Journal articles on the topic 'Physician and patient Sexual behavior'
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Hersh, Eitan D., and Matthew N. Goldenberg. "Democratic and Republican physicians provide different care on politicized health issues." Proceedings of the National Academy of Sciences 113, no. 42 (October 3, 2016): 11811–16. http://dx.doi.org/10.1073/pnas.1606609113.
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Physicians frequently interact with patients about politically salient health issues, such as drug use, firearm safety, and sexual behavior. We investigate whether physicians’ own political views affect their treatment decisions on these issues. We linked the records of over 20,000 primary care physicians in 29 US states to a voter registration database, obtaining the physicians’ political party affiliations. We then surveyed a sample of Democratic and Republican primary care physicians. Respondents evaluated nine patient vignettes, three of which addressed especially politicized health issues (marijuana, abortion, and firearm storage). Physicians rated the seriousness of the issue presented in each vignette and their likelihood of engaging in specific management options. On the politicized health issues—and only on such issues—Democratic and Republican physicians differed substantially in their expressed concern and their recommended treatment plan. We control for physician demographics (like age, gender, and religiosity), patient population, and geography. Physician partisan bias can lead to unwarranted variation in patient care. Awareness of how a physician’s political attitudes might affect patient care is important to physicians and patients alike.
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Hyams, Andrew L. "Expert Psychiatric Evidence in Sexual Misconduct Cases Before State Medical Boards." American Journal of Law & Medicine 18, no. 3 (1992): 171–201. http://dx.doi.org/10.1017/s0098858800007085.
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The growing problem of physician sexual misconduct has captured the attention not only of the medical and legal communities, but of the public as well. State medical boards, administrative agencies with generous rules of evidence and varying levels of expertise, face the difficult task of responding to patients’ allegations of physician sexual abuse. This Article, based in large part on the author's survey of current state medical board practice, reveals an increasing reliance on expert psychiatric testimony to explain the behavior of complainants and accused physicians. Drawing analogies from the use of psychiatric evidence in child sexual abuse cases, the author examines the factors that boards must consider in determining the admissibility of expert testimony in physician sexual misconduct cases, and calls upon states to establish clear evidentiary rules to govern the use of such testimony in administrative hearings.
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Carnes, Patrick J. "Sexual Addiction and Compulsion: Recognition, Treatment, and Recovery." CNS Spectrums 5, no. 10 (October 2000): 63–74. http://dx.doi.org/10.1017/s1092852900007689.
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AbstractThe management of patients with compulsive sexual behavior requires an understanding of the profile of the sexually compulsive or addicted patient. This article summarizes patient characteristics and their implications for treatment. Data from a study of the recovery of 957 patients who had problematic, sexually excessive behavior are presented. Spanning 5 years, the study shows six distinct stages patients experienced and the clinical activities that were most useful to them. A trajectory of a typical diagnosis and treatment path is provided, as well as important resources for physicians and patients.
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Waheed, Rizwana. "OBSCENE BEHAVIOR: A REAL CHALLENGE FOR THERAPEUTIC RELATIONSHIP." Pakistan Journal of Rehabilitation 11, no. 2 (July 7, 2022): 159–66. http://dx.doi.org/10.36283/pjr.zu.11.2/022.
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Background and Aims: Number of studies in healthcare context has described the rehabilitators as harassment perpetrator and patient as the victim, in particular therapists. Therefore, these issues must examine the dynamics of patient-therapists’ relationships to understand the factors related to the inappropriate sexual behavior. Methodology: A cross-sectional survey was conducted on physical and occupational therapists, recruited via convenience sampling technique. The data was collected through Inappropriate Patient Sexual Behavior questionnaire, sent to participants via email or WhatsApp groups. Results: A total number of 106 participants including 12.3% males and 87.7% females with 71.7% physical and 28.3% occupational therapist. The finding revealed that 82.1% therapists never had training in the context of understanding the inappropriate patient sexual behavior. Whereas 28.3% revealed that a patient has stared the body that made them uncomfortable, 9.5% reported to have sexual flattering remarks, 4.7% had purposeful touched in a sexual manner. Unfortunately, only 37.7%has expressed their disgust and raised voice to report the issues. Conclusion: It was concluded that relatively very low percentage of IPSB is present and reported cases are usually recorded as disgust feeling or raised voice. Thus for healthy therapeutic relationship, training for handling obscene behavior must be conducted and the curriculum should promote knowledge of this aspect.
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Ramisetty-Mikler, Suhasini, and LeAnn Boyce. "Communicating the risk of contracting Zika virus to low income underserved pregnant Latinas: A clinic-based study." PLOS ONE 15, no. 11 (November 20, 2020): e0241675. http://dx.doi.org/10.1371/journal.pone.0241675.
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Objective Frequent travel between the Southern border states in the USA, Mexico, and Latin American countries increases the risk of the Zika virus (ZIKV) spread. Patient education on virus transmission is fundamental in decreasing the number of imported cases, particularly among pregnant women. Methods The study used cross-sectional methodology to investigate information sources and knowledge concerning the ZIKV virus among 300 under-served pregnant Latinas recruited from prenatal care clinics in the North Texas region. Bivariate and multiple logistic regression models were used to investigate associations between the primary outcomes and patient characteristics. Results Physicians, nurses, and families are the major sources for pregnancy information, while media/internet (65%) and physician/nurse (33%) are the main sources for ZIKV information. Less than one-half of the mothers reported that their physician/nurse did not discuss safe sexual practices or inquired about their sexual practices. A considerable proportion of women from the community clinic were neither warned nor queried about travel to ZIKV risk countries. There is an overall understanding of Zika virus transmission, symptoms, complications, and recommended guidelines. Younger age and single mother status are risk factors for lack of ZIKV knowledge. Foreign-born mothers are 2.5–3.0 times more likely to have knowledge on disease transmission, symptoms, and microcephaly condition. While, younger mothers (18–24) are less likely to have knowledge of ZIKV infection symptoms (fever, rash and pink eye) and transmission of infection via unprotected sexual (vaginal, anal, or oral) behavior, compared to older mothers. Conclusions Interventions are needed to heighten the knowledge of ZIKV, particularly among women of reproductive age and their male partners in the community health care setting. Our study underscores the need for health care providers to be trained in delivering messages to enhance risk perception during health emergencies to vulnerable and underserved families (lower economic background, language ability, and culture). During health emergencies, clinics must disseminate crucial information via multi modalities to ensure messages reach the targeted patients.
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Komlenac, Nikola, and Margarethe Hochleitner. "Predictors for Low Frequencies of Patient-Physician Conversations Concerning Sexual Health at an Austrian University Hospital." Sexual Medicine 8, no. 1 (March 2020): 100–106. http://dx.doi.org/10.1016/j.esxm.2019.09.006.
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Searight, H. Russell, and Patricia Pound. "The HIV-Positive Psychiatric Patient and the Duty to Protect: Ethical and Legal Issues." International Journal of Psychiatry in Medicine 24, no. 3 (September 1994): 259–70. http://dx.doi.org/10.2190/ueyt-9523-1a0m-jwng.
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A small, yet significant, percentage of HIV-positive patients have a concomitant psychiatric or neurological disorder associated with impaired judgment. Clinical problems such as psychoses, certain personality disorders, and dementias are associated with disinhibition of impulses and diminished capacity for self-monitoring. These deficits in reasoning and judgment may prevent the patient from comprehending the significance of their HIV status and the consequences of sexual behavior or needle sharing. There are indications that the Tarasoff duty-to-protect may apply to this situation. Method: Available data about the prevalence of HIV risk behavior and HIV infection among psychiatric patients are reviewed. The applicability to these situations is described. Results: When an HIV patient engages in high risk sexual behavior with identifiable partners and refuses to notify them of their HIV status, physicians and mental health professionals may have a legal and ethical duty to warn. Conclusion: A decision model for this clinical dilemma is presented. Clinical strategies for these patients may include ongoing supervision and monitoring as well as possible quarantine.
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Hock, Lauren E., Brittni A. Scruggs, Patrick B. Barlow, Thomas A. Oetting, Michael D. Abràmoff, and Erin M. Shriver. "Responding to Patient-Initiated Verbal Sexual Harassment: Outcomes of a Pilot Training for Ophthalmologists." Journal of Academic Ophthalmology 12, no. 02 (July 2020): e175-e180. http://dx.doi.org/10.1055/s-0040-1717062.
