonance between the patient and the physician. These 3 dimensions were used in a descriptive framework to characterize visit types as: simple medical, ritual visit, complicated medical, the tango, simple frustration, psychosocial disconnect, medical disharmony, and the heartsink visit.	The discovery of a wide variation of encounter types among adult frequent attenders and the resulting descriptive framework laid a foundation for defining the appropriateness of outpatient health care utilization, for designing interventions to reduce inappropriate utilization, and for educating physicians regarding effective management of frequent attender patients.	
11624165	In "George A. Miller, Language, and the Computer Metaphor of Mind" (see Note 1), I sought to explain how and why Miller invested the computer metaphor of mind with such strongly revolutionary, antibehaviorist meanings. In reply, Christopher Green (see Note 2) has argued that the answer to this question has to do with the importance of mental representation was an important issue to cognitivists. In response, I argue that, though mental representation was an important issue to cognitivists, there were several other factors of equal or greater importance: specifically, the fascination of Miller and his cohort with language and communication, their frustration with the narrowness of the disciplinary vision of the behaviorists, and their involvement in a different experimental program than that of mainstream behaviorists.
11600488	This study examined whether patients with borderline personality disorder and controls with other personality disorders remember their childhoods differently with respect to separation difficulties, evocative memory, temperamental factors such as frustration tolerance and mood reactivity, and onset of symptoms. Two hundred and ninety patients with borderline personality disorder and 72 with other personality disorders were assessed using an instrument to rate memories of separation difficulties, temperamental problems, and onset of symptoms before age 18. Patients with borderline personality disorder remembered more difficulties with separation between ages 6 and 17 years, more mood reactivity and poorer frustration tolerance between ages 6 and 17, and the onset of more symptoms (most prominently sadness, depression, anxiety, and suicidality) before age 18 than did patients with other personality disorders. The groups did not differ in reports of evocative memory before age 18. These results indicate that many of the features of adult patients with borderline personality disorder may initially appear during childhood and adolescence and that these features may be used to differentiate borderline from other personality disorders.
11589531	To determine whether family factors are predictive of outcome in children with anxiety disorders who are receiving cognitive-behavioral treatment.Participants were 61 children aged 8 to 12 years (mean = 10.0, SD = 1.4) with Axis I anxiety disorders who had been referred to a large Toronto children's hospital. Parents and children completed measures assessing family functioning, parenting stress, parental frustration, and parental psychopathology before and after treatment. Outcome measures included clinician-rated functioning (Children's Global Assessment Scale) and self- and parent-rated anxiety (Revised Children's Manifest Anxiety Scale).	Child ratings of family dysfunction and frustration predicted clinician-rated improvement (total R2 = 0.28, p < .001). Mother and father reports of family dysfunction, and maternal parenting stress, predicted mother-rated child improvement (total R2 = 0.18, p < .01). Father-rated somatization and child reports of family dysfunction and frustration predicted child-rated improvement (total R2 = 0.25, p < .001). Several family factors improved with treatment.	Family dysfunction appears to be related to less favorable treatment outcome in children with anxiety disorders.	
11584541	Study in two operators' groups with high and low levels of psychic stability revealed that individuals with high emotional stability, good self-control, low frustration and sthenic reactivity type demonstrate higher resistance to psychologic stress at work. Opposite personal features lower resistance to stress and result in transfer of stress at work into family relationships sphere that itself could become a stressor.
11579975	A United States probability sample of 880 licensed drivers participated in a telephone survey of red light running perceptions and behaviors. Despite most drivers believing red light running was problematic and dangerous, approximately one in five respondents reported running one or more red lights when entering the last ten signalized intersections. Among several demographic and attitude variables, only age group predicted recent red light running. Specifically, younger respondents were more likely to be violators. Drivers also reported being more likely to run red lights when alone, and were typically in a hurry when speeding up to be beat red lights. Contrary to expectations, frustration was not as important for predicting red light running as it was for other driving behaviors, such as speeding, tailgating, weaving, and gesturing angrily at others. Additionally, drivers perceived and received few consequences for running red lights. Less than 6% had received a traffic ticket for red light running and most believed that police would catch less than 20% of violators. Slightly more than one in ten had been involved in a red light running crash. Respondents most commonly suggested legal initiatives to reduce red light running. Accordingly, we recommend traffic safety experts pursue interventions that apply immediate and consistent negative consequences to violators to change the public's red light running perceptions and behavior.
11579373	"Zest for Life Instead of Strain of Illness" - Implementation and Evaluation of a Programme Activating Chronic Back Pain Patients in a Rehabilitation Clinic.A group training was developed for chronic back pain patients in a rehabilitation clinic to enhance coping, to activate internal and external resources, and to make transfer to everyday life easier. The training consists of 12 either physiotherapeutic or psychologically oriented sessions. The training was evaluated in a longitudinal, quasi-experimental control-group design. Patients of the intervention group (n = 144) and control group (n = 157) rated the usefulness of the rehabilitation for private and working life at the end of the in-patient phase (t1) and three month later (t2). They also evaluated selected elements of the rehabilitation (t2). Results show that the anticipated usefulness of the rehabilitation was rated higher at the end of the stay than three months later. This indicates frustration after returning to everyday life. Patients of the intervention group rated the transfer possibilities to working life higher than the control group. They also are more satisfied with the psychological parts of the rehabilitation. After minor revisions, such as strengthening the topic of employment, the training now is implemented in the clinic for all patients with chronic back pain.
11569423	To examine the influence of psychological factors on outcome of in vitro fertilisation (IVF).Prospective clinical study.	Department of Gynaecology and Obstetrics, Charles University School of Medicine and General University Hospital Prague.	Sixty-six couples undergoing IVF treatment were administered psychometric tests: State-Trait Anxiety Inventory, Beck's Depression Inventory, Interpersonal Check List and Dusin Frustration Test. Results of pregnant and non-pregnant group were compared.	We found statistically significant differences only in women. Women from the pregnant group had significantly lower scores of trait anxiety then women from the non-pregnant group (P < 0.05). Pregnant women evaluated themselves (P < 0.01) and their partners (P < 0.01) as more hostile then the non-pregnant women in the ICL. In the scores of trait anxiety, depression and frustration were not any differences. In the non-pregnant group were the women significantly more anxious (state anxiety P < 0.02, trait anxiety P < 0.01) and depressed (P < 0.05) then their partners. We didn't find these differences in the pregnant group.	Women from the pregnant group had significantly lower scores of trait anxiety then women from the non-pregnant group. Those women react in IVF treatment with higher stress and this stress response decreases their chance of conception. They were not any differences between the two groups of man. We found significant differences in the interpersonal interaction. In the non-pregnant group had the women significantly higher scores of depression and both state and trait anxiety. In the ICL evaluated themselves and their partners as more affiliate then the women in the pregnant group. According our opinion adequate hostility protects the women for depression and anxiety and is better coping style.	
11565277	AD most often arises in infants and children and can persist into adulthood. It is a common and important condition that can have a negative impact on quality of life by affecting psychosocial adjustment in children, creating embarrassment, disrupting sporting activities in older children, and by interfering with employment opportunities in adults. Substantial impact on family function can result from having a child with AD. Parents describe feelings of guilt, exhaustion, frustration and helplessness. AD disrupts sleep not only in patients but also in parents and family members. Parents can miss work or avoid outside work altogether due to a child with AD, and the caregiver's social functioning can be damaged. Spousal and other familial relationships can be affected along with parenting behavior. All of these challenges become even greater with low-income families, who often have minimal social support mechanisms. There is a profound need for enhanced and expanded efficacy and cost research regarding the treatment and control of AD. Informed and thoughtful changes of public policy could minimize its future socioeconomic toll on patients and their families.

11556771	Little sociological research has sought to investigate the ways in which women with hospitalized newborn infants construct and practice motherhood. This article seeks to address this lacuna, using data from a qualitative research project based in two Australian neonatal nurseries. Thirty-one mothers of hospitalized newborns and 20 neonatal nurses were interviewed, and other data were obtained via observations of the nurseries, tape-recorded verbal interactions between parents and nursery staff and casual conversations with mothers and nurses. The data revealed that while the mothers' and nurses' discourses on what makes a 'good mother' in the context of the neonatal nursery converged to some extent, there were important differences. The mothers particularly emphasized the importance of physical contact with their infants and breastfeeding, while the nurses privileged presence in the nursery and willingness to learn about the infant's condition and treatment. There was evidence of power struggles between the mothers and nurses over the handling and treatment of the infants, which had implications for how the mothers constructed and practised motherhood. The mothers attempted to construct themselves as 'real mothers', which involved establishing connection with their infants and normalizing them. In time, many of the mothers sought to position themselves as the 'experts' on their infants. For their part, the nurses attempted to position themselves as 'teachers and monitors of the parents', 'protectors of the infants' and 'experts' by virtue of their medical training and experience. Differences in defining the situation resulted in frustration, resentment and anger on the part of the mothers and disciplinary and surveillance actions on the part of many of the nurses, both covert and overt. The nurses' attitude to and treatment of the mothers was integral in the development of the mothers' relationship with their infants in the nurseries, and this influence extended beyond discharge of the infants.
11552397	In countries with a very low or non-existent prevalence of late whiplash syndrome, accident victims do not routinely hear reports of acute whiplash injury leading to chronic symptoms or disability. They do not witness such behaviour in others, and do not thereby have any expectation of such possibilities. They do not engage in a process that encourages hypervigilance for and attention to symptoms, thus eliminating many factors that promote symptom amplification. They also do not engage in a process that engineers anxiety, frustration, and resentment (that is, battling with insurance companies and proving that your pain is real). They do not change their activity in response to what they, after all, view as a minor injury. They will not amplify pre-accident symptoms, or symptoms or amplify daily life's aches and pains. They will not attribute all these different sources of symptoms to chronic damage they believe the accident caused. There is no cultural information to encourage this chronic pain behaviour being seen in other cultures.
11530765	Discomfort, lack of confidence in skills, and environmental constraints may cause primary care providers to miss opportunities to discuss human immunodeficiency virus (HIV) risk with patients. We used a systems approach to address both intrapersonal and environmental barriers to HIV risk assessment and prevention counseling in a managed care clinical setting. The design was one-group pretest/posttest. The study took place in two primary care clinics of a large Pacific Northwest managed care organization. Participants (n = 49) included physicians, physician assistants, nurse practitioners, registered nurses, and social workers. The intervention included training, clarification of provider/staff roles, assess to tools and materials, and reminders/reinforcers. Outcome measures were provider attitudes, beliefs, outcome expectations, knowledge, confidence in skills, and perceived supports and barriers, measured by written pretest/posttest surveys administered 12 months apart. Seven months after the most intensive part of the intervention, providers' attitudes and beliefs were more favorable to HIV risk assessment and prevention counseling. They were less likely to express frustration with high-risk patients (decrease from 100% to 79% agreement, p = 0.001) and more confident that their advice would be effective with gay men and single adult heterosexuals (p = 0.002 and 0.005, respectively). They reported more confidence in their training in sexual history taking (p = 0.0003) and their skills assessing readiness for change (p = 0.007), and more support in practice environments. This study demonstrated that it is possible to affect important personal and environmental factors that influence primary care providers' HIV prevention behavior using an interactive, real-world systems approach. Further research is needed on providers' impact on patient behavior.
11496477	During the past decade, economic and political forces have caused radical transformations in health care systems resulting in changed circumstances within which nursing executives must function. This paper provides an understanding of nursing executives' roles and responsibilities and the impact changes in the health industry have had on their careers. One hundred and forty-seven (52%) of the 281 nursing executives employed in the Queensland Public Health Sector completed a postal self-administered survey. The findings of this study demonstrate their role has expanded to include not only nursing administration, but also responsibility for financial, human resources, strategic and resource management, staff development and quality improvement. The impact of these role changes has affected the health and well-being of nursing executives, with nearly half reporting increased stress, frustration and irritation. Their workload has increased and some reported deterioration in their health, specifically, exhaustion, fatigue and insomnia. Respondents reported they now have less time to spend with families and friends, which has had a negative impact on family relationships. Overall, nursing executives were satisfied with their current position, the work itself and their relationships with their co-workers, but dissatisfied with organisational aspects, especially the quality of mentorship and opportunities for promotion.
11490434	Taking into consideration the age of individuals, 100 patients (25 men and 75 women) aged 21-60 years were examined by using clinical, psychological and statistic (correlation) analysis to determine whether there are relations between clinical manifestations of the irritable bowel syndrome and personality. They were all referred to a psychiatrist from a gastroenterology hospital. The formation and dynamics of this syndrome, as well as its the clinical variations (diarrhea, pain, constipation) are largely determined by personality traits (increased anxiety; high inclination to somatization of emotions with inability to adequately verbalize them, pronounced intrapunitivity; direction of hostility to themselves; permanent inclination to depressive reactivity) and a passive-defensive behavior under the conditions of frustration.
11485121	The purpose of this study was to develop the Stress Response Inventory (SRI), which includes emotional, somatic, cognitive, and behavioral stress responses, and then to use the scale in clinical practice.First, a preliminary survey was conducted using 109 healthy adults to obtain 75 response items. Second, the preliminary questionnaire was completed by 215 healthy subjects. Third, stress responses were compared among 242 patients (71 with anxiety disorder, 73 with depressive disorder, 47 with somatoform disorder, and 51 with psychosomatic disorder) and the 215 healthy subjects.	Factor analysis yielded seven subscales: tension, aggression, somatization, anger, depression, fatigue, and frustration. Reliability was computed by administering the SRI to 62 healthy subjects during a two-week interval. Test-retest reliability for the seven subscale scores and the total score was high, ranging between 0.69 and 0.96. Internal consistency was computed, and Cronbach's alpha for the seven subscales ranged between 0.76-0.91 and 0.97 for the total score. Convergent validity was computed by correlating the seven subscales and the total score of the SRI with the total score of the Global Assessment of Recent Stress (GARS) scale, the Perceived Stress Questionnaire (PSQ), and the subscale scores of the Symptom Checklist-90-Revised (SCL-90-R). The correlations were all at significant levels. The sensitivity of the SRI was 0.57, specificity 0.74, and the predictive value positive (PVP) was 0.71. The patient group also scored significantly higher on the six subscale scores and the total score than the control group, with the exception being the aggression subscale. The depressive disorder group was highest in total scores on the SRI among the four patient groups, and showed significantly higher total scores than the anxiety disorder and psychosomatic disorder groups. In total scores on the SRI, female subjects scored significantly higher than males.	These results indicate that the SRI is highly reliable and valid, and that it can be utilized as an effective measure of stress for research in stress-related fields. The depressive disorder group showed more prominent stress responses than the anxiety and psychosomatic disorder groups.	
11482177	This article compares the positive and negative stress response work attitudes of 126 home health care registered nurses (RNs) and 145 hospital RNs. Home health care nurses reported significantly lower levels of the negative work attitudes, anger/hostility, and frustration with the system. There was no significant difference between the two groups of RNs among the positive work attitudes of job satisfaction, positive affect, hope, meaningfulness, manageability, and trust in the supervisor and the negative work attitudes frustration with the supervisor, job alienation, and negative affect.
11469051	Medical staff working in rehabilitation often criticize their in-patients' lack of motivation to cooperate in therapy. Consequently, very often the aims of the therapy would not be reached. That, again, causes expenses that could be avoided and it also causes frustration on both sides. On the basis of Schwarzer's Health Action Process Approach (HAPA) we designed a questionnaire on motivation to predict the degree of the in-patients' cooperation in therapy during rehabilitation. The results presented here are based on an interim analysis of 508 questionnaires answered by LVA insurees (Landesversicherungsanstalten, wage earners' pension insurance funds) who had applied for rehabilitation in a clinic. The applicants suffered from illness of the back and spine as well as degenerative illness of the joints. A first examination of the scales Specific Outcome Expectancies, Specific Self-efficacy and Intention of the questionnaire showed very good statistical results as well as correlations between these variables that correspond to HAPA. It also turned out that there is a direct connection between the scores of the motivation variables (e.g. Specific Self-efficacy) and that of cooperation in therapy. These initial test results indicate a generic character of the instruments used in this research project. They also point out starting points for interventions to increase motivation that are to be developed.
11446221	Clinical observation indicates that sexual acting out takes place during periods in which the integrity of the self is threatened by some disappointment, some frustration, or what is perceived as an unavoidable but unfair demand. Rather than confront the problem within the object relationship, the conflict is acted out. The sexual encounter reduces anxiety and facilitates the containment of depressive and aggressive feelings. Self-integration is attempted even at the risk of losing something, be it a wife, a husband, a girlfriend or the presidency. At the time it seems the only possible way to cope with painful or threatening stimuli.
11441686	To explore the psychological, interpersonal and sexual correlates of vulvar vestibulitis via qualitative and quantitative analysis.Sixty-nine women diagnosed with vestibulitis were recruited from a vulvar/vaginal disease clinic to complete a comprehensive quantitative and qualitative questionnaire designed to assess general health concerns, mental health, sexual functioning and interpersonal relationships.	The majority of participants reported drastic changes in sexuality associated with the onset of vestibulitis. Upon developing vestibulitis, 88% reported decreased interest in sexual activity, 87% indicated that they were less willing to participate in sexual activity, and 94% maintained that they were less able to participate in sexual activity. High levels of frustration and symptoms of depression also were frequently reported.	Vulvar vestibulitis is associated with significant changes in sexuality, intimate relationships and psychological well-being. When treating women with vestibulitis, medical professionals should consider the psychological and sexual aspects of the disease in addition to physical concerns.	
11436754	At the end of 1997, one quarter of the American public used health maintenance organizations. This paper reports findings on physicians' perspectives on the role of managed care in their professional practices. The research data come from mailed surveys to physicians who are selected from the Cigna Directory of Physicians practicing in the State of Ohio. Subjects were asked to explain what managed care meant to them, and how long they have been practicing medicine. Questions also focused on professional autonomy, quality of care and career aspirations for the future. The results from the study suggest that managed care has had a negative impact on how physicians practice medicine. Several of our respondents reported that they are playing the role of a "double agent" and feel a sense of frustration in doing so. The degree of antipathy toward managed care differs between primary care physicians and specialists.
11429086	Differing definitions of depression, limited sample sizes, and variability in methodologies have contributed to equivocal findings about the prevalence of depression among persons with traumatic brain injury. The present investigation used standardized diagnostic criteria and a large sample to identify the manifestations of depression after TBI.722 outpatients with brain injury, referred for comprehensive assessment at a regional Level I trauma centre, were studied. Depressive symptoms were characterized utilizing standard DSM-IV criteria and the Neurobehavioural Functioning Inventory.	Forty-two per cent of patients with brain injury met the prerequisite number of symptoms for a DSM-IV diagnosis of major depressive disorder. Fatigue (46%), frustration (41%), and poor concentration (38%) were the most commonly cited manifestations of depression.	Many patients with brain injury are at great risk for developing depressive disorders. Future research should focus on prognostic factors, developing protocols for identification of high risk patients, and examining the efficacy of treatment interventions.	
11428301	The study aimed at assessing burnout in psychiatrists and psychiatric residents, all of them working in the Canton of Zurich, Switzerland, and at identifying some of its correlates.Potentially burnout- related demographic, work, leisure activities, and personality (Munich Personality Test) variables were studied in three subgroups of 307 probands--psychiatric residents, psychiatrists working as staff members or in leading positions in psychiatric institutions, and psychiatrists working in private practice--the degree of burnout having been assessed with the Tedium Measure (TM).	The mean TM score of all probands of 2.9 (SD = 0.7) was on a low level, high TM scores (> 3.5) were indicated by 57 (18%) participants. Significantly higher TM scores were indicated by psychiatric residents, who also scored higher with regard to neuroticism and lower with regard to frustration tolerance on MPT.	Neuroticism alone explained a substantial proportion of the total TM variance in individual groups. Work-related variables turned out to be of a small importance only, whereas no influence could be demonstrated for different leisure activities.	
11426203	Photodynamic therapy is a combination of the systemically injected photosensitizing drug, verteporfin, and the subsequent exposure of the affected retina to a low-beam diode laser. Eligible participants in the photodynamic therapy clinical trial were those with "wet" cases of age-related macular degeneration with subfoveal, predominantly classic lesions. The expected outcome of the treatment is to preserve vision, not to restore lost vision. Study participants are frustrated in their performance of daily activities and often have unrealistic expectations of photodynamic therapy treatment outcomes (eg, improved vision). Frustration and fear are evident at visits during which their actual vision loss is measured. One of our goals is to help the patients have realistic expectations of treatment outcomes.
11411056	Treatment of pain in elderly patients can meet with diagnostic problems, namely in those with cognitive disorders, as well as with problems concerning pharmacokinetic and pharmacodynamics brought about by the advanced age. Our article presents an overview on the basic differences in the diagnostics and treatment of pain, on the therapeutic risks, and on other interrelations, which have to be considered in the therapy of elderly patients. The review is supplemented with results of our examination on the rate of analgesic treatment, spectrum of analgesics in use in the population of patients older than 75 years. About one quarter of the population use analgesics regularly, the order of most frequently prescribed analgesics is: ibuprofen 38%, diclophenac 24%, tiaprophenic acid 14%, tramadol 8%, indometacine 4%. Included were also data concerning the quality of life of patients with pain and information about the relations among patients and the curing personnel where obtained by our own inquiry. Patients concluded that pain was better tolerated at home, administration of drugs in tablets revealed to be most satisfactory, all information, namely from medial doctors, were welcome. Treatment of pain improved the quality of life in 1/3 of patients; one half of them considered it as successful. Personnel also asked for better professional information, though they had good of knowledge on the evaluation and documentation of pain and the principles of pharmacological treatment. Failure of treatment evokes in 69% of the personnel the feeling of impotency, in 41% affection of unsatisfactoriness, in 20% a tension, in 13% feeling of failing, in 18% depression and frustration. Reconciled with failure is 6% of the curing personnel.
11380384	The prenatal loss of an expected child entails parental despair and grief. The grief after a stillborn child is sometimes described as a "forgotten form of grief" and the fathers as the "forgotten mourners." Our aim was to describe how fathers experienced losing a child as a result of intrauterine death.Eleven men were interviewed 5 to 27 months after the intrauterine death of their child during weeks 32 to 42 of pregnancy. The interviews were analyzed using a phenomenological methodology.	After being informed of the infant's death, most fathers first wanted their partners to have a cesarean section, but all later thought that it would be right for the child to be delivered vaginally. A strong feeling of frustration and helplessness came over them during and after the delivery. Several men found meaning and relief in their grief by supporting their partner. Tokens of remembrance from the child were invaluable, and fathers appreciated that the staff collected these items, even if the parents declined them. The perceived prerequisite for resuming their everyday lives consisted of the support they received from the hospital staff and precious memories of the child. The most important comfort in their grief was a good relationship with their partner. Some fathers missed having a man to talk to both at the time of the stillbirth and subsequently.	The fathers' general trust in life and the natural order was suddenly and unexpectedly severely tested by the death of their child, which they perceived as a terrible waste of life. They sought understanding as grieving men and fathers from both the hospital personnel and their partners, as well as from relatives. Being able to protect their partner and to grieve in their own way was important to the fathers.	
11401739	The researchers wanted to understand how irritable bowel syndrome (IBS) affects patients' lives and their interactions with physicians and the health care system.A qualitative study was performed using focus groups of people with physician-diagnosed IBS. Immersion/crystallization was used to identify overriding themes.	Adult volunteers with a previous physician diagnosis of IBS were included.	The outcomes were patient-reported symptoms, episode triggers, treatments, lifestyle changes, and interactions with their physicians that were related to IBS, and overriding themes identified from the focus groups.	The subjects described IBS as a chronic episodic illness that affects their daily lives. Interaction with the medical community seldom clarified understanding of the condition or improved its management. Three overriding themes emerged from the groups: a sense of frustration, a sense of isolation, and a search for a niche in the health/sick role continuum. Frustration was evident in the perceived inability to control symptoms, prevent episodes, identify episode triggers, and obtain medical validation of the condition. The constant anticipation of the next IBS episode, the need for immediate access to toilet facilities, and the nature of the bowel symptoms often required withdrawal from social activities and resultant isolation.	IBS is perceived as a chronic condition resulting in frustration and social isolation, and physicians are perceived to be providing inadequate medical information or support to patients with IBS.	
11385830	Personality changes in 7 participants with bilateral ventromedial prefrontal lesions (PF-BVM), 14 participants with prefrontal lesions but not bilateral ventromedial involvement (PF-NBVM), and 36 with nonprefrontal lesions (NPF) were investigated with the Iowa Rating Scales of Personality Change. Informants rated 30 specific characteristics for degree of disturbance and change from premorbid personality. PF-BVM participants showed a higher rate of acquired disturbances than NPF participants in blunted emotional experience, apathy, low emotional expressiveness, inappropriate affect, poor frustration tolerance, irritability, lability, indecisiveness, poor judgment, social inappropriateness, lack of planning, lack of initiation and persistence, and lack of insight. Differences between the PF-BVM and PF-NBVM groups were significant for several of these characteristics. All 7 PF-BVM participants developed a syndrome, including general dampening of emotional experience; poorly modulated emotional reactions; defective decision making, especially in the social realm; impaired goal-directed behavior; and striking lack of insight. Similarities between this syndrome of "acquired sociopathy" and developmental psychopathy in characteristic personality disturbances and psychophysiological abnormalities suggest that diminished emotionality, impaired decision making, and psychosocial dysfunction may be related to ventromedial prefrontal dysfunction in both groups.
11376543	This article provides a theoretical and methodological framework for the use of cognitive analysis to support the representation of biomedical knowledge and the design of clinical systems, using clinical-practice guidelines (CPGs) as an example. We propose that propositional and semantic analyses, when used as part of the system-development process, can improve the validity, usability, and comprehension of the resulting biomedical applications. The framework we propose is based on a large body of research on the study of how people mentally represent information and subsequently use it for problem solving. This research encompasses many areas of psychology, but the more important ones are the study of memory and the study of comprehension. Of particular relevance is research devoted to investigating the comprehension and memory of language, expressed verbally or in text. In addition, research on how contextual variables affect performance is informative because these psychological processes are influenced by situational variables (e.g., setting, culture). One important factor limiting the acceptance and use of clinical-practice guidelines (CPGs) may be the mismatch between a guideline's recommended actions and the physician-user's mental models of what seems appropriate in a given case. Furthermore, CPGs can be semantically complex, often composed of elaborate collections of prescribed procedures with logical gaps or contradictions that can promote ambiguity and hence frustration on the part of those who attempt to use them. An improved understanding of the semantics and structure of CPGs may help to improve such matching, and ultimately the comprehensibility and usability of CPGs. Cognitive methods of analysis can help guideline designers and system builders throughout the development process, from the conceptual design of a computer-based system to its implementation phases. By studying how guideline creators and developers represent guidelines, both mentally and in text, and how end-users understand and make decisions with such guidelines, we can inform the development of technologies that seek to improve the match between the representations of experts and practitioners. We urge informaticians to recognize the potential relevance of cognitive analysis methods and to begin more extensive experimentation with the their use in biomedical informatics research.
11372814	Delusions of parasitosis, though uncommon, are an important cause of distress for affected patients and frequently of frustration for their physicians. They occur primarily in middle-aged or older women, who have the delusional belief that they are infested with parasites. Although the vast majority of cases involve dermatologic manifestations, some patients may have delusions of intestinal infection, as illustrated by this case.
11351894	This study investigated the possible relationship between Ellis's construct of irrational thinking and Seligman's construct of explanatory style, with a view toward possibly strengthening the personality theory underlying Rational Emotive Behavior Therapy in particular and cognitive-behavior therapies more generally. In this investigation 180 college students were administered the Survey of Personal Beliefs and the Attributional Style Questionnaire to measure irrational thinking and explanatory style, respectively. Students who scored higher on Pessimistic Explanatory Style also scored higher on Overall Irrational Thinking and on Low Frustration Tolerance than did those who were categorized as having an Optimistic Explanatory Style. This indicates support for Ellis's developing personality theory, especially his theoretical account of depression.
