Shared Decision Making in Hallux Valgus Surgery: A Prospective Observational Study.

Patient-physician communication has the potential to improve outcomes and satisfaction through the shared decision-making process (SDM). This study aims to assess the relationship between perception of SDM and demographic, clinical, and patient-reported outcomes in patients undergoing Hallux Valgus (HV) correction. A prospective analysis of 306 patients scheduled for HV surgery was completed. The CollaboRATE score was used to measure SDM. Multivariable linear regression model was used to assess whether SDM scores were associated with preoperative characteristics or postoperative outcome scores. The mean CollaboRATE score was 2.9 (SD 0.9) and did not differ by age, socioeconomic status, or sex. Lower CollaboRATE scores were associated with more symptoms of depression, lower socioeconomic status, and lower general health scores (p-value < 0.05). There was no association between SDM scores and postoperative outcome scores. In this study, patients with depressive symptoms and lower socioeconomic status had worse perceptions of SDM. There was no difference in postoperative outcomes among participants based on SDM scores. Level of Evidence: Level III, prospective observational study.

Happiness Maximization Is a WEIRD Way of Living.

Psychological science tends to treat subjective well-being and happiness synonymously. We start from the assumption that subjective well-being is more than being happy to ask the fundamental question: What is the ideal level of happiness? From a cross-cultural perspective, we propose that the idealization of attaining maximum levels of happiness may be especially characteristic of Western, educated, industrial, rich, and democratic (WEIRD) societies but less so for others. Searching for an explanation for why "happiness maximization" might have emerged in these societies, we turn to studies linking cultures to their eco-environmental habitat. We discuss the premise that WEIRD cultures emerged in an exceptionally benign ecological habitat (i.e., faced relatively light existential pressures compared with other regions). We review the influence of the Gulf Stream on the Northwestern European climate as a source of these comparatively benign geographical conditions. We propose that the ecological conditions in which WEIRD societies emerged afforded them a basis to endorse happiness as a value and to idealize attaining its maximum level. To provide a nomological network for happiness maximization, we also studied some of its potential side effects, namely alcohol and drug consumption and abuse and the prevalence of mania. To evaluate our hypothesis, we reanalyze data from two large-scale studies on ideal levels of personal life satisfaction-the most common operationalization of happiness in psychology-involving respondents from 61 countries. We conclude that societies whose members seek to maximize happiness tend to be characterized as WEIRD, and generalizing this across societies can prove problematic if adopted at the ideological and policy level.

Universalities and Idiosyncrasies in Self-Concept: East-West and North-South / Universalidades e Idiosincracia del Autoconcepto: Este-Oeste y Norte-Sur

Abstract Self-concept has been crucial to the description of human beings since ancient times. Different authors have offered definitions and approaches to the study of the self. Many instruments have been developed to measure this multifaceted construct. However, there is great difficulty in using definitions and instruments developed in one ecosystem to describe the peoples from different cultures. In order to include the universals and idiosyn-crasies of the self, a model that takes culture into account is needed. The purpose of this article is to compare the cognitive, emotional, and motivational aspects of the self-concept in different countries representing the east-west and north-south axis, such as Mexico, Peru, Japan, China, United States and Chile, from a psycho-socio-cultural point of view. The paradigm for this purpose included descriptions and comparisons based on Hofstede´s cultural syndromes, as well as an overview of some instruments that have been used to measure the construct. The discussion focuses on the importance of considering culture to understand the meanings of this construct, placing emphasis on the methodological tools derived from the theoretical orientation and the attentions that must be had when making cross-cultural comparisons, be it Between countries and even within the same country. This means that we must not forget the aspects shared by cultures in the relationship with oneself (etic), but we must forget about the particular aspects (emic) or idiosyncratic aspects, which are what are finally given by the particularities to self-concept.

Resumen El auto-concepto es un constructo crucial en el estudio de los seres humanos desde la antigüedad. Diferentes autores han propuesto definiciones y acercamientos al estudio del self, así como muchos instrumentos para medir este constructo en sus diversas aproximaciones (social, académico, entre otros). Sin embargo, existe una gran problemática, la cual se asocia a el uso que tienen los instrumentos sin considerar la realidad cultural para la cual se utiliza, es decir, al describir a las personas de una cultura cuando las hemos evaluado con instrumentos desarrollado en una cultura diferente. Por lo tanto, es necesario desarrollar la discusión respecto de cuestiones universales como específicas de cada cultura en relación al autoconcepto. El propósito del presente artículo es realizar esta discusión en relación a comparar los aspectos cognitivos, emocionales y motivaciones del auto-concepto en diferentes países del este-oeste y norte sur desde una perspectiva psico-socio-cultural, los países considerados son: México, Perú, Japón, China, Estados Unidos y Chile. Para ello se incluyen descripciones y comparaciones basadas en los síndromes culturales planteados por Hofstade así como una revisión de los instrumentos que se han utilizado para medir este constructo. La discusión se centra en la importancia de considerar la cultura en el estudio del auto-concepto, haciendo énfasis en las herramientas metodológicas que se derivan de las orientaciones teóricas propuestas y de las atenciones que se deben tener a la hora de realizar comparaciones transculturales, ya sea entre países e incluso dentro de un mismo país. Esto quiere decir, que no se debe olvidar los aspectos compartidos por las culturales en relación al self (etic), pero sin caer en el olvido de los aspectos particulares (emic) o idiosincrático, que son los que finalmente le dan las particularidades al autoconcepto.