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Abstract Background Sexual harassment of physicians by patients is highly prevalent and rarely reported. Little is known on how to prepare physicians to handle verbal sexual harassment that detracts from their ability to provide care but does not meet the threshold for reporting. Purpose To assess the impact of a sexual harassment workshop and toolkit for ophthalmologists and ophthalmology trainees on responding to patient-initiated verbal sexual harassment. Methods A survey study of ophthalmology faculty, fellows, and residents who participated in workshops on responding to patient-initiated verbal sexual harassment was performed at an academic center. A toolkit of strategies for response was distributed. Volunteer participants completed a retrospective pretest–posttest evaluation at the conclusion of the workshop and follow-up survey 3 weeks after the workshops on whether they experienced harassment and intervened. The pretest–posttest surveys assessed the workshop's effect on ophthalmologists' perceptions of and preparedness to respond to sexual harassment in the moment using a 5-point Likert scale, including bystander intervention. Participants described their responses observing and/or experiencing patient-initiated sexual harassment in the 3 weeks following the workshop and whether they had intervened toward the harassment. Results Ophthalmologists (n = 31) felt significantly more prepared to respond to patient-initiated sexual harassment directed toward themselves or a trainee in the moment after participating in the workshop (4.5 ± 1.63) than before (3.0 ± 1.3) with a mean change of 1.6 (95% confidence interval: 0.98–2.2, p < 0.001). After the workshop, 86.3% of participants felt mostly or completely prepared to respond to comments about their age, gender, marital status, appearance, attractiveness, a specific body part, and sexual or inappropriate jokes. Most participants (83.9%) said that they had not previously received training on techniques for responding to patient-initiated sexual harassment. Two-thirds (66.7%) of participants who experienced (n = 8) or observed (n = 13) harassment (n = 15) following the workshop intervened. All participants who intervened toward patient-initiated harassment behavior after the workshop (n = 10) found the Sexual Harassment Toolkit helpful in addressing harassment in the moment. Conclusion Participation in a brief skills-based workshop significantly improved ophthalmologists' preparedness to respond to verbal sexual harassment by patients.
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Kim, Dohee, Kyoung Min Kim, and Myung Ho Lim. "A Case of Paraphilia with Osteoporosis and Administered with Depot Leuprorelin." Medicina 55, no. 10 (October 20, 2019): 705. http://dx.doi.org/10.3390/medicina55100705.
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Paraphilia is a complex psychological and psychiatric disorder that has been difficult to treat. Leuprorelin has been used as one of the therapeutic methods for paraphilia. Leuprorelin administration could change insulin resistance and accelerate bone loss. The case study in this work was a 59-year-old man who visited a hospital with the chief complaints of frotteuristic behaviors in public places, a continuous increase in sexual desire, and sexual molestation behavior that started in 2007. We injected leuprorelin (3.6 mg) intramuscularly every month for this patient with paraphilia and comorbidities of osteoporosis and hyperthyroidism. The clinical global impression (CGI), Sex Addiction Screening Test (SAST), Wilson Sex Fantasy Questionnaire (WSFQ), physical examination, and laboratory tests were performed. After 12 months of leuprorelin injection for paraphilia, we found a significant improvement in abnormal sexual behavior/desire without aggravation of osteoporosis/hyperthyroidism. Gonadotrophin-Releasing Hormone (GnRH) analogs could be used as alternative or supplementary treatment methods for paraphilia with osteoporosis/hyperthyroidism.
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Zhang, Ruixuan J., Madeline Bach, Julia Yip, and Athena Lin. "Cross-Sectional Study on Perceptions Regarding Cervical Cancer Screening and Human Papillomavirus Vaccination Among Female Patients in Rural Taiwan." Journal of Global Oncology 5, Supplement_1 (October 2019): 14. http://dx.doi.org/10.1200/jgo.19.23000.
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PURPOSE Cervical cancer remains the eighth leading cause of cancer mortality among women in Taiwan. Despite availability of a National Health Insurance program with free yearly screenings, Papanicolaou testing and human papillomavirus (HPV) vaccination rates have been historically low in Taiwan. Even in the United States, cervical cancer screening rates for Asian women are significantly lower than other ethnic groups. The goal is to direct future interventions by providing insight on barriers leading to low screening and vaccination rates among Taiwanese and Asian women. METHODS Anonymous surveys without patient identifiers were randomly administered to patients at a traditional Chinese medicine clinic in Hualien City in June 2018. Inclusion criterion was females. No exclusion criteria were defined. Participants provided written consent. Sixty-three completed surveys were received. A χ2 test was used to determine statistical significance (α = 0.05). RESULTS Formal education level correlated with increased knowledge of HPV ( P = .001), its route of transmission ( P = .044), its link to genital cancer ( P = .0024), and HPV vaccination ( P = .0039). Women were more likely to have Papanicolaou smears if they were older than 30 years of age ( P = .0033), visited the gynecologist ( P < .001), or were recommended one by their physicians ( P < .001). Although 57% of respondents knew of the HPV vaccine, only 19% were vaccinated. Among those not vaccinated, most cited reasons included an inability to find a physician providing it (23.5%), safety concerns (16.4%), belief that it encourages sexual behavior (14.5%), and high out-of-pocket expense (9.1%). CONCLUSION Knowledge of HPV does not predict a higher adherence to cervical screening guidelines. Instead, diligent physician recommendations on Papanicolaou smears can elevate adherence rates among patients. Significant contributors to low HPV vaccination rates in rural Taiwan include lack of awareness and access to the vaccine. Our study emphasizes the physician-patient relationship as a means to target vulnerable populations and increase rates of cervical cancer screening and HPV vaccination.
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Trotta, D., T. Strepetova, L. Otranto, G. De Maio, F. Gorga, and C. Langella. "Absence of Pleasure during Orgasm: A Functional or an Emotional Problem?" Klinička psihologija 9, no. 1 (June 13, 2016): 60. http://dx.doi.org/10.21465/2016-kp-op-0037.
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Objective: We present the case of an adult man complaining of orgasmic anhedonia. The patient who has no health problems or psychic diseases, doesn’t smoke and is immune of biological risk factors. Andrological physical, biochemical and instrumental investigation shows no evidence of organic cause. The man who is forty five, is married, has two children and is able to copulate twice a week, with his attractive wife. We have two objectives: 1 to uncover the cause of the patient’s sexual complaint and 2 to give him the possibility to profit of his erectile capacity and fully enjoy sexuality. Design and Method: After a complete sexual anamnesis, we invite the patient to describe in detail his sexual activity and behavior, his attitude and feeling towards sex and sexuality. We investigate his autoerotic and sexual fantasies and focus our attention on the continuity-discontinuity of his sexual reality and imaginary. Results: The clinical investigation, conducted with empathy and respectful of the patient’s difficulties, let gradually emerge a controversial sexual scenario. Our first objective is reached. The patient has now the possibility to solve his symptom, negotiating with its reasons or to continue to live with it. Conclusions: Lack of sexual pleasure or male orgasmic anhedonia can be expression of an unmanageable or dystonic erotization and not of a functional inability. Sexologist can help patients to clarify by themselves the nature of their symptoms and to decide about the suitability of their resolution.
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Gill, G., M. Zachary, and P. Korenis. "Psychiatric comorbidities of Incarceration in a Patient with Gender Dysphoria: A Case Report." European Psychiatry 65, S1 (June 2022): S604. http://dx.doi.org/10.1192/j.eurpsy.2022.1547.
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Introduction Mental health remains key comorbidity in the transgender population. There are more grave consequences on mental health if there is long-term incarceration history of a transgender person. 21% of transgender women are incarcerated in their lifetime, compared to <3% of the US general population. Incarcerated, transgender women are typically at risk for verbal, physical, and sexual assault that has been cross-sectionally linked to poor mental health in transgender patients. Childhood traumas and Adverse childhood experiences like sexual abuse may attribute to gender dysphoria as well as the externalizing and internalizing behaviors of the child in later part of life. Objectives Better understand Gender Dysphoria and Incarceration. Methods A case report and review of the literature. Results X is a 56-year-old transgender female, admitted for Major Depressive disorder with Psychotic features, and substance abuse disorder. She was disoriented to person place, or time, believing she was at the “Federal Penitentiary.” She was also selectively mute and socially isolative as well as unable to perform ADL’s. She has an extensive legal history, which started in 1985 when she burglarized a pharmacy store for estrogen. Patient was started on Sertraline, Mirtazapine, and Risperidone. She was still socially withdrawn but was soon oriented to person place, and time and was able to complete her daily tasks. Conclusions In this poster we discuss the challenges of managing an acute patient with extensive legal and substance abuse history, while also addressing the features of gender identity disorder and highlighting the difficult path of both the patient and physician in managing these challenges. Disclosure No significant relationships.
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Amadeo, Marco. "Antiandrogen Treatment of Aggressivity in Men Suffering from Dementia." Journal of Geriatric Psychiatry and Neurology 9, no. 3 (October 1996): 142–45. http://dx.doi.org/10.1177/089198879600900307.