11351884	To test the hypothesis that the irrational evaluative beliefs, postulated by Rational-Emotive Behavior Therapy, are associated with body dissatisfaction, 94 women (21 diagnosed with an eating disorder, 38 with high body dissatisfaction but without an eating disorder, and 35 with low body dissatisfaction) completed the Survey of Personal Beliefs and the Eating Disorders Inventory. Analysis showed no significant difference in body dissatisfaction between the Eating Disordered and High Body Dissatisfaction subgroups. No significant correlations between body dissatisfaction and irrational beliefs were found for the Eating Disordered subgroup. For the High Body Dissatisfaction subgroup, significant but low correlations were found between scores on body dissatisfaction and irrational standards for self and others and with negative self-rating. In terms of irrational beliefs the Eating Disordered and High Body Dissatisfaction subgroups showed a significantly greater tendency towards Catastrophizing, Low Frustration Tolerance, and Negative self-rating, compared to the controls, without any significant difference between the former two groups. The Eating Disordered subgroup but not the High Body Dissatisfaction subgroup differed significantly from the controls in terms of more Self-directed demands.
11346326	The practice of medicine has many expected and accepted challenges, but all physicians experience some patients as difficult to a degree that transcends these expectations. Physician-experienced difficulty is associated with a syndrome of three characteristics: patient psychopathology, abrasive interpersonal styles, and multiple physical symptoms.To assess the roles played by the number of physical symptoms and by specific symptoms in determining whether physician-experienced difficulty occurs.	New analyses of epidemiologic survey data from the Primary Care Evaluation of Mental Disorders (PRIME-MD) 1000 Study.	Four primary care clinics.	627 ambulatory patients seen by 27 physicians.	Physician-experienced difficulty was measured by using the 10-item Difficult Doctor Patient Relationship Questionnaire (DDPRQ-10); patient-reported physical symptoms and physician-assessed psychopathology and somatoform symptoms were evaluated by using the PRIME-MD; and physical illnesses were measured by using a physician questionnaire.	The number of physical symptoms and the number of somatoform symptoms correlated with difficulty (r = 0.39 and r = 0.37, respectively; P < 0.001), and the correlations remained significant after adjustment for physical and mental disorders (r = 0.20 for both correlations; P < 0.001). Difficult patients were more likely to have each of 16 physical symptoms; the odds of being difficult were greater for patients with 1 of 5 particular symptoms (stomach pain, fainting, loose stools/diarrhea, palpitations, and sleep problems), even after adjustment for physical and mental disorders. All 10 items on the DDPRQ-10 were influenced by physical symptoms, particularly those items that asked about physician frustration and whether patients were manipulative and time consuming.	The association between physical symptoms and difficulty is due in part to the association between physical symptoms and mental disorders, but symptoms also contribute independently to difficulty. The independent component of symptom-associated difficulty may be due to 1) differences between patient and physician in expectations about treatment and 2) the part that symptoms play in conferring the "sick role" on a patient.	
11332258	To gain insight into the prevalence of faecal incontinence, looking for medical attention, treatment and the impact of faecal incontinence on the quality of life in community-residing men and women of 60 years and over.Enquiry and interview.	A questionnaire about the incidence of faecal incontinence and the request for help from the family doctor was mailed in 2000 to persons aged 60 and older listed in seven general practices in and round Nijmegen. In an interview with persons with faecal incontinence questions were asked about the need for assistance and the psychosocial consequences of the incontinence.	Of the 3887 questionnaires mailed, 3345 were available for analysis, from 1536 males and 1809 females. The prevalence of faecal incontinence was 6%. The male-female distribution was equal and a rise in prevalence was seen with advancing age. One-third of the population discussed the incontinence with their physician, more women (58%) than men (42%). The faecal incontinence had hardly any impact on daily or social activities but the subjects did feel anxiety, shame or frustration. Treatment, if given (14/17), consisted of a prescription for diapers (n = 2) or of referral to an internist for examination of the intestines (n = 4).	Faecal incontinence occurred in 6% of persons aged 60 or older living independently. Explicit looking for medical attention was not common. There were hardly any male-female differences. The most impact on the quality of life concerned the emotional wellbeing. Treatment had a little effect.	
11331802	The purpose of this study was to examine the prevalence of religious coping among persons with persistent mental illness and to gain a preliminary understanding of the relationship between religious coping and symptom severity and overall functioning.A total of 406 individuals who were diagnosed as having a mental illness and who were patients at one of 13 Los Angeles County mental health facilities completed a survey consisting of the Religious Coping Index, the Symptom Checklist 90-R (SCL-90), the Global Assessment of Functioning (GAF) scale, and a 48-item demographic questionnaire.	More than 80 percent of the participants used religious beliefs or activities to cope with daily difficulties or frustrations. A majority of participants devoted as much as half of their total coping time to religious practices, with prayer being the most frequent activity. Specific religious coping strategies, such as prayer or reading the Bible, were associated with higher SCL-90 scores (indicating more severe symptoms), more reported frustration, and a lower GAF score (indicating greater impairment). The amount of time that participants devoted to religious coping was negatively related to reported levels of frustration and scores on the SCL-90 symptom subscales.	The results of the study suggest that religious activities and beliefs may be particularly compelling for persons who are experiencing more severe symptoms, and increased religious activity may be associated with reduced symptoms. Religion may serve as a pervasive and potentially effective method of coping for persons with mental illness, thus warranting its integration into psychiatric and psychological practice.	
11313080	We investigated whether melancholic and non-melancholic Japanese depressive patients differed in regard to a personality feature, interpersonal sensitivity, as measured by the Interpersonal Sensitivity Measure (IPSM).In addition to 154 normal controls, 66 remitted melancholic patients and 55 remitted non-melancholic patients filled out the IPSM and two widely-used comprehensive personality inventories, the Temperament and Character Inventory (TCI) and the Munich Personality Test (MPT). The subdivision of patients was made according to three major symptom-based criteria for melancholia (those of RDC, DSM-III, DSM-IV).	Multivariate and post-hoc univariate analyses of variance revealed significant differences among the three groups in several personality dimensions after Bonferroni's adjustments of P values. While reported scores of both melancholic and non-melancholic patients deviated from normative scores on several personality dimensions, non-melancholic patients reported significantly higher scores on the total IPSM and the 'fragile inner-self' (a subscore of the IPSM) than did normal controls or melancholic depressives. The principal component analysis isolated two factors related to depressive disorders: one factor corresponding to the five IPSM scores; and the other corresponding to harm avoidance, neuroticism and frustration tolerance. The scores on the former factor differentiated non-melancholic depressives from melancholic depressives and normal controls. The scores on the latter factor differentiated both melancholic and non-melancholic depressives from normal controls.	Prospective studies in which depressive subjects are subdivided into melancholic and non-melancholic subjects will be required to see whether the personality deviations here related to depressive disorders strongly reflect the premorbid personality function.	These results indicate that the IPSM scales (particularly, the fragile inner-self scale and the total IPSM scale) are relatively independent of all dimensions included in the two comprehensive personality inventories, and have a capability to describe personality differences between non-melancholic depression and melancholia.	
11302071	Traditionally, supports and services for people diagnosed with Alzheimer's disease have focused on the caregivers. The increase in early diagnosis of Alzheimer's disease has resulted in greater numbers of older adults that have some insight and awareness of their deficits and are capable of dealing with the ramifications of their illness. Yet there are few places to turn for support and education. Circle of Care, a community-based home support agency in Toronto, has developed a support group for individuals with early stage dementia. Comprehensive Rehabilitation and Mental Health Services (COTA), a community-based rehabilitation agency, was invited to provide a co-facilitator for this group. To date, three groups have been held, each one having a fixed membership and meeting for eight sessions of one and a quarter hours. Topics focused on causation, coping with memory problems, loss, grief, and daily living skills. Positive themes emerged to reveal feelings of affirmation, camaraderie, and improved confidence, while feelings of helplessness and frustration were also raised. Implications for future planning and interventions also will be discussed in this paper.
11291024	Deficits in motivated behavior are a very common sequela of most neuropsychiatric disorders, a source of significant disability to the individual, and a source of great frustration to their caregivers. Well-intentioned attempts to encourage certain activities in the apathetic patient often precipitate aggressive, dyscontrolled behavior. The psychopharmacologic approach to motivated behavior deficits is informed by the study of the components, circuitry, and neurochemistry of motivated behavior in animals and humans. This article selectively reviews this literature. The circuitry of motivated behavior involves a combination of behavior specific regions in the hypothalamus as well as a general reward system running from midbrain to forebrain and including important components of several frontal-subcortical circuits. Catecholaminergic systems, particularly the mesolimbic dopaminergic system, are key modulators of motivated behaviors. Treatment thus involves the use of catecholaminergic agents.
11279917	The purpose of our study was to determine whether or not patients reporting weekend headache exhibit distinctive features in their work habits, family life, and leisure on workdays and on weekends as compared to other headache sufferers, and whether or not they are inclined to change their living habits at the weekend. The study was done on an initial sample of 50 patients referred to the University of Parma Headache Centre between October 1996 and April 1997. These patients completed a specially designed questionnaire which, in addition to demographics, contained specific questions relevant to the subject matter being investigated. They were also given a diary which they had to complete for 8 consecutive weeks in order to determine the actual frequency of headache attacks over different days of the week. The questionnaire data were only analyzed for the 38 women in the sample, because there were too few male controls for an accurate comparison with weekend headache sufferers. Among the women with weekend headache, work habits, family life, and leisure were such as to suggest a possible increase in stress and frustration on weekends, which might have made them perceive the headaches occurring on Saturdays and Sundays as more severe. No changes were found in the intake of substances such as coffee and alcohol, nor in cigarette smoking over the different days of the week. Finally, analysis of the diaries showed an increased frequency of headache attacks on weekends only among the men, which seems to corroborate the hypothesis of weekend headache as a disorder typically affecting men.
11270456	To test the 'absolute misery hypothesis' that suicide rates are a proxy measure of psychological maladjustment within the general population of young people.Study I regressed World Health Organization statistics on youth suicide rates on measures of adolescent adjustment across seven countries. Study II analysed the results of a Canadian survey involving 2,111 children from 31 schools in grades seven to 12 (ages 11-20 years, mean = 15.5, SD = 1.7). The survey contained measures of suicidality, depressed affect and social comparison.	Study I found that male suicide was much more likely in psychologically well-adjusted countries than in less well-adjusted countries. Although not statistically significant in a sample of this size (n = 7), correlation analysis suggested that the relationship between suicide and adjustment was in the opposite direction for females. Study II found that suicidality in boys was not associated with depressed affect on its own, or with social comparison on its own, but was associated with the combination of depressed affect and negative social comparison. By contrast, suicidality in girls was significantly associated both with absolute and comparative levels of unhappiness.	A new, 'relative misery hypothesis' is proposed to account for these results. Under this hypothesis, the disposition of vulnerable young men towards suicide is influenced by their affective state relative to others. When those around them are perceived to be better off than they are, the predisposition of young men to suicide is increased. By contrast, female suicide is predicted to be less influenced by young women's relative state, and more by their absolute level of unhappiness. The primary implication of the relative misery hypothesis is that the prevention of young male suicide in particular is likely to require methods that discourage vulnerable individuals from making negative social comparisons.	
11261056	The present Government has made much of its commitment to gaining patients' views on the health services they receive. Qualitative studies of patients with leg ulcers have highlighted the fact that patients feel healthcare professionals do not always empathize with their plight and sometimes appear to lack the skills to help them. Quality of life in chronic wound care has, thus far, eluded definition but strenuous efforts are being made to quantify the impact that issues such as pain, isolation and frustration can have on leg ulcer patients. If healthcare professionals are able to demonstrate empathy with patients they may be able to maximize the cooperation needed for the management of ulcers. By reflecting on gaps in their knowledge and becoming more assertive in their demands for appropriate training, nurses can improve the outlook for patients' quality of life.
11260485	What psychosocial issues do adolescent cystic fibrosis (CF) patients experience after undergoing lung transplantation (Tx)? The aim of this study was to determine, using an ethnographic study design, the common themes and emotional responses in post-lung transplant adolescent CF patients of the Cardiothoracic Transplant Clinic at the Childrens Hospital Los Angeles. Nineteen CF lung transplant recipients were studied (eight males, 11 females: mean age at time of transplant, 15.7 +/- 2.7 yr). The mean time interval from Tx to interview was 25.4 months (range 1-58 months). Sixteen patients had living donor lobar lung Tx while three patients received cadaveric lungs. A series of 25 questions was used to assess the psychosocial impact of Tx, and a semi-structured interview focused on the following five domains: lifestyle, family functioning, social functioning, body image, and psychological functioning. The major themes identified by patients included: a strong desire to set and attain meaningful long-range goals, the need to control as many aspects of their lives as possible while dealing with parental over-protectiveness, and the adjustment to a new lifestyle. Common emotional responses included manageable fear/anxiety of lung rejection and uncertainty of the future, impatience with disruptions of daily routines caused by post-transplant medical management and its effect on the attainment of set goals, and frustration with parental over-protectiveness. In general, patients reported a positive outlook on life, with greater emphasis on sought-after goals as well as inter-personal relationships. This study demonstrates that adolescent CF transplant recipients develop long-term goals and plans for independence. By identifying and anticipating the emotional needs of this population, health care providers can assist patients in improving the quality of their lives from a physiological, as well as a psychological, viewpoint.
11251715	This study explored paediatric nurses' experiences of caring for children with special needs and their families in an acute care setting. The aim of the study was to increase understanding of nurses' experiences of caring for these children and their families. The study was designed to reveal the caring practices embedded within these relationships through exploring nurses' stories.Gadamerian hermeneutic phenomenology and feminist research principles were the approaches used to guide the study. Interviews were held with experienced paediatric nurses and interpretation of interview transcripts using a Gadamerian hermeneutic phenomenological approach resulted in the identification of four themes.	The four themes revealed were: Special Relationships; Multiple Dimensions of Who is Expert; Development of Trust Between Nurses and Families; and Feelings of Frustration and Guilt.	The study emphasized the context-specific nature of relationships between nurses and children and their families. The nurses spoke about the difficulties they encountered in their practice and some of the ways that they dealt with these problems. They discussed the things that they valued and those that made them feel guilty and frustrated. In doing so, they revealed their warmth, strength, humanity and caring.	
11234711	Advantages and risk of weight reduction achieved by combining diets or unbalanced diets with restriction of carbohydrates or fat are discussed. Nutriments differ according to their density, their flavour, their satiating, and their thermogenic effect. Food is also a source of pleasure and a remedy to frustration. One of the problems of dieting is that most patients regain the weight they have lost due to a hypometabolism secondary to caloric restriction. Only physical exercise together with behavior therapy are able to slow down this weight regain. The indication of drug treatment with orlistat, sibutramine and fluoxetin and the indication to bariatric surgery are presented. The importance of the prevention of obesity by nutrition teaching in schools as well as the necessity of a long term treatment as in type II diabetes are underlined.
11234104	The author presents a psychoanalytic reading of the Danish author Peter Høeg's masterpiece 'Miss Smilla's Feeling for Snow', focusing on the special linguistic style of the novel. Further, the author puts forward an interpretation of the heroine, seeing her as a literary example of female bisexuality. Investigating the heroine's fate, the author discusses Miss Smilla's phallic defence and identity. The narrative technique in Høeg's novel is analysed through Lacan's concepts of the Real, the Imaginary and the Symbolic. The main figure is interpreted as an imaginary example of female bisexuality. Miss Smilla has neither an unambiguous gender identity nor ethnicity. The heroine is pictured in a conflict between two cultures: the Greenlandish and the western European, and her bisexuality both reflects this and is part of it. The author proposes to interpret a significant memory from Smilla's early childhood as an example of a castration phantasy, which retroactively gives new significance to the little girl's pre-oedipal frustration.
11226555	There have been few studies of the psychiatric characteristics of analgesics addiction. The physician's perceptions that patients were addicted to analgesics might be partially attributable to frustration with poor response to treatment. In this retrospective study, we evaluated the medical records of 20 subjects (15 male and 5 female) who were perceived as having addiction to meperidine by general physicians. The most common medical diagnosis among these patients was chronic pancreatitis (7/20). Among them, five had a past history of suicide attempt and three had self-injury behavior during the index admission. The fact that subjects were perceived as being addicted might be attributable to a vicious cycle of the following factors: 1) chronic intractable pain; 2) poor staff-patient relationship; 3) lower pain threshold or tolerance due to anxiety or depression; 4) patients with a history or tendency of substance abuse; 5) placebo use and inadequate analgesics regimen. The findings of this study suggest that the importance of the following diagnostic and treatment procedures in these patients: 1) suicide risk should be evaluated; 2) comorbid psychiatric diseases should be treated; 3) factors that cause a vicious cycle in pain control should be identified; 4) misconceptions of opiate analgesics among medical staff should be discussed; 5) poor staff-patient relationship should be managed aggressively; and 6) "addiction" is a critical diagnosis that should be avoided if possible.
11219911	Breath holding attacks are most common in children aged 6 months to 6 years, in 76% of cases between 6 and 18 months of age. Very often they are misinterpreted as tonic epileptic seizures. They are provoked by frustration, anger or sudden injury. Child starts to cry, then holds the breath at the end of expirium. After a few seconds it becomes cyanotic, and losses consciousness. It is usually floppy, but sometimes stiffness, and clonic seizures can be present, and child can be diagnosed as having epilepsy. The form in which child is pale is less frequent, and crying is usually brief or even absent in this type. Breath holding attacks usually do not last more then one to three minutes. Good heteroanamnesis is essential for diagnosis, revealing provoking factors for each attack. Interictal EEG registration is usually normal. Attacks often spontaneously cease after 5 or 6 years of age, and do not require any medical treatment. In more severe cases behavioral therapy has shown good results. It has been noticed that those children in adolescence have syncope more frequent then rest of population. Seventeen children (12 male and 5 female) were investigated at Pediatric Hospital in Sarajevo as breath holding attacks in period from June 1997 to June 2000. Age of patients was between 5 months and 5.5 years (median was 11 months). Hypochromic anemia was present in 12 patients (76%), with average hemoglobin value of 8.2 g/dl (5.9-11.0 g/dl). All children had normal EEG recording. Iron therapy gave positive response in 8 out of 9 patients that were followed (88.9%). Three patients had not come for follow up. It is concluded that hypochromic anemia is often a part of clinical presentation of breath holding attacks in children, and iron therapy can stop them.
11216425	Traumatic experience has overall far reaching consequences on personality. In particular, it has significant impact on teenagers that are just approaching the phase of solving their identity problems. This research examines the relation of traumatic experience and attitude towards the future in two groups of adolescents. The first group consists of 20 adolescents-refugees from the East Slavonia that were settled in Rijeka area with their parents during the last six years. The second group consists of 20 adolescent's local inhabitants that were influenced by the war only indirectly. Results show significant difference between refugees and non-refugees in expressed interpersonal trust, frustration tolerance, and formation of close contacts, adaptability, precaution, bitterness, and social desirability. Both groups show increased depression, pessimism and poor self-control. This might be considered as general characteristic of society in war.
11216023	The purpose of this phenomenological study was to describe the experience of caring for a family member with Alzheimer's disease or related disorder (ADRD) living at home among a diverse sample of 103 family caregivers. The study involved secondary analysis of in-depth transcribed interview data using van Kaam's rigorous four phase, 12-step psychophenomenological method. A total of 2,115 descriptive expressions were categorized into 38 preliminary structural elements. Eight essential structural elements emerged from an analysis of the preliminary structural elements. The eight elements were then synthesized to form the following synthetic structural definition: Caring for a family member living at home with ADRD was experienced as "being immersed in caregiving; enduring stress and frustration; suffering through the losses; integrating ADRD into our lives and preserving integrity; gathering support; moving with continuous change; and finding meaning and joy."
11195533	100 patients (88 women, 12 men) of 16-64 years of age with functional dysphagia were examined. In all the cases the disease develops under the influence of stress in individuals with high anxiety, easy formation of dysthymic, obsessive-phobic reactions in the situation of frustration. Functional dysphagia arises most frequently at the age of 20-40 years. 4 stages pass in the course of the disease: a stage of reactive (neurotic) depression; psychosomatic reactions; psychosomatic cycles (mono- and polysomic); psychopathization. Psychopathization manifests pathologic (psychosomatic) development of personality observed usually in long-term course of dysphagia.
11182922	Reviews and consultations with regional health authority decision makers have indicated that both data quality and access can limit effective use of health services information when assessing outcomes, planning changes, testing solutions and making decisions. To further a more system-wide understanding of these data utilization issues, we asked senior managers, board members and information analysts in Alberta regional health authorities (n = 111) about the availability of, organizational supports for and barriers to the use of health service utilization data. Eighty percent of respondents stated that the lack of data impeded problem resolution, and 83 percent of managers stated that health service data alerted them to new problems. Examples of useful data related to good standardization and linkage of data sets, or to capacity for valid comparison and trending. Given the limitations highlighted in relation to meeting even the simplest needs of standardization, linkage, comparison and trending, Alberta health care managers indicate frustration in trying to use health service data as currently construed and distributed, particularly within their current frameworks and fast-paced timelines for decision making.

11128624	Current medical literature suggests that Type 2 diabetes mellitus can be controlled by diet and hypoglycemic agents or diet and insulin therapy. Nevertheless, adhering to a low glucose dietary regimen remains problematic for a majority of patients, and management of the disease is an ongoing source of frustration for physicians and other providers. While calling for more research on the physician's experience of treating chronic conditions like diabetes, the authors argue that much of the current frustration stems from the different frames or explanatory models that physicians and patients use to understand the disease. By comparing physician narratives collected in several clinical contexts (e.g., medical lectures, precepting sessions, patient care sessions and personal interviews) with patient stories obtained primarily through narrative interviews, the authors highlight crucial differences in the way physicians and patients experience and think about the disease. In particular, the authors highlight differences between physicians and patients across five dimensions: etiology, symptoms/signs, factors which affect blood sugar, ideal blood sugar, and future prospects. In concluding, the authors sketch out elements of a theory of clinical practice involving diabetes care. Data for the study was collected at two family practice training sites in Chicago.
11122962	The authors discuss the significance of identifying primary care patients with dramatic and persistent unexplained physical (medical) symptoms, especially given the concerns about containing health care costs. Such patients are a cause of frustration to the clinician, because the clinician may experience a sense of failure after using the state of the art and still being eluded by a diagnosis. We focus on the methods for understanding somatic worry or preoccupation, which is the essential process in a variety of somatoform disorders. The second half of the article focuses on evaluation and treatment considerations and includes a discussion of both psychotherapeutic and psychopharmacologic treatment strategies for the somatizing patient.
11118778	To identify emotional and attitudinal barriers to improved glycemic control (HbA1c) during intensive diabetes treatment, 55 patients attending a 4-5 month intensive diabetes medical/education clinic were followed. Subjects completed a battery of psychological surveys, had HbA1c and body mass index measured, and rated their attitude toward weight gain and the extent of problems with specific self-management behaviors before and after the medical intervention. Although HbA1c improved on average, 29% had only modest improvement and 16% showed no improvement. The number of diabetes-related annoyances, worry about hypoglycemia, and diabetes-related emotional distress diminished. Only the satisfaction subscale of the Diabetes Quality of Life survey, diabetes-related emotional distress, and problems with self-management behaviors correlated with HbA1c. Treatment-related frustration and emotional distress may initially act as motivators to improve glycemia but can later become barriers to that goal. Interventions designed to help patients overcome attitudinal barriers should be incorporated into medical programs geared toward improving glycemia.
11115010	Waiting lists for coronary artery bypass surgery (CABS) are common in many developed countries. Yet, there is limited information available regarding patients' health care needs at this time. This paper reports on a prospective study which aimed to investigate the experience of waiting for CABS from a qualitative perspective. An inductive research approach was used to conduct interviews with 70 randomly selected patients at three intervals over the first year on the waiting list - referral for surgery, again after waiting 6 months (n=49), and finally after waiting for 1 year (n=28). Attrition was mainly caused by surgery having been performed (n=36), although death (n=4) and refusal to participate (n=2) also contributed. Domicilliary interviews were taped and transcribed verbatim. Thematic content analysis identified three central themes in this experience - uncertainty, chest pain and anxiety; with six secondary themes - powerless, dissatisfaction with treatment, anger/frustration, physical incapacity, reduced self-esteem, and altered family and social relationships. The nature and meaning inherent in each theme is described using interview quotations, and a model is proposed which summarizes this data and the relationship between themes. From this analysis, uncertainty, chest pain and anxiety emerge as important indicators of a negative outcome for these patients. This report strongly suggests that patients awaiting bypass surgery require more information regarding the waiting time for such a surgery. Nurses should also offer advice regarding pain management to help improve patients' skills and decrease the fear associated with angina. Nursing intervention and support should also be directed at reducing patients' anxiety levels. This is the first known qualitative study which specifically examines patients' perception of the waiting period prior to bypass surgery. It may therefore provide new evidence on which to base practice for nurses in both hospital and community, and may also stimulate further research in this area.
11114391	The social and economic impact of lymphatic filariasis was studied in Northern Ghana. Qualitative methods of gathering information revealed that even though the disease was a problem to both men and women, men with hydrocele suffered a greater psychosocial burden. Particular attention was paid to them, distinguishing men with small hydroceles and men with large ones. Out of frustration men with small hydroceles sought health care from a wider range of places than men with larger ones. The pain associated with adenolymphangitis (ADL) renders them inactive for up to 5 days. Complications of lymph scrotum and ridicule from community members were a problem. Unmarried men in particular found it difficult to find a spouse with their condition, and various degrees of sexual dysfunction were reported amongst married men. The clinical significance and the value of time and attention for counseling to mitigate the effects of the disease on damaged male identity and the need for gender studies to address male issues and the need for including psychosocial issues in the calculating of disability adjusted life years (DALY's) is also discussed.
11096804	The discomfort and frustration often experienced by patients with gastrointestinal (GI) disorders may lead many to seek alternative health care (AHC). This study was conducted to describe AHC use by patients with GI disorders in a convenience sample (N = 73) from a tertiary hospital in Florida. AHC was explored within social exchange theory. Measurement instruments included the Alternative Health Care Gastrointestinal Sociodemographic Questionnaire, Alternative Health Care Use Questionnaire, and Alternative Health Care Advantages/Disadvantages Questionnaire. The study indicated that 32 subjects (43%) had used AHC for their GI disorders during the past 2 years. Most frequently used AHC included relaxation therapy, herbs, lifestyle diets, megavitamins, massage, and home remedies. There was a greater use of AHC by young persons (t = 2.39, p = .02) and by those not retired (chi 2 = 4.58, p = .03). AHC was associated with perceived rewards (r = .38, p = .03) and perceived profits (r = .38, p = .03). AHC was not associated with type or duration of GI disorder or other demographic variables. Subjects specifically cited benefits with relaxation therapy, vegetarian diets, spiritual healing, fish oil for inflammatory bowel disease, and use of milk thistle for hepatitis.
11094916	In meeting national needs for our terminally ill, health care educators need to become more aware of their students' aptitudes for hospice work. For these reasons we measured hospice nurses' attitudes toward caring for the terminally ill and their views on using opioids, and compared them to those of other health care personnel and their students. Thirty-eight hospice nurses, 64 other nurses, 93 physicians, and 676 senior medical students participated in this study. Our primary measures were scales assessing thanatophobia and opiophobia and a battery of personal and professional role trait measures. Our results indicated that in providing end-of-life care, hospice nurses expressed less discomfort, helplessness, and frustration, and indicated less reluctance to use opioids than did any of the other groups surveyed. Overall, these hospice nurses had 35 percent lower opiophobia and 55 percent lower thanatophobia scores than the other health care professionals. Despite dealing with issues of death and dying on a daily basis, hospice nurses also scored lower on depressed mood. In caring for the terminally ill, hospice nurses' other personal traits were also less maladaptive than those of the other health professionals. Psychiatrists exhibited the most opiophobia, not only scoring higher than physicians practicing oncology, but also higher than senior medical students. To assure cancer patients that they can expect to live their lives free of pain, medical educators can use these thanatophobia and opiophobia scales to develop better teaching, counseling, and monitoring strategies.
11073699	This study examined the associations between relationship qualities, sexual behaviors, and relationship length in 61 adolescent couples (aged 16-20). For both male and female partners, positive relationship qualities were associated with physical expressions of affection. Perceptions of higher levels of conflict and frustration were associated with more frequent sexual intercourse. Factor analysis and multiple regression indicated that the frequency of sexual behavior and the perception of global relationship quality (support, depth and intimacy) predicted relationship length for these couples. While the frequency of sexual expression was associated with relationship longevity for both male and female partners, positive relationship qualities (depth and intimacy) were additionally associated with relationship longevity for male partners only. Implications of these findings are discussed in light of current gaps in understanding the relational context of adolescent sexual behavior.