Do defense mechanisms vary according to the psychiatric disorder? / Os mecanismos de defesa se modificam de acordo com o transtorno psiquiátrico?

OBJECTIVE: The aim of this study was to evaluate the defense mechanisms used by depressive and anxious patients without comorbidities compared to those used by controls and to determine whether these patterns differ between diagnoses. METHOD: The sample was composed of 167 psychiatric patients and 36 controls that were evaluated using the Defense Style Questionnaire 40. All subjects were evaluated through a clinical interview, and each evaluation was confirmed through the application of the Mini International Neuropsychiatric Interview, a structured psychiatric interview. We used ANOVA and discriminant analysis to assess differences between groups. RESULTS: Neurotic defense mechanisms discriminated controls from all patients except those with social anxiety. Immature defense mechanisms differentiated controls from all patients, as well as distinguished depressive patients from panic disorder and obsessive disorder patients. The discriminant analysis indicated that depressive patients are characterized by projection, panic disorder patients by sublimation and obsessive-compulsive patients by acting out. CONCLUSIONS: Depressive and anxious patients differ from other individuals in their use of defense mechanisms, and each diagnosis has a particular pattern. These findings could lead to the development of specific psychotherapeutic interventions.

OBJETIVO: O objetivo do estudo é avaliar o uso dos mecanismos de defesa utilizados por pacientes deprimidos e ansiosos sem comorbidades comparados com aqueles utilizados por pacientes-controle e se esses padrões de defesa podem ser diferenciados entre os diagnósticos. MÉTODO: 167 pacientes psiquiátricos e 36 controles foram avaliados pelo Defense Style Questionnaire 40. Todos os indivíduos foram avaliados por uma entrevista clínica que foi confirmada pelo Mini International Neuropsychiatric Interview, uma entrevista psiquiátrica estruturada. Para detectar diferenças entre os grupos, os dados foram submetidos à análise discriminante e ANOVA. RESULTADOS: As defesas neuróticas discriminam os controles de todos pacientes, exceto dos pacientes com ansiedade social. As defesas imaturas diferenciam os controles de todos pacientes, além de discriminar os pacientes deprimidos dos pacientes com transtorno do pânico e obsessivo. A análise discriminante indica que a projeção diferencia pacientes deprimidos, sublimação diferencia pacientes com transtorno do pânico, e acting-out diferencia pacientes obsessivos-compulsivos. CONCLUSÕES: Os pacientes diferem dos controles no uso dos mecanismos de defesa, e cada patologia tem seu padrão particular. Esses achados podem permitir o desenvolvimento de intervenções específicas no tratamento psicoterápico.

Versão em português do Defense Style Questionaire (DSQ-40) para avaliação dos mecanismos de defesa: um estudo preliminar / Brazilian-Portuguese version of the Defense Style Questionnaire (DSQ-40) for defense mechanisms measure: a preliminary study

O objetivo desse estudo é o de descrever o processo de tradução e adaptação do Defense Style Questionnaire (DSQ-40) versão em português e avaliar a validade de conteúdo dessa versão do instrumento. MÉTODOS: A primeira versão da escala foi apresentada para cinco indivíduos, com graus diferentes de escolaridade, que efetuaram pequenos ajustes de linguagem. Posteriormente, a escala foi apresentada para três "experts", que avaliaram a validade de conteúdo do instrumento. A versão final foi retraduzida e apresentada para o autor do instrumento original que aceitou essa versão do DSQ-40. RESULTADOS: Houve necessidade de pequenos ajustes no vocabulário em nove questões e modificações na linguagem em quatro questões, resultando na versão final do instrumento. A média de correlação dos "experts" com cada defesa foi de 89 por cento, e dos fatores maduros, imaturos e neuróticos foi de 100 por cento. CONCLUSÕES: A adaptação do DSQ-40 por diferentes indivíduos com diferentes graus de escolaridade e pelo grupo de experts possibilitou o ajuste à realidade sociocultural brasileira.