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Three demented patients who manifested an aggressive syndrome and motor disturbances including agitation, pacing, and restlessness received a therapeutic trial of the antiandrogen agents medroxyprogesterone acetate and luprolide acetate. Within 4 weeks of the start of the antiandrogen therapy, verbal and physical aggressivity had ceased; activity disturbances such as agitation, pacing, and restlessness were markedly reduced. One patient also manifested marked disinhibited and disruptive sexual behavior. Following treatment, that behavior also ceased. Further control studies assessing the efficacy and safety of antiandrogen agents are recommended.
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Albrechta, Hannah E., Mira L. Katz, and Megan E. Roberts. "Health Disparities Among Sexual and Gender Minority Adults in Ohio." Ohio Journal of Public Health 4, no. 2 (January 28, 2022): 72–80. http://dx.doi.org/10.18061/ojph.v4i2.8561.
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Background: Many documented disparities associated with health behaviors and access to health care impact the health outcomes of sexual and gender minorities (SGM). The current study aimed to gain insight into the health dispari-ties experienced by SGM adults living in Ohio to obtain data to plan future health-related programs. Methods: A secondary data analysis was conducted using 2018 Ohio Behavior Risk Factor Surveillance System (BRFSS) data. Health behaviors, health care access, and health outcomes were analyzed by sexual orientation (n=11 301) and gender identity (n=11 426) to determine health disparities faced by sexual minority males, sexual minority females and transgender individuals. Results: Significant SGM health disparities in Ohio are related to substance use (ie, binge drinking, current smoking status, e-cigarette use, and marijuana use); poor physical and mental health status; lack of health care coverage; and experiencing COPD, emphysema, or chronic bronchitis (all p < 0.001). In addition, fewer sexual minority females reported being within recommended breast cancer screening guidelines than heterosexual females (p < 0.05). Conclusion: Sexual and gender minority adults in Ohio report disparities associated with several health behaviors and access to health care. These findings may be due to factors at the patient level (eg, experiencing minority stress), provider level (eg, implicit bias), system level (eg, discrimination), and/or society level (eg, lack of legal protections). Study results will be used to plan health campaigns and programs targeted to SGM adults and providers to achieve health equity for the SGM population in Ohio.
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Toma, Sebastian Ionut, Barabas Barna, Daniel Tabian, Calin Scripcaru, Marius Alexandru Moga, and Diana Bulgaru-Iliescu. "Homicidal Act Commited by an Elderly Person With Sexual Dysfunction. Case Report." BRAIN. Broad Research in Artificial Intelligence and Neuroscience 11, no. 3sup1 (2020): 08–19. http://dx.doi.org/10.18662/brain/11.3sup1/117.
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Sexual dysfunctions (SDs) are highly prevalent with aging. Studies reported an interactive correlation between psychiatric morbidity and SD. Also, SDs have significant influence on patients` self-esteem, body image, interpersonal relationships, and physical health in general. The aim of the present research is to present an intimate partner homicide case and to discuss a possible correlation between SDs of elderly patients and their inclination towards aggressive behavior from intimate partner violence (IPV). A forensic psychiatric assessment was performed on a married male patient, aged 61. He was diagnosed and treated for BPH and he could no longer have sexual intercourse. Using a knife, he provoked over 20 stab wounds to his wife, who died following the attack. He admitted that he was jealous, due to his wife having an affair. The psychiatric forensic expertise found that the killing was committed with discernment. Psychological states found in IPV perpetrators are partly like those met in SDs patients. The relation between SDs in older adults and aggressive behavior, especially IPV, requires further research. In the case discussed, a complex of negative emotions and aggressiveness could be determined equally by infidelity of the spouse or by the perpetrator’s SD, but we can assume that SD played a relevant role in the causal chain.
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Pearson, Amy W. Farnbach, Shoshana Adler Jaffe, Lila A. Baca, Nina Dimauro, Kendal A. Jacobson, and Miria Kano. "Abstract B066: Rejection of cancer identity among sexual and gender minority patients." Cancer Epidemiology, Biomarkers & Prevention 32, no. 1_Supplement (January 1, 2023): B066. http://dx.doi.org/10.1158/1538-7755.disp22-b066.
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Abstract For sexual and gender minority (SGM) populations, minority stress exacerbates the physical and emotional challenges of cancer diagnosis, treatment and survivorship; mitigating these effects will require improved understanding of SGM individuals’ cancer experiences both within and beyond the clinic. Among SGM cancer health disparities are increased stress surrounding diagnosis and treatment and poorer post-treatment mental and overall health. Emotional distress accompanying significant or chronic diseases such as cancer results in part from the threat illness poses to personal identity, often leading to disruption and subsequent realignment of one’s self-conception to a “new normal” as a cancer patient or cancer survivor. However, the process of aligning multiple stigmatized identities, as when SGM individuals experience cancer, is relatively unexplored. To this end, transcripts of semi-structured interviews with 11 SGM cancer patients and 8 cisgender, heterosexual (CH) patients matched for sex assigned at birth and cancer type were coded for indicators of health and illness in personal identity. Codes included (1) assertion of prior healthy behavior, (2) rejection of cancer identity, and (3) assertion of cancer identity; these were not mutually exclusive. SGM patients were less likely than CH peers to report engaging in healthy behaviors (exercise, dietary choices): 4 of 11 (36%) SGM patients did so, compared with 7 of 8 CH patients (88%). In contrast, SGM patients were more likely to explicitly reject self-identification as a cancer patient or cancer survivor: this occurred in interviews with 7 of 11 (64%) SGM patients but only 2 of 8 (25%) CH patients. Assertion of cancer identity – either through self-identification with a survivor label or intentional disclosure to reduce cancer stigma or obtain formal health accommodations – did not differ among SGM and CH patients. Five of 11 (46%) SGM patients and 4 of 8 (50%) CH patients identified as a cancer patient or cancer survivor in these ways. Notably for this sample, compared with CH peers SGM cancer patients were both less likely to volunteer a history of engaging in healthy behaviors and more likely to explicitly reject personal identity as a cancer patient or cancer survivor. This may indicate reluctance on the part of already-minoritized individuals to take on additional stigmatized identities, or may represent particular difficulty faced by SGM cancer patients in realigning their personal identities to accommodate their illness experiences. The ways individuals with cancer navigate personal identity following diagnosis and treatment has implications for cancer survivorship care: some aspects of cancer survivor identity are associated with positive outcomes, including improved mental health, more positive engagement with peers, and better quality of life. Understanding the ways cancer shapes personal identity among SGM patients and other minoritized individuals may offer pathways to constructive emotional processing of cancer experiences to reduce post-treatment cancer health disparities. Citation Format: Amy W. Farnbach Pearson, Shoshana Adler Jaffe, Lila A. Baca, Nina Dimauro, Kendal A. Jacobson, Miria Kano. Rejection of cancer identity among sexual and gender minority patients [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B066.
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Nardella, A., G. Falcone, G. Giordano, D. Erbuto, M. Migliorati, M. Innamorati, P. Girardi, and M. Pompili. "Suicide and drug and alcohol addiction: Self-destructive behaviours. An observational study on clinic hospital population." European Psychiatry 41, S1 (April 2017): S400. http://dx.doi.org/10.1016/j.eurpsy.2017.02.467.
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IntroductionSuicidal behaviour and drug and alcohol dependence represent two different aspects of self-destructive behavior.ObjectivesWe evaluated the relationship between suicidal behavior and substance and alcohol addiction. It was investigated the role of childhood trauma in these self-destructive behaviors and in the development of the two mental constructions of hopelessness and mentalization.AimsWe also assessed how a high level of hopelessness could affect suicidal ideation and how low or absent capacity of mentalization could influence the development of substance and/or alcohol addiction.MethodsThis naturalistic, observational study included 50 patients (mean age = 46.54; S.D = 14.57) recruited from the department of psychiatry (n = 18) and the centre for suicide prevention (n = 32) of Sant’Andrea Hospital (Rome). Different questionnaires were administered to each patient from February to May 2016.ResultsThere was not a statistically significant relationship between suicidal behavior and addict behavior. Childhood trauma resulted a risk factor for alcohol abuse with a relationship that tended to significance (P = 0.07). Physical and sexual abuses were significantly associated with addiction (respectively P = 0.014; P = 0.033). It was showed a statistically significant interaction between high level of hopelessness and suicidal ideation (P = 0.037). The absence of mentalization was related to the absence of alcohol abuse (P = 0.061). Finally, trauma experienced during childhood was associated with high level of hopelessness (P = 0.005).ConclusionsSuicidal behavior is influenced indirectly by a childhood traumatic experience that conditioning the level of hopelessness. Childhood trauma affected directly the development of drug abuse and alcoholism. The capacity of mentalization was not related with childhood trauma.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Savoy, Simon, Pierre-Nicolas Carron, Nathalie Romain-Glassey, and Nicolas Beysard. "Self-Reported Violence Experienced by Swiss Prehospital Emergency Care Providers." Emergency Medicine International 2021 (December 17, 2021): 1–6. http://dx.doi.org/10.1155/2021/9966950.