11062614	Increasing popularity of traditional Chinese medicine (TCM) by the American public warrants an examination of its role in all of nursing. Many people seeking alternative treatments do so out of frustration with the inability of Western medicine to help with chronic illnesses. Thus, Western practitioners need a basic understanding of these alternative modalities to help their clients make informed choices about their health care. This article describes the underlying theory of TCM, assessments, diagnostics, and treatments found in TCM, as well as uses of TCM in orthopaedic nursing. Also included are research considerations as well as precautions in the use of TCM.
11042431	The purpose of the present investigation is to describe how parents experience a delayed identification of their child's hearing impairment. Ten parents of 8 children were interviewed. The impairment was confirmed when the children were between 2 years, and 5 years and 8 months. The results show that the parents and their child pass through a series of distinct phases: Unawareness, Suspicion, Confirmation and Habilitation. After the birth of the child there was first a calm period, which lasted until the possibility of a hearing impairment was suspected. Once the suspicion was raised, a time of much anxiety and frustration ensued. The parents described how defective communication and misunderstanding lead to frequent conflicts with their child. The differing behaviour of the child, in combination with poor language development, initiated referral to audiological assessment and confirmation of the hearing impairment. After confirmation, the parents felt relief but at the same time a sorrow. When hearing aids had been fitted and education in sign language was under way, the child's language and social behaviour improved. Supposedly, the late detection is explained by the combination of an insufficient test method that cannot detect all children with a hearing impairment and, in cases of uncertainty, a tendency to let the child pass rather than "bringing bad news". All parents in the present study would have wished to participate in a hearing screening program for new-borns, had the opportunity been present.
11010346	Using an existential-phenomenological approach, this paper describes how women with breast cancer experience the giving and receiving of social support in a computer-mediated context. Women viewed their experiences with the computer-mediated support group as an additional and unique source of support in facing their illness. Anonymity within the support group fostered equalized participation and allowed women to communicate in ways that would have been more difficult in a face-to-face context. The asynchronous communication was a frustration to some participants, but some indicated that the format allowed for more thoughtful interaction. Motivations for seeking social support appeared to be a dynamic process, with a consistent progression from a position of receiving support to that of giving support. The primary benefits women received from participation in the group were communicating with other people who shared similar problems and helping others, which allowed them to change their focus from a preoccupation with their own sickness to thinking of others. Consistent with past research is the finding that women in this study expressed that social support is a multidimensional phenomenon and that their computer-mediated support group provided abundant emotional support, encouragement, and informational support. Excerpts from the phenomenological interviews are used to review and highlight key theoretical concepts from the research literatures on computer-mediated communication, social support, and the psychosocial needs of women with breast cancer.
11001134	The authors describe the initial cohort of participants in the GET SMART program, an age-specific, outpatient program for older veterans with substance abuse problems. Chief among the program's services is a relapse-prevention intervention consisting of 16 weekly group sessions using cognitive-behavioral (CB) and self-management approaches. Group sessions begin with analysis of substance use behavior to determine high-risk situations for alcohol or drug use, followed by a series of modules to teach coping skills for coping with social pressure, being at home and alone, feelings of depression and loneliness, anxiety and tension, anger and frustration, cues for substance use, urges (self-statements), and slips or relapses. Of the first 110 admissions, more than one-third were homeless, which is indicative of the severity of psychosocial distress of the patients, and more than one-third used illicit drugs. A total of 49 patients completed CB treatment groups and 61 dropped out of treatment. At 6-month follow-up, program completers demonstrated much higher rates of abstinence compared to noncompleters. The results suggest that CB approaches work well with older veterans with significant medical, social, and drug use problems.
10967012	In the absence of research with adult donor offspring, this study begins to bridge that gap by asking individuals about their experiences as donor offspring and considering the implications for psychotherapeutic and counselling practice. Sixteen participants (13 male, three female, age range 26-55 years) recruited through donor insemination support networks in the UK, USA, Canada and Australia, were sent semi-structured questionnaires by E-mail and post. Using identity process theory as a framework for understanding participants' accounts, the data were qualitatively analysed using interpretative phenomenological analysis. Participants consistently reported mistrust within the family, negative distinctiveness, lack of genetic continuity, frustration in being thwarted in the search for their biological fathers and a need to talk to a significant other (i.e. someone who would understand). These experiences could be postulated as being indicative of a struggle to assimilate, accommodate and evaluate information about their new identities as donor offspring. Psychotherapists and counsellors need to be aware of these identity issues if they are to meet the needs of donor offspring within therapeutic practice.
10954097	Patients' perceptions of the result of lower-extremity amputation vary widely, yet the factors associated with this variability are not well understood. Our objective was to identify important correlations with the perceived result that may help to indicate the factors that deserve particular emphasis in the management of patients who have had an amputation.In this retrospective study, 148 patients who had had a major lower-extremity amputation completed a standardized questionnaire designed to assess the demographic characteristics, comorbidities, amputation characteristics, prosthetic function, and social function at a mean of seven years after surgery. We correlated each of these variables with four result metrics: general satisfaction, quality of life, freedom from frustration, and walking distance.	The four result metrics were significantly and strongly correlated with (1) the comfort of the residual limb; (2) the condition of the contralateral limb; (3) the comfort, function, and appearance of the prosthesis; (4) social factors; and (5) the ability to exercise recreationally (p < 0.0001). Interestingly, the level and laterality of the amputation were not significantly correlated with the patients' perceived result.	The perceived result of amputation is not associated with the amount of the limb that was amputated but rather with factors that may be optimized by surgical, prosthetic, and social management.	
10923549	Management of diabetes mellitus is difficult for both the patient and the clinician, and poor communication resulting from different conceptions of the disease and different treatment goals can exacerbate the problem.We used qualitative methods, including semistructured interviews with patients and clinicians and direct observation of clinical precepting sessions by trained observers at an inner-city family practice training site. Transcripts from these sessions were analyzed for content (with the help of Nud.ist software) to identify themes that highlight problem areas in clinician-patient communication.	The most important themes revolved around the concept of control, which was used in at least 3 different ways, and the concept of frustration. Frustration resulted from different understandings of the biology, physiology, and natural history of the disease, and approaches to treatment. In the interviews, clinicians often spontaneously acknowledged the multiple physical, psychological, and social obstacles to treatment confronted by their patients, but in observed practice they almost always focused entirely on managing blood sugar numbers.	Different conceptions of the term "control" affect the ability of patients and clinicians to communicate effectively. The tendencies of clinicians to view their own management strategy as scientific truth, and their focus on managing numbers rather than attempting to understand their patient's conception of disease and their treatment goals, lead to frustration and are serious obstacles to effective collaboration.	
10920417	Movement disorders have rarely been the result of psychiatric disturbances. Psychogenic dystonia is caracterized by inconsistent findings, a known precipitant factor, onset in legs, pain, multiple somatizations and incongruent association with other movement disorders. We report two patients with clinically established psychogenic dystonia. Patient 1: a female that presented sudden loss of strength in her four limbs; she developed feet dystonia, alternant laterocollis, generalized and irregular tremor, and limb hypertonia that disappeared with distraction; psychological examination showed severe depression, hypochondria and obsessive disorder. Patient 2: a female that presented with irregular limb tremors that disappeared with distraction and left foot dystonia nine years ago; she gradually lost her walk capacity; she complained pain in lumbar area and in her left limb, psychological examination showed infantile behaviour, low frustration tolerance, impulsivity and self-aggression. Their complementary exams showed no alterations and they had no response to specific pharmacological treatment. Dystonia is rarely psychogenic, but this etiology is suggested when clinical characteristics are inconsistent and incongrous with a classical disorder. It should be part of differential diagnosis when appears in association with other somatization or psychiatric disorders.

10886445	This phenomenological study was undertaken to explore in depth the experiences of registered nurses caring for adolescent anorexic females within paediatric wards of general hospitals in Victoria, Australia. A qualitative design underpinned by the philosophy of Edmund Husserl was employed for this study. Audio taped in-depth interviews with five registered nurses working within the public health care system were conducted. Using Colaizzi's procedural steps of analysis, six themes of meaning were explicated. They were: (a) personal core values of nurses; (b) core values challenged; (c) emotional turmoil; (d) frustration; (e) turning points; and (f) resolution. These themes, when taken together, described the essence of the journey undertaken by registered nurses who cared for adolescent anorexic females. The findings of this study indicated that there is a need for extensive registered nurse preparation, on-going support, and development of education programmes to enable registered nurses to care for these patients with greater understanding. Further, the participants identified the need for new care regimes and protocols to be developed that incorporated new ways of thinking. They also expressed a desire to be have greater involvement in the planned care of their patients.
10897536	General practitioners (GPs) are encouraged to play a major part in the care and treatment of drug users; however, many regularly encounter physical or verbal abuse and feel frustration, disappointment, and disillusionment when treating such patients. Furthermore, communication difficulties between doctor and patient and the advent of HIV serve to intensify these problems. In order to address these issues, a questionnaire survey was carried out to assess what proportion of GPs are commonly employed in the management of drug misusers, and to examine the attitudes towards, and knowledge of, the management of these patients. The results show that this group of GPs are concerned about drug misuse in their immediate geographic area and believe it should be detected in general practice. Despite this, fewer than half of the GPs felt they had adequate knowledge of the issues surrounding opiate misuse. This finding certainly raises the question of the availability of training and education in the area of drug misuse.
10889634	Premature birth, the leading cause of perinatal morbidity and mortality in the United States affects between 8% and 12% of all live births. Approximately 80% of premature births are proceeded by premature labor. Significant progress has been made in the physical treatment of premature labor; however, the psychological cost to women being treated needs further study. My purpose in conducting this study was to assess the stress experienced by women treated at home for premature labor and to examine methods used by the women to cope. The theoretical framework was provided by Lazarus's model of Stress, Coping, and Emotion. A total of 50 women participated. Twenty responded to a questionnaire that included the Perceived Stress Scale (PSS) and the Ways of Coping Questionnaire only, 10 were interviewed only, and 20 completed the questionnaire and the interview.The women reported experiencing a moderate amount of stress. Their mean stress score was 26.75, just below the mean for the instrument (M = 28) and slightly less than the stress score of 27.52 reported by women experiencing a "normal" pregnancy. Appraisal was assessed by analyzing the data from the interviews. The women appraised their situation as both threatening and challenging. They described their emotional response most frequently as frustration because of fear concerning the pregnancy outcome, loss of control over their life, and inability to perform their usual roles of mother, wife, and worker. The women reported on the Ways of Coping Questionnaire that they used strategies from three subscales to cope with the premature labor. Those subscales were Seeking Social Support, Planful Problem-Solving, and Positive Reappraisal.	
10880006	This study is part of an AIDS research-service project, implemented by a faculty member and graduate students from the University of Maryland, School of Social Work. It focuses on the last of the completed studies between 1993 and 1998. To access women-centered health care services in Washington, D.C., a four member team engaged in a gender-specific research intervention. Nine women with AIDS were hand picked and interviewed. The research team wanted the women with HIV/AIDS to have a forum in which to tell their stories, in their own words regarding their medical and social service needs. Anecdotal accounts from the researchers' journals provide descriptions for findings. Qualitative evaluation theories guided the development of the interview questions. This study explores demographic factors, method of contraction, symptoms, initial reactions, support systems, level of satisfaction and frustration with services, physical health-care needs, social service needs, including legal, housing, financial and mental health needs of women living with HIV/AIDS. The literature search reaffirmed the gender related disparities of services offered found by the team in the field. Recommendations for service providers are given.
10874426	The interaction of strong aggressive and libidinal drives, various primitive intrapsychic fantasies linking somatic sensations, body parts, ego, object, and the effects of early environmental stress and trauma all produce a potential crisis in the paranoid-schizoid period of development. Certain innate methods of understanding somatic experiences as well as the interaction between internal and external reality lead to an unconscious triangulation of part objects. A frustrating, stimulating, or punitive "third" that blocks, nullifies, or overgratifies certain wishes then emerges as a pivotal object in the internal landscape. During the paranoid-schizoid, triadic process, there is a fluctuation between separation/individuation and de-differentiation/fusion. If the early triangulation process has been either exceedingly frustrating or overly stimulating in regards to "reaching the third" or "warding off the third," the infantile ego is fixed by aggressive and libidinal forces to de-differentiation experiences rather than to more separate and individuated ways of relating. Therefore, the later oedipal stage will be colored by excessive oral and anal conflicts and will be weighted on the side of primitive maneuvering based on splitting, projection, and introjection. When the child (and later the adult) becomes involved in oedipal situations marked by stimulation or frustration of triadic drives, there can be a regression to the earlier paranoid-schizoid triadic period. A case study was presented in which a patient struggled with a partial working through of these conditions in dreams and in the transference. This pulled her more in the direction of a differentiated Oedipal conflict and whole object functioning.
10874291	A Brunswikian Evolutionary-Developmental model was developed to relate the sex offending behavior of adolescents to other forms of social deviance, tracing a history of repeated frustration and failure in various competitive sexual strategies and escalation to more extreme means of obtaining sexual gratification. Four hypothetical constructs were proposed as stages in the development of sexual criminality: (1) Psycho-Social Deficiency (PSD); (2) Non-Criminal Sexuality (NCS); (3) Non-Sexual Criminality (NSC); and (4) Sexual Criminality (SC). Significant direct and indirect pathways led from PSD to SC through both NCS and NSC, each time facilitated by an interaction with PSD. Although the causal orders between stages remain equivocal, the current results are consistent with our theory and establish the heuristic value of our theoretical approach, providing empirical support for otherwise counterintuitive predictions. This interpretation also offers hope for focusing preventative intervention at one major root cause of this unfortunate cascade of consequences, Psycho-Social Deficiency.
10870292	This study examined the associations among family processes (cohesion, control, and conflict), school-focused parent-child interactions (support and pressure about achievement), and the child's own characteristics (assertiveness, frustration tolerance, intellectual effectiveness, and self-esteem) as correlates of rule compliance and peer sociability in the classroom. The sample consisted of 161 Grade 4 and 151 Grade 7 children. Family processes and parent-child interactions about school issues were associated with children's personal characteristics, which, in turn, predicted children's rule compliance and peer sociability. Some differences were found between the 4th- and 7th-grade samples; however, many variables consistently predicted the same outcomes across grades.
10867581	A close examination of dysphoria, anger and aloneness (three main characteristics of the borderline syndrome) provides a theoretical model of reference for the therapist. Dysphoria results from the cyclical emotional oscillation between hope for stability and disappointment in its inattainability; a dependent-anaclitic depression arises from the mixture of anger, aloneness and inner emptiness which is so characteristic of the borderline syndrome. The tendency to be immersed in the here-and-now, an intra-festum mentality, exacerbates the sense of isolation, causing more irritation, mute frustration and, consequently, anger. The effects and ramifications of anger, and the resultant precarious cohesion of the self, are explored in the borderline syndrome; they are especially illuminated by the application of Kernberg's pain-anger-hate-vengefulness cycle concept. Meanings of solitude, in its forms of aloneness and loneliness, are explored in their pertinence. Aloneness - the constant needy search for, but condemnation to never finding, objects to fill an inner sense of emptiness - is especially germane. Suggestions for assisting subjects with borderline personality disorder to overcome aloneness and the lack of historical progression are made.
10866022	To investigate the relationship between maternal depression and infant temperament in a Japanese population, a prospective questionnaire survey was administered in the postpartum period. Postnatal depression was assessed by Zung's (1965) Self-Rating Depression Scale on two occasions (5 days and 12 months after delivery). At 6 months and 18 months after birth, infant temperament was assessed using the Revised Infant Temperament Questionnaire (RITQ; Carey & McDevitt, 1978) and the Toddler Temperament Scale (TTS; Fullward, McDevitt, & Carey, 1984), respectively. Of the five temperamental dimensions of the RITQ and TTS, "rhythmicity" and "attention span and persistence" showed reciprocal relationships with postnatal depression. Unidirectional effects of maternal depression on infant temperament were found for "frustration tolerance" and "fear of strangers and strange situations."
10851681	Although research on young children's abilities to organize emotional states has increased in recent years, little is known about the emergence of complex strategies for emotion regulation in preschoolers. In the present study, emotion-regulation strategies used by 52 normally developing 3- and 4-year-olds were examined. Children and their primary caregivers (50 mothers, 2 fathers) participated in 2 controlled frustration episodes that were videotaped. Four types of strategies were coded: comforting behaviors, instrumental behaviors, distraction behaviors, and cognitive reappraisals. Results indicated that 3-year-olds used proportionately more instrumental strategies than 4-year-olds, and parents of 3-year-olds showed the same pattern, whereas parents of 4-year-olds did not. Moreover, 3-year-olds used a variety of strategies when frustrated, including cognitive reappraisals. Significant positive correlations were found between the types of strategies used by the children and by the parents to help their children. It is suggested that children may be using strategies to organize their emotional states before they are able to accurately report on them.
10845136	To explore illness experiences of patients diagnosed with fibromyalgia.Qualitative method of in-depth interviews.	Midsize city in Ontario.	Seven patients diagnosed with fibromyalgia.	Seven in-depth interviews were conducted to explore the illness experience of patients diagnosed with fibromyalgia. All interviews were audiotaped and transcribed verbatim. All interview transcriptions were read independently by the researchers, who then compared and combined their analysis. Final analysis involved examining all interviews collectively, thus permitting relationships between and among central themes to emerge. The analysis strategy used a phenomenologic approach and occurred concurrently rather than sequentially.	Themes that emerged from the interpretive analysis depict patients' journeys along a continuum from experiencing symptoms, through seeking a diagnosis, to coping with the illness. Experiencing symptoms was composed of four subcategories: pain, a precipitating event, associated symptoms, and modulating factors. Seeking a diagnosis entailed frustration and social isolation. Confirmation of diagnosis brought relief as well as anxiety about the future. After diagnosis, several steps led to creation of adaptive coping strategies, which were influenced by several factors.	Findings suggest that the conventional medical model fails to address the complex experience of fibromyalgia. Adopting a patient-centred approach is important for helping patients cope with this disease.	
10833753	This study examined the effects of scores on state anxiety on overall accuracy of performance and speed of working in a simulated pharmacy dispensing task. 75 undergraduates worked in a simulated pharmacy environment, designed by Schell and Grasha in 1998, to fill 42 mock orders for simulated pharmacy items. Participants' accuracy and work pace in the simulation, presimulation stress, and postsimulation perceived workload and state anxiety were measured. Analysis indicated that state anxiety and overall accuracy were strongly related. State anxiety appears to be one of the best predictors of errors in the simulated pharmacy dispensing task found so far, while the lack of relationship between work pace and accuracy was confirmed. Work pace predicted accuracy, indirectly, but only after statistically removing the effects of anxiety, task frustration, significant-other stress, and grade point average.
10810846	A qualitative research study was conducted to describe and explain expectant father's experiences during labor when their partners receive labor epidurals.Grounded theory.	Seventeen couples were interviewed using a semi-structured interview format.	Two major concepts were identified: "Losing Her" and "She's Back." The men reported that these were the two critical points at which the epidural affected their experience. The theory, "Cruising through Labor," explained the fathers' experiences.	Childbirth preparation classes that describe and explain women's responses to the increasing pain of labor contractions, the exhaustion of labor, and the effect of epidural analgesia could possibly assist men in preparing for the changes they will witness in their partners during the labor experience. Knowing that these changes are normal responses to the effects of labor might reduce men's levels of anxiety, frustration, and sense of helplessness. The labor nurse is a major support to the expectant fathers. Labor nurses who remain in the room during this phase, explain what is happening, and include the expectant father in their nursing care provide the best support.	
10806450	My address to you today is born of frustration with the growing claims, evident in the research literature and in clinical reports that happen to cross my desk, of causation made on the basis of correlational data. I recall, as a sophomore in college, being taught early in my first experimental psychology course, "you cannot infer causality from correlation." This point was made adamant in my first face-to-face critique of an experimental psychology research paper by Dr. Robert T. Brown, who pointed out, in lowering my grade, that I had inferred organic causes to behavior patterns in gerbils based solely on correlational data. This caution was reiterated in my statistics courses until it must have been indelibly stamped upon my then still somewhat plastic brain.
10803804	This study explores whether personality is mediating the effects of adverse parenting on having had a lifetime history of major depressive disorder and whether personality dimensions, related to the development of lifetime depression, are disposed by adverse parenting in cross-sectional data derived from an epidemiological sample of volunteer workers. Of 447 individuals who were asked to complete the Munich Personality Test (MPT), the Parental Bonding Instrument (PBI) and the Inventory to Diagnose Depression Lifetime version (IDDL), 322 subjects were included in the analyses (150 male and 172 female; and 38 were diagnosed as having had a history of depression). Comparisons in fit between logistic regression models revealed that a combination of frustration tolerance and rigidity among personality dimensions, as measured by the MPT, and maternal care among the PBI scales were most primary in predicting a lifetime history of depression. Maternal care was, however, not significantly predictive of dimensional scores on the personality dimensions. Neither frustration tolerance nor rigidity was predicted by any PBI scale. When entering the variables sequentially, maternal care and the personality variables were additive and independent risk factors in predicting a lifetime history of depression. The results of this preliminary study raised an objection to a hypothesis that adverse parenting experienced in childhood disposes one to a dysfunctional personality, which then predisposes one to the development of depression in adulthood.
10795357	To explore the traditional Mexican religious fiesta as a primary locus for community-based excessive drinking and violence against women. The research argues that the pattern of drinking and violence cannot be placed within explanations that tie a breakdown in social norms to drinking nor drinking to a breakdown in social norms.The data were gathered over 14 continuous months of participant observation in 1995 and 1996, followed by two summer research projects in 1997 and 1998. The researcher documented the activities of the participants at each fiesta and followed-up each event with interviews of the parties involved in violent confrontations. In addition, life stories and archival data on violence were conducted and used to situate current findings against historical data.	All data were collected in the community of Santa Maria Atzompa. Atzompa is a cabécera or municipal seat, for six colonias (large neighborhoods), and three ranchos (agriculturally based communities) and has a population of just over 5200. The main community of Atzompa, where most of the research was conducted, has a population of 2700+.	Over 1000 individuals participated in community religious fiestas that the researcher attended. More than half of these were men, and almost all the men present participated in the binge drinking.	Sixteen religious fiestas and 13 non-religious fiestas were documented through participant observation and photographs.	In every religious-based fiesta, violence erupted and was directed primarily against women. Husband and wife abuse accounted for 10 of the 16 violent disruptions (63%) while male/male abuse accounted for six (38%).	The perpetuation of binge drinking and violence are part of a historic cycle of male dominance that dates back to the introduction of alcohol distillation during colonization by the Spaniards in the 16th century, compounded today by frustration over their inability to control the economic and political aspects of their households and community. Women's acquiescence to the violence is a form of mediation over male frustrations that allow women to continue in their roles as economic providers.	
10788281	The practice of self-harm is increasing in the United Kingdom, accounting for the highest number of acute medical admissions for women. The medical and nursing response to repeaters, set within a climate of dwindling emergency and accident resources, has been one of impatience, frustration, and hostile care. The author undertook a correspondence study with 6 women who regularly self-harmed. The women claimed that medical and nursing professionals viewed their self-harm as irrational and illogical. However, a qualitative examination of the motivations and interests of all parties reveals that self-harm acts possess situated internal logic, whereas professionals tend to use rational logic in attempting to understand them.
10786556	To validate, from a client and family perspective, the defining characteristics for the nursing diagnosis altered family processes: alcoholism; and to identify demographic, family, and selected treatment information from clients and family members.Subjects (N = 150) completed Fehring's (1987) Clinical Diagnostic Validation (CVD) Index for 110 defining characteristics of the nursing diagnosis altered family processes: alcoholism.	Alcoholic families display behaviors of alcohol abuse, loss of control of drinking, denial, nicotine addiction, impaired communication, inappropriate expression of anger, and enabling behaviors. Family feelings indicate the presence of unhappiness, hurt, frustration, guilt, moodiness, powerlessness, loneliness, mistrust, anger, anxiety, and hopelessness.	These clinically validated characteristics will complete the assessment phase of this research and direct the path to future studies to determine appropriate goals/outcomes and interventions related to alcoholic families.	
10778276	The effects of presentation of an aversive stimulus and simultaneous failure on a bogus intelligence test upon a subject's aggressive reactions were studied. The subject's fist clenching was used as an indicator of aggression. Four conditions, generated by the combinations of two kinds of stimulus delivered to the subjects (aversive or nonaversive) and two outcomes of the task (failure or success), were investigated. 20 female and 20 male students (ages: 17-34 years) were instructed, upon the reception of an aversive or nonaversive acoustic signal, to press with the right hand a device that displayed a slide. Each slide presented an item from an intelligence test, to which the subjects were either allowed to answer successfully (success) or not (failure). Failure increased the subject's autonomic arousal, as measured by photoplethysmographic sensors, in all stimulation conditions, but only the condition with aversive stimulation increased the speed of clenching. This was interpreted as indicating subject's tendencies to aggression. These results are discussed in relation to the effects of frustration.
10758070	The purpose of this study was to investigate doctors' and patients' views of irritable bowel syndrome (IBS) in order to assess why problems in the doctor-IBS patient relationship seem to occur.A qualitative study was undertaken involving in-depth, semi-structured interviews that were tape-recorded, transcribed verbatim and analysed using the constant comparative method. The subjects comprised 12 doctors, including six GPs and six gastroenterologists, and 14 patients with IBS.	Doctors hold two definitions of IBS, one 'public' and akin to a textbook definition, the other 'private' and including experiential knowledge and absorbed prejudices about IBS patients. Doctors are not universally hostile towards IBS patients, although the views of gastroenterologists may tend to be more pejorative than those of GPs. Most doctors experience frustration with IBS, and this is due as much to medical uncertainty and shortage of effective interventions as to intolerance of the personal characteristics of IBS patients. Doctors distinguish between 'good' and 'bad' IBS patients and manage them accordingly. Many patients tend to find their IBS symptoms very troublesome. Patients are more satisfied if they are taken seriously and helped to manage their symptoms, but many feel that they are labelled as neurotic by the medical profession. They tend to feel stigmatized and let down by doctors.	Better partnerships could be created with patients, and better outcomes for IBS might be achieved, if doctors recognized the impact of medical beliefs about IBS on patients. Doctors should offer IBS patients empowering explanations for their disorder.	
10750550	We examined the applicability of attribution theory to mothers' perceptions and reactions to their child's problem behavior. Participants were 149 Latina mothers of children with developmental disabilities who were interviewed regarding specific incidents in which their child exhibited a behavior problem. The findings indicate that most mothers viewed their child as not being responsible for the behavior problem. Furthermore, as predicted by attribution theory, mothers who ascribed relatively high responsibility to the child were significantly more likely to report negative emotions (anger and frustration) and aggressive/harsh behavioral reactions than mothers who ascribed low responsibility. Also. mothers were more likely to ascribe high responsibility to the child when the problem was characterized as a behavioral excess than as a behavioral deficit. The results provide support for the applicability of an attributional framework and may have important implications for helping parents in addressing the problem behaviors of their children with developmental disabilities.
10745786	Staff educators recognize the importance of affective competency for effective nursing practice. Inservice programs must include affective learning with objectives stated in measurable terms. Staff educators often express frustration in developing affective objectives and evaluating the learning outcome because attitudes and feelings are usually inferred from observations. This article presents affective learning objectives for a gerontological nursing inservice program and a rating scale that measures attitudes to evaluate the learning outcome.
10709285	Personality of the patients with anorexia nervosa is characterised by high neurotization and anxiety that resulted in diffuse anxiety in stress situation. Personal peculiarities included also high total hostility and intrapunitivity, inclination to obsessive-phobic and dysthymic reactions and tendency to somatization of anxiety. Such peculiarities promoted the choice of intrapunitivity type of reaction in situation of frustration. Its manifestation increases with an increase in the disease duration. The range of psychotic disorders in anorexia nervosa is restricted to anxious-depressive, obsessive and asthenic sphere.