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Background. Workplace violence is a serious and increasing problem in health care. Nevertheless, only few studies were carried out concerning this topic and then mainly in English-speaking countries. The objectives were to describe the acts of violence experienced by prehospital emergency care providers (PECPs) in the western part of Switzerland between January and December 2016 and to assess the consequences for subsequent PECPs behaviors. Methods. An observational cross-sectional study, carried out using an online survey, has been sent to all 416 PECPs in the Canton of Vaud, in the western, French-speaking, part of Switzerland. The survey contained items of demographic data and items to assess the type and consequence of violence sustained. This was classified as five types: verbal assault, intimidation, physical assault, sexual harassment, and sexual assault. Results. 273 (65.6%) PECPs participated in the survey. During 2016, workplace violence was reported by 229 survey participants (83.9%). Most declared to be the victim of such violence between one and three times during the year. In all cases of violence described, the patient and/or a relative initiated aggressive behavior in 96% of cases. Verbal assaults were the most common (99.2% of all acts), followed by intimidation (72.8%), physical assault (69.6%), and sexual harassment (16.3%). Concerning physical assault, PECPs were predominantly victims of spitting and/or jostling (50%). After a violent event, in 50% of cases, the PECPs modified their behavior owing to the experience of workplace violence; 82% now wear protective vests, and 16% carry weapons for self-defense, such as pepper sprays. Seventy-five percent changed their intervention strategies, acting more carefully and using verbal de-escalation techniques or physical restraints for violent patients. Conclusions. Workplace violence is frequent and has significant consequences for PECPs. In order to increase their own security, they increased their protection. These results illustrate their feelings of insecurity, which may have deleterious effects on work satisfaction and motivation. Trial Registration. Our article does not report the results of a health care intervention on human participants.
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Khanagar, Sanjeev B., Ibrahim Aldawas, Abdullah Almutairi, Mohammed Alamro, Naif Altammami, Sultan Aldakhil, and Suliman Hodan. "Dental Students’ Experience, Impact, and Response to Patient Aggression in Saudi Arabia: A Nationwide Study." Healthcare 10, no. 11 (November 9, 2022): 2239. http://dx.doi.org/10.3390/healthcare10112239.
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Patient aggression and violence comprise a wide range of behaviors and actions that may include verbal aggression and physical aggression. The aim of this study is to report dental students’ experience with, impact from, and response to patient aggression in Saudi Arabia. A cross-sectional analytical study was conducted among dental students from various health universities representing each region of Saudi Arabia. Data were collected using a self-administered, structured and validated questionnaire. A total of 375 participants responded to the questionnaire and 121 (32.3%) study participants reported experiencing patient aggression. Out of those, 91 (75.21%) experienced patients displaying anger or raising their voice toward them, 37 (30.58%) reported being insulted by a patient, 22 (18.18%) reported being threatened, 12 (6.2%) had experienced sexual harassment, and 65 (50.41%) had experienced verbal harassment. Furthermore, 91 (75.21%) participants reported being abandoned by patients because they were students. A total of 55 (45.45%) participants stated that aggressive patient behavior had an impact on their clinical performance, and 44 (36.36%) considered themselves stressed out. A total of 24 (19.83%) participants took time off due to incidents and 22 (18.18%) thought about quitting dentistry. Prevalence of patient aggression was significant among dental students in Saudi Arabia. These episodes of patient aggression negatively impacted students’ academic performance and wellbeing, necessitating urgent attention. Educational institutions should conduct periodic workshops for students in order to address these issues. Policymakers should develop better policies in order to reduce violence and aggression against health care providers.
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Damjanov, Dimitrije, Tatiana Jocic, Olgica Latinovic-Bosnjak, Dragomir Damjanov, Zeljka Savic, Dijana Kosijer, Vladimir Vracaric, Tihomir Orlic, and Zarko Krnetic. "Rectal syphilis - a case report." Vojnosanitetski pregled 76, no. 11 (2019): 1194–96. http://dx.doi.org/10.2298/vsp171023189d.
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Introduction. Syphilis rarely affects anorectal region. The symptoms are nonspecific and are commonly disregarded in our country. Therefore, they pose a difficulty both for a diagnosis and for a treatment.We presented a patient with the clinical, laboratory, endoscopic and histological characteristics of rectal siphilis who was initially suspected to have inflammatory bowel disease. Case report. A 29-year-old man was hospitalized with a suspected inflammatory bowel disease, with symptoms such as frequent blood-stained diarrhea, lower abdominal pain and a loss of appetite. The physical examination showed maculopapular skin rash on the body. The ileocolonoscopic examination revealed finely granulated rectal mucosa, the loss of vascular pattern, and at 3 cm from the anal verge, an exulcerated submucosal lesion 1.2 cm in diameter, with two smaller, similar looking lesions. The histological examination of biopsies showed diffuse inflammatory-cell infiltration, with cryptitis, Paneth cell metaplasia with granuloma without caseous necrosis, which was highly suggestive of Crohn?s disease. The Treponema pallidum test results were positive [hemagglutination assay (TPHA)] with a titer 1 : 2,560 and the rapid plasma reagin test (RPR) with a titer 1 : 16. The ensuing detailed anamnesis on the patient?s sexual behavior showed that the patient had unprotected anal sexual relation with another man and the diagnosis of secondary syphilis was confirmed. After the treatment with benzathine penicillin G once a week, during a three-week period, the patient had no symptoms and had normal inflammatory markers, with a significant decrease of RPR titre and normal mucosa on rectosigmoidoscopy. Conclusion. Taking in consideration the variable clinical and endoscopic manifestations of this disease, it is necessary to take a detailed history of sexual behavior, since it can be crucial for determining the diagnosis and differential diagnosis of syphilis.
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Cmiljanić, Vesna. "Methods nurses with violent and aggressive patient / Postupci medicinske sestre i tehničara sa nasilnim i agresivnim bolesnikom." SESTRINSKI ŽURNAL 1, no. 1 (October 20, 2014): 32. http://dx.doi.org/10.7251/sez0114032c.
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Aggression is an act of threats directed at others who may be verbal, physical or sexual nature. Medical management of aggressive behavior among the psychiatric emergency area in which decisions must be made quickly in a short period of time. Quality of medical services largely depends on the level of knowledge and training of nurses. High frequency and diversity of occurrence of aggressive and violent behavior by the medical staff not only to the psychiatric ward, the necessity to a wider range of health professionals meet and train to work with such patients in first aid, health care and therapy. For emergencies in psychiatry, particularly aggressive behavior, most often there is no time for planning and setting goals of care. These conditions require a high level of expertise, training and knowledge of the medical technicians to act “here and now”. Working with these patients has its own characteristics and is different from other medical interventions in emergency situations.
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Vallecillo Adame, C., T. Jiménez Aparicio, C. De Andrés Lobo, A. Gonzaga Ramírez, M. Queipo De Llano De La Viuda, G. Guerra Valera, I. Santos Carrasco, et al. "Voices change my name." European Psychiatry 65, S1 (June 2022): S801. http://dx.doi.org/10.1192/j.eurpsy.2022.2070.
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Introduction We present the clinical case of a patient where the psychotic clinic coexists with gender dysphoria. This scenario can be the result of a change in gender identity derived from the psychotic process or appear independently of it. Objectives We want to explain the importance of knowing how to act with a patient in whom these two processes coexist. Methods 20-year-old woman, with no history of mental health. She comes to the emergency department for behavioral alteration. The family observes strange behaviors, unmotivated laughter, soliloquies and aggressive episodes. Abandonment of studies, hobbies and radical physical change. Delusions of prejudice and self-referential delusions. Possible phenomena of echo and diffusion of the thought. Auditory hallucinations talking to her in male gender, since then she presents doubts about her sexual identity and manifests her desire to change sex. Altered judgment of reality. Results During admission, we started treatment with an antipsychotic with good tolerance and she was referred to mental health team, where psychopharmacological treatment was adjusted with good response. In the following medical appointments the psychotic clinic disappeared at the same time that sexual identification was completely restored and made a critique of the behavior and experiences. Conclusions This case highlights the importance of assessing the chronology of symptoms, the patient’s criticality, the response to antipsychotic treatment and the need to exclude the psychotic background of the desire for gender reassignment before making a therapeutic decision. Disclosure No significant relationships.
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Vlastarakos, Petros V., Angeliki Gkouvali, and Despoina Katsochi. "Attitudes and Parameters Affecting the Behavior Toward Precursor Symptoms of Head and Neck Cancer." Ear, Nose & Throat Journal 98, no. 6 (April 24, 2019): E58—E63. http://dx.doi.org/10.1177/0145561319840881.
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The present study aimed to identify the association between sociodemographic and lifestyle-related factors with the response time from the appearance of symptoms potentially related to head and neck cancer (HNC) and gain an insight regarding the main source of health information about this specific area. Specific perceptions about human papillomavirus (HPV) infection in the head and neck area were also explored. An Internet-based survey was conducted between June 30, 2016, and July 31, 2016, using a structured questionnaire. The study sample comprised 1058 adults. A direct association was found between the response time period from the potential appearance of a mouth ulcer/soreness ( P < .001), earache ( P = .014), hoarseness ( P < .001), or painless lump in the neck ( P = .003) and alcohol consumption, as well as between smoking ( P = .012) and soft-drink consumption ( P < .001) and the appearance of hoarseness. Inverse association was found between age and the appearance of a mouth ulcer/soreness ( P = .017) and between a person’s educational level ( P < .001) and yearly income ( P = .006) and the appearance of an earache. A total of 79.1% of study participants seemed aware that oral sex represents the main mode of HPV transmission; this understanding was directly associated with a person’s educational level ( P < .001) and yearly income ( P = .001) and inversely associated with alcohol consumption ( P = .037). Health policy makers and health professionals need to devise strategies to increase the awareness of HNC risk associated with sexual behavior especially in young adults. The repressing effect of alcohol on timely patient response should be demonstrated in targeted campaigns, and the understanding of the “iceberg phenomenon,” frequently associating even common head and neck symptoms with HNC, acknowledged in undergraduate and postgraduate physician training.
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Oliveira, Roberta Meneses, Lucilane Maria Sales da Silva, Maria Vilani Cavalcante Guedes, Adriana Catarina de Souza Oliveira, Rosario Gómez Sánchez, and Raimundo Augusto Martins Torres. "Analyzing the concept of disruptive behavior in healthcare work: an integrative review*." Revista da Escola de Enfermagem da USP 50, no. 4 (August 2016): 695–704. http://dx.doi.org/10.1590/s0080-623420160000500021.
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Abstract OBJECTIVE To analyze the concept of disruptive behavior in healthcare work. METHOD An integrative review carried out in the theoretical phase of a qualitative research substantiated by the theoretical framework of the Hybrid Model of Concept Development. The search for articles was conducted in the CINAHL, LILACS, PsycINFO, PubMed and SciVerse Scopus databases in 2013. RESULTS 70 scientific articles answered the guiding question and lead to attributes of disruptive behavior, being: incivility, psychological violence and physical/sexual violence; with their main antecedents (intrapersonal, interpersonal and organizational) being: personality characteristics, stress and work overload; and consequences of: workers' moral/mental distress, compromised patient safety, labor loss, and disruption of communication, collaboration and teamwork. CONCLUSION Analysis of the disruptive behavior concept in healthcare work showed a construct in its theoretical stage that encompasses different disrespectful conduct adopted by health workers in the hospital context, which deserve the attention of leadership for better recognition and proper handling of cases and their consequences.
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Lamont, John A., and Christel Woodward. "Patient-Physician Sexual Involvement." Obstetrical & Gynecological Survey 50, no. 1 (January 1995): 25–26. http://dx.doi.org/10.1097/00006254-199501000-00014.
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Lessard, David, Alexandre Aslan, Jérémy Zeggagh, Stéphane Morel, David Michels, and Bertrand Lebouché. "Acceptability of a digital patient notification and linkage-to-care tool for French PrEPers (WeFLASH©): Key stakeholders' perspectives." International Journal of STD & AIDS 30, no. 14 (November 22, 2019): 1397–407. http://dx.doi.org/10.1177/0956462419878043.
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The objective of this study was to describe stakeholders’ perspectives on the acceptability of WeFLASH© (AADISS, Paris, France), a digital smartphone sexually transmitted infection (STI) patient notification (PN) tool to be launched among French HIV pre-exposure prophylaxis users (PrEPers). In Paris, Lyon, and Nice, we conducted 2-hour focus group discussions with PrEPers (n = 21) and community mediators (n = 10), and one-on-one interviews with PrEP-prescribing physicians (n = 5) and HIV/STI management decision-makers (n = 4). Recordings were transcribed. The analysis focused on perceived benefits and risks. Concerning benefits, participants mentioned that WeFLASH© could provide: improved PN and STI screening, by refining the notification of anonymous partners; customized linkage-to-care, by providing users with tailored information on care; and transferable epidemiological data, by filling a need for real-time data. Participants anticipated risks for: privacy and confidentiality and suggested specific security settings to protect users’ identity; sexual behavior and suggested game-like functions to improve the integration of the tool in sexual contexts; and fairness and emphasized the importance of making WeFLASH© accessible to all men who have sex with men. WeFLASH© could facilitate PN for an increasing proportion of anonymous partners met online, and empower users, including notified partners, on questions of confidentiality and consent, access to STI prevention and screening services, and access to data.
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Ijaz, Sardar Hassan, Ali Haider Jafry, Areeba Shahnawaz, and Mark Allee. "ICD Pocket-Site Infection Secondary to Gonococcal Bacteremia: The First Reported Case." Case Reports in Infectious Diseases 2021 (May 4, 2021): 1–3. http://dx.doi.org/10.1155/2021/9250967.
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Introduction. Cardiovascular implantable electronic devices (CIEDs) are being increasingly used in the primary and secondary prevention of malignant ventricular arrhythmias and conduction system disorders. Infectious complications associated with CIEDs include infective endocarditis, lead infections, and pocket-site infections, primarily involving Staphylococcus species. Infective endocarditis is a rare but life-threatening complication of gonococcal bacteremia. We report the first case of a CIED pocket-site infection secondary to Neisseria gonorrhoeae (N. gonorrhoeae). Case. A 56-year-old male with a history of congestive heart failure status postimplantable cardioverter-defibrillator (ICD) insertion presented with a pocket-site swelling initially concerning for a hematoma which began to exhibit erythema and tenderness. The patient reported a history of high-risk sexual behavior. On presentation, he was afebrile and hemodynamically stable. Physical exam showed a 5 cm × 6 cm pocket-site swelling with overlying erythema. Labs revealed elevated ESR and CRP levels. Transthoracic and transesophageal echocardiography was concerning for infective endocarditis and lead vegetations. Blood cultures tested positive for N. gonorrhoeae. He underwent surgical debridement with complete ICD extraction and drainage of infected serosanguineous pocket fluid. Tissue cultures were negative, but isolation of N. gonorrhoeae in blood cultures confirmed it as the causative agent of the pocket-site infection in the absence of prior Gram-positive coverage. He was started on a prolonged course of ceftriaxone for 4 weeks with reimplantation of ICD at a different site after completion of treatment. Conclusion. In patients with high-risk sexual behavior, gonococcal bacteremia can potentially lead to CIED infection. These individuals should be prudently evaluated for infective endocarditis or pocket-site infections as presenting complaints can be subtle.
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Lin, Cheryl, Jewel Mullen, Danielle Smith, Michaela Kotarba, Samantha J. Kaplan, and Pikuei Tu. "Healthcare Providers’ Vaccine Perceptions, Hesitancy, and Recommendation to Patients: A Systematic Review." Vaccines 9, no. 7 (July 1, 2021): 713. http://dx.doi.org/10.3390/vaccines9070713.
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Despite vaccines’ effectiveness in reducing the rate of preventable diseases, vaccine hesitancy has threatened public health and economies worldwide. Healthcare providers’ (HCP) communications and behavior strongly influence patient receptivity and uptake. The goal of this review was to examine HCP vaccine perceptions, knowledge, and reservations and how these attitudes affect their recommendations and vaccination practices. Primary research studies published by 16 September 2020 were searched in PubMed, Web of Science, Embase, CINAHL, and PsycINFO. A 14-item scale was developed for survey study and risk of bias appraisal (SSRBA). In total, 96 papers from 34 countries were included, covering 17 vaccines (HPV and influenza vaccines the most studied). Recommendation was positively associated with provider knowledge and experience, beliefs about disease risk, and perceptions of vaccine safety, necessity, and efficacy. HCP vaccination attitudes and practices varied across specialties, vaccines, and countries; demographic impact was inconclusive. Barriers included anticipation of patient/parental concerns or refusal, lacking clear guidelines, time constraints, and cost. For HPV, vaccines were more often recommended to older, female adolescents and by physicians who discussed sexual health. HCPs are vital advocates for patients and the public, but studies indicated a prevalence of provider hesitancy pertaining to inadequate knowledge, low vaccine confidence, and suboptimal uptake themselves. Improving HCP knowledge and assuring their access to information they deem trustworthy are essential to supporting HCPs‘ role as “trusted messengers” to promote vaccine acceptance.