10705801	The target group includes caregivers of demented persons at home and in institutions. The aim is a synopsis of different ways to cope with behavioural disturbances by milieu-therapy for demented persons. Appeals are made to their remaining resources, thus getting them more joy and less frustration by less excessive demands. Less boring activities avoid to feel under-challenged. More activity during day-time provides better sleep at night.--Consequently there are less behavioural disturbances with less stress for caregivers thus enabling them to keep the patients longer at home, leading to lower health costs. Behavioural disturbances of demented persons should always be treated by milieu-therapy achieving a response rate of up to 60%. With application of adjuvant medication, e.g. geriatric neuroleptics, a rate of 70% is within reach. Milieu-therapy is optimal for the prevention of behavioural disturbances. The better the adaptation of milieu-therapy to the individual patient's deficits and lifestyle and to the lifestyle of his caregiver, the better the effect.
10703387	Medical decisions about organ donation and transplantation are considered by a growing number of individuals. The complex issue of whether and to what extent organ recipients and donor families should interact or communicate has gained increasing public awareness, thereby creating an area of major ethical and legal concern for the transplant community. Communication issues have traditionally been decided by transplant coordinators and guided by personal beliefs, agency guidelines, and organizational policies. Organizations are often inconsistent in their practices, and this in turn causes frustration and confusion for both donor families and transplant recipients. This study explored how the experience of meeting the recipient(s) of a loved one's organ affected the grieving process of donor families and altered their lives. The information from this study might be useful to transplant professionals to develop guidelines and policies that lessen the confusion and frustration felt by those involved with the transplant process.
10701283	The infrastructure and organization of hospitals are changing rapidly as a result of major transitions in health care. Downsizing in hospitals has caused employees to have to take on new tasks and, often, multiple tasks with a decrease in available resources and an increase in job complexity. Naturally, such organizational changes have a profound effect on the nature and duration of patient hospitalization and on the job responsibilities and roles of inpatient staff. In many hospitals, there is a perception of chaos, sometimes resulting in frustration among the nursing personnel. The purpose of this study was to describe the relationship between nurses' job satisfaction and organizational climate.
10679843	To identify specific premorbid personality traits in patients with Alzheimer's disease (AD).A prospective case-control study.	A memory clinic of a department of geriatric medicine in a teaching hospital.	Fifty-six consecutive patients with probable AD. Sixty-five controls with Parkinson's disease (PD).	Premorbid personality traits were assessed using the relative rating version of the Munich Personality Test (MPT).	The AD patients showed higher neuroticism than the controls with PD (p=0.013). In comparison with MPT normative values for psychiatric inpatients, the AD patients scored significantly (p<0.05) lower on neuroticism and higher on frustration tolerance and rigidity.	Our results support the assumption of specific premorbid characteristics in AD patients, ie increased neuroticism and rigidity. More research is needed to confirm the existence of typical premorbid personality traits in AD.	
10672750	Despite the popularity of violent electronic games, anecdotal evidence suggests that many parents lack even basic information about children's game-playing habits. The goal of the present study was to examine parental knowledge of children's electronic game-playing habits by assessing the congruence between children's and parents' perceptions of child's playing time, parental supervision, game preference, and reaction to actual game-playing. 35 children in Grades 3 to 5 and one parent of each child completed a background questionnaire and played either a violent or nonviolent electronic game. In paired comparisons, parents reported significantly higher estimates of supervision time than children. Most parents either named an incorrect game or were not able to guess their child's favorite game. In 70% of these incorrect matches, children described their favorite game as violent. Parents may underestimate their child's exposure to violence in electronic games. After playing the same electronic game as part of the study, parents reported significantly higher frustration than children. Higher frustration with game-playing could contribute to deficits in parental knowledge of children's playing habits.
10662237	One hundred staff in three acute care public hospitals were asked about their perceptions of successes and failures of their discharge planning activities. The intention was to highlight ways in which the quality of discharge planning could be improved within the acute hospital setting. Generally staff described failures more commonly than successes, with a number of key failures being identified, including problems associated with vacating beds, lack of appropriate staff, patients and career education about discharge activities, general process issues, problems associated with community service provision and patients who are difficult to discharge. Staff identified the lack of feedback on the outcome of their efforts as a source of frustration and a barrier to improving discharge planning activities. The challenges for improving the quality of discharge planning in the acute hospital setting would appear to be in establishing appropriate structures and processes that promote interaction between staff, patients and community providers, and provide incentives for behavioural change.
10661295	The study aims at exploring the experience of the patients suffering from high blood pressure, analysing the difficulties they evoke and trying to generate similarities. It is a qualitative study, based on the phenomenological method. The interviews highlight the fact that the patients are preoccupied only by the symptoms of high blood pressure. They also show that all the patients live through the disease with a lot of emotions, with feelings of frustration, stress, anxiety and helplessness. A better understanding of the patients' experience must enable the nurses to have better targeted actions.
10659609	As a factor of recurrence of drinking in patients with alcoholic dependence, emotional disorders accompanied by alcohol dependence has been noted in many reports. Particularly, it is noted to be very likely that depression after abstinence is an incentive to re-start drinking. In this study, we investigated depressive feeling in aspects of psychiatric and physical subjective symptoms after abstinence in patients with alcohol dependence, and compared the symptoms with those in patients with involutional depression. On analysis of the major component of psychiatric subjective symptoms, a sense of alienation, emotional instability, anxiety, and aggressiveness were observed. In involutional depression, depressive feeling, somnipathy, anxiety, self accusation/sense of guilt, delusion of culpability were observed. On analysis of the major component of physical subjective symptoms, autonomic nervous symptoms accompanied by feebleness, hysterical neurosis-like autonomic nervous symptoms, reduced sexual libido, anorexia, hydrodipsia/sweating were observed. Similarly, in patients with involutional depression, hysterical neurosis-like autonomic nervous symptoms, anorexia, elevation of tonus, general malaise, and hydrodipsia were noted. Differences in status were emphasized in comparison between the two groups in both analyses. Unlike involutional depression that exhibits the current features of depression, patients with alcohol dependence showed a sense of alienation, emotional instability, anxiety, and aggressiveness, reflecting self-uncertainty and loss of self-respect. Drinking may be re-started to relieve or reduce tension and frustration in such conditions.
10653510	This article reviews how a temperament approach emphasizing biological and developmental processes can integrate constructs from subdisciplines of psychology to further the study of personality. Basic measurement strategies and findings in the investigation of temperament in infancy and childhood are reviewed. These include linkage of temperament dimensions with basic affective-motivational and attentional systems, including positive affect/approach, fear, frustration/anger, and effortful control. Contributions of biological models that may support these processes are then reviewed. Research indicating how a temperament approach can lead researchers of social and personality development to investigate important person-environment interactions is also discussed. Lastly, adult research suggesting links between temperament dispositions and the Big Five personality factors is described.
10641539	Administration of rehabilitation psychotherapy, including pathogenetic and symptomatic psychotherapy, raises efficacy of combined sanatorium treatment of early stages of such cardiological diseases as ischemic heart disease, angina of effort class I, essential hypertension stage I. Psychotherapy also promotes relief of psychoemotional stress, anxiety, frustration, rigidity, aggression, alexithymia, asthenia being primary and secondary prophylaxis of psychosomatic disorders.
10641882	Physiological and behavioral traits of sexually mature boars were compared between episodes of copulation and sexual frustration in order to determine reliable indicators of the differences in emotional states. Ten boars, approximately 6 mo of age, were trained to mount a stationary artificial sow (ArtSow) and to ejaculate when digital pressure was applied to the extended penis. This method of semen collection is the typical procedure of the industry. All 10 boars used in this study were fully trained to this procedure before the onset of the study. Each boar was subjected to trials in which one of the following two treatments was applied. In the control (CTRL) treatment, boars were treated the same as during their training (i.e., allowed to complete ejaculation). In the frustration (FRUS) treatment, boars were allowed to mount the ArtSow, but because no manual pressure was applied to the extended penis, ejaculation never occurred. Blood was collected via indwelling catheters before onset of the trial, during exposure to the ArtSow, and after returning to their home pen. Concentrations of testosterone, cortisol, and beta-endorphin were quantified. Behavior of the boars was recorded during exposure to the ArtSow and for 30 min after return to their home pen. Relative to preexposure levels, serum cortisol increased (P<.05) during CTRL exposure and after exposure to both treatments (CTRL; P<.04 and FRUS; P<.06). Serum testosterone did not change during and after either treatment. Serum concentrations of beta-endorphin did not change during or after CTRL trials, but serum beta-endorphin was greater (P<.05) during FRUS than during CTRL trials. Behavioral analysis revealed that boars spent less time lying down and more time moving about their home pen (P<.05) after a FRUS than after a CTRL trial. In summary, serum cortisol did not allow us to distinguish between the excitement of copulation and the negative affect associated with sexual frustration, whereas increases in serum beta-endorphin and motor activity seemed to be indicators of the negative emotional state of sexual frustration in trained boars.
10633525	Uncooperative behavior that is associated with a child being strong-willed is responsive to specific behavioral intervention strategies that have been extensively studied. These strategies are ones which are likely to be effective in the pediatric dental setting. We propose that these strategies are most effective when an integrative approach to strong-willed behavior is adopted by the pediatric dentist. Utilization of such an approach will reduce difficult child behavior, increase positive interactions between the dentist and child, and reduce parent frustration and concern.
10630755	Despite the increasing number of adults with congenital heart disease (CHD), little is known of the emotional life of these long-term survivors; hence, we undertook a study to establish a psychological profile of these individuals so as to optimize their care.We performed psychiatric evaluation by both interview and questionnaire on 29 ambulatory patients with CHD (mean age, 38 years; range, 26-56 years).	Although many met symptomatic criteria for psychiatric diagnosis, most were functional in day-to-day life and used denial in adapting to their CHD. In childhood, extended absences from school, cyanosis, scars, and sports restrictions hindered friendships and conflicted with a sense of "normalcy"; teasing and low self-esteem were more notable in boys; girls more readily hid behind makeup, nail polish, and clothing. In adulthood most were concerned about shortened life expectancy, disability, and childbearing and child rearing. Virtually all were highly committed to both school and work performance. All but those with complete, uncomplicated early repair expressed unresolved frustration, anger, and fears of a future that might include further medical complications.	Listening to this selected group of patients offers insight that may be helpful to the clinical care of patients with CHD and other patients with lifelong disease.	
10621983	There is evidence of dissatisfaction with locum doctors' performance, but little is known about doctors who work as locums in general practice or about their experiences of this work.To describe the motivations and experiences of doctors providing locum cover in general practices.	A postal questionnaire survey distributed to locums through organizations such as locum groups, commercial agencies, and general practices.	Questionnaires were returned by 111 doctors currently working as locums in general practice. Four main reasons for working as a locum GP were: as a short-term option while between posts, to gain experience of different practices before commitment to one practice, to balance work and family or other commitments, to continue part-time work after retirement. One-quarter of responders intended to continue working as a locum indefinitely. The drawbacks of locum work included frustration with low status, lack of security, and difficulty accessing structured training and education.	Locum doctors in general practice are a heterogeneous group that includes those who have chosen this type of work. The doctors who intend to continue as locums indefinitely represent a useful resource in primary care whose ability to provide short-term cover could be maximized. The need to control the quality of 'freelance' doctors should not overshadow the need to control the quality of their working environments.	
10619282	As part of a wider survey of parents of children with autistic spectrum disorders in the UK, the diagnostic experiences of 614 parents of children with autism and 156 with Asperger syndrome were compared. Although the ages of the children in the two groups were very similar at the time of the survey, parents of children given a diagnosis of Asperger syndrome had experienced significantly longer delays and greater frustration in obtaining a diagnosis than those with a child with autism. In the 'autism group' the average age when diagnosis was confirmed was around 5.5 years; in the 'Asperger group' it was 11 years. Parents of children with a diagnosis of autism were generally aware of problems in their child's development by 18 months of age; in the Asperger group concerns emerged later, at around 30 months of age. Initial worries in both groups centred around abnormal social development but parents of children with Asperger syndrome were less likely to have noted communication problems. Stereotyped or repetitive behaviours were not prominent in the early years in either group. Despite the problems inherent in data collected by postal survey, many of the findings of this study are supported by other research. The practical implications of delayed diagnosis, especially in the case of more able children with Asperger syndrome are discussed.
10603287	This study tested the hypothesis that implicit power motivation moderates individuals' testosterone responses to the anticipated success in and actual outcome of a dominance contest. Salivary testosterone levels were assessed in 42 male students at the beginning of the study, after they had imagined a success in an ensuing power contest, and immediately after the contest had taken place. Contest outcome (winning or losing against a competitor on a speed-based task) was varied experimentally. Participants' power motive was assessed with a picture-story exercise, in which an assertive, personalized (p Power) component was distinguished from an altruistic, socialized (s Power) component. In contrast to all other participants, individuals high only in p Power (a) had elevated testosterone after imagining a success in a subsequent dominance contest and (b) continued to have high testosterone levels after actually winning, but not after losing, the contest.
10600054	Hypertension is the leading preventable cause of premature morbidity and mortality from coronary heart disease, chronic heart failure, stroke and kidney failure. Despite the remarkable advances made in the design, development, and distribution of antihypertensive drugs and the plethora of published guidelines for hypertension treatment over the last two decades, blood pressure control rates remain rather disappointing. In the United States, Canada, and the United Kingdom, as well as in countries with far less resources devoted to health care, fewer than one in four hypertensives are controlled. This observation remains a major source of frustration for clinicians and health policy makers alike and serves as a constant reminder for more refined strategies for hypertension treatment and control. The 14th International Interdisciplinary Conference on Hypertension in Blacks (ISHIB99), held in Toronto, Canada on July 10-14, 1999 provided a unique forum for the discussion of this issue. The recommendations discussed are summarized herein under 10 specific headings that include: (1) Renewed emphasis on health education for patients and their families; (2) Increased involvement of non-physician health care providers; (3) Aggressive detection, evaluation and control of attendant cardiovascular risk factors; (4) Renewed determination for clinicians to set and achieve blood pressure targets; (5) Increased patient involvement in management decisions; (6) Improved access to quality care for the "working poor" and indigent; (7) Renewed commitment to community participation; (8) Partnership with managed care and professional organizations; (9) Renewed emphasis on the importance of psychosocial factors; (10) Enhanced communication and networking among hypertension care providers and between providers and patients.
10597013	When considering the indications for operative correction of funnel chest, the first question is what is medically actually necessary, and what is founded simply on 'doctors opinion'. Furthermore symptoms are often only indirectly correlated with the basic illness. This paper suggests a possible way of objectivating the symptoms in 56 patients with funnel chest.According to the results of our retrospective examinations the differentiation between 'physical' and (merely) 'cosmetic' findings in the definition of indications for operation of funnel chests in children, youngsters and young adults, should be dispensed with. The symptoms of "funnel chest" can be of varied significance, according to the degree of deformity, ranging from cosmetic fault to a severe handicap. Definition of indication thus depends in each case on all-inclusive plus differential plus interlocking-systemic diagnosis. In the course of this, not only somatic data, but also psychosocial characteristics can be objectivated and quantified.	The results of our examinations show that the handicaps of a funnel chest influence all areas of life. Older children (over 11 years) display as a whole more psychological disorders. Along with specific embarassment reactions, social anxiety, feelings of stigma, limited capacity for work, orientation towards failure, reduced tolerance of frustration and temptation, limited capacity for communication and even markedly depressive reactions are observed.	The underlying deformity and the psychological reactions to it make a long-term psychotherapy necessary. This may be laid out methodically more simply and takes less time, when a permanent correction is brought about at operation.	
10593109	Manual therapy is based on a biomedical model of illness and places considerable reliance on the patient's report of pain. Reported pain intensity is assumed to bear a close relationship with underlying nociception but research has shown that the experience of pain is also influenced by a wide range of psychological factors. Firstly, response to pain provocation (whether palpation or induction of biomechanical stress) can be affected by fear of an adverse outcome (such as pain) and fear of injury. Secondly, a patient's global rating of their pain may be widely influenced by factors in addition to nociception such as distress, fear and mistaken beliefs about the nature of pain and likely outcome of treatment. The manual therapist needs, therefore, to conduct and understand biomedical assessment within a biopsychosocial framework. In appraising the patient's response, the therapist may find it helpful to incorporate specific assessment of subjectively reported fear or behavioural indicators of fear such as guarded movements or behavioural signs. Therapists need to understand that in manual therapy, they are frequently managing the patient's pain behaviour and distress, rather than simply the nociceptive component of their pain.
10576683	A formative evaluation for a communication campaign to decrease rail-automobile accidents was conducted with a survey of 891 randomly selected residents in Michigan, USA. The formative evaluation was theoretically grounded in the extended parallel process model. The results of the study suggest that the majority of respondents engage in safe driving behaviors around railways. However, 10-20% reported extremely risky behaviors such as trying to 'beat the train' (labeled 'risk seekers'). Further analyses revealed that the risk seekers were disproportionately male with strong sensation seeking tendencies to engage in new and novel experiences and to avoid boredom. The results suggest that high sensation seeking tendencies cause one to experience greater frustration and exhibit greater judgment distortions around rail crossings, which in turn, cause one to try and beat the train. Specific recommendations are given for campaign developers and limitations to the study are addressed.
10539211	You've watched them comfort colleagues, defuse tense situations, and take the heat from tough bosses. You've seen them step in to ease the pain during layoffs and change programs. Who are they? The authors call them toxic handlers--managers who voluntarily shoulder the sandness, frustration, bitterness, and anger of others so that high-quality work continues to get done. Toxic handlers are not new. They are probably as old as organizations themselves. But there has never been a systematic study of the role they play in business. In this article, the authors introduce the role of toxic handlers, explaining what they do and why. Managing the pain of others is hard work. Toxic handlers save organizations from self-destructing, but they often pay a high price--emotionally, professionally, and sometimes physically. Some toxic handlers experience burnout; others suffer far worse consequences, such as ulcers and heart attacks. The authors contend that these unsung corporate heroes have strategic importance in today's business environment. Effective pain management can--and does--contribute to the bottom line. No company can afford to let talented employees burn out. Nor can it afford to have a reputation as an unhappy place to work. The authors offer practical advice for managers and organizations about how to support toxic handlers--before a crisis strikes. The role of toxic handler needs to be given the attention it deserves for everyone's benefit, because the health of employees is a key element in the long-term competitiveness of companies and of society.
10519828	This study attempted to compare the behavioral effects of active, rhythm-based group music therapy vs. those of passive, listening-based group music therapy on preadolescents with emotional, learning, and behavioral disorders. It was hypothesized that preadolescents who participated in active music therapy would more significantly improve target behaviors than those involved in passive music therapy. Achenbach's Teacher Report Form (TRF) was used to confirm changes among subjects in attention, motivation, and hostility as rated by homeroom teachers. Twelve music therapy sessions were conducted over a 4-month period with three different groups of subjects (n = 16), with two groups participating in active music therapy and the other receiving passive music therapy. Results indicate that subjects improved significantly after receiving both music therapy interventions. The most significant change in subjects was found on the aggression/hostility scale. These results suggest that group music therapy can facilitate the process of serf-expression in emotionally disturbed/learning disabled adolescents and provide a channel for transforming frustration, anger, and aggression into the experience of creativity and self-mastery. Discussion of results also includes recommendations for chousing one music therapy approach over another based on personality types and/or clinical diagnoses of subjects.

10485127	Eysenck's biological model of personality suggests that extravertive persons will not persevere when solving boring, frustrating problems. This hypothesis was tested using a difficult jigsaw task. Quitting behaviour was strongly associated with scores on Extraversion.
10480462	This study assessed the diagnostic accuracy of formal diagnostic criteria for canine compulsive disorder (canine CD). Canine CD is a syndrome of abnormal behaviors that are believed to result from conflict or frustration. Differential diagnoses include normal conflict behavior and learned behavior. In studies of canine CD, confidence in the diagnosis comes with knowing the accuracy of the diagnostic method. This accuracy may be quantified as the chance-corrected agreement between the diagnostic method and a 'gold standard' diagnostic test. The present study examined the agreement between diagnoses of canine CD made by an expert (the 'gold standard') and by using formal diagnostic criteria. The owners of 84 dogs suspected of having CD received 2 telephone interviews. The first utilized a detailed, pre-tested questionnaire; a dog was then diagnosed with CD if the behavioral history met 7 diagnostic criteria. The second interview was given by a behavioral expert whose diagnosis was based on personal experience. The interviewers were blind to each other's diagnoses. The chance-corrected agreement between diagnoses was minimal (kappa = 0.02) and disagreement was associated with 3 of the formal criteria: a history of conflict or frustration, an increase in the number of contexts that elicit the behavior, and an increase in the daily frequency of the behavior. Reasons for the disagreement include the order of the interviews, response biases, the setting of the interviews, and, possibly, the diversity of the behaviors associated with canine CD. To the authors' knowledge, this type of study is the first in clinical ethology to address validation of the diagnostic method. The results indicate 3 developmental aspects of canine CD that should be examined in future work.
10472177	Although previous research has highlighted the debilitating effects of tinnitus on quality of life, most studies appear to have targeted the general population, with few researchers focusing specifically on elderly persons. Hence, the purpose of this study was to investigate the perceptions of tinnitus in a group of 20 senior citizens. A questionnaire based on existing research instruments developed by Stouffer and Tyler (1990) and Wilson et al. (1991) was used to elicit information regarding the auditory-perceptual characteristics of tinnitus, effects of tinnitus on lifestyle, perceived causes, factors aggravating or ameliorating tinnitus and coping strategies employed. Results supported findings from earlier research and indicated that tinnitus did indeed exert an impact on respondents' lives with 65% avoiding noisy situations, 65% having difficulty relaxing, and 55% struggling to follow conversations. Almost two-thirds, namely 70%, of respondents reported feelings of frustration, 60% and 55% mentioned feelings of tenseness and irritability respectively, while 50% experienced depression associated with the tinnitus. These findings are discussed in terms of their implications for the education of health care professionals, management of tinnitus patients in general, public and patient awareness campaigns, the establishment of Tinnitus Self Help Groups, and further research.
10470357	One hundred key informants were interviewed regarding their awareness and attitudes toward suicidal behaviour. Eighty-eight informants were male, 58 were Muslim and 42 were Christian. Informants on average, claimed to know more persons who had completed suicide than those who had attempted suicide. Almost all informants mentioned more than one cause for suicide. Of these, frustration was the most frequently mentioned cause. Most informants believed that suicide attempters are cruel, feared and not trustworthy. Their attitude toward suicide completers was expressed as condemned sinners, do not deserve funeral ceremony, and should be buried separately from others. Christians gave importance to the funeral issue more than did the Muslims. Generally, the attitudes of informants were punitive and disapproving.
10466849	Recent alcohol cue exposure studies have noted that not all alcoholics demonstrate increased reactivity when presented with alcohol-related cues. This study examined the relationship of private self-consciousness (PSC) to subjective, self-report measures of reactivity and measures of negative mood states that involve a focus on internal processes. These subjective measures of reactivity were contrasted with salivary reactivity, an objective measure of reactivity which does not require individual self-report or awareness. A cue reactivity assessment was administered to 47 men meeting DSM-III-R criteria for a diagnosis of alcohol dependence. Our hypothesis, that PSC would predict urge reactivity status and greater levels of negative mood states, was supported. Urge reactors were more likely to be high in PSC, while the proportions of salivary reactors and nonreactors were not significantly different between the high and low PSC groups. Although regression analyses indicated that PSC did not significantly predict urge to drink alcohol, it did predict angry/frustrated mood and sad/depressed mood at the first alcohol trial. These results suggest that individuals high in PSC may benefit more from cue exposure-based treatment, as they are more likely to be urge reactors and to evidence negative mood reactivity. Low PSC individuals may be at higher risk for relapse given they are less able to recognize internal reactions signaling the presence of a high-risk alcohol use situation, and therefore less likely to mobilize coping responses.
10461124	We investigated whether odors can become conditioned to emotionally salient experiences such that when later encountered they influence performance consistent with a previously associated event. To test this hypothesis, 5-year-olds were given the experience of failure/frustration on a cognitive maze in a room scented with fragrance and later given another cognitively challenging test in a different room scented with either the same odor, a different odor, or no odor. Results revealed that subjects who performed the test in the presence of the same odor as the maze task did significantly worse than subjects in any other group. Performance in the different odor and the no odor groups were equivalent. Facial expressions and verbal remarks made during the maze task indicated a predominant display of negative affect. These findings show that odors can become conditioned to experiential states and when later encountered have directional influences on behavior.
10455611	Burnout is a major contributor to shortages of experienced nurses. The research literature shows a correlation between moral distress and burnout in critical care nurses. This paper reports on part of an interpretive interactionist study concerning nurses' experiences of moral distress which prompted attempts to advocate for vulnerable patients. One critical incident is used as an example of the qualitative findings of the study. In this paper, we theorize about what happened when nurses advocated for their patients by challenging medical treatments which the nurses believed to be both inappropriate and to contributing to patient suffering. When attempts at advocacy were unsuccessful, the nurses experienced intensified moral distress, frustration and anger. Being an unsuccessful advocate resulted in nurses being relocated within the hospital, nurses being scapegoated and/or burning out. The theoretical links which this paper makes between advocacy, moral distress and burnout are supported by empirical data from the study.

10445417	The aim of this study was to generate distinct clusters of women with breast cancer, and to evaluate differences between clusters with respect to decisional control, psychological adjustment, and frustration expression. Thirty-seven Stage I and 33 Stage II newly diagnosed breast cancer patients from two medical oncology clinics participated. A cluster analysis of the coping data produced three distinct patient clusters. The primary finding was that women from the low avoidance coping cluster were significantly better adjusted than women from the remaining clusters. Women from the low avoidance coping cluster also preferred more active involvement in treatment decision-making. Further research is needed to prospectively detail the mechanisms by which cognitive avoidance hampers psychological adjustment to cancer.
10445016	Fatigue is a ubiquitous side effect of many cancer therapies. Nevertheless, after treatment is complete, many survivors continue to feel a profound tiredness that affects almost all aspects of life. Even after recovery, patients are often frustrated by their continuing need for extra rest. In this deeply personal, first-person account, a physician relates the various ways that cancer-related fatigue can affect family dynamics, job responsibilities, social interactions, finances, and intimacy. Clinicians can help by searching for treatable medical conditions, but also by taking cancer-related fatigue, and the frustrations it causes, seriously. Patients should be reassured that the fatigue they feel is real, and that by learning personal energy conservation, they should be able to improve their abilities to function, to socialize, to interact with others, and ultimately to adjust to a "new normal" baseline.
10434145	The purpose of this study was to detect subjective elements that came into play with the satisfaction of patients that had been undergoing total hip replacement surgery. None of the patients had ever had a psychiatric pathology or undergone orthopedic surgery before. We defined specific questionnaires in order to support this study, based upon a clinical experience very representative of daily practice. In this study, we have also included the summary of clinical notes which highlight one of the present roles of a psychiatrist in a field which is no longer strictly psychiatric disease. Working daily with surgeons gave us access to patients who do not belong to traditional psychiatry but who need carefully selected words and not only a surgical operation in order to become really relieved. This work demonstrated that the standard quality-of-life questionnaires did not allow to evaluate patients' subjective assessments. In order to take into account this subjectivity, it was necessary to combine questionnaires and open-ended interviews. The analysis of the data gathered in this study showed that half of the patients underwent, roughly 3 months after surgery, a period of temporary frustration, although the hip was already in very good condition, according to objective measures. Patients could get out of this temporary period of disappointment--which seemed to be a necessary stage of mourning of their complaint--without any specific treatment. But a good relationship between surgeon and patient was necessary; it helped the patient and the surgeon to escape a duel or a confrontation. For some patients it may have taken as long as one year to enjoy all the benefits of the operation.
10425669	In the shifts to programmatic hospital organizations, social workers are having to learn to reframe their work, reorganize their thinking, and restructure their professional disciplines in order to survive. The experience is frequently one of frustration, anger, and impotence. Yet, social workers are masters of systems thinking in hospitals, and are well positioned to effect change. The beauty of shifting to a flattened hierarchy that is patient focused, is that it endorses change consistent with the social work mission in health. The challenge for social work is to grapple with the big issues: our belief in ourselves; defining our roles and functions and priorities; defining our vision in programmatic hospital organizations; being critical of what we do; and articulating what we have to offer. This paper identifies ways social workers can position themselves to effect positive change in hospitals undergoing restructuring.
10418770	Although substance abuse is frequently encountered in men receiving services in violence treatment settings, systematic study of these 'dual-problem' men has lagged. This study had two main objectives: (1) the characterization of psychoactive substance abuse disorders in a naturalistic sample of men in domestic violence treatment; and (2) clarification of the role of substance abuse on the sociodemographic, personality, psychosocial, and abuse characteristics of dual-problem men. Fifty-three adult men who were attending domestic violence treatment were recruited. They were administered the Addiction Severity Index, the Conflicts Tactics Scale, Structured Clinical Diagnostic Interview, the 16PF and the Symptoms Checklist-90. Partners, when available, were asked to provide corroboration. Sixty-three percent of the men had a current diagnosis of psychoactive substance abuse or dependence, while 92.5% had a lifetime diagnosis. Of the former, the majority was diagnosed as multiply dependent on alcohol and other drugs. As the severity of the substance abuse increased, so too did the dangerousness and frequency of abusive behaviors. Moreover, dual-problem men reported more hostility, apprehension, frustration and suspiciousness and past arrests than did their violence-only cohorts as well as a history of multiple (unsuccessful) treatments for substance abuse. These findings suggest that the trend toward multiple drug complaints seen in other clinical milieus is also being confronted in conjugal violence settings. In addition to the greater therapeutic challenge such dual-problem men present, these findings speak to the need to investigate integrated treatment approaches to improve the outlook of men grappling with both conjugal violence and multiple substance abuse problems.
10409985	Nurses have been providing reproductive health counseling to adolescent females for over 20 years. Yet, we found no studies in the nursing literature in which the investigator examined the types of reproductive health counseling nurses provide to adolescent females. Therefore, the purpose of this study was to examine nurses' description and evaluation of the types of reproductive health counseling they used for adolescent females. Five registered nurses, with at least 10 years experience in providing reproductive health counseling to adolescent females, were interviewed using a semi-structured guide. Four areas were explored: type of information provided, barriers to providing counseling, adolescent female decision-making capacity, and nursing recommendations. Two general themes emerged from the respondents' evaluations: frustration and unused potential of nurses to affect the reproductive health of adolescent females, and the inappropriateness of current reproductive health strategies for adolescent females.In response to a lack of research on the topic, this study gathered data from nurses in the US on the types of reproductive health counseling (RHC) they offer adolescent females.  A review of the literature provides background information on the use of contraceptive/prophylactic technology by adolescents, on the dictates of informed consent, and on the empowering value of RHC delivered by registered nurses to adolescents.  The description of the methodology explains that, using a qualitative approach known as naturalistic inquiry, data were collected via intensive interviews with 5 nurses who had at least 10 years of experience providing RHC to adolescent females.  Data analysis followed a case study approach.  As the respondents evaluated their RHC efforts, they generally reported the inappropriateness of current RHC strategies used for adolescent females and their frustration with the unused potential of nurses to affect the reproductive health of adolescent females.  The nurses recommended that RHC could be improved if careful attention were given to nurse-patient interaction, staff education, adolescent empowerment education, and adolescent mentoring.  They also thought that creation of adolescent clinics would be helpful.  The article concludes that additional research is needed on ways to 1) involve parents and increase community investment in youth, 2) determine if the sexual activity of adolescent females is consensual, 3) develop a nursing instrument for fostering critical thinking skills in youth, and 4) examine the value of current RHC strategies.	
10409900	The present paper addresses the topic of involuntary childlessness and its psychological sequelae for the fathers-to-be. There are at least two different psychological stresses men have to cope with: not being able to generate a child, and missing a child as one's life fulfillment. A short review of empirical research on male coping with infertility illustrates that men suffer from involuntary childlessness as do women. Nevertheless, the quality of the psychological burden remains open. Results from the Heidelberg Research Project on Male Infertility are summarized to assess this quality. Involuntary childlessness does not entail psychological sufferings for all patients; indeed, it is only a subgroup that remains fixated to the wish to have a child for psychological reasons. The project data elucidate the motives behind this fixation. They show that the most important psychological burden is not the narcissistic wound not to be able to generate a child, but the frustration of hope invested into the longed--for child on whom many otherwise unfulfilled aspirations are projected.
10409875	Related to the research of the effects of separation and divorce on children there is a lack of empirical studies in Germany. The following cross-sectional field-study directly investigate 48 children from divorced and 32 children from two-parent-families regarding socio-emotional and some cognitive characteristics (nonclinical samples). Projective and semi-projective tests were the preferred instruments. One of the main questions was related to frustration behavior, measured by the Rosenzweig-Picture-Frustration Test (childrens form). This test was used for the first time by a population of German children of divorce. Children of divorce showed a special frustration behavior, a so called M-profile showing many impunitive reactions. They avoid direct conflicts or struggle and try to deny the frustration. Also the subtests of the Hamburg-Wechsler-Intelligence test for children (HAWIK) show clearly that children from divorced families obtain much poorer test values in contrast to children from two-parent homes.
10405560	To derive a deeper understanding of postpartum depression (PPD) and its impact on the family through the experiences of fathers whose spouses suffered from this disorder.Phenomenology.	Eight men were interviewed. Interviews were recorded on audio tape and transcribed verbatim. Thematic analysis conducted within an interdisciplinary phenomenological research group led to a description of the experiences and emotions involved.	Respondents in this study revealed a major disruption in their lives and in their relationship with their wives as a result of PPD. The men experienced fear, confusion, and much concern for their spouses, and felt unable to help them in overcoming PPD. The inability to "fix the problem" created frustration and anger. The majority of the respondents reported that they made many sacrifices to hold the relationship and the family together. Even though the PPD improved over time, fathers were left to face an uncertain future with a spouse who seemed to be very different from the person they had previously known.	Health care professionals need to design interventions that are more supportive of men, for men also suffer when their spouses experience PPD.	
10402732	A widow is a women who lost her partner, Separation is what happened to her. Every separation is a big trauma and a possible source of psychopathology. The widow's children have experienced trauma as well, with all known consequences of separation. Admixture of pride partially reduces the intensity of frustration. However, this pride will soon lead to the sense of guilt and auto-aggressive component becomes dominant. Eighty nine widows, members of the Club "April 3, 1992" in Valpovo, were examined by the means of a questionnaire. Due to the widow's anxiety, depression and thinking about their own death and children's psychosomatic disturbances there is the imperative of the long-term psychotherapeutic work with them which is aimed at the correction of possible psychopathology.
10373798	While most healthy older women who become pregnant have uneventful pregnancies and healthy babies, thousands more are unable to achieve pregnancy because of declining ovarian function. A decline in ovarian function is normal with increasing age. A woman's number of eggs steadily decreases from a peak at mid-gestation of 7 million to approximately 400,000 at puberty. Certain tests can reflect gradations in ovarian reserve status and predict a woman's potential fertility. The most important lab test is the day 3 follicle-stimulating hormone level. A constant source of frustration in fertility centers is that patients are referred to the specialty clinic too late, when diminished ovarian reserve is so marked that treatment success is severely limited. Earlier assessment of ovarian function would alter this unfortunate trend.
10346732	This study sought to determine if depression is an inevitable outcome of childhood bereavement experiences, as the Freudians believed, or if children can experience healthy mourning, as Bowlby predicted.  In an application of Q methodology, 43 adults parentally bereaved as children sorted statements about childhood bereavement experiences and outcomes in adulthood.  Debriefing interviews followed.  Four distinct types of experience emerged through factor analysis: appreciation, frustration, enmeshment, and ambivalence. Depression was not found to be an inevitable outcome, and Bowlby's prediction that certain positive family factors can influence a child toward healthy mourning during childhood were corroborated.  Salient factors contributing to healthy childhood mourning included positive relationships between the child and both parents, ample emotional and psychological support from the surviving parent, and open and honest communication with the child about the death and its impact on the family.
10345780	How does the stress of a program merger affect job stress in air medical transport?This study was an anonymous survey of 104 transport personnel in a Mid-western critical care transport program with merged air and ground components. Tools included the Social Readjustment Rating Scale (SRRS), which quantitates stressful life events on a weighted scale that allows summation as a score, and the Medical Personnel Stress Survey (MPSS), which quantitates work stress in four categories: organizational stress (OS) related to work environment, frustration/exhaustion (FE) related to patient care, job satisfaction (JS) related to decreased self-worth, and psychosomatic complaints (PC), stress manifested as personal illness. Statistical analysis was performed with a variety of tools.	Fifty of 104 personnel responded completely. The average SRRS was low at 130.9; only 20% had scores above 200. No significant differences in MPSS occurred in personnel with high and low SRRS scores. Additionally, the SRRS correlated weakly with OS (r = -0.297, P < 0.05). Within the MPSS, OS correlated with FE and JS (r = 0.493, P = 0.0005; r = -0.593, P < 0.0001) and FE correlated with JS (r = -0.36, P = 0.01).	The overall personnel stress levels in this air medical program with merged air and ground components were low and appeared to be unrelated to organizational stress. This finding may be a result in part of the careful attention paid to stress and the elimination of stressors during the merger process.	
10340233	According to the "sense of coherence" concept, those subjects who can give meaning to a traumatic event can comprehend what has happened and have a sense of manageability of the sequelae, are able to cope better with the traumatic event itself. In the present study, this concept was applied to traffic accident victims. Severely injured traffic accident victims were assessed a few days after the accident and at 6-month follow-up. At follow-up, patients filled in the 29-item version of the Sense of Coherence (SOC) self-rating scale. The results show that the SOC total score correlated negatively with the development of: (i) posttraumatic psychopathology; (ii) psychological disorders (i.e., posttraumatic stress disorder after the accident); and (iii) anxious cognitions. The personality trait of neuroticism correlated negatively and extraversion and frustration tolerance correlated positively with SOC total score. Previous hypotheses are supported by our findings.
10333858	The authors determine the effect of patient-focused redesign on midlevel nurse managers' role responsibilities and perceptions of work environment.Patient-focused redesign models have been initiated in a number of hospitals over the past 10 years. Few studies of the impact of these models on nurse leaders' roles and work responsibilities have been conducted.	Nine midlevel nurse managers were interviewed about their redesigned leadership roles and the challenges they experienced in implementing patient-focused redesign.	Several themes emerged from the data. These themes focused on role change, ambiguity, position power, and environmental uncertainty and turbulence. Each of the nurse managers described feelings of frustration, disconnectedness, and inadequacy and spoke of how difficult it was to be the central figure in the eye of the storm. They noted that previously successful administrative strategies were not producing the same effect as in the past.	This study provides beginning information about the magnitude of the impact of organizational redesign on midlevel nurse managers. Midlevel managers in this study struggled to keep up with the demands of the change and their own recognition of the importance of remaining committed to the uncertain goals of the institution. They were frustrated by their perceived inability to fix the situation and to meet the multiple needs of the staff. Nonetheless, they supported senior executives and attempted reasonable solutions to the problem.	
10331916	Negative incentive contrast effects (NCEs) have typically been attributed to frustration or the decremental generalization of learned associations. The purpose of these experiments was to clarify the relation of NCEs to the repertoires of functional search behaviors evoked by incentive downshifts. Rats shifted from 32% to 4% sucrose-solution decreased consummatory responses but increased nose-down locomotion, orientation, location entries, and sampling of alternatives relative to unshifted controls. These changes in behavior were terminated or failed to occur under incentive upshifts. Furthermore, reward downshifts did not produce avoidance of the location of the shifted incentive. Increased search occurred whether or not alternative reward locations were available. Together the evidence suggests that NCEs are related to evoked search modes supporting a repertoire of functional behaviors related to finding food.
10321748	From the Buddhist point of view, anger is a form of suffering-because the angry individual suffers as well as his or her victims. In the traditional Buddhist view, suffering is caused by three mental factors, The Three Poisons: Desire, Aversion, and Ignorance. The dynamics of anger are conceptualized on the basis of these three mental factors, as well as the biology of anger and aggression. The treatment of anger is presented in seven steps: (i) Taking Responsibility; (ii) Becoming Aware; (iii) Understanding Anger; (iv) Reflection; (v) Decision: (vi) Relaxation; and (vii) Opening the Heart.
10218035	To investigate the opinions, attitudes and practices towards oral cancer prevention among UK dentists as a baseline from which to measure the need for continuing education efforts in this area.Postal questionnaire survey carried out in August 1991. A questionnaire with 13 test items was piloted at continuing education courses then distributed to all subscribers of the British Dental Journal with a postage paid return envelope. The aspects inquired into were recent attempts by dentists at updating their knowledge on oral cancer, their practical approaches to screening for oral mucosal diseases and follow-up actions after oral screening, their questions to patients regarding the major risk factors for oral cancer, their efforts towards behavioural counselling for patients and any constraints felt or experienced in this regard.	The questionnaire was circulated to 15,836 dentists. The response rate of 16% was poor but due to the many dentists circulated, 2519 responses were available for analysis. This large sample, though presumptively biased towards those interested in professional matters, showed an encouraging 84% claiming to perform screening of the oral mucosa routinely. Among these, 74% reported referral of screen detected cases to a hospital for further attention and only 4% would adopt a wait and see policy. Disturbingly, half of the respondents did not enquire about risk habits related to oral cancer and, among the other half who claimed to make such enquiries, only 30% routinely provided brief health education advice concerning these. Seventy-one percent agreed that giving advice against tobacco use is desirable but major constraints were identified, notably a lack of training, and frustration regarding patient compliance. There was even greater reluctance on the part of the respondents to enquire into the alcohol use of their patients and to provide advice on alcohol moderation.	Most of this large but unrepresentative sample of UK dentists were carrying out screening of the oral mucosa as a part of their prevention activities in 1991. However, the survey indicated a considerable need for improvement in the manner and extent of provision of health advice in respect of the major risk factors for oral cancer: such a substantial need amongst the presumptively better motivated implies that the need amongst the practitioner population at large is even greater.	
10215991	This study examined the causes of stress experienced by National Health Service nurses in England over the course of a single week with the aim of generating a cognitive structural model. Qualitative data served as the foundation of a network study which employed inductive eliminative analysis. These data were also analysed using conventional qualitative methods and by content analysis. The results were consistent with previous studies that identified a number of primary sources of stress. However, the network study indicated that two systems of causation were operating. The first centres on inadequate staffing levels, which were seen as leading to poor attitudes and abilities among colleagues, multiple work roles and lack of support. Lack of support also contributed to powerlessness and poor attitudes and abilities. The behaviour of managers was strongly endorsed as a direct cause of stress, but the strongest explanatory link was through staffing levels and powerlessness. The second system of causation related patients' suffering to stress. The qualitative data validated the network study results through elaborating the understanding of the respondents' nominated causes. Discussion focused on the pressure and frustration experienced by nurses because of organizational factors and interaction effects with the caring nature of nursing work. It is suggested that nursing discourse is subordinated to managerial and biomedical discourse reflecting the relative powerlessness of nurses. The extent to which such powerlessness is primarily a result of the failure of nurses to assert themselves or intrinsic organizational factors is not clear. The consequences of a stressed and demoralized nursing workforce on the quality of patient care and risk profile are identified as the focus for future research.
10204526	A child- and adolescent-generated IBD quality-of-life index was designed to be descriptive (to be used to assess the overall impact of IBD on individual patients), and evaluative (to be used as an outcome measure in clinical trials).Item-generation and item-reduction interviews with 82 patients with IBD aged 8 to 17 years (61 with Crohn's disease, 21 with ulcerative colitis; 36 girls, 45 boys) generated a list of ways in which their lives were affected by IBD. These issues were incorporated into an item-reduction questionnaire, which was administered to 117 patients (87 Crohn's disease, 30 ulcerative colitis). Patients indicated on a visual analog scale how important an item was to them and how often it bothered them. Mean and median importance-plus-frequency scores for each issue were calculated for the entire group and among patients in subgroups according to age and IBD type.	Ulcerative colitis and Crohn's disease affect the lives of children and adolescents differently. Bowel symptoms are more troubling and disabling to patients with ulcerative colitis, whereas systemic symptoms and body image concerns are greater for patients with Crohn's disease. The impact of Crohn's disease on ability to function in school and leisure activities is greater. Worries about future health problems and about the effects of IBD on the family are shared. Crohn's disease and ulcerative colitis trigger emotional responses of unfairness and frustration, but anger and embarrassment are more prevalent in ulcerative colitis. Disparities between age groups are fewer and less marked than those between types of IBD.	In selection of items to be retained in a pediatric IBD quality-of-life measure, the variation in concerns with disease type must be considered. A single index to assess IBD-related quality of life must include items of major importance to one subgroup of patients, even if not important to all. Alternately, a core of common concerns could be supplemented by disease-specific modules, thereby increasing the content validity of the tool for all patients.	
10204523	Focus group meetings were held with two groups, each containing 12 children with Crohn's disease aged 8 to 12 and 12 to 17 years. The children were asked broad questions about how Crohn's disease and its treatment affected their lives. To explore these areas in more detail, an 88-item questionnaire was developed and read to an additional 16 of 20 children with Crohn's disease selected at random from outpatients. At first, many of the children denied that Crohn's disease affected their lives at all, but it soon became apparent that many were frustrated or angry about physical symptoms, lack of understanding about Crohn's disease, unpleasant investigations, treatment, and hospitalisation.The questionnaire covered six domains of health-related quality of life including symptoms and treatment, social, emotional, family, educational, and future aspects.	Elemental diet was the preferred treatment, although surgery was more effective in controlling symptoms. Children receiving steroids had more depressive symptoms. Absenteeism from school and inability to engage in school sports, swimming, and running were frequent problems. There were also difficulties with taking holidays and staying at friends' houses. Worry was reported in 14 of 16 children, anger and frustration and feeling fed up in 12 of 16.	In addition to being a symptomatically disabling condition, Crohn's disease has a great impact on the health-related quality of life of affected children. Future studies of treatment in children with inflammatory bowel disease should include an attempt to assess the impact on the child's health-related quality of life.	
10191513	The present study examined the relation between early emotion regulation and later compliance. When infants were 5, 10, and 18 months of age, they participated in a frustration task. The degree to which they reacted negatively to the stimuli and the behaviors they used to regulate that response were coded. Baseline heart rate also was recorded and a measure of cardiac vagal tone (VNA) was derived. Several tasks (electrode placement, toy clean-up, and test situation) were administered to elicit compliance/noncompliance when the participants were 30 months of age. Results revealed that infants who demonstrated low levels of regulatory behavior were more likely to be noncompliant as toddlers. Several interaction effects suggested that the prediction to later noncompliance was also dependent upon the infants' level of reactivity. Cardiac vagal tone also was related to compliance but in a contradictory fashion. High VNA was related to noncompliance to toy clean-up, whereas low VNA was related to noncompliance to electrode placement. The data provide support for a developmental model of compliance that includes the ability to regulate emotional arousal.
10091852	The parents of children with epilepsy (PCE) face multiple psychosocial and economic problems that are often neglected. We undertook this study to ascertain these problems among the patients attending a tertiary referral center for epilepsy in India. A structured questionnaire was administrated to parents of 50 children aged between 5-10 years and having epilepsy for more than 1 year's duration. Some 52% of the children had partial epilepsy whilst the remaining had generalized epilepsy. The median seizure frequency was one per 6 months. The majority of the patients (86%) were living in villages. The family income was less than 1000 Rs per month (1 USD = 42 INR) for 66% of the patients. A decline in social activities, after the onset of epilepsy in their children, was reported by 80% of the parents. Daily routines were significantly affected in over 75% of the parents. Parents had been experiencing frustration (52%) and hopelessness (76%), whilst 60% were in financial difficulties. The most important item of expenditure was cost of drugs or cost of travel to hospital for 54% and 36% parents respectively. Impaired emotional status and poor social adaptation were co-related with the severity of epilepsy (frequent seizures/generalized seizures/attention disorder) and low economic status of the parents. These observations need to be borne in mind while organizing rehabilitation programs for epilepsy.
10088982	Proliferation of arterial smooth muscle cells (aSMC) is a key component of atherogenesis. A sample of 225 volunteers, aged 21-65 years, was exposed to "frustration," "harassment," or "relaxation," after completing the 50-item Hostility subscale of the Minnesota Multiphasic Personality Inventory (MMPI). Whole blood was measured before and after exposure for platelet-derived growth factor (PDGF), and sera were evaluated for total and HDL cholesterol concentrations and PDGF-independent mitogenic activity (SMA). Blood pressure and pulse rate were also evaluated. Analyses of SMA (i.e., serum independent of PDGF) revealed an increase in mitogenic effect for cultured human aSMC when hostility was treated as a dichotomous modifier. Among high-hostility subjects, surprisingly, those in the relaxed group and those with a lower educational level were found to have a significant mitogen response; no significant effects were observed for the low-hostility groups. The data suggest that endogenous stresses may occur in high-hostility individuals when "relaxed," to influence proliferation of arterial smooth muscle cells, as a contribution to atherogenesis. In individuals with lower educational levels and higher hostility scores, lifestyle changes may play a role.
10083959	Just as our caveman forebears were frail in the face of predatory animals, we are frail in today's society of childhood neglect or abuse, bumper-to-bumper traffic, frustration at work, and multiple daily hassles. The same neuroendocrine systems and pain regulatory mechanisms that protected early man during acute stress are still encoded in our genome, but may be maladaptive in psychologically and physiologically vulnerable people faced with chronic stress. Many patients with fibromyalgia become vulnerable because of the long-lasting psychological and neurophysiological effects of negative experiences in childhood. Ill-equipped with positive cognitive, emotional, and behavioral skills as adults, they display maladaptive coping strategies, low self-efficacy, and negative mood when confronted with the inevitable stressors of life. Psychological distress ensues, which reduces thresholds for pain perception and tolerance (already relatively low in women) even further. Converging lines of psychological and neurobiological evidence strongly suggest that chronic stress-related blunting of the HPA, sympathetic, and other axes of the stress response together with associated alterations in pain regulatory mechanisms may finally explain the pain and fatigue of fibromyalgia. Vulnerable people who can be classified by the ACR criteria as having fibromyalgia do not have a discrete disease. They are simply the most ill in a continuum of distress, chronic pain, and painful tender points in the general population.
10076727	Many crucial problems are associated with the diagnosis of inherited cancer susceptibility. One of the most important is related to the psychosocial consequences of the knowledge by the patients and their relatives of their own genetical status. Little data are available in the literature, mainly from studies including small numbers of selected and motivated patients.From January till December 1997, we studied the psychometric and quality of life parameters of 77 subjects followed in two French specialized centers. These subjects had been treated for either sporadic or familial or were at risk for medullary thyroid carcinoma. All patients had previously attended genetic counselling with detection of germline Ret-mutations, were informed on their own genetic risk, had good short-term prognosis and performance status and did not receive recent cancer treatment. Each patient was invited to answer two questionnaires, the hospital anxiety and depression scale (HADS) and the subjective quality of life profile (SQLP).	We report herein the descriptive results of this study (HADS and SQLP scores and distributions) and describe the individual clinical covariates that might explain the observed differences between subgroups of individuals. Although psychometric scores appeared similar in these subgroups, quality of life scores were lower in Ret-mutation carriers. Genetically-predisposed patients were less satisfied and expressed more expectations for favourable change in their quality of life.	This finding suggests a high level of frustration and latent unsatisfaction related either to the management of the genetic information given by the clinicians and its psychosocial consequences or simply to the knowledge of the genetic risk of cancer. Further studies on the individual consequences of genetic testing, information delivery and when necessary psychotherapeutic interventions, are needed to insure the quality of presymptomatic genetic testing in this field of oncology.	

10073121	In the present study we investigate whether, in addition to established risk factors, some personality traits of the victims are associated with elder mistreatment. Identified victims of chronic verbal aggression (n = 37), physical aggression (n = 38) and financial mistreatment (n = 55) as well as equal-sized control groups were interviewed. The control groups were matched on age, gender, and the characteristics that have been identified as risk factors for the types of elder mistreatment listed above. All respondents were over 65 years of age. In a standardised interview, commonly used instruments were utilised to assess coping style, locus of control, perceived self-efficacy and hostility. To analyse the data multivariate logistic regression analyses were performed. The study found that, chronic verbal aggression was associated with having less control over problem situations and a higher tendency to react aggressively when feeling angry or frustrated. Physical aggression was associated with a passive and avoidant way of handling problems. Financial mistreatment was associated with having negative beliefs of self-efficacy and a tendency to turn aggression and frustration on themselves. These results indicate that in addition to the established risk factors, some personality traits of the victims have to be considered as risk factors of elder mistreatment. The way people handle problems makes them more or less vulnerable to becoming victims of elder mistreatment. Furthermore, the results indicate that elder mistreatment may be associated to some extent with long-standing interaction patterns among family members. These findings are important for prevention of an intervention in cases of elder mistreatment.
10064177	We present a case of reflex-induced simple partial seizures, triggered by feelings of frustration, anger and despair. Such emotions were provoked by pondering over complex national and international, political and moral issues. The present case may suggest that activation of right temporal networks may mediate negative and adverse emotions induced by preoccupation with agitating, controversial issues.
10185307	The relationship between patient emotions during hospitalization and their retrospective satisfaction varies across service elements, across emotions, and is influenced by the temporal positioning of both emotions and the service element. Marketers should concentrate on reducing negative emotions attributed to the provider (e.g., hostility and frustration) and to the hospitalization situation (e.g., distress and depression), according to the results of the authors' study. Providers also should attempt to alleviate negative emotional states connected with arousal (e.g., jittery and excited). Positive emotions were found to be only weakly related to satisfaction. The authors suggest segmenting patients on the basis of their emotional states at particular junctures of the service delivery and then "socializing" both providers and patients to ensure successful emotion management.
9932310	A substantial proportion of GPs' patients are women who suffer from "unexplained" pain conditions, often from the musculoskeletal system. Few medical findings are revealed, although the symptoms lead to extensive suffering and disability. Two experienced Swedish GPs, Katarina Hamberg and Eva E Johansson, took their own frustration as their point of departure to explore the expectations, experiences, family lives and working lives of women who were sick-listed due to chronic musculoskeletal pain. Their doctoral dissertations, defended at the University of Umeå in September this year, are based on a qualitative interview study with 20 women aged 21-61 years. Johansson and Hamberg found that when seeing a doctor, the women expect to be seen, heard and taken seriously, to get information and time for discussion with the doctor, and to receive help and support over time. However, they experienced being ignored, disregarded and rejected. Symptom perception was characterized by loss of control and feelings of threat and unpredictability. The women believed that the pain had a bodily origin triggered by various mechanisms such as heavy and monotonous work, environmental influences, tensions and worries, rightful punishment or heritage. The Swedish study showed that family considerations had a strong impact on organizations and priorities in paid work. In this sample of working class women, family orientation strengthened and works aspiration declined in a situation of pain and sick leave. Problems related to rehabilitation could be explained by looking more closely on home conditions, especially the unwritten deal among the woman and her partner regarding the division of duties and power structure--the marital contract. Experiences of abuse and violence were reported to Hamberg and Johansson by several women, most of them considering this to be one root of their pain and ill health. The women emphasized that an understanding doctor would ask about violence, apprehend the hints, confirm that it was acceptable to talk about it, and avoid the questioning and blame that easily might increase the woman's feelings of guilt.
9924832	The purpose of this study was to examine whether premorbid personality traits predispose to noncognitive symptoms in Alzheimer's disease (AD). The Munich Personality Test was used to evaluate caregivers' perception of personality prior to symptom onset in 56 outpatients with probable AD. Caregivers also completed the "mood" and "disturbed behavior" scales of the Nurses' Observation Scale for Geriatric Patients. A neuropsychiatrist rated depressive symptoms on the Cornell Scale for Depression and the occurrence of personality change in four domains according to ICD-10. Under statistical control of confounding variables, results showed a moderate association between (high) premorbid neuroticism, subsequent troublesome behavior, and personality change, on the one hand, and (low) frustration tolerance and depression, on the other. Premorbid personality traits may indeed predispose to subsequent noncognitive symptoms in AD.