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Luštrek, Mitja, Marko Bohanec, Carlos Cavero Barca, Maria Costanza Ciancarelli, Els Clays, Amos Adeyemo Dawodu, Jan Derboven, et al. "A Personal Health System for Self-Management of Congestive Heart Failure (HeartMan): Development, Technical Evaluation, and Proof-of-Concept Randomized Controlled Trial." JMIR Medical Informatics 9, no. 3 (March 5, 2021): e24501. http://dx.doi.org/10.2196/24501.
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Background Congestive heart failure (CHF) is a disease that requires complex management involving multiple medications, exercise, and lifestyle changes. It mainly affects older patients with depression and anxiety, who commonly find management difficult. Existing mobile apps supporting the self-management of CHF have limited features and are inadequately validated. Objective The HeartMan project aims to develop a personal health system that would comprehensively address CHF self-management by using sensing devices and artificial intelligence methods. This paper presents the design of the system and reports on the accuracy of its patient-monitoring methods, overall effectiveness, and patient perceptions. Methods A mobile app was developed as the core of the HeartMan system, and the app was connected to a custom wristband and cloud services. The system features machine learning methods for patient monitoring: continuous blood pressure (BP) estimation, physical activity monitoring, and psychological profile recognition. These methods feed a decision support system that provides recommendations on physical health and psychological support. The system was designed using a human-centered methodology involving the patients throughout development. It was evaluated in a proof-of-concept trial with 56 patients. Results Fairly high accuracy of the patient-monitoring methods was observed. The mean absolute error of BP estimation was 9.0 mm Hg for systolic BP and 7.0 mm Hg for diastolic BP. The accuracy of psychological profile detection was 88.6%. The F-measure for physical activity recognition was 71%. The proof-of-concept clinical trial in 56 patients showed that the HeartMan system significantly improved self-care behavior (P=.02), whereas depression and anxiety rates were significantly reduced (P<.001), as were perceived sexual problems (P=.01). According to the Unified Theory of Acceptance and Use of Technology questionnaire, a positive attitude toward HeartMan was seen among end users, resulting in increased awareness, self-monitoring, and empowerment. Conclusions The HeartMan project combined a range of advanced technologies with human-centered design to develop a complex system that was shown to help patients with CHF. More psychological than physical benefits were observed. Trial Registration ClinicalTrials.gov NCT03497871; https://clinicaltrials.gov/ct2/history/NCT03497871. International Registered Report Identifier (IRRID) RR2-10.1186/s12872-018-0921-2
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Sánchez, S. Pérez, I. Martín Herrero, M. A. Cutillas Fernández, D. Raya Güimil, and A. Crespo Portero. "Environmental stressors associated with suicidal behavior in adolescents with psychiatric pathology." European Psychiatry 64, S1 (April 2021): S640—S641. http://dx.doi.org/10.1192/j.eurpsy.2021.1701.
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IntroductionIn the assessment of suicidal behavior, recent studies describe the great influence of an environmental component with adverse life events and stressors that can influence self-harm ideation and gesture.Objectives1. To analyze the reasons for consultation of adolescents between 11 and 17 years of age who consult for suicidal behavior. 2. To estimate the frequency of the different socio-family life events.MethodsA retrospective review of the emergency room visits in the last 3 months was carried out. Sociodemographic data, vital events, reason for consultation and evolution are collected in the following 30 days after consultation in the emergency room.ResultsData were collected from 16 adolescents who consulted in the emergency room for suicidal ideation / gesture in a period of 3 months, of which 43% (7) were women and 56% (9) were men between 11 and 18 years old. The reasons recorded as stressful life events were: 22% unstructured family environment, 10% death of a close relative, 43% little parental supervision, 26% end of a romantic relationship, 5% legal problems, 2% sexual or physical abuse, 70 % academic problems, 3% bullying. It was observed that in 63% of the cases they presented more than one adverse experience.ConclusionsSuicidal ideation and behavior are frequently preceded by different adverse life events that can be minimized or go unnoticed and undervalued. A meticulous medical history can clarify some of the reasons that influence the hopelessness and clinical anguish that the suicidal patient presents. Its early detection provides the opportunity for an early and specialized approach.DisclosureNo significant relationships.
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Wang, Ping, Chao Li, Marcos Bella-Fernández, Marina Martin-Moratinos, Leticia Mallol Castaño, Pablo del del Sol-Calderón, Mónica Díaz de Díaz de Neira, and Hilario Blasco-Fontecilla. "Comparing Differences between Two Groups of Adolescents Hospitalized for Self-Harming Behaviors with and without Personality Disorders." Journal of Clinical Medicine 11, no. 24 (December 7, 2022): 7263. http://dx.doi.org/10.3390/jcm11247263.
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Self-harm (non-suicidal self-injury (NSSI) and suicidal behavior (SB)) is frequent display during adolescence. Patients with personality disorders (PDs) frequently self-harm. However, few studies have focused on the role of PDs in self-harming adolescents. In this study, we collected 79 adolescents hospitalized due to self-harm (88.6% female; 78.5% Caucasian) and divided them into two groups, with or without a diagnosis of PD. The socio-demographic and psychological-clinical data were collected through a structured interview by clinicians. Univariate, subgroup, and multiple logistic regression analyses were performed. Univariate analysis showed that adolescents with a PD and self-harm had (1) an older age at hospitalization (p < 0.01); (2) experienced physical and sexual abuse (p = 0.05, and p < 0.01, respectively); (3) ADHD (p = 0.05); (4) a greater number of SA (p < 0.01); and (5) probability of being a major NSSI patient (>20 lifetime NSSI episodes) (p < 0.01). After multivariate stratified analysis, the results indicated that an older age, and particularly major NSSI status were predictors of PD diagnosis. Early identification and a better understanding of the characteristics of adolescent PDs can assist clinicians in intervening earlier and developing more rational treatment strategies to reduce the long-term effects of PDs.
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Warsame, Rahma M., Gladys Asiedu, Ashok Kumbamu, Sharonne Hayes, Carrie A. Thompson, Timothy J. Hobday, and Katharine Andress Rowe Price. "A novel qualitative methodology study to characterize discrimination and inclusion among hematology/oncology trainees." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 10530. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.10530.
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10530 Background: Learner wellbeing may be adversely affected by the experience of discrimination. Eliciting details from this vulnerable population about these experiences is a challenge. This study characterizes trainee experiences of discrimination and inclusion to inform graduate medical education (GME) policies and practice. Methods: Anonymous semi-structured, private phone interviews were conducted with fellows after informed consent. No identifying information was exchanged and the interviewer had no supervisory role over learners. Demographic information was obtained via anonymous online survey. Results: Of 29 fellows approached, 20 consented; 17 interviewed (10 men; median age 32 years). Racial & ethnic distribution: 6 Asian, 2 Black, 2 Multi-racial, 4 White, 3 Hispanic/Latino. All fellows reported discriminatory behavior that they either experienced or witnessed. Incidents of discriminatory behavior towards trainees were more common from patients (pts) (n = 41) than staff (n = 12). Discrimination from pts included requesting a different physician based on accent (n = 13), race (n = 11), perceived avoidance of a trainee considered “different” (n = 11), sex (n = 5), & ethnicity (n = 4). Six trainees were aware of policies against pt discrimination but only 1 trainee reported an incident. Trainees did not report because of the nature of incidents (micro aggressions that are difficult to characterize) and sense of futility of reporting. Discriminatory behavior from staff was based on perceived micro aggressions (n = 4), sex (n = 3), ethnicity (n = 3), ageism (n = 1), and sexual orientation (n = 1). Impact on trainees ranged from negative (personal anguish) to positive (motivation to improve communication). Coping mechanisms included debriefing with family/trainees and focusing on good pt experiences. Trainees felt that having diverse co-fellows, involvement on committees, and supportive program leadership promoted inclusivity. Conclusions: Our study found that discriminatory behavior towards trainees is common. Our methodology allows for honest & safe discussions. GME programs must assess their learning climate with respect to bias/inclusivity & develop appropriate processes.
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Mittleman, Murray A., Barbara Voetsch, and Louis R. Caplan. "Triggers of Ischemic Stroke: Results from the Stroke Onset Pilot Study." Stroke 32, suppl_1 (January 2001): 366–67. http://dx.doi.org/10.1161/str.32.suppl_1.366-e.