9885315	Residual emotional and behavioral difficulties in individuals who have sustained a traumatic brain injury (TBI) have been well documented in the literature. The issues are complex, interdependent, and often include substance abuse, depression, anxiety, chronic suicidal or homicidal ideation, poor impulse control, and significant degrees of frustration and anger. Often, preexisting psychological conditions and poor coping strategies are exacerbated by the trauma. Emotional and behavioral difficulties can interfere with the neurorehabilitation process at all levels. In acute rehabilitation, these issues have traditionally been addressed on an individual basis. However, in postacute settings, an interpersonal group format can be effectively implemented. The majority of individuals with TBI have minimal funding for long-term cognitive and behavioral remediation; often the only avenue available is support groups. This article will describe group psychotherapy models used with individuals with acute or postacute TBI within a comprehensive rehabilitation center. Interdisciplinary treatment of frustration and substance abuse and a continuum of care will be emphasized. Education, social support, skills development, interpersonal process, and cognitive-behavioral approaches will also be discussed. The psychotherapy groups focus on treatment of substance abuse and frustration management through education, social support, and development of interpersonal skills. Practical considerations of running such groups are presented.
9883098	This study aimed to examine effects between alcohol and frustration in regard to graffiti. Forty-two subjects, 21 men and 21 women were randomly assigned in equal numbers to each of the three experimental groups, namely a Control group, an Alcohol group, and an Alcohol + Frustration group (alcohol dose: 1 ml 100% alcohol/kg body weight). For the purposes of this experiment, a test (AET) was constructed that provided scores of "scrawling-graffiti" (i.e., the amount of scrawling on pictures), "destruction", "aggression", and "sexuality". An elaboration test and a test measuring the "dispositional optimism" were also applied. The primary results indicated that (a) the Alcohol + Frustration group scored significantly higher on scrawling-graffiti compared to the Control group, (b) female subjects performed graffiti-scrawling to a greater extent than male subjects in all three groups, (c) women scored significantly higher on elaboration as compared to men. These results were interpreted as supporting the hypothesis that alcohol intake by itself is unlikely to induce destructive behavior unless accompanied by a "provocative" factor (e.g. frustration) that precipitates the putative expressions of aggressiveness.
9873239	Stress coping is defined as a behavioral or cognitive response of an individual to uncomfortable or difficult situations. It has been suggested that coping, like personality, is related to the pathology and course of mental disorders. Accordingly, we here used a clinical sample to investigate the relationships between coping strategies and personality traits.Subjects were 60 outpatients who were in remission from major depressive disorder and who completed the Coping Inventory for Stressful Situations (CISS) and the Munich Personality Test (MPT).	Task-oriented coping showed a positive correlation with extraversion and frustration tolerance. Emotion-oriented coping was closely associated with neuroticism, esoteric tendencies and isolation tendency. Avoidance-oriented coping was related to extraversion. Principal component analysis indicated three corresponding factors between coping and personality; one was related to psychopathology (loading from the neuroticism, esoteric tendencies and isolation tendency scales of the MPT, and from the emotion-oriented coping scale of the CISS), a second was a social-adaptive ability component (loading from the frustration tolerance and extraversion scales of the MPT, and from the task-oriented coping and avoidance-oriented coping scales of the CISS), and a third was a passive-avoidance coping component (loaded from the emotion-oriented coping and avoidance-oriented coping scales of the CISS only).	Some personality traits such as extraversion and frustration tolerance are significantly related to task-oriented coping, and psychopathological personality traits such as neuroticism are associated with emotional-oriented coping in major depressive disorder.	

9864746	Children diagnosed with Developmental Dysplasia of the Hip (0.2% of live births) are often treated by splintage to hold the head of the femur in the acetabulum during early joint development. Whilst clinically effective, this can create difficulties for the parents in handling the child and affects the mobility of the family, which subsequently creates emotional and social difficulty resulting from the disruption of the family routine. To identify these problems and their order of priority, a survey of 113 recently affected families was carried out in England and Northern Ireland. Parents identified mobility, emotional and social problems. Splintage size and shape was the fundamental problem from which the other difficulties arose. Solutions to the basic difficulties of transporting and seating a child in splintage would largely alleviate the feelings of frustration felt by the families and enable more normal activities of daily living.
9857423	Small animal practitioners are increasingly confronted with patients showing adaptation related problems (ARP) which are expressed as disturbed or abnormal behavior (DAB). As a result, practitioners are asked increasingly to euthanize animals which seemingly cannot be socialized. In healthy dogs and cats, three main causes for DAB can be detected: refusal of obedience because of the drive for dominance; anxiety and frustration; and geriatric DAB. Increasingly, disease conditions not readily diagnosed can cause DAB, especially hypothyroidism. Influencing and contributing factors to DAB are breed, sex, experiences as a puppy, behavior of owners, changes in the pet's environment. ARPs may also cause disturbances in the condition of skin and fur, e.g. atopic dermatitis, pruritus sine materia, lick granuloma, and of the intestinal organs (vomiting, irritated bowel syndrome) and may result in an immune deficiency. Therapeutic approaches include behavioral therapy, surgical or hormonal castration with progestins or antiandrogens, substitution with thyroxin in cases with hypothyroidism, and/or the use of psychopharmaca, most prominently of modern antidepressiva like amitriptyline; buspirone; clomipramine and fluoxetine, but also of selegiline, a mono-aminoxydase inhibitor. These compounds, among other effects, are elevating prolactin levels. This seems to allow to formulate a working hypothesis: in the canine species, prolactin is obviously a hormone enabling socialization; hence all drugs which safely cause an increase in prolactin production might be suitable to manage or control ARPs and DAB in the dog, but also in the cat. Higher levels of prolactin than those required for socialization, as seen in nursing bitches or some clinically overt cases of pseudopregnancy, may cause maternal aggression and can be controlled with prolactin inhibitors, if needed.
9850947	Correctional or prison mental health nursing is a highly specialized area of practice that has undergone substantive role development in recent years. However, little research has explored aspects of prison-based nursing practice or practice arrangements. The experience of delivering mental health nursing care in prison can be disempowering, resulting in feelings of frustration, isolation, and stigma. In developed nations, prison mental health nurses face the rewarding challenge of gaining greater recognition for the specialized nature of their practice and their key role in the correctional and criminal justice continuum.
9839060	To show why women are still seeking anorexiant medications despite current concerns over their use.In-depth interviews using grounded theory methodology.	Participants chose where they were to be interviewed.	Women older than 18 years who had previously taken or were currently taking anorexiant medications for the purpose of losing weight.	Nine women completed two semistructured in-depth interviews during which they described their experiences from the time they began pharmacologic therapy for obesity until they discontinued the medications. Interview data were compiled and analyzed until saturation was reached.	Control was an important factor for the women. Their previous lack of control was due to frustration with failed dieting attempts and feeling pressure from others to lose weight. Prescription medications controlled physiologic hunger while the women sought to lose weight. Increased control over hunger and a decrease in weight gave participants confidence to continue their weight-loss efforts without the medications. Once the medications were discontinued, the women were able to maintain weight control through various lifestyle modifications.	Anorexiant medications provide some women with a perception of control that helps them lose weight and not regain it. Health care professionals should be aware of their patients' struggles with weight loss and understand the importance of these medications for some patients.	
9836564	To evaluate the psychosexual benefit obtained from multicomponent penile implant surgery in patients with erectile dysfunction.A psychosexual questionnaire was given to 35 patients undergoing penile prosthesis implantation before surgery and at 3 months, 6 months, and 1 year after surgery. The questionnaire consisted of 13 questions scored on a scale from 1 through 5. Results of the questionnaire were statistically analyzed for differences among the preoperative, 3-month postoperative, 6-month postoperative, and 1-year postoperative period.	The general linear model evaluation showed a significant difference for each overall combination of the following pairs: preoperative versus 3 months postoperative (P=0.0005) and 3 months postoperative versus 6 months postoperative (P=0.002). There was no overall difference between psychosexual total score at 6 months after surgery and 1 year after prosthesis implantation (P=0.85). The patients perceived improvement in their erectile ability and libido. Concern about obtaining and maintaining an erection during intercourse was significantly alleviated. There was an increase in the frequency of sexual activity and an improvement in satisfaction with sex life. A decrease in feelings of sadness, depression, anxiety, anger, frustration, and embarrassment related to sexual activity was also noted.	The current study demonstrates significant improvement in the psychosexual well being of multicomponent penile implant recipients, with attainment of a high level of patient satisfaction up to 1 year after surgery.	
9832918	Individuals who have had a stroke must cope with many changes in their lives. Initially, the focus is on the physical changes and functional abilities; however, coping with the emotional and cognitive changes also requires attention. Changes in mental status can affect a person's rehabilitation outcomes. This study describes the predominant themes related by stroke survivors that affected their recovery. Eleven right-hemisphere stroke patients (6 women and 5 men) were interviewed four times (at 1 week, 1 month, 3 months, and 6 months) after their stroke. The descriptions of personal changes, feelings, and experiences were categorized and analyzed for recurrent themes. The major mental changes were in mood, judgment, memory, and personality. At 6 months, the predominant themes were depression, memory loss, nervousness, irritability, frustration, lack of energy, and decreased initiative. These mental changes are important for nurses to consider when planning rehabilitation goals.
9816901	Dangerous behaviors in psychiatric institutions constitute major clinical and administrative problems. Staff competency in dealing with assaultive patients is an important factor in reducing institutional violence. One of the training programs for mental health staff working with dangerous patients is called Professional Assault Response Training (PART). PART is a product of several years of experience accumulated by the group of California authors in their efforts at designing a safe and effective approach in responding to various dangerous behaviors. PART principles guide staff in 1) de-escalating dangerous incidents through verbal crisis interventions; 2) avoiding or minimizing the risk of minor physical injury through evasion; 3) preventing serious bodily harm through the use of manual restraint. The importance of maintaining self-control by staff is reinforced throughout the entire course as a crucial professional skill. Other PART principles include identifying realistic treatment expectations for assaultive patients, proper physical mobility and emotional balance of staff, recognizing warning signals of impeding danger, using reasonable force to match response to the level of dangerousness. The PART training explores various theoretical explanations of violence (legal model, stress model, environmental model, communication model, developmental model, basic needs model and common-sense model). Verbal interventions which are a cornerstone of the PART approach are matching specific motives of threatening behavior--fear, frustration, manipulation and intimidation. Physical interventions taught in the course (evasion and manual restraint) include only techniques which can be used safely and which are not pain inducing. Finally, the PART training also assists staff in properly documenting assaultive incidents.
9800422	Burnout, viewed as the exhaustion of physical or emotional strength as a result of prolonged stress or frustration, was added to the mental health lexicon in the 1970s, and has been detected in a wide variety of health care providers. A study of 600 American workers indicated that burnout resulted in lowered production, and increases in absenteeism, health care costs, and personnel turnover. Many employees are vulnerable, particularly as the American job scene changes through industrial downsizing, corporate buyouts and mergers, and lengthened work time. Burnout produces both physical and behavioural changes, in some instances leading to chemical abuse. The health professionals at risk include physicians, nurses, social workers, dentists, care providers in oncology and AIDS-patient care personnel, emergency service staff members, mental health workers, and speech and language pathologists, among others. Early identification of this emotional slippage is needed to prevent the depersonalization of the provider-patient relationship. Prevention and treatment are essentially parallel efforts, including greater job control by the individual worker, group meetings, better up-and-down communication, more recognition of individual worth, job redesign, flexible work hours, full orientation to job requirements, available employee assistance programmes, and adjuvant activity. Burnout is a health care professional's occupational disease which must be recognized early and treated.
9796362	Fundamental principles of the "Logotherapy and Existential Analysis", which was founded by FRANKL and further developed by LANGLE, are examined from the view of the Clinical Child and Adolescent Psychology with regard to theoretical aspects as well as to their practice-oriented relevance for the Child and Adolescent Psychiatry and Pediatry. Applying the "existential analytic diagnostic scheme" central subject-matters of finding the purpose in life as personal and existential basic motivations are considered in the differential-diagnostic proceedings and permits--as demonstrated by examples--a holistic consideration of specific problems. The indication of a functional, counseling-attendant or psychotherapeutic intervention depends on the impairment in the dimensions of personal and/or existential meaning-frustration. Finally the significance of personal attitude towards differential diagnosis as well as towards the motivation for therapy is emphasized, a criterion non considered in actual versions of international diagnostic schemes as ICD-10 or DSM-IV.
9795892	Aggression continues to be a problematic, ill-defined concept for most contemporary analysts. Questions about the nature and origin of aggression remain unanswered. On the one hand, aggression is conceived of as an instinctual drive; on the other, it is thought to originate as an instrument of reaction to external sources of frustration and environmental failures to meet developmental needs. Aggression has also been dichotomized as either the benign activity of assertiveness, or the darker destructive force of hostility, believed by many to arise from separate motivational systems. There is a problem with the view of aggression as largely an ad hoc reaction to deprivation or other environmental shortcomings leading to disappointment and frustration. This view understates the importance of the original expansive demands for pleasurable satisfaction made by the individual upon the environment. Desire itself seems to be responsible for an inward vulnerability to external sources of disappointment and frustration, so that what is not desired cannot be effectively frustrated. Though the prototypical object of aggression is taken to be an external source of frustration, danger, and narcissistic injury, the mobilization of aggression more accurately reflects a susceptibility to the disturbing pressure of psychic stimuli that are the inner desire for satisfaction. Aggression contributes its force to various constructive or destructive purposes, from love to mastery to vengeance. Its most immediate aims, primarily narcissistic, are not concerned with the needs of others. Aggression also makes important contributions to maintaining psychic equilibrium, to the psychic organization's stake in instinctual gratification, to ego function, and to superego operation.
9789272	From 69 transsexual patients (48 men, 21 women) having consulted the Basel University Psychiatric Outpatient-Department between 1970 and 1990, 13 men-to-woman- and 4 woman-to-man-transsexuals could be examined in a follow-up (5-20 years after the operation). The social conditions and the quality of life of the 13 men-to-woman-transsexuals had significantly deteriorated: 9 of the 13 depend on life annuity or on social welfare assistance. The patients live socially very isolated. Eight of them report almost not being able to experience sexual pleasure, 10 suffer from anxieties, depression or addictions. Three regret having demanded the operation and two have passed a second operation for restoration of the original state. The 4 woman-to-man-transsexuals showed slightly better results: 2 of them are fully professionally active and live in constant personal relationships of several years of duration. The 2 others, however, suffer from depression and problems of addiction and give the impression of affective lability. The results lead to the following conclusions: 1. the criteria of indication for the operation of the transsexuals should be observed thoroughly, especially the psychotherapeutic accompaniment before the operation during at least 1 year; 2. the question of emotional stability, of frustration tolerance and of the danger of an outbreak of psychosis are to be examined carefully; 3. the professional and social integration before and after the operation is of central importance.
9769086	Traditionally, human factors have tended to concentrate on making products 'usable'--focusing on utilitarian, functional product benefits. This paper reports an interview-based study looking at the issue of 'pleasure' in product use. The study was a 'first pass' at addressing the hedonic and experiential benefits and penalties associated with product use, and at identifying the properties of a product that influence how pleasurable or displeasurable it is to use. Feelings associated with using pleasurable products included security, confidence, pride, excitement and satisfaction. Displeasurable products, meanwhile, were associated with feelings that included annoyance, anxiety, contempt and frustration. The properties of products that were salient in terms of influencing the level of pleasure/displeasure with a product included features, usability, aesthetics, performance and reliability. Responses to questions investigating behavioural correlates to pleasure in product use suggested that pleasurable products were used more regularly and that future purchase choices would be affected by the level of pleasure in product use. It is concluded that the issue of pleasure in product use involves more than usability alone. As the user's representative in the product creation process, the human factors specialist should consider many other factors in order to ensure that the user's experience of product use is maximised.
9768454	Besides specific technical skills, successful encounters with patients require an understanding of the many ways in which patients may express themselves. This qualitative study reports on the clinical experiences of doctors when meeting patients with fibromyalgia (FM). Ten strategically chosen rheumatologists and 10 GPs in central Sweden were interviewed. The interviews were taped, transcribed and analysed in accordance with the empirical, phenomenological, psychological method. The analyses indicate that doctors try to comply with the wishes and demands of patients, and at the same time avoid perceptions of personal frustration. They are inclined to be objective and to act instrumentally, apparently in order to keep in touch with what gave biomedical meaning to an otherwise incomprehensible phenomenon. The meaning structures revealed by doctors' descriptions of FM and of relating to FM patients were characterized mainly by the way in which the doctors were (i) managing their clinical uncertainty, (ii) adhering to the biomedical paradigm, (iii) prioritizing diagnostics, (iv) establishing an instrumental relationship, and (v) avoiding recognizing FM as a possible biomedical anomaly.
9737757	Ground-based research has investigated the loss of cognitive function in the extreme conditions of G-induced loss of consciousness, however, little is known about pilots' abilities to maintain cognitive performance throughout prolonged conscious exposure in the high-G environment. The effects of fatigue and G layoff on performance during exposure to high G are mostly unknown for the female population.This research was conducted on the centrifuge Dynamic Environment Simulator. Active-duty personnel (8 male and 8 female) were trained to fly the F-16 simulation while 30 performance measures were recorded. Performance was re-evaluated after 24 h of sleep deprivation.	Neither male nor female overall performance was affected significantly by sleep status, although individual tasks showed sensitivity; call-sign reaction time was longer by 33%, and missile survival was less likely. Also, when sleep deprived, perceived effort and physical demand were higher while perceived performance was lower. No differences in performance were found in either gender due to lay-off, although some physiologic deconditioning was apparent. Women commanded and endured the same amount of G load as men, however, on average they could not perform the tracking task quite as well.	Sleep deprivation (24 h) produced sensations of fatigue and frustration, but overall performance was not reduced. The ability of personnel to complete a complex defensive maneuver was reduced when they were sleep deprived. The women that we tested apparently could not optimize the tracking task as well as their male counterparts when Gz was in the simulation. None of these results were sufficient to suggest that women should not be allowed to compete for flying assignments in high-performance aircraft.	
9736333	Adolescence is a stressful time for many children and identification as homosexual adds to the frustration normally experienced during this period of development. The processes of coming out and disclosing this homosexual identity, while often difficult, are necessary if the adolescent is to develop a stable sexual identity. In families where disclosure has occurred, feelings of regret, confusion, and denial are common; in order to deal with these feelings, many families seek professional help. It is important the therapist working with these family systems has an understanding of homosexuality, positive attitudes towards homosexuality, and an appropriate counseling model to use with these family systems. A counseling model based on problem-solving communication-training (Robin & Foster, 1984, 1989), meant as a framework upon which professionals can build, is presented; professional attitudes, assessment processes, and goal setting are also discussed.
9725728	Women's anger experience has been poorly understood and insufficiently researched. Yet the emotion of anger is vitally important to women's physical and mental health, and to the quality of their relationships. This phenomenological study was undertaken as an expansion and extension of the Women's Anger Study, the first large survey of the genesis, manifestations and correlates of anger in American women. Although the earlier study contributed to understanding of anger, a deeper examination of the context and meanings of anger experience was sought. Twenty-nine Caucasian women ranging in age from 21 to 66 years were interviewed. Illustrative occupations ranged from homemaker, student, waitress to business executive, professor, and human service professional. Analysis involved thematizing by the researchers independently and within a multidisciplinary phenomenological research group. The thematic structure of women's anger involved a building over time of a confusing mixture of feelings (hurt, frustration, disillusionment) precipitated by a violation of the core values of the self. The precipitant of anger was unfair and/or disrespectful treatment or lack of reciprocity in relationships. When the anger was confined within self, the woman felt helpless and powerless. However, powerlessness was also evident when anger was externalized in an outburst. To the study participants, an angry outburst meant a loss of control rather than ability to achieve control. Women reported a sense of power when using anger to restore justice, respect, and relationship reciprocity. Clinicians can assist women to reflect on their core values and use the power of their anger effectively. Further studies are in progress to examine the relevance of these findings for women of other races and cultural contexts.
9713717	Progression of coronary atherosclerosis remains a significant problem after percutaneous transluminal coronary angioplasty (PTCA), requiring patients to make ongoing modifications in their coronary risk factors and lifestyle.To examine patients' reactions to suggested lifestyle changes, to identify barriers and facilitators to risk reduction, to identify sources of health information, and to elicit suggestions for nursing interventions to aid in long-term recovery.	Qualitative study using 2-hour, tape-recorded focus group sessions. Participants were enrolled in one of seven groups (4 to 9 members each).	Forty-five patients (26 men, 19 women) who had undergone PTCA 3 to 18 months earlier were recruited from a university-affiliated midwestern medical center.	Using a constant-comparative method for data analysis, six major themes emerged. Positive themes included seeking control from successful changes made; compromise with medical recommendations to maintain quality of life; and acceptance of the uncertain nature of their disease. Negative themes included powerlessness to stop disease progression; frustration with enacting lifestyle changes; and concerns about the uncertainty of the future. Specific barriers and facilitators for risk reduction were readily identified. Though patients had few suggestions for nursing interventions, the most predominant requests were for newsletters, "hot lines," and a video library.	These results provide insight into the experiences of the relatively understudied PTCA population. Patients were making at least some of their necessary lifestyle changes, though often with some difficulty. Nurses have an excellent opportunity to expand their focus and provide guidance and support to patients as they adopt a heart-healthy lifestyle.	
9711367	The aim of this paper is to assess the attitudes of Spanish general practitioners towards somatisers and the degree of involvement that family doctors are ready to adopt in the care of these patients.A postal questionnaire on attitudes was sent to a representative sample (n = 135) of general practitioners from two health districts of the region of Aragon. Seventy (51.8%) of them returned usable questionnaires.	Most of the general practitioners were interested in the treatment of somatisers and considered that they should be treated at primary care level. However, when specific treatment tasks were proposed, they only accepted to act as a filter to specialised care and to care for patients with chronic functional syndromes. Additionally, they refuse to detect presenting somatisers, to prescribe psychotropic drugs or offer any psychological approach, and to avoid reinforcing abnormal illness behaviour in these patients and their families. These findings can be explained because the main emotions somatisers produce in doctors are frustration and anger.	Family doctors need a lot more help, education and support in the management of somatisers, and psychiatrists need to provide it. Any management program for the treatment of somatisers in primary care should include methods to modify general practitioners' attitudes towards these patients.	
9710165	To develop a self-report questionnaire for persons with lower limb amputations who use a prosthesis. The resulting scales were intended to be suitable to evaluate the prosthesis and life with the prosthesis. The conceptual framework was health-related quality of life.Multiple steps of scale development, terminating with test-retest of the Prosthesis Evaluation Questionnaire (PEQ) by mail. SOURCE OF SAMPLE: Records from two Seattle hospitals.	Ninety-two patients with lower limb amputations who varied by age, reason for amputation, years since amputation, and amputation level.	The 10 scales used were 4 prosthesis function scales (Usefulness, Residual Limb Health, Appearance, and Sounds), 2 mobility scales (Ambulation and Transfers), 3 psychosocial scales (Perceived Responses, Frustration, and Social Burden), and 1 Well-being scale. Validation measures were the Medical Outcomes Study Short Form-36, the Social Interaction subscale from the Sickness Impact Profile, and the Profile of Mood States-short form.	Nine PEQ scales demonstrated high internal consistency. All met test-retest criteria for comparing group results. Validity was described based on methods used to gather original items, distribution of scores, and comparison of scores with criterion variables.	The PEQ scales displayed good psychometric properties. Future work will assess responsiveness of PEQ scales to changes in prosthetic components. We conclude that they will be useful in evaluation of prosthetic care.	
9706635	The Pediatrician is daily in contact with a large number of adolescents, and therefore is able to recognize those who display behavioural problems. The Pediatrician is often asked for advice in order to solve practical problems such as the choice of school, the practice of sports, ecc. His advice is somehow conditioned by his previous experiences as an adolescent and, if he is a parent himself, by his present familial situation. In the last years, the problems of the adolescents and the fears of their parents have changed, the main concern being today the one for work, due to the high levels of unemployment and underemployment affecting our society. In this situation, some of the most frequent attitudes of parents towards adolescents seem to be erroneous, such as asking them for social success at any cost (e.g. attending unwelcome studies or performing inappropriate sports). This leads to failures that often prove to be unbearable for young people not trained to face and overcome frustration. Parents also seem often to underestimate the possibility of their own "child" being involved in episodes of hooliganism, shoplifting, violence like the ones daily described by the media. The excessive idealization of adolescents by their parents seems to be one of the main causes of this situation. The Pediatrician can intervene with advice, in order to orientate adolescents towards realistic life objectives and a satisfactory development of their personality.
9697582	A phenomenological study was conducted to answer the question, What is it like being an individual with a disability who uses a wheelchair for full-time mobility and lives in society with many potential barriers? A total of 9 people from Ohio and Pennsylvania composed the purposively selected sample. Colaizzi's method of data analysis was used to review transcriptions of interviews with those in the sample. The analysis identified a major theme: all participants had feelings of frustration concerning access. Four subtheme clusters related to this frustration emerged: issues of independence, attitudes of others toward people with disabilities, others' lack of understanding of the situations of individuals with disabilities, and lack of involvement of people with disabilities in decisions regarding the development of facilities for them. This study provides insights into the lived experience of accessibility in today's environment for people with disabilities who use a wheelchair for full-time mobility, offers direction for health professionals who work with these individuals, and serves as an impetus for further research.
9690845	In this study the authors try to clarify the ambiguities in previous studies on demographic and social factors and fatigue. We have divided people with fatigue complaints and associated symptoms into those who have chronic and non-chronic complaints, and into men and women. The research is based on diaries kept by Dutch citizens over a 21-day period, and uses univariate and discriminant analyses. The results show the utility of stratification for chronicity, gender and age. Compared to non-chronically fatigued subjects (NCFd) the chronically fatigued subjects (CFd) reveal multiple sources of vulnerability: physical, psychological, psycho-social and socio-economic. They report more days of fatigue, they tend to be older, and their physical health is characterized by significantly more acute complaints and chronic disease. Their sum scores on psychological and psycho-social problems are above average. Their health histories are worse, they express greater feelings of frustration and irritation due to their ailments and report more health-related initiatives. The socio-economic profile of the CFd is disadvantaged: their educational level, occupational classification and income are lower than that of the NCFd, and they are more frequently unemployed. CFd women are more frequently divorced or widowed than NCFd women. The factors predicting chronic vs non-chronic fatigue vary with the age and gender of the population. It is easier to predict non-chronic than chronic fatigue. Additional stratification within the group of CFd is recommended.
9686451	Trends in bigoted violence are often explained by reference to frustrations arising from macroeconomic downturns. Historical and recent time-series studies have turned up significant links between economic conditions and lynchings of Blacks in the pre-Depression South (e.g., Hepworth & West, 1988; Hovland & Sears, 1940). However, replicating the time-series analyses of lynching, extending them through the Great Depression, and applying similar techniques to contemporary data fail to provide robust evidence of a link between economic performance and intolerant behavior directed against minorities. The authors speculate that the predictive force of macroeconomic fluctuation is undermined by the rapid rate of decay in the frustration-bred aggressive impulse and the absence of prominent political actors affixing economic blame on target groups.
9677917	Approximately one-third of patients with glioblastoma multiforme experience aphasia (Kraemer & Bullard, 1994). This loss of language abilities can be a major source of frustration for patients. Their quality of life is affected by the inability to interact with others. In this paper, an examination of the phenomenon of expressive aphasia will be conducted through the application of the content methodology process. Content methodology is a process for developing nursing knowledge, which strives to bridge the gap between theory, research and practice (Dawson & Wells, 1992). This process will guide in the development of substantive content for practice. An assessment tool and intervention plan will be presented.
9675631	Clinical data suggests that schizophrenic patients have an impaired ability to carry our purposeful activities which were previously self-regulative. Schizophrenic psychomotor performance is consequently slow and deliberate, and readily interfered with. This impairment often leads to frustration and despair in the patient as well as in caregivers, and interferes with the rehabilitation process. Psychological interventions in the form of performance contingent verbal feedback and planned interpersonal interaction in small groups were introduced, and were found to ameliorate motor deficits to a significant extent. Implications for patient motivation, well being and rehabilitation are discussed.