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P153 Despite progress in the identification of risk factors for stroke, relatively little is known about the immediate precipitants or triggers of acute ischemic stroke (IS). We therefore conducted a pilot study to determine the presence of potential triggers within 24 hours preceding the onset of IS to establish the feasibility of conducting a case-crossover study of potential triggers of IS. The case-crossover design is an epidemiologic method that uses each patient as his/her own control, developed to evaluate the effect of potential triggers on the incidence of acute events. During the time of the pilot, we recruited 50 patients (88% of all eligible hospitalized patients) mean age 62±16 years, including 32% women. Patients were typically interviewed in hospital within 2 or 3 days of the onset of IS. The structured interview covered use of medications, caffeinated beverages, alcohol, smoking behavior, illicit drugs including marijuana and cocaine, timing of meals particularly unusually large meals, episodes of straining for defecation or urination, sexual intercourse and heavy physical exertion. Separate questions emphasized lifting heavy objects, and psychometric evaluations of anger, anxiety and depression. Large vessel atherothrombotic lesions were responsible for 39% of strokes, cardioembolic sources for 28%, small vessel disease (lacunar infarcts) for 22%, and other etiologies for 11%. The prevalence of exposure in the year prior to stroke varied from 10% for marijuana to 88% for caffeinated beverages. Exposure to potential triggers in the 24 hours before stroke onset was reported in over 30% of cases, including heavy exertion ≥ 6 METs (8%), lifting ≥ 50lbs (10%), straining for urination or defecation (4%), sexual intercourse (2%), outbursts of anger (4%), alcohol (28%), and marijuana (6%). The Stroke Onset Study Pilot demonstrates that potential triggers are present in approximately one-third of patients with IS. A larger study is required to assess whether external stressors can trigger the onset of stroke. Identifying and understanding the mechanisms by which particular exposures trigger the onset of stroke may lead to novel preventive strategies.
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Rothstein, Jules M. "Inappropriate Patient Sexual Behaviors." Physical Therapy 73, no. 11 (November 1, 1993): 738–39. http://dx.doi.org/10.1093/ptj/73.11.738.
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Lestari, Indah, Catur Prasastia lukita Dewi, and Riska Aprilia. "THE RELATIONSHIP SELF-FORGIVENESS WITH QUALITY OF LIFE IN HIV / AIDS PATIENTS AT POLYCLINIC VCT MOJOKERTO REGENCY." INTERNATIONAL JOURNAL OF NURSING AND MIDWIFERY SCIENCE (IJNMS) 2, no. 03 (January 19, 2019): 250–58. http://dx.doi.org/10.29082/ijnms/2018/vol2.iss03.173.
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ABSTRACT
The number of people with HIV / AIDS is like an iceberg, which appears to be only a small part. At present, HIV cannot be cured. This condition has a comprehensive impact on patients. Through Self-forgiveness, it is expected that patients can reduce negative feelings or emotions, so that they will be motivated to change their behavior for the better. The research objective proved the relationship self forgiveness with quality of life in HIV/AIDS patients. The research design was analytic correlation with Cross Sectional approach. The Sample was all patient of HIV / AIDS (selected who were diagnosed with HIV / AIDS because of sexual relations) who undergoing treatment in Polyclinic VCT Mojokerto Regency amounting to 122 people, with consecutive sampling. The independent variable was self forgiveness and the dependent variable was quality of life in HIV/AIDS patients. The instrument used a HFS (Heartland Forgiveness Scale) questionnaire for self-forgiveness. WHOQOL-HIV BREF for quality of life. The result of Spearman-Rho Correlation showed significant = 0.000, so a positive relationship between Self-Forgiveness and Quality of Life in HIV / AIDS. Respondents who have high self-forgiveness, also have a good quality of life, as many as 55 respondents (44.8%) and very good, that is as many as 25 respondents (20.7%). Forgiveness can affect the physical health of individuals and the factors that affect self-forgiveness, namely, the emergence of empathy, emotional intelligence, self-reflection, and personality characteristics. Improvement of quality of life can occur if the HIV / AIDS patient has been able to accept his condition, transforming himself into an open person and always apply the forgiveness attitude and can forgive or forgive the incident ever done by himself or others, so as to neutralize the negative feelings into positive.
Keywords: Self Forgiveness. Quality of Life, HIV/AIDS
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Lestari, Indah, Catur Prasastia lukita Dewi, and Riska Aprilia. "THE RELATIONSHIP SELF-FORGIVENESS WITH QUALITY OF LIFE IN HIV / AIDS PATIENTS AT POLYCLINIC VCT MOJOKERTO REGENCY." INTERNATIONAL JOURNAL OF NURSING AND MIDWIFERY SCIENCE (IJNMS) 2, no. 03 (January 19, 2019): 250–58. http://dx.doi.org/10.29082/ijnms/2018/vol2/iss03/173.
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ABSTRACT
The number of people with HIV / AIDS is like an iceberg, which appears to be only a small part. At present, HIV cannot be cured. This condition has a comprehensive impact on patients. Through Self-forgiveness, it is expected that patients can reduce negative feelings or emotions, so that they will be motivated to change their behavior for the better. The research objective proved the relationship self forgiveness with quality of life in HIV/AIDS patients. The research design was analytic correlation with Cross Sectional approach. The Sample was all patient of HIV / AIDS (selected who were diagnosed with HIV / AIDS because of sexual relations) who undergoing treatment in Polyclinic VCT Mojokerto Regency amounting to 122 people, with consecutive sampling. The independent variable was self forgiveness and the dependent variable was quality of life in HIV/AIDS patients. The instrument used a HFS (Heartland Forgiveness Scale) questionnaire for self-forgiveness. WHOQOL-HIV BREF for quality of life. The result of Spearman-Rho Correlation showed significant = 0.000, so a positive relationship between Self-Forgiveness and Quality of Life in HIV / AIDS. Respondents who have high self-forgiveness, also have a good quality of life, as many as 55 respondents (44.8%) and very good, that is as many as 25 respondents (20.7%). Forgiveness can affect the physical health of individuals and the factors that affect self-forgiveness, namely, the emergence of empathy, emotional intelligence, self-reflection, and personality characteristics. Improvement of quality of life can occur if the HIV / AIDS patient has been able to accept his condition, transforming himself into an open person and always apply the forgiveness attitude and can forgive or forgive the incident ever done by himself or others, so as to neutralize the negative feelings into positive.
Keywords: Self Forgiveness. Quality of Life, HIV/AIDS
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BAYER, TIMOTHY, JOHN COVERDALE, and ELIZABETH CHIANG. "A National Survey of Physicians’ Behaviors Regarding Sexual Contact With Patients." Southern Medical Journal 89, no. 10 (October 1996): 977–82. http://dx.doi.org/10.1097/00007611-199610000-00008.
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Cousin, Gaëtan, and Marianne Schmid Mast. "Agreeable patient meets affiliative physician: How physician behavior affects patient outcomes depends on patient personality." Patient Education and Counseling 90, no. 3 (March 2013): 399–404. http://dx.doi.org/10.1016/j.pec.2011.02.010.
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STEWART, DONNA E., ERIK VENOS, and IRAM J. ASHRAF. "Mental health policies on reporting child sexual abuse and physician-patient sexual relationships." World Psychiatry 8, no. 1 (February 2009): 45–48. http://dx.doi.org/10.1002/j.2051-5545.2009.tb00210.x.
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Gulbrandsen, Pål, Jonas Christoffer Lindstrøm, Arnstein Finset, and Judith A. Hall. "Patient affect, physician liking for the patient, physician behavior, and patient reported outcomes: A modeling approach." Patient Education and Counseling 103, no. 6 (June 2020): 1143–49. http://dx.doi.org/10.1016/j.pec.2020.01.003.
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Adeyemo, S., I. Adeosun, O. Ogun, and A. Adegbohun. "Prevalence and correlates of adverse childhood experiences among adolescents living with HIV-AIDS in Lagos, Nigeria." Babcock University Medical Journal (BUMJ) 2, no. 1 (September 30, 2017): 18–28. http://dx.doi.org/10.38029/bumj.v2i1.3.
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Objective: Adverse childhood experience is a known risk factor for risky behavior and negative mental health outcomes. There is dearth of information on adverse childhood experiences among adolescents living with HIV-AIDS in Nigeria. This study assessed the prevalence, pattern and correlates of adverse childhood experience among adolescents with HIV/AIDS attending two tertiary health facilities in Lagos, Nigeria.Method: Using a cross-sectional study design, 201 adolescents with HIV-AIDS attending out-patient clinics at the Nigerian Institute of Medical Research, Yaba, Lagos and the Lagos state University Teaching Hospital completed the adverse childhood experience questionnaire (ACE) and a socio-demographic questionnaire. The data was analysed with SPSS version 20.