9668957	Problem situations in the patient-health care relationship may relate to the patient or to the health care provider characteristics or to the way they interact; they may also relate to the general social context. Such situations force the clinician dealing with non-specific low back pain patients to look beyond the traditional biomedical model that assumes a linear connection between pathology and symptomatology. The introduction of the biopsychosocial model approximately 10 years ago has improved the understanding of common low back pain. This chapter gives some insight into areas relating to factors that may hamper the patient-therapist relationship and thus complicate treatment and recommendation outcomes. It emphasizes the necessity to involve the patient in the decision-making. Recognizing the patients' psychological, social and cultural background as well as the level of education and employability are important to make successful recommendations. This knowledge is not new but the difficulty is to implement it in today's cost effectiveness driven society. However the benefit at the end may be the decrease of chronicity and/or permanent disability, suffering for the patient and frustration for the clinician. Identifying the underlying cause of non-compliance or of unexpected delayed recovery is an exciting issue. The cause may or may not be biomedical. If a specific cause can be identified, it has to be diagnosed and evaluated. If the clinical examination has ruled out specific or emergency conditions, another perspective may be needed and the course of action could then be determined.

9658265	To determine difficulties experienced by carers of younger people with dementia.Cross-sectional questionnaire survey.	102 eligible carers of persons less than 65 years of age with dementia, recruited through support groups and clinicians' referrals.	Problems with diagnostic process; professionals/services consulted; psychological, physical, occupational and financial impact of illness on carers and children; use of and satisfaction with services.	Diagnostic problems were reported by 71% of carers. Mean time until diagnosis was 3.4 years (SD 2.8) after consulting 2.8 (1.4) professionals. Carers reported frustration (81%) and grief (73%). Adverse psychological effects were common, more so in female than male carers (p < 0.01). The younger the carer, the more psychological and physical effects were experienced (p < 0.01). Only 8% of carers considered that their children had encountered no problems because of the dementia. Of 61 working carers, 59% reduced their hours or stopped working after diagnosis, and 89% of all carers had experienced financial problems subsequent to diagnosis. Most carers (89%) had used a support service, but 25% had never used community support, 32% had never used respite. Proportions of carers rating services as good ranged between 43 and 100%.	Younger people with dementia, and their carers, face difficulties in obtaining a diagnosis. Carers also experience psychological problems, financial worries, loss of employment and family conflict, and their children are affected. Most carers had used services, but some dissatisfaction existed.	
9643593	To explore views of patients, their families and professionals about head and neck cancer services.Focus group interviews of 33 patients and relatives and 33 professionals from four hospitals and two patient support groups in SouthEast England.	Although patients and relatives were grateful for their care, many thought that some areas could be improved. Many thought that their ward facilities were inappropriate. Patients wanted to have more information about the impact of their treatment and about different treatment options whereas professionals tended to concentrate on giving information about the details of operations. Counselling services were often found to be inaccessible and inappropriate. Administrative difficulties were a major source of frustration for professionals, as were failure of treatment and communication difficulties. Professionals valued joint clinics and a team approach in keeping up to date, in clinical decision making, and in providing mutual support.	The findings highlight areas that could be improved which would benefit both patients and professionals.	
9640986	The aim of this study was an attempt to estimate depression prevalence in medical students. Simultaneously we tried to asses the impact of early negative experiences on the level of depression in that population. We examined 92 third year medical students of the Silesian Academy of Medicine (54 women and 38 men) at the age from 20 to 24. Frequency and intensification of depression were assessed by using Beck Depression Inventory. Early experiences including negative and positive ones were estimated with the use of a self prepared repertory test called "biographical path", based on Personal Construct Theory of George Kelly. The obtained results indicated that 25% of examined students had depression symptoms. These students were exposed more frequently to early negative experiences than students without depression. In childhood depressive students were under pressure of their environment to score successes. If they did not realise these expectations they were exposed to discontent and frustration of their parents. Depressive students came less frequently into contact with other people and acquired independence later than non depressive students.

9629557	According to DSM-IV affective instability in borderline personality disorder is due to marked reactions to environmental events. The aim of this study was to investigate affective responsiveness of abnormal personalities with self-harming impulsive behaviors by means of an affect-stimulation design. The first experiment was based on the presentation of a short story that allowed affective responses to various stimuli to be assessed in regard to quality, intensity, and alterations over time. The second one presented a typical frustration design, which provoked specific feelings of anger and disappointment. Impulsive personalities showed an affective hyperreactivity that was characterized by a decreased threshold for affective responses, as well as by intensive, rapidly changing affects. Furthermore, affect experiences turned out to be qualitatively diffuse and undifferentiated. Results support that affective instability of patients with borderline personality disorder should be differentiated from the autonomous deviations of mood typical of affective disorders. Their affective hyperreactivity is a crucial part of impulsive personality functioning.
10186390	Many physicians today feel ravaged by the brutal speed with which change has been occurring. They see the beliefs and practices of a lifetime being abandoned and replaced by the flavor of the month, management du jour. But if you are willing and able to take the brave step of approaching your physicians without an agenda, meeting with them to listen to their concerns, and can also avoid hanging a lightning-rod label on every bright new idea that comes out of the sessions, you'll be on the way to effective new management. This new style is a "Zen" approach (but don't give it that label) that lets real collaboration come into the place that is supposed to be all about healing--the health care organization. From "never call it anything" to "stay with them until they get it," ideas on how to be a Zen manager are presented, with the ultimate goal of truly partnering with physicians and infusing them with a desire to move beyond the frustration and disenchantment they are feeling.
10186381	The profound changes in the health care industry have led to the anger, frustration, and unhappiness that physicians are feeling. It is important to examine physicians' responses to the threats to their professional autonomy, image, lifestyles, and relationships with their patients. The "learned helplessness" behavior exhibited by physicians is astounding, considering the education, status, and reputation of physicians as healers for those in need. This article explores the concept of resiliency among physicians and describes why physicians as a group may be less resilient than other individuals. In fact, the structure and training of the medical profession stacks the deck against those who want to change or to be resilient in the face of the changing environment.
9615511	Qualitative data, as part of a larger study, were collected to assess perceptions about quality of life (QOL) after bone marrow transplant (BMT) and its impact on long-term survivors who had undergone an unrelated donor bone marrow transplant. A sample of 28 survivors participated in the study. Quality of life was described in terms of "normality," enjoyment, and fulfillment with life: being psychologically and physically healthy, being independent, having family and relationships, having work, experiencing happiness, and having material support. There were many factors with which survivors found it difficult to cope: symptoms, frustration brought from the inabilities to function in life, family life, returning to work, and infertility. However, about 25% of the survivors reported a positive impact of the BMT on their lives. Main concerns about the future were related to health status, the long-term effects of the transplant, financial concern, infertility, the normalization process, and the family. These data confirmed that unrelated donor BMT patients do not have a different perception about their QOL than other BMT patients receiving autologous or allogeneic marrow transplants. Some of the issues that differed from the previous BMT literature included higher inability to perform daily tasks and dependency on others, adverse memories of the transplant, and concerns about the future. These areas should be the target of pretransplant interventions and the long-term psychosocial services provided to patients. As mentioned by the respondents, health care professionals could further improve their patients' QOL by providing counseling and psychologic support, education about the effects of the various treatments, and improved research in BMT treatment and side effects.
9609855	Personal creative writing is increasingly used in medical schools to foster self-reflection. This article looks particularly at poetry as a vehicle for expressing personal experiences of professional development. The authors present a series of poems written by students at their medical school. In them, the students reflect on embryology, gross anatomy, telling (or not telling) bad news to trusting patients (and family members), encountering death, and encountering their own anger and frustration with the demands of medicine. These poems not only capture individual students' feelings and imaginations but also demonstrate the students' constant struggle to sustain their idealism about medicine throughout the four years of their education.


9563288	Children with Attention Deficit-Hyperactivity Disorder (ADHD) may learn poorly under conditions of inconsistent (partial) reinforcement because they are easily frustrated and fail to develop persistence. To test this hypothesis, a nonsense word spelling task was used with 22 ADHD and 20 control children to investigate the effects of partial and continuous reinforcement on facial responsivity (frustration measure), words spelled correctly (learning performance measure), and persistence ratings. Partially reinforced ADHD children manifested higher levels of frustration in both acquisition and extinction than any other group and gave significantly lower persistence ratings across acquisition than partially reinforced control children. ADHD children spelled fewer words correctly than controls, regardless of reinforcement schedule. These findings suggest that partial reinforcement training develops persistence in normal but not ADHD children. The findings have theoretical implications for the etiology of ADHD as well as practical implications for designing behavior modification programs to treat ADHD.
9556117	A 28-year-old man presented to the Dermatology Outpatient Department with a complaint of a burning sensation and soreness over his left cheek and left ear of 10 days duration. It had started suddenly one morning when he woke up from sleep. He noticed a large blister with intense redness over his left cheek, associated with a burning sensation. There was a history of similar episodes over the past year, and all were sudden in onset, involved the cheeks, and were noticed after waking up from sleep. The patient volunteered that the episodes were always associated with a drinking spree the previous night. The individual was a healthy man with a wife and two children. The patient had been dependent on alcohol for the past year, and had been consuming alcohol for many years. On examination, there was an eschar occupying almost the entire cheek, with a few scattered lesions over the left tragus and left external ear. Peripheral scarring was noted with hyperpigmentation. While the angle of the mouth was superficially involved on the left side, the oral mucosa was normal. The right cheek also showed a few areas of scarring with patches of alopecia. There were no similar lesions elsewhere on the body. The peculiar history and the morphology of the lesion, that defied any classical diagnosis description, prompted us to interrogate both the man and his wife with regard to any serious differences. After much persuasion and on assurance of secrecy, the wife admitted that her husband was an alcoholic and was neglecting his family. When her efforts to prevent his drinking failed, she resorted to this drastic measure. Each time he passed out after a drinking bout, she poured acid on his cheek, hoping that the sequelae would frighten him from drinking. The acid was readily available to her as she used it for domestic cleaning. The couple were sent for psychiatric evaluation as Munchausen's syndrome by proxy (MSBP) or witchcraft's syndrome (WS) was suspected. Detailed psychiatric evaluation, together with psychometric assessment, revealed that the patient had an alcohol dependence (Axis-I diagnosis) and had a cyclothymic personality. Severe marital discord due to alcohol dependence had been present for the past 2 years. Evaluation of the patient's wife revealed that she was under significant psychologic distress. She showed major depressive symptoms with a histrionic personality. She revealed that she had resorted to using the corrosive out of frustration and anger over the behavior of the patient while he was in an inebriated state. The couple are currently undergoing psychiatric treatment.
9549025	To clarify what issues are important to stroke patients and their carers. To determine whether these issues change over time.Prospective study of consecutive patients admitted to hospital with a diagnosis of an acute stroke. Each participant had interviews at six and 24 months. In addition, a subgroup of these patients (consecutive discharges over a two-month period) were also seen at two weeks post discharge.	Hospital-based cohort of stroke survivors. Interviewed in their own homes.	Documentation of the questions asked.	At two weeks, six and 24 months, a median of three, two and three questions were asked by each patient respectively. Enquiries about basic aspects of stroke were common but diminished over time. Fear of recurrence was apparent at all three interview periods. Enquiries about the psychological sequelae of stroke became more prevalent at six and 24 months. At two years, 32% of respondents asked about concentration/memory difficulties with smaller numbers commenting on tiredness, depression and frustration. At two years, 18% of the sample were still uncertain of their chances of further recovery.	Patients with stroke continue to have unanswered questions even two years after their stroke. The types of questions asked changed over time.	
9547933	Arousal-regulating mechanisms are important in explaining individual differences in antisocial behavior.Alterations in salivary cortisol concentration and cardiovascular activity were studied in 21 boys with oppositional defiant disorder (ODD) and 31 normal controls (NC) during a 2-hour stressful procedure involving frustration and provocation.	Baseline levels of heart rate (HR) were significantly lower in the ODD group, but their HR levels were higher during provocation and frustration. Cortisol levels in the ODD group were overall lower than those of the NC group, and the effect of stress seemed to be minimal and similar for both groups; however, individual differences were large. Since anxiety plays an important mediating role in cortisol response, subjects were divided into one of four groups based on the intensity of their externalizing behavior and anxiousness. Cortisol increase due to stress exposure was strongest in highly externalizing and highly anxious subjects; cortisol decrease was strongest in those subjects who were high in externalizing behavior and low in anxiousness.	The results of the study support an important role for hypothalamic-pituitary-adrenal axis sympathetic autonomic functioning in persistent antisocial behavior in young boys.	
9545654	The objective of the present study was to determine whether serum lipid concentrations interact with hostility to affect cardiovascular responses to mental stress. One-hundred and seventy-four male subjects were screened with the Cook and Medley hostility scale (Ho), the anger expression inventory by Spielberger and a general health questionnaire. Subjects in the upper (n = 22) and lower (n = 22) quartile of the Ho score distribution were asked to take part in a laboratory experiment. Continuous measures of heart rate, blood pressure, respiration and electrodermal activity were taken while participants carried out a series of behavioral maneuvres, including mental arithmetic and mirror star tracing. Prior to the experiment fasting blood samples were taken for lipid determinations. The results show higher heart rate reactivity in high hostile than low hostile subjects. High hostile subjects also reported more anger and frustration in response to tasks. Hostility groups differed in lipid levels in that high hostiles had higher triglyceride and VLDL-c concentrations than low hostiles. Cholesterol levels showed an inverse association with cardiovascular reactivity but only in low hostile subjects. No such associations could be found in high hostiles. We conclude that there is partial support for both, the hyperreactivity and the health behavior model linking hostility and cardiovascular disorder.
9523419	If self-regulation conforms to an energy or strength model, then self-control should be impaired by prior exertion. In Study 1, trying to regulate one's emotional response to an upsetting movie was followed by a decrease in physical stamina. In Study 2, suppressing forbidden thoughts led to a subsequent tendency to give up quickly on unsolvable anagrams. In Study 3, suppressing thoughts impaired subsequent efforts to control the expression of amusement and enjoyment. In Study 4, autobiographical accounts of successful versus failed emotional control linked prior regulatory demands and fatigue to self-regulatory failure. A strength model of self-regulation fits the data better than activation, priming, skill, or constant capacity models of self-regulation.
9504207	This study examined patterns, variations, and existential turning points in young mothers' narratives of self and their visions of the future as part of a larger hermeneutic, longitudinal study. The study was philosophically based in the phenomenology of everyday practices as inherently meaningful, situated, and historically derived and drew on dialogical views of the self. The sample consisted of 13 (of the original 16) young mothers and family members who had been interviewed 4 years earlier. For the present study, data consisted of life history accounts of the intervening 4 years, stories of caregiving routines, and recent coping episodes of parenting elicited through in-depth interviews. Findings offer a situated understanding of young mothering and highlight meaningful distinctions in the ways young mothers experience the self and project themselves into the future. The discovery of patterns and variations in the young mother's sense of self and future have implications for guiding clinical practice and are preliminary to designing programs and interventions that are tailored to the practical understanding and situated possibilities of young mothers.The prevailing view that an early pregnancy jeopardizes a young woman's emotional development disregards the social nature of the construction of self and others.  Although parenting can be a stressful life experience, it also has the potential to create new ways of coping and to contribute to a revised understanding of the self.  For many impoverished African-American teens, with few opportunities to establish an identity through education or a career, motherhood provides the route to adulthood.  The present study investigated patterns in young mothers' narratives of self and their visions of the future.  In-depth interviews were conducted with 13 US adolescent mothers 4 years after the birth of their first child at an average age of 15.6 years.  In the majority of cases, mothering was described as a generally positive experience that engendered a sense of responsibility and supplied a social identity consistent with family and cultural meanings of becoming a woman.  The mothers' efforts to become a responsible parent tended to transform their sense of identity and provide a sense of future possibility not previously available.  Those who lived in conditions of extreme poverty and danger, without social support, were less able to turn motherhood into an opportunity for reconstruction of the self.  Instead, mothering diminished the self and exacerbated feelings of powerlessness, frustration, and conflict.  These findings suggest that motherhood is adversely affected by the conditions associated with poverty rather than maternal age per se.  Needed, to improve the outcomes of adolescent pregnancy, are interventions that focus on ethical and political questions rather than technical issues.	
9472119	In this study, idiopathic spasmodic torticollis (ST) has been classfied into three types from the opinion of social adaptation and the differences of frustration tolerance. The three types were as follows: type I (overadaptive type), type II (maladaptive type), and type III (compatible type). Type I is a typical psychosomatic with high frustration tolerance. Type II is personality disorder with low frustration tolerance. In type III, frustration tolerance varies depending on social circumstances (i.e., different at home and at the office). In type I, the prognosis of ST is generally unfavorable, since it is associated with recurrence and prolongation of the symptoms. In type II, the prognosis of ST is generally favorable. However, type II patients experience relationship or social difficulties. One characteristic of type III is that the onset of symptoms is usually found in an older person because of proper use of frustration tolerance at home and at the office.
9460479	March and Simon's theory of participation provided the framework for a study of personal and organizational factors predictive of intent to stay. Findings indicate that job satisfaction correlates positively with intent to stay, although interaction effects between social climate, work excitement, and work frustration also are contributory. Conclusions suggest that accurate indicators of intent to stay are not captured with measures of job satisfaction alone. Organizational effects, such as social climate, work frustration, and work excitement are background forces that need to be considered in the evaluation of job satisfaction.
9449001	The paper traces the relationship between attachment processes and the development of the capacity to envision mental states in self and others. We suggest that the ability to mentalize, to represent behavior in terms of mental states, or to have "a theory of mind" is a key determinant of self-organization which is acquired in the context of the child's early social relationships. Evidence for an association between the quality of attachment relationship and reflective function in the parent and the child is reviewed and interpreted in the context of current models of theory of mind development. A model of the development of self-organization is proposed which has at its core the caregiver's ability to communicate understanding of the child's intentional stance. The implications of the model for pathological self-development are explored, with specific reference to the consequences of maltreatment.

9420361	There has been scant empirical study of the psychological consequences of contemporary peacekeeping missions. This study examined relationships among 4 variables characterizing this type of operation (traditional combat events, negative aspects of peacekeeping, pressure to uphold restraint, and positive aspects of peacekeeping) and symptoms of posttraumatic stress disorder (PTSD). Participants were 3,310 male and female soldiers who served in the 1992-1994 Somalia mission. Structural equation modeling procedures were applied to data from subsamples of non-African Americans and African Americans. For both groups, traditional combat and negative aspects of peacekeeping were associated with PTSD, frustration with restraint, and positive aspects of peacekeeping; however, restraint was not related to PTSD. Discrepancies between the groups involved relationships among the restraint, positive aspects, and PTSD variables. Recommendations are offered to foster inquiry into this new research.
9407753	This study enquired about the knowledge and reported use of sport science in elite Olympic class sailors.The sailors responded to a simple questionnaire.	The questionnaire was administered as part of an introductory seminar on sport science during a training camp.	The participants were 28 (22 male, 6 female) elite New Zealand Olympic class sailors.	None.	The questionnaire asked whether or not they used a training race diary, enquired about their current and past injuries and their knowledge and use of sport science in the areas of nutrition, psychology and physical training.	Only ten (36%) of the sailors kept a training/race diary. Whilst only four (14%) had a current injury, sixteen (57%) reported an injury in the previous three years. The injuries were in the lower back (45%), knee (22%), shoulder (18%), and arm (15%). Although nineteen (68%) of the sailors had experienced dehydration during racing, the average volume of fluid reported to be taken on a four hour sail was only 0.9 litre, of which only an average of 0.7 litres (77%) was reported to be drunk. All the sailors reported being sometimes (46%) to very often (3%) anxious before races and sometimes (43%) to always (7%) being frustrated with their own mistakes. Only one sailor reported never having negative thoughts whilst fifteen (53%) reported having them sometimes, and seven (25%) often or very often. Twenty-four (86%) of the sailors reported that they sometimes had a loss of concentration near the end of the race. Whilst eighteen (64%) reported practising relaxation and seventeen (61%) reported practising visualisation as a mental skill, only five (18%) practised progressive mental relaxation, two (7%) practised meditation and none practised yoga. Seventeen (61%) undertook strength/circuit training, ten (36%) flexibility and twenty-one (75%) off water aerobic training. Twenty-four (86%) reported undertaking on-water aerobic training.	The results indicate that there is considerable scope for improvement in the knowledge and use of sports science amongst elite New Zealand Olympic class sailors.	
9407583	Although many studies have examined the relationship between personality factors and adjustment after surgery, most of them have had very short follow-up periods. The present prospective study examines whether preoperative psychodynamic assessment of personality traits enhances prediction of various areas of psychosocial adjustment assessed at least 1 year after surgery.In 53 patients undergoing pelvic pouch surgery for ulcerative colitis, we examined the relationship between personality traits measured before surgery, and postoperative psychosocial adjustment assessed at a median of 17 months postoperatively, controlling for the effect of surgical functional outcome. Personality traits were assessed with the Karolinska Psychodynamic Profile (KAPP). Surgical functional outcome scales and the Psychosocial Adjustment to Illness Scale (PAIS) were used.	Problems with sexual satisfaction, perfectionistic body ideals, lack of alexithymia, and poor frustration tolerance predicted poor postoperative adjustment in various areas, beyond what was predicted by surgical functional outcome alone. Moreover, moderate preoperative levels of alexithymia were beneficial to postoperative adjustment in the area of psychological distress.	The findings suggest that the preoperative assessment of the patient's long-term sexual functioning and satisfaction, the importance attached to his or her appearance, level of alexithymia, and general capacity to tolerate frustration and set-backs in life, might alert both the surgeon and the patient to potential risk factors for poor postsurgical adjustment.	
9375700	To identify the predictors of depressive and anxiety disorders in general medical patients presenting with physical complaints and to determine the effect of these mental disorders on patient outcome.In this cohort study, 500 adults presenting to a general medicine clinic with a chief complaint of a physical symptom were interviewed with PRIME-MD to diagnose DSM-IV depressive and anxiety disorders. Clinical predictors were identified by logistic regression analysis. Outcomes were assessed immediately postvisit and at 2 weeks and 3 months. These included symptomatic improvement, functional status, unmet expectations, satisfaction with care, clinician-perceived patient difficulty, and health care utilization and costs.	A depressive or anxiety disorder was present in 146 (29%) of the patients. Independent predictors of a mental disorder included recent stress, multiple physical symptoms (ie, 6 or more), higher patient ratings of symptom severity, lower patient ratings of their overall health, physician perception of the encounter as difficult, and patient age less than 50. Patients with depressive or anxiety disorders were more likely to have unmet expectations postvisit (20% versus 8%, P < 0.001), be considered difficult (26% versus 11%, P < 0.0001), and report persistent psychiatric symptoms and ongoing stress even 3 months following the initial visit. Psychiatric status was not associated with symptomatic improvement, health care utilization, or costs.	Simple clinical clues in patients with physical complaints identify a subgroup who may warrant further evaluation for a depressive or anxiety disorder. Such disorders are associated with unmet patient expectations and increased provider frustration.	
9396225	Much of the recent interest in the risk factors of relapse in alcoholics has focused on the withdrawal depressive state. Although the clinical relevance of this syndrome is often acknowledged, definite empirical research on subjective symptoms has not been presented in detail. Therefore, the purpose of this paper is to explore the characteristics of mentally or physically subjective symptoms of alcoholics and to discuss the risk factors to "slip". To evaluate the subjective symptoms, the health questionnaire that is composed of 62 items was applied to 73 admitted alcoholics. The principal component analysis obtained for the questionnaire of mental symptoms extracted five factors as followed, 1) feeling of estrangement or emptiness, 2) anxiety or impatient, 3) depressive mood or sleeping disturbance, 4) endogenous depressive factor, 5) unstable emotion. Additionally, five factors on physical symptoms were extracted as follows, 1) autonomic dysregulation related to neurasthenic state, 2) autonomic dysregulation related to hysterical neurosis, 3) loss of libido, 4) appetite loss, 5) dry mouth or sweating. These findings emphasized that many alcoholics felt the feeling of maladjustment and emotionally unstable under the "sobriety" state. These also suggest the "slip" of alcoholics should depend on expectation to reduce their tension, conflict and frustration under the influence of alcohol.
9393888	Feeding difficulties are common in neurologically impaired children, often leading to great distress and frustration in the child and family. A gastrostomy may be advocated if oral intake is inadequate causing poor weight gain or when there is significant aspiration during feeding, or if feeding is very distressing. To find out if caregivers were happy with the outcome of gastrostomy (with fundoplication, when indicated), a 35-item questionnaire was developed and sent to 38 of them. Twenty-nine replies were received and appeared to be representative of the whole group. Coughing, choking, and vomiting improved in most cases. Weight gain improved in all in whom it had been a problem. In the majority, it became easier to give the children their medications although control of epilepsy was unchanged overall. Time spent feeding the child was reduced and many caregivers had more time to devote to other children and themselves. Only one parent regretted the operation. In children with severe disability and feeding problems, a gastrostomy (with fundoplication if there is significant reflux) can reduce symptoms of vomiting, coughing, and choking, help growth and improve quality of life in the child, when patients are properly selected.
9391708	Progressively during the 20th century dentistry for children has become more efficient, less painful, and more prevention oriented. In the last quarter of the 20th century there was a dramatic decrease in dental decay for many American children. These two facts paired with the fact that stories about dentistry being painful are gone in many American communities and have been replaced with stories about how pleasant the dental appointment can be would seem to predict that child patient management and the interception of inappropriate behavior would not be a critical skill for the dental clinician that treats children today. This finding however is not the case. It is submitted that misbehavior now stems from the fact that today's parents are not encouraged to raise their children as urgently as in the earlier part of the century. It is offered that the child's incompetence in working with other people in the constituent speech acts of requests and promises causes the child confusion, frustration, and perhaps anxiety. The child's dental experience is a complex conversation between the dentists as requester and the child patient as the promisor of effective actions to the dentists' reasonable requests.
9362023	Since the 1960s nurse educators have been searching for the most effective approach to prepare nursing students for care of the dying. Studies investigating the effectiveness of death education programs for nursing students have reported inconsistent findings. A phenomenological study was conducted to explore the meaning of 26 undergraduate nursing students' experiences in caring for dying patients. The nursing students' written descriptions of their experiences were analyzed using Colaizzi's (1978) phenomenological method. Six themes emerged from this analysis. While caring for dying patients, nursing students experienced a gamut of emotions such as fear, sadness, frustration, and anxiety. Contemplation of the patient's life and death occurred as the students cared for their patients. In addition to providing physical, emotional, and spiritual support for dying patients, an integral part of nursing students' care involved supporting the patients' families. Helplessness was experienced by the students regarding their role as patient advocates. While caring for dying patients, nursing students' learning fluorished. Educational strategies for preparing nursing students to care for the dying are addressed based on the findings of this qualitative study.
9356888	The objective of the present study was to determine the prevalence and characteristics of food cravings in women with a history of anorexia nervosa.One hundred one control women selected at random and 64 women with a diagnosis of anorexia nervosa 10 to 14 years earlier (cases) completed the Diagnostic Interview for Genetic Studies, a food craving questionnaire, the Temperament and Character Inventory and the Three-Factor Eating Questionnaire.	A similar proportion of cases and controls reported food cravings. A greater proportion of cases reported strong cravings with two or more features of intensity (p = .02). Cravings in the cases were more likely to be characterized by difficulty resisting the craved food (p = .0008), anxiety when the craved food was unavailable (p = .002), and a high frequency of occurrence (p = .001). The cases who craved were significantly more likely to have had lifetime BN (p = .02).	A similar prevalence of food craving in cases as in controls suggests that successful control of food intake and/or denial of hunger overrides dietary restriction as a precondition for craving in anorexia nervosa. A dysfunction in the serotonergic system, the provision of intermittent reinforcement by binge episodes, and/or frustration due to unsuccessful attempts at dietary restraint may mediate the association of cravings with the presence of lifetime bulimia.	
9328776	Recent studies of the doctor-patient relationship have shown that certain patients are perceived as frustrating or difficult by their doctors; however, little is known about the characteristics of these patients that elicit this dissatisfaction. As part of a larger study of rheumatology clinic patients with fibromyalgia or rheumatoid arthritis (N = 68) we used stepwise multiple regression to select the factors most associated with physician frustration while controlling for the effects of other variables. Variable domains included demographics, psychiatric diagnoses, personality factors, functional disability, disease state, and trauma history. These domains as well as individual variables within these domains were systematically evaluated for their unique contribution to the prediction of physician frustration as measured by the Difficult Doctor-Patient Relationship Questionnaire (DDPRQ). Initial bivariate correlates of physician frustration included marital status, current dysthymia and agoraphobia, lifetime panic disorder and obsessive-compulsive disorder, adult rape and physical abuse, somatization disorder, physical and social disability, the presence of fibromyalgia, as well as neuroticism, illness impact, and perceived loss of control. The best multivariable model for estimating frustration magnitude included somatization disorder, perception of lack of control over illness, and a lifetime history of obsessive-compulsive disorder. These factors explained 48% of the variance in DDPRQ score. Physicians in this study were most frustrated with patients who had ongoing preoccupation with multiple medically unexplained physical symptoms as well as the perception of greater impact and lack of control over their illness. These findings suggest that treatment of somatization in patients with chronic symptoms may decrease physician frustration.

9316097	Many pediatricians now recognize the importance of incorporating an assessment of health-related quality of life (HRQL) into their clinical studies. Conventional clinical measures provide valuable information about the status of the affected organ system but they rarely capture the functional impairments (physical, emotional, and social) that are important to the patients in their everyday lives. To obtain a complete picture of a child's health status, both the conventional clinical indices and the child's HRQL have to be measured. Parents do not perceive accurately their children's HRQL, hence it is necessary to obtain the information directly from each child. Children with asthma are distressed by the symptoms (shortness of breath, wheezing, and cough), and they are limited in their day-to-day activities (sports, school, work, and playing with pets). In addition, children are often upset and frightened by asthma attacks, and express anger (younger children) and frustration (older children) because they have asthma. They frequently feel different from their friends and get frustrated that they cannot participate in activities. Disease-specific quality of life questionnairs for children with asthma have been developed. These questionnaires have good measurement properties and validity, and can be used both in clinical trials and in clinical practice to assess the impact of asthma on a child's life. Because one of the aims of treatment is to ensure that the children benefit from treatment, an essential component of clinical assessment of these children should be the evaluation of health-related quality of life.

9291412	Reading this article will enable health care providers to recognize and to diagnose paroxysmal sneezing, sighing dyspnea, habit cough, and vocal cord dysfunction and to reinforce their knowledge of the epidemiology, etiopathology, clinical features, and treatment of these disorders.The literature was reviewed using a MEDLINE search for information relating to the above-mentioned disorders. Indexing terms used included psychogenic wheezing, vocal cord dysfunction, functional respiratory disorders, sighing dyspnea, paroxysmal sneezing, habit cough, and psychogenic stridor. Review was restricted to English language articles from 1966 onward, with cross-referencing to obtain older references.	All human studies that clearly identified the above-mentioned disorders as being nonorganic on the basis of historic and appropriate laboratory evaluation were reviewed. No studies were rejected on the basis of subject age, although special emphasis was given to articles concerning children and adolescents (<18 years old). Of all initially identified studies, 95% fulfilled the inclusion criteria.	Functional respiratory disorders are common and affect mostly children, adolescents, and young adults, resulting in considerable morbidity and contributing significantly to patient and physician cost and frustration. A history of a psychiatric disorder with temporally related psychogenic stressors is frequently found. Professionals disagree on the technical classification of some of these conditions (ie, psychosomatic versus somatoform), but there is agreement that treatment directed toward underlying stressors should be the cornerstone of therapy.	Functional respiratory disorders must be considered in patients with atypical symptoms, especially those resistant to conventional therapy. Possible psychogenic stressors must be inquired into and, when identified, treated in a multidisciplinary manner. This may involve reassurance regarding the absence of significant organic abnormality, counseling, and occasional recourse to formal psychiatric intervention.	
9384189	To describe the experience of impaired verbal communication during short-term oral intubation in surgical critical care patients.Semi-structured interviews (N = 10)	Patients identified feelings related to discomfort, fear, and frustration. Patients desired to communicate messages regarding pain and discomfort, difficulty breathing, length of intubation, use of restraints, family, physical status, and suctioning.	Findings can be used to educate patients and families and develop patient-driven communication tools.	
9333717	This study examined the changes from hospital admission to discharge of different categories of cognitive distortions - automatic thoughts, self-concepts and dysfunctional attitudes - in 67 patients with an ICD-10 diagnosis of a depressive episode. Furthermore, the relationships were analyzed between cognitive distortions, degree of depression, and personality dimensions (isolation tendency, extraversion, rigidity, schizoidia, frustration tolerance and neuroticism). There was a significant correlation between automatic thoughts and negative self-concepts on the one hand, and severity of depression on the other upon admission. There was a significant reduction of automatic thoughts and the negativity of self-concepts from admission to discharge. No significant association was observed, however, between the severity of depression and dysfunctional attitudes. In addition, dysfunctional attitudes showed a significant decrease until discharge only in patients with a full remission of depressive symptoms. These results underline the fact that automatic thoughts and self-concepts are more state-dependent than dysfunctional attitudes. Moreover - even taking into account the degree of depression - there was a significant relationship between the personality dimension neuroticism and all cognitive scales upon admission. This indicates that a high degree of neuroticism may facilitate the emergence of negative cognitions during a depressive episode.
9274156	This article was initiated to help two graduating Master's students learn what might be expected of them upon graduation. The purpose of this article is to provide insight from reviewing the current literature on clinical nurse specialist's (CNS's) characteristics. The authors believe that this information is especially useful for graduate CNS students and helpful for those who currently hold CNS positions. Based on a literature review, the article categorizes descriptions of the characteristics of the CNS role as perceived by the CNS, management, staff nurses, and physicians. Within the identified perceptions of each group were the following similarly common CNS role components: (a) clinical practice, (b) education, (c) administration, (d) research, and (e) consultation. The key to congruent expectations and understanding of the CNS role is clear communication between the members of each group. Without this communication, the common result is ambiguity, conflict, and frustration.
9248251	Optometry has experienced a dramatic upward shift in the percentage of women entering the profession during the past 20 years. Our survey assessed the mechanisms for sustaining balance in professional and personal roles used by women optometrists and how these mechanisms may differ from those of their male colleagues.A survey questionnaire was mailed to a large nationwide random sample of optometrists, composed of equal numbers of men and women.	Data were analyzed from 353 men and 358 women; margin of error was +4%. Most of the respondents indicated they derived personal satisfaction from their career. A majority of both groups did not indicate that lack of time for their career was a source of frustration. However, significantly more women than men indicated some frustration in pursuing those activities that lead to career advancement. There were significant differences in response patterns of men and women about the effect of family, child care, and household work on their careers.	Both men and women optometrists are satisfied with their careers and neither group feels compelled to choose between career and family. Optometrists do not fit into one pattern, but instead make individualized career choices on the basis of needs.	
9241574	Personality traits were assessed by means of the Munich Personality Test (MPT) in 75 Japanese subjects, 27 patients in remission from an episode of moderate to severe primary unipolar depression, with melancholic features during one episode or more of the disorder, in 24 patients in remission from other non-organic mental disorders and in 24 healthy controls. Compared with healthy controls, unipolar depressives displayed decreased Frustration Tolerance and elevated Rigidity as well as a stronger Orientation towards Social Norms. No significant difference was found between patients in remission from either unipolar depression or other mental disorders. However, the increase in Rigidity in comparison with healthy subjects was significant in the depressives only whereas the other patients, in contrast to the depressives, had significantly lower scores in Extraversion than the healthy subjects. Our results in Japanese patients are similar to findings of previous German studies, including two high risk studies, in which the same assessment instrument was used. This suggests that, beyond cultural differences, Rigidity, possibly in combination with a strong Orientation towards Social Norms and a reduced Frustration Tolerance, is a stable vulnerability marker for at least the more severe forms of primary unipolar depression.
9221973	The development and validation of the Center for Neurologic Study-Lability Scale (CNS-LS), the first self report measure of affective lability in patients with amyotrophic lateral sclerosis (ALS).Potential questionnaire items were identified through interviews with patients and families and expert review. Potential items, as well as measures of affect intensity, affective lability in psychopathology, and depression were administered to 99 patients with ALS for item selection and the examination of factor structure and construct validity. Test-retest reliability was examined using an additional sample of 31 patients with ALS, and criterion related validity was examined by comparing CNS-LS scores with physicians' diagnoses of affective lability in a sample of 77 patients with ALS.	A seven item questionnaire emerged, composed of two subscales measuring labile laughter (four items) and labile tearfulness (three items). The CNS-LS showed a pattern of associations with affect intensity, affective lability in psychopathology, and depression consistent with a scale measuring affective lability. The CNS-LS also showed good test-retest reliability and internal consistency, and successfully predicted physicians' diagnoses of affective lability. An auxiliary subscale measuring labile frustration, anger, and impatience also emerged.	The CNS-LS is a short, easily administered, and psychometrically sound measure of affective lability for use with patients with ALS. It has potential applications as both a clinical screening device and a research tool. The need for future research into the relation of depression as well as labile frustration, anger, and impatience to the syndrome of affective lability in neurological disorders is discussed.	
9277002	To evaluate the effects of complex spa therapy (swimming training in a hot spring pool + fango therapy + inhalation of iodine salt solution) on psychological factors, three psychological examinations; CMI (Cornell Medical Index), SDS (Self-Rating Depression Scale) and CAI (Comprehensive Asthma Inventory); were given 25 patients with bronchial asthma (10 male, 15 female, mean age 60 years), and the results of these examinations were compared before and after spa therapy. 1. Physical symptoms, respiratory system and CIJ symptoms by CMI were significantly improved after spa therapy, however the improvement of psychical symptoms was not significant. 2. In SDS, 11 of 25 patients showed more than 40 points, indicating depressive state. The number of such patients decreased from 11 to 2 and the mean SDS score significantly improved from 38.7 to 34.2 after spa therapy. 3. Conditioning, suggestion, fear of expectation, frustration, flight into illness, negative attitudes towards prognosis, and decreased motivation towards therapy by CAI were significantly reduced after spa therapy, with the reduction in negative attitudes towards prognosis and decreased motivation towards therapy being relatively large. Furthermore, CAI score, which is the average of the categories in CAI, was also significantly decreased from 37.9 to 28.4 after spa therapy. These results suggested that complex spa therapy improves psychological factors in patients with bronchial asthma.
9242975	A two-part study was conducted with sport physiotherapists to examine their perceptions of both frequency and significance of emotions and behaviours displayed by injured athletes during treatment, and the importance of psychological skills in rehabilitation. A questionnaire, developed from a preliminary study (Part 1) with experienced sport physiotherapists (N = 10), was mailed to 500 sport physiotherapists in Australia, New Zealand and Canada (Part 2). Responses from Australian (N = 147), New Zealand (N = 65) and Canadian (N = 45) subjects suggested that: (i) anxiety and frustration is experienced frequently by injured athletes, and non-compliance to the rehabilitation program is a significant problem preventing effective recovery and rehabilitation; (ii) psychological skills training and learning to deal with psychological responses to injury would facilitate more effective treatment; and (iii) athlete self-presentation styles influence the support and attention received from physiotherapists. Results are discussed in relation to previous research and recommendations for improving both the art (applied skills) and science (theoretical content) of professional training programs for sport physiotherapists are provided.
9233208	Sleepy babies can be a source of frustration to both mothers and health care providers during the early days of breastfeeding. This paper looks at some reasons for excessive sleepiness and offers suggestions for helping sleepy babies to breastfeed using the baby as a guide.
9214883	Nurses caring for abused women become frustrated and concerned when their patients return to the violent relationship. This disconcerted feeling can hinder the care nurses render to these women, subsequently leaving the victim powerless. Understanding this phenomenon can improve patient care, increase the image of women and, ultimately, help banish violence against women.
9254486	The clinical and medico-psychological research of the servicemen, long time staying by hostages in captivity is lead. Boundary mental frustration, in particular neurotic reactions and the conditions, asthenodepressive syndrome, posttraumatic stress frustrations, are revealed in 45.8% surveyed. The most psychotraumatic is initial period of adaptation to conditions of captivity. The necessity to carry out the measures of medico-psychological rehabilitation and treatment of the servicemen, released from captivity, should be taken into account during planning of medical maintenance of the troops in local wars and armed conflicts.
9236701	Service provision for those with cerebral palsy (CP) becomes fragmented after adolescence. Young people with CP in two age groups, their carers and associates, were interviewed, and use of health and social services was investigated. Leisure activities were also compared with a matched control group of able-bodied young people. Use of health and social services decreased when the children with CP left school, thereby increasing the demands upon carers. Carers expressed anxieties about the provision of services, and frustration in obtaining information about help. Findings from the questionnaires showed the young people with CP in both age groups to be socially less active than the controls. Among the subjects, the older age group was socially less active than the younger age group. Communication is poor both between the agencies providing care and between the agencies and the young person or carer. There is a need to identify those with responsibility for coordinated-care planning for adolescents with CP.
9161122	Three years of analytical psychotherapy with a professional woman in mid-life, suffering from chronic fatigue syndrome (CFS), is described. Gradual recovery merged into mid-life changes; marriage, along with a new balance of maternal and paternal imagos, enabled her to trust enough to become pregnant-coniunctio in the most primal bodily and psychic modes. Her life-long, schizoid type pattern, "the pendulum of closeness and isolation', with its extreme of psycho-physical collapse and devitalization, was replayed in therapy. The analyst's symbolic attitude is emphasized, containing the patient's initial affective explosion and validating the physicality of her condition. Mirroring and steady rhythmic attunement became a new, pre-verbal, source of trust-vitalization; differentiation and separation replaced defensive splitting and dissociation. Then the overwhelmingly powerful bodily/maternal could be counterbalanced by the masculine, and a transitional space emerged for symbolic work. Both the regressive and the dynamic aspects of CFS are located in the earliest undifferentiated, archetypal, bodily/psychic modes, when the frustration of primary needs evokes the defences of the self. It is argued that our psychodynamic understanding can contribute to the stalemate in seeing chronic fatigue syndrome as either an organic illness or depression, and that a new linking of the somatic and psychic calls for a new professional collaboration.
9117950	Accountability is an issue that creates stress and frustration for managers at all levels within an organization. With the current trends to "push decision-making down" and "empower people" to run more efficient units or departments, many managers are finding most of their efforts are not yielding the intended results. Employees are not embracing new responsibilities and accountability. They seem to find it another burden added to what they report as already too much work. What can be done to manage this dilemma? Interestingly enough, the solution may have to start by taking a journey into self-awareness.
9109062	1. Patients who demonstrate self-wounding behaviour require behavioral, pharmacological, and psychotherapeutic interventions to meet their highly complex needs. 2. Nurses caring for patients who wound themselves will experience frustration related to the safety needs of the patients and guilt whenever an injury occurs. 3. Staff members managing the patient who wounds himself or herself need administrative support, education, and counseling to relieve guilt, personal and professional conflict, and stress.
9108585	Amsel's frustration effect refers to a facilitation of behavior immediately after unexpected nonreward. The original experiments were plagued with problems of interpretation, mainly because the critical comparison involved conditions that were not equated in terms of reward frequency and amount. A replication of the original experiment (with a 50% partial reinforcement schedule used to induce response facilitation) is reported here with one important addition: A control group matched in terms of reward parameters, for which the reward was not signaled by a discrete cue. Matching is achieved through the use of a Pavlovian training procedure. The results show facilitation of rats' lever-contact performance after unexpected reward omissions. The control group showed no facilitation. These results provide support for the view that response facilitation is caused by increased arousal after unexpected nonreward.
9156107	The objective was to study attitudes and views of primary care professionals towards terminally ill cancer patients who die at home, using a cross-sectional study based in the health district of Manresa (province of Barcelona, Catalonia, Spain) of the Catalan Health Service, involving 151 primary health care professionals (87 physicians and 64 nurses). By using a self-responded anonymous questionnaire (response rate 89%) it was found that despite excellent motivation, primary care professionals reported widespread frustration and a poor opinion of the quality of care provided to terminally ill cancer patients. Attitudes and views clearly differ by age, sex and geographic setting. In the study area, most professional are reluctant to disclose the diagnosis of cancer, and this attitude is associated with a more favourable assessment of the support provided to the family. The idea that the most appropriate place of death is at home is strongly linked to the belief that patients ought to be informed of their illness, to feelings of frustration and to youth. These findings further substantiate the need and the potential for ample changes in terminal cancer care in Spain.
9104203	Practice transition between health care settings is often fraught with frustration, stress, and even traumatic learning experiences for nurses. As the need for qualified infusion therapists in home care increases, more acute care nurses are making the transition from hospital to home. This article is designed to profile the differences between the care settings and offer suggestions to smooth the change from hospital to home care.
10166013	Families of patients in critical care experience extreme anxiety and frustration while awaiting their loved ones' recovery or stabilization. To study the hypothesis that meeting families' informational needs can reduce their anxiety and help them cope with the initial crisis, a small task force at a Midwest acute care facility, using a CQI approach, studied possible solutions. Initial findings showed low satisfaction for families of critically ill patients with the present system of imparting information to them. After initiation of a storyboard to present information by the critical care team, families reported increased satisfaction and greater knowledge recall.
9083588	This paper describes parents' views of the New York City Public High School's AIDS Education and Condom Availability Program. It presents findings from 12 focus groups with 81 parents of students at six representative high schools. Focus groups were conducted as part of an independent, comprehensive 3-year evaluation of the program, consisting of both qualitative and quantitative components. Participants were mostly supportive of the program, citing intense concern about AIDS among adolescents, fear that teenagers do not adequately perceive themselves as being vulnerable, and personal experiences with infected relatives and friends. Implications of these findings for program development are discussed and recommendations for social policy changes are presented.During 1992-94, focus groups of parents of students from six randomly selected New York City public high schools were conducted to determine the parents' attitudes about changes affecting implementation of the AIDS Education and Condom Availability Program.  The changes included failure to reappoint the chancellor who initiated the program, voluntary departure of many of his staff who were architects of the program, and the court-order parent opt-out.  Most parents supported school-based AIDS education and condom availability.  They considered AIDS to be a deadly threat to teens.  They thought that sexually active adolescents do not adequately perceive AIDS as a threat.  Some parents saw a general sense of invincibility and futility among teens as a major barrier to their understanding of the seriousness of AIDS.  The death of a family member made AIDS salient to teens.  Parents were most interested in the protection afforded by regular condom use.  They believed that schools can reinforce what parents teach at home.  A minority of parents objected strongly to the program, especially the availability of condoms.  They wanted the program to focus on abstinence, moral values, and self-respect.  Opponents of the program were most likely to object to the lack of outreach of the program to involve parents in the development of the program.  Informational workshops have helped parents communicate with their children about AIDS and helped them alleviate their fear that condom availability promotes sexual activity.  These workshops were not in place at all schools, however.  Many parents said that the threatening nature of the AIDS epidemic supersedes issues of parental authority.  A minority of parents chose the opt-out provision because sex and condoms were the parents' responsibility, not the school's.  Their reactions again suggested frustration with not being included in the decision-making process.  Most parents talked to their children about AIDS, sex, and condoms.  The media more than the school promoted such discussions, however.  Parents who had poor communication patterns especially appreciated the program.	
9074369	Surgeons often "know" preoperatively which patients will achieve good postoperative quality of life (QOL). This intuition is probably based on impressions of the patient's personality. The present aim was to examine whether preoperative personality traits predict postoperative QOL.In 53 patients undergoing pelvic pouch surgery for ulcerative colitis the relationship between preoperative personality traits, and surgical functional outcome and QOL was examined at a median of 17 months postoperatively. Personality assessment instruments (KAPP and KSP), and specific measures of alexithymia were used. Postoperatively, the Psychosocial Adjustment to Illness Scale (PAIS), and surgical functional outcome scales were used.	Using multiple correlation/regression, analysis lack of alexithymia, poor frustration tolerance, anxiety proneness, and poor socialization (resentment over childhood and present life situation) were found to predict poor postoperative QOL.	The findings suggest personality traits, in addition to surgical functional outcome, to be important for the patient's postoperative QOL.	
9024444	Child abuse and wife abuse are linked. Studies indicate 30% to 59% of mothers of children reported for child abuse also are battered. In homes where domestic violence occurs, the children are at increased risk of physical abuse or neglect. Children who witness battering of their mothers are at risk for psychosocial sequelae including developmental delays and posttraumatic stress disorder.To determine pediatric emergency medicine fellows' level of preparedness to respond to battered mothers, and to assess obstacles and attitudinal barriers to their effective response.	Self-reported written survey.	A 30-item anonymous questionnaire was mailed to 162 pediatric emergency medicine fellows in the United States and Canada in 1995. A response rate of 77.2% (n = 125) was achieved.	Before fellowship, 97.6% of respondents had training (including formal courses, conferences, and direct patient contact) on child abuse/neglect although only 29.6% received similar instruction on woman battering. There was a marked disparity between patient contact experience for child abuse/neglect and woman battering throughout training. Before fellowship, 89/122 (73%) reported direct involvement in at least 10 cases of child abuse/neglect. Seventy-one (57.3%) of 124 fellows had not handled any cases of woman battering before fellowship; 106/124 (85.5%) had been directly involved in fewer than 10 cases. During fellowship 81 (67.5%) of 120 respondents had been involved in at least 10 cases of child abuse/neglect and 46/120 (38.3%) had handled at least 20 cases. In contrast, 72 (73.5%) of the 98 responding fellows had not handled any cases of woman battering during fellowship. Furthermore, 86/100 fellows reported no formal training on woman battering in their fellowship curricula. Only 5/118 (4.2%) reported having protocols in place for responding to battered women in the pediatric emergency department. Items most frequently selected from a list of potential obstacles to responding to battered women included: lack of a protocol (82/113), lack of formal training in the field (103/118), and lack of experience with woman battering cases (100/117). The majority, 75/118 (63.6%), believed that responding to battered mothers did not belong in the preview of pediatrics. Potential attitudinal barriers confirmed with the greatest frequency included: frustration that nothing could be done and lack of time to respond appropriately to battered mothers in the pediatric emergency department.	Battered mothers are rarely identified in the pediatric emergency department even though the physicians report handling a significant number of child abuse/neglect cases. Education on domestic violence, including the implications of woman battering for childrens' health, should be incorporated in the training curricula of pediatric emergency department physicians to raise awareness of the need to explore for the presence of concurrent abuse in both children and their mothers. Identifying battered women through their children will impact greatly on the welfare of both mother and child.	
9655033	Breath odor research has recently received increasing attention from periodontologists. Because a large portion of the adult population suffers from gingivitis and eventually periodontitis, the etiologic factor in all cases at risk must be considered. The first patient visit should, therefore, systematically include examination of the paranasal cavities and throat to avoid unnecessary time loss and frustration. Metabolic diseases and imaginary malodor should also be considered. Not only the mere presence of a chairside volatile sulfide monitor but also of that of an ear, nose, and throat specialist and eventually a psychiatrist or psychologist who determines whether a breath odor clinic merits its denomination. Volatile sulfur components are an important cause of breath malodor but they are not the sole cause. This explains why organoleptic and gas chromatographic diagnosis scores better than a portable sulfide monitor. Other than etiologic therapy, masking can be achieved for a number of hours by toothpastes containing a combination of triclosan and zinc chloride.
9529728	Although first introduced more than 15 years ago, Critical Incident Stress Debriefing (CISD) has not been frequently utilized within the correctional community. As a structured protocol designed to prevent or mitigate traumatic stress, CISD has two main goals: (1) to lessen the impact of distressing critical incidents on the personnel exposed to them; (2) to accelerate recovery from those events before harmful stress reactions have a chance to damage the performance, careers, health, and families of personnel responding to emergencies. The need for debriefing remains acute. Whenever I conduct a jail-suicide prevention training seminar and explain the importance of the CISD process, correctional officers invariably approach me at the end of the workshop and begin to explain their experience with an inmate's suicide. Their voices are always characterized by frustration. This is one officer's story.
9477343	A theory of grandparent development is described that includes the formulation of assumptions, goals for guiding instruction, curriculum design, and a measurement tool to assess learning needs and evaluate the effects of educational intervention. Cultural considerations are illustrated by a three generational study of African-American (n = 777), Caucasian (n = 1086), and Hispanic (n = 672) subjects who were administered the Grandparent Strengths and Needs Inventory. Perceptions of each generation about the attitudes and behaviors of grandparents were examined with multivariate analysis of variance and post-hoc comparisons to analyze the scores, confirm results, and facilitate interpretation of findings. Results showed significant differences between generations and within cultures. Each generation identified elements of grandparent success as well as issues that deserve consideration in building educational programs.
9467794	Clinical trials require a quite distinct shift in attitudes and procedures from ordinary clinical practice insofar as they require a proactive approach to patient recruitment, enrollment, and followthrough as well as significant attention paid to issues of documentation, regulatory compliance, and error prevention. Take documentation, for example: Today's requirement to have an independent record of clinical events that are recorded on the case report forms was until 5 or 7 years ago not addressed in as much detail as it is today. This is one of the first adjustments that the new investigator must address. The researcher must keep looking to see what is missing from the location and procedures as a study takes place in order to create the necessary patient base for doing the study and ensuring that all needs necessary to produce the result are in place and that procedures are done with as few errors as possible. Everything must be done in conformance with good clinical practice and the standards set by the protocol. The researcher must be willing to deal with a world of breakdowns such as missing data, and the failure of the patient to revisit the office within the appropriate time dictated by the protocol and within the window of time or grace period allowed by the study. The researcher must ensure that the patients comply with the dosing schedule and that they are trained to return medications for accurate pill counts. And so on. This means creating new procedures that are motivated by a commitment to producing a specific enrollment result defined by specific criteria and increasingly because of the press of time enrolled in a specific time period and put through a well-defined protocol process. Clinical research is dependent on a willingness to commit to a specific end result and do all that is necessary on a day-by-day basis to produce that result in terms of specific numbers, clean and accurate case report forms that are backed up by corroborating source documents in line with a specific timeline in which to accomplish the task, and an outreach effort to recruit and enlist patients, which may involve advertising and promotion of the program, all of which may contrast significantly with customary practice. Clinical research involves reliance on additional dedicated personnel who are critical parts of the research team, including the telephone screening person who must be trained to follow a script and at the same time to be aware of the nuances of enrolling appropriate and compliant patients. The entire staff must be made part of the process and must work in concert to recruit and maintain the patient in a study while being aware of the effect these efforts may have on the placebo effect. It also requires considerable training, review, and constant communication among the staff to ensure that the complex coordination of numerous patients and procedures works smoothly. There needs to be a willingness among the staff and the investigators to take correction from monitors who visit the site periodically and whose focus is on the quality of the data and not so much on the qualifications of the staff. This is not an action that people in nonresearch environments are trained to take. Failure to appreciate the complexity of conducting clinical trials can contribute to much frustration to everyone involved. When there is understanding of all the variables that influence the ultimate results, there is a willingness to anticipate breakdowns and to turn breakdowns into opportunities to create new structures and develop new procedures that will ultimately facilitate a successful outcome.
9402916	Now, more than ever before, a wealth of options exists for depressed patients who do not benefit from treatment with standard, first-line antidepressant agents. In this paper, alternate antidepressant strategies are reviewed within the context of a five-stage strategy, ranging from lesser to greater degrees of treatment resistance. The overall strategy recommended progresses from simpler (i.e., an alternate monotherapy) to more complex strategies (i.e., combination or augmentation regimens), with the nonselective monoamine oxidase inhibitors (+/- lithium salts) and electroconvulsive therapy typically reserved for treatment of Stages III and IV of resistance, respectively. Psychotherapeutic management also is an important ingredient in the ongoing treatment of these patients, particularly to counteract the demoralization and frustration that understandably accompany the failure to respond to so many treatments.
9381708	The behavior of parents may have a decisive impact on the child's adjustment to treatment. Their positive attitudes have a calming effect, support the patient's emotionally and overcome problems and bear sufferings involved in the treatment. Conversely, negative attitude may ruin the adjustment and provoke pessimism, lack of cooperation and even aggressiveness. Although the nature and degree of parental behavior and attitude may vary, their impact on pediatric patient adaptation processes shows a general trend. Of particular importance is the pattern of parental attitude at stages of treatment which involve frustration, extrapunitive behavior of parents being a possible negative factor. Our experience suggests that psychologists employed at children's oncological clinics should provide more counseling for parents and more training professional for the medical staff to improve adjustment of patients to therapy.