Result: The mean age of the participants was 13.88 (± 2.53) years, and 61.7% were males. High levels of adverse childhood experiences ( AC E > 4 ) were reported by 28.4% of the participants. Nearly three quarters (73.6%) were victims of physical abuse, while 48.7% and 11.8% had been emotionally and sexually abused. There was statistically significant association between high levels of adverse experiences in childhood and occupational class of the father (p=0.022), previous history of hospitalisation (p=0.027) and having HIV positive siblings (p=0.009).
Conclusion: There is a crucial need for interventions targeted towards prevention of physical, emotional and sexual child abuse, and other forms of adverse childhood experiences.HIV-AIDS, adverse childhood experiences, child abuse, adolescents
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Roman, Brenda, and Jerald Kay. "Residency Education on the Prevention of Physician-Patient Sexual Misconduct." Academic Psychiatry 21, no. 1 (March 1997): 26–35. http://dx.doi.org/10.1007/bf03341894.
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Silber, Tomas J. "False Allegations of Sexual Touching by Physicians in The Practice of Pediatrics." Pediatrics 94, no. 5 (November 1, 1994): 742–45. http://dx.doi.org/10.1542/peds.94.5.742.
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It is normal for adolescents to be concerned about their bodies and harbor thoughts and worries about their sexuality.1 This can be manifested as anxiety during the physical examination, especially when the genital examination is performed.2-4 Because of this and the possibility of misinterpreting medical procedures such as breast and pelvic examinations, it has been suggested that male practitioners examine female adolescent patients in the presence of a chaperone. Studies involving chaperones use in office practice show a wide variation of approaches.5-7 Recently there has been an increasing recognition of sexual contact between physicians and their patients, both in the medical,8 psychiatric,9 and the lay literature,10 raising consciousness among the public about possible inappropriate sexual behavior by professionals.
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Hoch, Caroline, Jonathan Pire, Daniel J. Scott, and Christopher E. Gross. "The Influence of Pain and Resiliency on Foot and Ankle Surgery Outcomes." Foot & Ankle Orthopaedics 7, no. 2 (April 2022): 247301142211081. http://dx.doi.org/10.1177/24730114221108137.
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Background: Resilience is the ability to recover after stressful events and has been shown to correlate with surgical outcomes. However, there has been minimal research on the impact of patient resiliency on foot and ankle surgical outcomes. This study aims to determine the predictive value of preoperative resiliency scores on surgical outcomes and investigate how this compares with the predictive value of pain scores. Methods: We conducted a retrospective review of adult patients who completed a preoperative Brief Resilience Scale (BRS) and underwent surgery between November 2019 and November 2020 with a fellowship-trained foot and ankle surgeon (N=184). Data included demographics, comorbidities, surgical details, complication and reoperation rates, pre- and postoperative opioid and benzodiazepine use, and additional patient-reported outcome measures (ie, visual analog scale [VAS], Pain Catastrophizing Scale [PCS], Pain Disability Index [PDI], Foot and Ankle Outcome Score [FAOS] pain subscale). Mean follow-up duration was 4.49 (range, 1.10-14.17) months. Results: BRS weakly correlated with decreased postoperative benzodiazepine use ( P=.007). PCS magnification ( P=.050) and helplessness ( P=.047) subscales weakly correlated with increased follow-up duration. PDI total score and most subscores significantly correlated with an increase in at least 1 of the following: follow-up duration, or postoperative opioid or benzodiazepine use. Neither the VAS nor FAOS pain subscore correlated with any outcome. PDI total score was the strongest predictor of postoperative opioid (β=0.334) and benzodiazepine (β=0.315) use. Preoperative opioid users had significantly higher PDI total score (user=39.3, nonuser=24.9; P=.012) and subscores (ie, social activity, sexual behavior, self-care, life-support activities). Conclusion: BRS is an unreliable tool for predicting outcomes in foot and ankle surgery, as it only weakly correlated with decreased benzodiazepine use. Rather, given the PDI’s strong associations with postoperative measures in this study, physicians should consider the value of preoperative PDI completion when predicting how foot and ankle surgery recipients will fare postoperatively. Level of Evidence: Level III, retrospective cohort study.
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Adamson, Matthew, Kelsey Choi, Stephen Notaro, and Crina Cotoc. "The Doctor–Patient Relationship and Information-Seeking Behavior." Journal of Palliative Care 33, no. 2 (March 7, 2018): 79–87. http://dx.doi.org/10.1177/0825859718759881.
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Background: In cancer communication, patients and physicians often understand a patient’s experience and situation differently. This can negatively impact health outcomes and the physician–patient relationship. Aim: To explore how cancer patients’ interpretations of the physician’s role as information giver affect the communication relationship with the physician and their information-seeking behavior regarding different aspects of their cancer care. Design: Participants completed a semistructured qualitative interview addressing their treatment experience and communication with their physician. Interviews were coded and analyzed using inductive thematic analysis. Setting/Participants: Ten patients with cancer treated at a regional cancer center in central Illinois participated in the study. Cancer stages I to IV and 4 cancer types were represented. Results: Participants’ orientations to the relationship with their physician (and their information-seeking behavior) were classified into 4 general categories: (1) “questioners” have a general mistrust toward their physicians and the information doctors are giving; (2) “the undecided” focuses on physician “fit,” often requiring time to step away in order to make decisions and process information; (3) “cross-checkers” are concerned with content of their treatment protocol, often double-checking the treatment plan; and (4) “the experience-oriented” feel a gap between their experience and their physician’s experience (and perspective), often seeking information from other survivors. All categories described a perceived lack of adequate exchange of information and the need to seek information outside of the physician–patient relationship to compensate. Conclusion: Participants exhibited different information-seeking behaviors based on how they interpreted the role of their physician as information giver. This affected what kind of information they sought and how they understood the information received, which in turn affected understanding of their broader experience and care.
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Beagan, Brenda, Erin Fredericks, and Mary Bryson. "Family physician perceptions of working with LGBTQ patients: physician training needs." Canadian Medical Education Journal 6, no. 1 (April 20, 2015): e14-e22. http://dx.doi.org/10.36834/cmej.36647.
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Background: Medical students and physicians report feeling under-prepared for working with patients who identify as lesbian, gay, bisexual, transgender or queer (LGBTQ). Understanding physician perceptions of this area of practice may aid in developing improved education.Method: In-depth interviews with 24 general practice physicians in Halifax and Vancouver, Canada, were used to explore whether, when and how the gender identity and sexual orientation of LGBTQ women were relevant to good care. Inductive thematic analysis was conducted using ATLAS.ti data analysis software.Results: Three major themes emerged: 1) Some physicians perceived that sexual/gender identity makes little or no difference; treating every patient as an individual while avoiding labels optimises care for everyone. 2) Some physicians perceived sexual/gender identity matters primarily for the provision of holistic care, and in order to address the effects of discrimination. 3) Some physicians perceived that sexual/gender identity both matters and does not matter, as they strove to balance the implications of social group membership with recognition of individual differences. Conclusions: Physicians may be ignoring important aspects of social group memberships that affect health and health care. The authors hold that individual and socio-cultural differences are both important to the provision of quality health care. Distinct from stereotypes, generalisations about social group differences can provide valuable starting points, raising useful lines of inquiry. Emphasizing this distinction in medical education may help change physician approaches to the care of LGBTQ women.
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Mast, Marianne Schmid, Judith A. Hall, Christina Köckner, and Elisa Choi. "Physician Gender Affects How Physician Nonverbal Behavior Is Related to Patient Satisfaction." Medical Care 46, no. 12 (December 2008): 1212–18. http://dx.doi.org/10.1097/mlr.0b013e31817e1877.
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Ledford, Christy J. W., Christopher C. Ledford, and Marc A. Childress. "Extending Physician ReACH: Influencing patient activation and behavior through multichannel physician communication." Patient Education and Counseling 91, no. 1 (April 2013): 72–78. http://dx.doi.org/10.1016/j.pec.2012.11.011.
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Leiblum, Sandra R., Johna D. Lucas, and Patricia E. Koochaki. "Need for Improved Strategies for Patient-Physician Discussions on Sexual Health." Obstetrics & Gynecology 101, Supplement (April 2003): 97S. http://dx.doi.org/10.1097/00006250-200304001-00230.
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LEIBLUM, S. "Need for improved strategies for patient-physician discussions on sexual health." Obstetrics & Gynecology 101, no. 4 (April 2003): S97. http://dx.doi.org/10.1016/s0029-7844(02)02990-3.
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